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Owodunni OP, Yocky AG, Courville EN, Peter-Okaka U, Alare KP, Schmidt M, Alunday R, Greene-Chandos D, Bowers CA. A comprehensive analysis of the triad of frailty, aging, and obesity in spine surgery: the risk analysis index predicted 30-day mortality with superior discrimination. Spine J 2023; 23:1778-1789. [PMID: 37625550 DOI: 10.1016/j.spinee.2023.08.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 08/09/2023] [Accepted: 08/13/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND CONTEXT The United States has experienced substantial shifts in its population dynamics due to an aging population and increasing obesity rates. Nonetheless, there is limited data about the interplay between the triad of frailty, aging, and obesity. PURPOSE To investigate discriminative thresholds and independent associations of the Risk Analysis Index (RAI), Modified Frailty Index-5 (mFI-5), and greater patient age. STUDY DESIGN An observational retrospective cohort study. PATIENT SAMPLE We analyzed 49,754 spine surgery patients from the American College of Surgeons National Surgical Quality Improvement Program database from 2012 to 2020. OUTCOME MEASURE A total of 30-day postoperative mortality. METHODS Using receiver operating characteristic (ROC) and multivariable (odds ratios [OR] and 95% confidence intervals [CI]) analyses, we compared the discriminative thresholds and independent associations of RAI, mFI-5, and greater patient age in elderly obese patients who underwent spine surgery. RESULTS There were 49,754 spine surgery patients, with a median age of 71 years (IQR: 68-75), largely white (82.6%) and male (51.9%). The ROC analysis for 30-day postoperative mortality demonstrated superior discrimination for RAI (C-statistic 0.779, 95%CI 0.54-0.805) compared to mFI-5 (C-statistic 0.623, 95% CI 0.594-0.651) and greater patient age (C-statistic 0.627, 95% CI 0.598-0.656). Multivariable analyses revealed a dose-dependent association and a larger effect magnitude for RAI: frail patients OR: 19.52 (95% CI 18.29-20.82) and very frail patients OR: 65.81 (95% CI 62.32-69.50). A similar trend was observed in the interaction evaluating RAI-age-obesity (p<.001). CONCLUSION Our study highlights a strong association between frailty and 30-day postoperative mortality in elderly obese spine patients, revealing a dose-dependent relationship. The RAI has superior discrimination than the mFI-5 and greater patient age in predicting 30-day postoperative mortality after spine surgery. Using the RAI in preoperative assessments may improve outcomes and help healthcare providers effectively communicate accurate surgical risks and potential benefits, set realistic recovery expectations, and enhances patient satisfaction.
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Affiliation(s)
- Oluwafemi P Owodunni
- Department of Emergency Medicine, University of New Mexico Hospital, MSC11 6025, 1 University of New Mexico, Albuquerque, NM 87131, USA; Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, NM, USA.
| | - Alyssa G Yocky
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, NM, USA; University of New Mexico School of Medicine, 2501 Frontier Ave NE, Albuquerque, NM 87106, USA
| | - Evan N Courville
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, NM, USA; Department of Neurosurgical Surgery, University of New Mexico Hospital, MSC08 4720 1 UNM, Albuquerque, NM 87131, USA
| | - Uchenna Peter-Okaka
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, NM, USA; West Virginia University School of Medicine, 64 Medical Center Dr, Morgantown, WV 26506, USA
| | - Kehinde P Alare
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, NM, USA
| | - Meic Schmidt
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, NM, USA; Department of Neurosurgical Surgery, University of New Mexico Hospital, MSC08 4720 1 UNM, Albuquerque, NM 87131, USA
| | - Robert Alunday
- Department of Emergency Medicine, University of New Mexico Hospital, MSC11 6025, 1 University of New Mexico, Albuquerque, NM 87131, USA; Department of Neurosurgical Surgery, University of New Mexico Hospital, MSC08 4720 1 UNM, Albuquerque, NM 87131, USA; Center for Adult Critical Care, University of New Mexico Hospital, 2211 Lomas Blvd NE, Albuquerque, NM 8710, USA
| | - Diana Greene-Chandos
- Center for Adult Critical Care, University of New Mexico Hospital, 2211 Lomas Blvd NE, Albuquerque, NM 8710, USA; Department of Neurology, University of New Mexico Hospital, MSC08 4720 1 UNM, Albuquerque, NM 87131, USA
| | - Christian A Bowers
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, NM, USA
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Dobbie LJ, Coelho C, Crane J, McGowan B. Clinical evaluation of patients living with obesity. Intern Emerg Med 2023; 18:1273-1285. [PMID: 37119384 PMCID: PMC10412477 DOI: 10.1007/s11739-023-03263-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 03/11/2023] [Indexed: 05/01/2023]
Abstract
Obesity is a significant public health concern which is implicated in cardiometabolic disease, mechanical complications and psychiatric sequelae. BMI is currently used for diagnosis; however, it has limited sensitivity for adiposity in certain circumstances. This has led to the development of risk stratification tools like the Edmonton Staging criteria and the Kings Obesity Staging Criteria: these facilitate and guide comprehensive obesity-related complication assessment. Healthcare professionals working within obesity clinics should adopt evidence-based communication strategies, including shared decision-making, motivational interviewing, and realistic goal setting. It is also vital to avoid weight-stigmatising terminology in all aspects of care, as this can negatively impact patients. Primary care plays an essential part in obesity care and should work to promptly identify cases, initiate treatment and forward on to specialist services where appropriate. Clinical evaluation of the patient living with obesity should take a holistic approach and involve input from bariatric physicians, dietitians, psychologists, and bariatric surgeons, wider members of the multi-disciplinary team should be involved where needed. Clinicians should take a detailed history, examination and order laboratory tests to investigate for complications. Overall, with appropriate evaluation, these assessments can guide patient management and facilitate long-term improvement in health.
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Affiliation(s)
| | | | - James Crane
- Guy’s and St Thomas’ NHS Foundation Trust, London, UK
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Zhao W, Ma X, Ju J, Zhao Y, Wang X, Li S, Sui Y, Sun Q. Association of visceral adiposity index with asymptomatic intracranial arterial stenosis: a population-based study in Shandong, China. Lipids Health Dis 2023; 22:64. [PMID: 37198613 DOI: 10.1186/s12944-023-01831-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 05/09/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND AND OBJECTIVE The visceral adiposity index (VAI), as a composite indictor to evaluate visceral adipose function, has been demonstrated to be correlated with atherosclerosis. The study objective was to explore the association between asymptomatic intracranial arterial stenosis (aICAS) and VAI in Chinese rural dwellers. METHODS The cross-sectional study consisted of 1942 participants ≥ 40 years old who were living in Pingyin County, Shandong Province and free from history of clinical stroke and transient ischemic attack. The aICAS in the study was diagnosed by transcranial doppler ultrasound combined with magnetic resonance angiography. The multivariate logistic regression models were deployed to explore the correlation of VAI with aICAS, and receiver operating characteristic (ROC) curve were plotted to compare the performance of models. RESULTS The participants with aICAS comparing to those without had a significantly higher VAI. After adjusting for confounding factors including age, hypertension, DM, sex, drinking habit, LDL-C, hsCRP, and smoking habit, the VAI-Tertile 3 (vs. VAI-Tertile 1) was positively associated with aICAS (OR, 2.15; 95% CI, 1.25-3.65; P = 0.005). The VAI-Tertile 3 was still markedly associated with aICAS among the underweight and normal weight (BMI ≤ 23.9 kg/m2) participants (OR, 3.17; 95% CI, 1.15-8.71; P = 0.026) with an AUC = 0.684. A similar relationship between VAI and aICAS was obtained among the participants with no abdominal obesity (WHR < 1, OR, 2.03; 95% CI, 1.14-3.62; P = 0.017). CONCLUSIONS The possible correlation between VAI and aICAS was found to be positive for the first time among Chinese rural residents over 40 years old. A higher VAI was found to be significantly associated with aICAS among the participants who were underweight or normal weight, and these results may provide additional risk stratification information for aICAS.
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Affiliation(s)
- Weihua Zhao
- Department of Neurology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
| | - Xiaotong Ma
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324 Jingwu Weiqi Road, Jinan, Shandong, 250021, P.R. China
| | - Jiachen Ju
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324 Jingwu Weiqi Road, Jinan, Shandong, 250021, P.R. China
| | - Yuanyuan Zhao
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324 Jingwu Weiqi Road, Jinan, Shandong, 250021, P.R. China
| | - Xiang Wang
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324 Jingwu Weiqi Road, Jinan, Shandong, 250021, P.R. China
| | - Shan Li
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324 Jingwu Weiqi Road, Jinan, Shandong, 250021, P.R. China
| | - Yanling Sui
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324 Jingwu Weiqi Road, Jinan, Shandong, 250021, P.R. China
| | - Qinjian Sun
- Department of Neurology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China.
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324 Jingwu Weiqi Road, Jinan, Shandong, 250021, P.R. China.
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Downs TL, Whiteside EJ, Foot G, Mills DE, Bliss ES. Differences in total cognition and cerebrovascular function in female breast cancer survivors and cancer-free women. Breast 2023; 69:358-365. [PMID: 37018967 PMCID: PMC10122006 DOI: 10.1016/j.breast.2023.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/24/2023] [Accepted: 03/30/2023] [Indexed: 04/03/2023] Open
Abstract
Reduced cognition is often reported by breast cancer patients and survivors, but the mechanisms for this decline are yet to be determined. We compared the differences in cerebrovascular function and cognition in breast cancer survivors (n = 15) and cancer-free women (n = 15) matched by age and body mass index. Participants undertook anthropometric, mood, cardiovascular, exercise performance, strength, cerebrovascular, and cognitive measurements. Transcranial Doppler ultrasound was used to measure the cerebrovascular responsiveness (CVR) to physiological (hypercapnia; 5% carbon dioxide) and psychological stimuli. Breast cancer survivors had a lower CVR to hypercapnia (21.5 ± 12.8 vs 66.0 ± 20.9%, P < 0.001), CVR to cognitive stimuli (15.1 ± 1.5 vs 23.7 ± 9.0%, P < 0.001) and total composite cognitive score (100 ± 12 vs. 113 ± 7, P = 0.003) than cancer-free women. These parameters remained statistically different between the groups following adjustments for covariates using an analysis of co-variance. We observed significant correlations between multiple measures and exercise capacity the only variable positively correlated to all primary measures (CVR to hypercapnia, r = 0.492, P = 0.007; CVR to cognitive stimuli r = 0.555, P = 0.003; and total composite cognitive score, r = 0.625, P < 0.001). In this study, breast cancer survivors had lower cerebrovascular and cognitive function than age-matched cancer-free women, which may be attributable to the effects of cancer and cancer treatment on brain health.
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The benefits of regular aerobic exercise training on cerebrovascular function and cognition in older adults. Eur J Appl Physiol 2023; 123:1323-1342. [PMID: 36801969 PMCID: PMC9938957 DOI: 10.1007/s00421-023-05154-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 02/06/2023] [Indexed: 02/23/2023]
Abstract
We compared the differences in cerebrovascular and cognitive function between 13 aerobic exercise trained, older adults and 13 age-, height- and sex-matched sedentary, untrained controls. We determined whether other measures accounted for differences in cerebrovascular and cognitive function between these groups and examined the associations between these functions. Participants undertook anthropometric, mood, cardiovascular, exercise performance, strength, cerebrovascular, and cognitive measurements, and a blood collection. Transcranial Doppler ultrasonography determined cerebrovascular responsiveness (CVR) to hypercapnia and cognitive stimuli. The trained group had a higher CVR to hypercapnia (80.3 ± 7.2 vs 35.1 ± 6.7%, P < 0.001), CVR to cognitive stimuli (30.1 ± 2.9 vs 17.8 ± 1.4%, P = 0.001) and total composite cognitive score (117 ± 2 vs 98 ± 4, P < 0.001) than the controls. These parameters no longer remained statistically different between the groups following adjustments for covariates. There were positive correlations between the total composite cognitive score and CVR to hypercapnia (r = 0.474, P = 0.014) and CVR to cognitive stimuli (r = 0.685, P < 0.001). We observed a relationship between cerebrovascular and cognitive function in older adults and an interaction between regular lifelong aerobic exercise training and cardiometabolic factors that may directly influence these functions.
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Jarrar F, Tennankore KK, Vinson AJ. Combined Donor-Recipient Obesity and the Risk of Graft Loss After Kidney Transplantation. Transpl Int 2022; 35:10656. [PMID: 36247488 PMCID: PMC9556700 DOI: 10.3389/ti.2022.10656] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 09/12/2022] [Indexed: 11/13/2022]
Abstract
Background: As the prevalence of obesity increases globally, appreciating the effect of donor and recipient (DR) obesity on graft outcomes is of increasing importance. Methods: In a cohort of adult, kidney transplant recipients (2000-2017) identified using the SRTR, we used Cox proportional hazards models to examine the association between DR obesity pairing (body mass index (BMI) >30 kg/m2), and death-censored graft loss (DCGL) or all-cause graft loss, and logistic regression to examine risk of delayed graft function (DGF) and ≤30 days graft loss. We also explored the association of DR weight mismatch (>30 kg, 10-30 kg (D>R; D
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Affiliation(s)
- Faisal Jarrar
- Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Karthik K. Tennankore
- Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
- Division of Nephrology, Department of Medicine, Nova Scotia Health Authority, Halifax, NS, Canada
| | - Amanda J. Vinson
- Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
- Division of Nephrology, Department of Medicine, Nova Scotia Health Authority, Halifax, NS, Canada
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Rahman MJ, Parvez SM, Rahman M, He FJ, Cunningham SA, Narayan KMV, Abedin J, Naser AM. Urinary Sodium Excretion and Obesity Markers among Bangladeshi Adult Population: Pooled Data from Three Cohort Studies. Nutrients 2022; 14:3000. [PMID: 35889957 PMCID: PMC9323227 DOI: 10.3390/nu14143000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 07/05/2022] [Accepted: 07/13/2022] [Indexed: 11/16/2022] Open
Abstract
We evaluated the relationship of urinary sodium excretion with a conditional mean, 10th and 90th percentiles of body mass index (BMI), and waist circumference among 10,034 person-visits of Bangladeshi population. We fitted linear mixed models with participant-level random intercept and restricted maximum likelihood estimation for conditional mean models; and quantile mixed-effect models with participant-level random intercept and Laplace estimation for 10th and 90th percentiles models. For each 100 mmol/24 h increase in urinary sodium excretion, participants had a 0.10 kg/m2 (95% CI: 0.00, 0.10) increase in the mean; a 0.39 kg/m2 (95% CI: 0.23, 0.54) increase in the 10th percentile; and a 0.59 kg/m2 (95% CI: 0.39, 0.78) increase in the 90th percentile of BMI. For each 100 mmol/24 h increase in urinary sodium excretion, participants had a 0.20 cm (95% CI: 0.10, 0.30) increase in mean; a 0.18 cm (95% CI: -0.03, 0.40) change in the 10th percentile; and a 0.23 cm (95% CI: 0.03, 0.43) increase in the 90th percentile of waist circumference. We found a modest association between urine sodium and conditional mean of BMI and waist circumference. The magnitude of associations between urine sodium and the 10th and 90th percentile BMI distributions were higher compared to the conditional mean models, suggesting high sodium intake could be more detrimental to underweight and obese participants.
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Affiliation(s)
- Musarrat J. Rahman
- International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA;
| | - Sarker M. Parvez
- Environmental Interventions Unit, Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka 1212, Bangladesh; (S.M.P.); (M.R.)
| | - Mahbubur Rahman
- Environmental Interventions Unit, Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka 1212, Bangladesh; (S.M.P.); (M.R.)
| | - Feng J. He
- Centre for Public Health and Policy, Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London EC1M 6BQ, UK;
| | - Solveig A. Cunningham
- Emory Global Diabetes Research Center, Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA; (S.A.C.); (K.M.V.N.)
| | - K. M. Venkat Narayan
- Emory Global Diabetes Research Center, Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA; (S.A.C.); (K.M.V.N.)
| | - Jaynal Abedin
- Data Science Institute, National University of Ireland Galway, H91 TK33 Galway, Ireland;
| | - Abu Mohd Naser
- Division of Epidemiology, Biostatistics and Environmental Health, School of Public Health, University of Memphis, Memphis, TN 38152, USA
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Bliss ES, Wong RHX, Howe PRC, Mills DE. The Effects of Aerobic Exercise Training on Cerebrovascular and Cognitive Function in Sedentary, Obese, Older Adults. Front Aging Neurosci 2022; 14:892343. [PMID: 35663579 PMCID: PMC9158462 DOI: 10.3389/fnagi.2022.892343] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 04/11/2022] [Indexed: 11/15/2022] Open
Abstract
Cerebrovascular function and cognition decline with age and are further exacerbated by obesity and physical inactivity. This decline may be offset by aerobic exercise training (AT). We investigated the effects of 16 weeks AT on cerebrovascular and cognitive function in sedentary, obese, older adults. Twenty-eight participants were randomly allocated to AT or a control group. Before and after the intervention, transcranial Doppler ultrasonography was used to measure the cerebrovascular responsiveness (CVR) to physiological (hypercapnia, 5% carbon dioxide) and cognitive stimuli. AT increased the CVR to hypercapnia (98.5 ± 38.4% vs. 58.0 ± 42.0%, P = 0.021), CVR to cognitive stimuli (25.9 ± 6.1% vs. 16.4 ± 5.4%, P < 0.001) and total composite cognitive score (111 ± 14 vs. 104 ± 14, P = 0.004) compared with the control group. A very strong relationship was observed between the number of exercise sessions completed and CVR to cognitive stimuli (r = 0.878, P < 0.001), but not for CVR to hypercapnia (r = 0.246, P = 0.397) or total composite cognitive score (r = 0.213, P = 0.465). Cerebrovascular function and cognition improved following 16 weeks of AT and a dose-response relationship exists between the amount of exercise sessions performed and CVR to cognitive stimuli.
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Affiliation(s)
- Edward S. Bliss
- Respiratory and Exercise Physiology Research Group, School of Health and Medical Sciences, University of Southern Queensland, Ipswich, QLD, Australia
- *Correspondence: Edward S. Bliss,
| | - Rachel H. X. Wong
- Centre for Health Research, Institute for Resilient Regions, University of Southern Queensland, Ipswich, QLD, Australia
- Clinical Nutrition Research Centre, School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, NSW, Australia
| | - Peter R. C. Howe
- Centre for Health Research, Institute for Resilient Regions, University of Southern Queensland, Ipswich, QLD, Australia
- Clinical Nutrition Research Centre, School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, NSW, Australia
- Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Dean E. Mills
- Respiratory and Exercise Physiology Research Group, School of Health and Medical Sciences, University of Southern Queensland, Ipswich, QLD, Australia
- Centre for Health Research, Institute for Resilient Regions, University of Southern Queensland, Ipswich, QLD, Australia
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Altered Visceral Adipose Tissue Predictors and Women’s Health: A Unicenter Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095505. [PMID: 35564900 PMCID: PMC9105488 DOI: 10.3390/ijerph19095505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 04/20/2022] [Accepted: 04/22/2022] [Indexed: 11/17/2022]
Abstract
(1) Background: The excess visceral adipose tissue (VAT) accumulation in women may reflect an early or advanced state of a metabolic disorder and a higher risk of cardiovascular disease than other types of obesity. This study aimed to determine the predictor variables (demographic information, anthropometric data, and blood biomarkers) for changes in VAT in adult women. (2) Methods: This cross-sectional study was conducted with women aged 18–59 years attending nutritional consultation at the Centro Universitário de Brasília (CEUB)’s nutrition school clinic, Brazil. All participants’ medical records were reviewed throughout the study and data of interest were collected. Various anthropometric measurements and biochemical exams were performed and analyzed in a univariate logistic regression model to identify the possible risk factors predictors for the presence of altered VAT. (3) Results: Our logistic regression model considered body mass index (BMI) greater than 25 kg/m2, lipid accumulation product (LAP), and waist–hip ratio (WHR) as predictors of altered VAT. (4) Conclusion: LAP has a robust predictive capacity for changes in visceral fat in adult women, followed by WHR and BMI, making these variables effective in assessing the risk for changes in visceral fat and their inclusion essential in the individual and collective clinical practice.
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Barua L, Banik PC, Islam SMS, Faruque M. Application of country‐specific Globorisk score to estimate next 10 years risk of cardiovascular diseases and its associated predictors among postmenopausal rural women of Bangladesh: A cross‐sectional study in a primary care setting. LIFESTYLE MEDICINE 2021. [DOI: 10.1002/lim2.32] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Lingkan Barua
- Department of Noncommunicable Diseases Bangladesh University of Health Sciences Dhaka Bangladesh
| | - Palash Chandra Banik
- Department of Noncommunicable Diseases Bangladesh University of Health Sciences Dhaka Bangladesh
| | | | - Mithila Faruque
- Department of Noncommunicable Diseases Bangladesh University of Health Sciences Dhaka Bangladesh
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Katta N, Loethen T, Lavie CJ, Alpert MA. Obesity and Coronary Heart Disease: Epidemiology, Pathology, and Coronary Artery Imaging. Curr Probl Cardiol 2020; 46:100655. [PMID: 32843206 DOI: 10.1016/j.cpcardiol.2020.100655] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 07/03/2020] [Indexed: 01/15/2023]
Abstract
Overweight and obesity contribute to the development of cardiovascular disease (CVD) in general and coronary heart disease (CHD) in particular in part by their association with traditional and nontraditional CVD risk factors. Obesity is also considered to be an independent risk factor for CVD. The metabolic syndrome, of which central obesity is an important component, is strongly associated with CVD including CHD. There is abundant epidemiologic evidence of an association between both overweight and obesity and CHD. Evidence from postmortem studies and studies involving coronary artery imaging is less persuasive. Recent studies suggest the presence of an obesity paradox with respect to mortality in persons with established CHD. Physical activity and preserved cardiorespiratory fitness attenuate the adverse effects of obesity on CVD events. Information concerning the effect of intentional weight loss on CVD outcomes in overweight and obese persons is limited.
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Eissa MS, Abdellateif MS, Elesawy YF, Shaarawy S, Al-Jarhi UM. Obesity and Waist Circumference are Possible Risk Factors for Thyroid Cancer: Correlation with Different Ultrasonography Criteria. Cancer Manag Res 2020; 12:6077-6089. [PMID: 32801859 PMCID: PMC7382758 DOI: 10.2147/cmar.s256268] [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] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 06/30/2020] [Indexed: 01/06/2023] Open
Abstract
Background Obesity has an important role in the pathogenesis of cancer; however, there are no clear mechanisms explaining the association between obesity and risk of thyroid cancer (TC). Methods It is a cross-sectional study including 184 patients with benign thyroid nodules (BN) and 19 patients with TC. Body mass index (BMI), waist circumference (WC), hip circumference (HC), waist/hip (W/H) ratio were assessed and correlated to relevant clinico-pathological features of the patients, different ultra-sonographic (U/S) criteria and risk of malignancy. Results There was a significant increase in BMI, WC and W/H ratio in TC patients compared to BN group (P=0.001, 0.011 and 0.003). Increased BMI, WC and HC were associated significantly with solid nodules (P<0.05). WC increased in hypoechoic (103.1±15.4cm) and heterogeneous (103.8±16.7cm) nodules, compared to isoechoic (97.3±15.5cm) and hyperechoic (96.1±10cm) nodules (P=0.046). It also increased with lymph nodes enlargement (P=0.04). There was a significant association between WC and TIRADS classification (P=0.032), as it increased with TR4b (118.5 ± 12.9 cm) and TR5 (117.3 ± 13.9 cm) compared to TR2 (114.1 ± 15.7 cm, P=0.025 and 0.008, respectively). WC is an independent predictor for TC [OR: 1.092, CI: 1.020-1.170, P=0.012]. It achieved sensitivity, specificity and AUC (71.4%, 68.7% and 0.750; respectively), at a cutoff value of 108.5 cm (P=0.003), and when combined with BMI at a cutoff value of 32.59 (77.8% and 68.4%, respectively, AUC: 0.780, P<0.001). Conclusion Central adiposity is strongly associated with the risk of TC. WC is more superior to BMI when correlated with TIRADS classification and also is an independent predictor for TC.
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Affiliation(s)
- Marwa S Eissa
- Internal Medicine and Endocrinology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mona S Abdellateif
- Medical Biochemistry and Molecular Biology, Cancer Biology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Yasmine F Elesawy
- Pathology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Sabry Shaarawy
- Medical Biochemistry and Molecular Biology, Cancer Biology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Ula M Al-Jarhi
- Internal Medicine and Endocrinology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
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Mascherini G, Tosi B, Giannelli C, Ermini E, Osti L, Galanti G. Adjuvant Therapy Reduces Fat Mass Loss during Exercise Prescription in Breast Cancer Survivors. J Funct Morphol Kinesiol 2020; 5:jfmk5030049. [PMID: 33467265 PMCID: PMC7739281 DOI: 10.3390/jfmk5030049] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/10/2020] [Accepted: 07/11/2020] [Indexed: 01/23/2023] Open
Abstract
Improvements in cancer care over the years have increased the numbers of cancer survivors. Therefore, quality of life, fat mass management and physical activity are growing areas of interest in these people. After the surgical removal of a breast cancer, adjuvant therapy remains anyway a common strategy. The aim of this study was to assess how adjuvant therapy can affect the effectiveness of an unsupervised exercise program. Forty-two women were enrolled (52.0 ± 10.1 years). Assessments performed at baseline and after six months of exercise prescription were body composition, health-related quality of life, aerobic capacity by Six-Minute Walk Test, limbs strength by hand grip and chair test and flexibility by sit and reach. Statistical analyses were conducted by ANOVA tests and multiple regression. Improvements in body composition, physical fitness and quality of life (physical functioning, general health, social functioning and mental health items) were found. The percentage change in fat mass has been associated with adjuvant cancer therapy (intercept = -0.016; b = 8.629; p < 0.05). An unsupervised exercise prescription program improves body composition, physical fitness and health-related quality of life in breast cancer survivors. Adjuvant therapy in cancer slows down the effectiveness of an exercise program in the loss of fat mass.
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Sheehan D, Van Ittersum K, Craig AW, Romero M. A packaged mindset: How elongated packages induce healthy mindsets. Appetite 2020; 150:104657. [DOI: 10.1016/j.appet.2020.104657] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 02/05/2020] [Accepted: 03/07/2020] [Indexed: 01/17/2023]
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Zhang L, Wu H, Zhang X, Wei X, Hou F, Ma Y. Sleep heart rate variability assists the automatic prediction of long-term cardiovascular outcomes. Sleep Med 2020; 67:217-224. [PMID: 31972509 PMCID: PMC7281861 DOI: 10.1016/j.sleep.2019.11.1259] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 11/11/2019] [Accepted: 11/27/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVE We aimed to investigate the association between sleep HRV and long-term cardiovascular disease (CVD) outcomes, and further explore whether HRV features can assist the automatic CVD prediction. METHODS We retrospectively analyzed polysomnography (PSG) data obtained from 2111 participants in the Sleep Heart Health Study, who were followed up for a median of 11.8 years after PSG acquisition. During follow-up, 1252 participants suffered CVD events (CVD group) and 859 participants remained CVD-free (non-CVD group). HRV measures, derived from time-domain and frequency-domain, were calculated. Regression models were created to determine the independent predictor for long-term CVD outcomes, and to explore the association between HRV and CVD latency. Furthermore, based on HRV and other clinical features, a model was trained to automatically predict CVD outcomes using the eXtreme Gradient Boosting algorithm. RESULTS Compared with the non-CVD group, decreased HRV during sleep was found in the CVD group. HRV, particularly its component of high frequency (HF), was demonstrated to be independent predictor of CVD outcomes. Moreover, normalized HF was positively correlated with CVD latency. The proposed prediction model achieved a total accuracy of 75.3%, in which sleep HRV features served as a supplement to the well-recognized CVD risk factors, such as aging, adiposity and sleep disorders. CONCLUSIONS Association between sleep HRV and long-term CVD outcomes was demonstrated here, suggesting that altered HRV during sleep might occur many years prior to the onset of CVD. Machine learning models, combining sleep HRV and other clinical characteristics, should be promising in the early prediction of CVD outcomes.
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Affiliation(s)
- Lulu Zhang
- Key Laboratory of Biomedical Functional Materials, School of Science, China Pharmaceutical University, Nanjing 210009, China
| | - Huili Wu
- ENT Sleep Monitoring Center, Coal General Hospital, Beijing 100028, China
| | - Xiangyu Zhang
- SEU-lenovo S-H-E Wearable Intelligent Monitoring Lab, State Key Laboratory of Bioelectronics, The School of Instrument Science and Engineering, Southeast University, Nanjing 210096, China
| | - Xinfa Wei
- Department of Otolaryngology, Coal General Hospital, Beijing 100028, China
| | - Fengzhen Hou
- Key Laboratory of Biomedical Functional Materials, School of Science, China Pharmaceutical University, Nanjing 210009, China.
| | - Yan Ma
- Division of Interdisciplinary Medicine and Biotechnology, Department of Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, United States
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Tate J, Knuiman M, Davis WA, Davis TME, Bruce DG. A comparison of obesity indices in relation to mortality in type 2 diabetes: the Fremantle Diabetes Study. Diabetologia 2020; 63:528-536. [PMID: 31838571 DOI: 10.1007/s00125-019-05057-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 11/05/2019] [Indexed: 10/25/2022]
Abstract
AIMS/HYPOTHESIS This prospective association study aimed to compare the relationship between each of four obesity indices and mortality risk in people with type 2 diabetes. METHODS The associations of BMI, waist circumference, WHR and A Body Shape Index (ABSI) with all-cause mortality were analysed in 1282 participants of the Fremantle Diabetes Study, followed for up to 20 years after baseline assessment. Models were adjusted for age and other confounders; assessments as continuous measures and by quintile were carried out for men and women separately. Sensitivity analyses were conducted to minimise reverse causality. RESULTS When indices were assessed as continuous variables, there were significant bivariate associations with mortality for: ABSI, which was greater in both men and women who died (p < 0.001); WHR, which was greater in women only (p = 0.033); and BMI, which was lower in women only (p < 0.001). When assessed by quintile, there were significant bivariate associations with mortality for ABSI in men and women (p < 0.001) and BMI in women only (p = 0.002). In Cox models of time to death, adjusted for age, diabetes duration, ethnicity and smoking, ABSI quintiles showed a linear trend for both men (p = 0.003) and women (p = 0.035). Men in the fifth ABSI quintile had an increased mortality risk compared with those in the first quintile (HR [95% CI]: 1.74 [1.24, 2.44]) and women in the fifth ABSI quintile had an increased mortality risk that approached statistical significance (1.42 [0.97, 2.08], p = 0.08). Men in the fifth WHR quintile had an increased mortality risk (1.47 [1.05, 2.06]). There was no association between mortality and BMI or waist circumference in either sex. CONCLUSIONS/INTERPRETATION ABSI was the obesity index most strongly associated with all-cause mortality in Australians with type 2 diabetes. There was no evidence for an obesity paradox with any of the assessed indices. ABSI may be a better index of central obesity than waist circumference, BMI or WHR when assessing mortality risk in type 2 diabetes.
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Affiliation(s)
- Joel Tate
- School of Population and Global Health, University of Western Australia, Nedlands, WA, Australia
| | - Matthew Knuiman
- School of Population and Global Health, University of Western Australia, Nedlands, WA, Australia
| | - Wendy A Davis
- Medical School, Fremantle Hospital, PO Box 480, Fremantle, WA, 6959, Australia
| | - Timothy M E Davis
- Medical School, Fremantle Hospital, PO Box 480, Fremantle, WA, 6959, Australia
| | - David G Bruce
- Medical School, Fremantle Hospital, PO Box 480, Fremantle, WA, 6959, Australia.
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Mascherini G, Tosi B, Giannelli C, Grifoni E, Degl'innocenti S, Galanti G. Breast cancer: effectiveness of a one-year unsupervised exercise program. J Sports Med Phys Fitness 2019; 59:283-289. [PMID: 29498250 DOI: 10.23736/s0022-4707.18.08131-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/03/2024]
Abstract
BACKGROUND Improvements in prevention and therapeutic strategies over the years have considerably increased the number of breast cancer survivors. Sedentary behavior is now acknowledged to be a risk factor for cancer and cancer relapse. Currently, there are different approaches to increasing the effectiveness of long-term physical activity in these patients. The aim of this study was to verify the long-term effectiveness of a home-based program for active lifestyle change in overweight breast cancer survivors. METHODS We enrolled 43 women (age 51.5±9.9 years), who underwent an evaluation of their spontaneous physical activity levels, their baseline aerobic capacity through a 6-Minute Walking Test (6MWT), their flexibility, grip and lower limb strength, and their body composition. We repeated the measurements of these physical and anthropometric parameters six times during one year of unsupervised exercise. RESULTS At the beginning of the program the sample showed a moderate level of spontaneous physical activity (physical activity level=1.44±0.12, steps/day=7420.3±1622.3). After being prescribed an individual exercise program, a significant reduction in BMI (T0=27.9±4.3, T5=25.8±3.0 kg/m2; P<0.001) and skinfold sum was observed (T0=99.5±25.2, T5=86.2±22.7 mm; P=0.019), with a parallel maintenance of cell mass (T0= 21.4±3.3, T5= 22.5±3.0 kg; P=0.654). The functional parameters showed an increase in lower limb muscle fitness and a reduction in diastolic blood pressure after 6 MWT (T0= 78.4±10.1, T5= 72.5±14.9 mmhg; P=0.032). CONCLUSIONS Physical activity is recommended for cancer patients; this model of prescribing unsupervised exercise seems to ensure optimal compliance, thus allowing long-term therapeutic efficacy.
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Affiliation(s)
- Gabriele Mascherini
- Unit of Sport and Exercise Medicine, Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy -
| | - Benedetta Tosi
- Unit of Sport and Exercise Medicine, Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Chiara Giannelli
- Unit of Sport and Exercise Medicine, Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Elisabetta Grifoni
- Unit of Sport and Exercise Medicine, Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Sonia Degl'innocenti
- Unit of Sport and Exercise Medicine, Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Giorgio Galanti
- Unit of Sport and Exercise Medicine, Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
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Benites-Zapata VA, Toro-Huamanchumo CJ, Urrunaga-Pastor D, Guarnizo-Poma M, Lazaro-Alcantara H, Paico-Palacios S, Pantoja-Torres B, Ranilla-Seguin VDC. High waist-to-hip ratio levels are associated with insulin resistance markers in normal-weight women. Diabetes Metab Syndr 2019; 13:636-642. [PMID: 30641781 DOI: 10.1016/j.dsx.2018.11.043] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 11/13/2018] [Indexed: 02/07/2023]
Abstract
AIM To assess the association between high waist-to-hip ratio (WHR) levels and insulin resistance (IR) or hyperinsulinemia after oral glucose tolerance test (OGTT) in a sample of normal-weight women. METHODS We conducted an analytical cross-sectional study in euthyroid non-diabetic women, who attended the outpatient service of a private clinic in Lima-Peru from 2012 to 2016. Participants were divided in two groups according to the presence or absence of high WHR levels, IR or hyperinsulinemia after OGTT. We considered WHR values > 0.85 as high levels. IR was defined as a Homeostasis Model Assessment (HOMA-IR) value > 2.39 and hyperinsulinemia after OGTT as a serum insulin value ≥ 80μU/mL after 120 min of 75-g glucose intake. We elaborated crude and adjusted Poisson generalized linear models to evaluate the association between high WHR levels and IR or hyperinsulinemia after OGTT and reported the prevalence ratio (PR) with their respective 95% confidence intervals (95%CI). RESULTS We analyzed the data of 248 euthyroid, non-diabetic and normal-weight women. The prevalence of high WHR levels was 68.9% (n = 171) while the prevalence of IR and hyperinsulinemia after OGTT was 25% (n = 62) and 15.3% (n = 38), respectively. WHR values were positively correlated with HOMA-IR (r = 0.307; p < 0.001) and serum insulin after OGTT (r = 0.260; p < 0.001). In the adjusted model, high WHR levels were associated with both IR (aPR = 2.63; 95%CI: 1.39-5.01) and hyperinsulinemia after OGTT (aPR = 2.35; 95%CI: 1.03-5.38). CONCLUSION High WHR levels were associated with both IR markers used in our study, appearing to be a useful anthropometric indicator to assess IR in euthyroid normal-weight women without type 2 diabetes mellitus.
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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.
| | - Diego Urrunaga-Pastor
- Universidad San Ignacio de Loyola, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Lima, Peru.
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Fitzpatrick J, Sozio SM, Jaar BG, McAdams-DeMarco MA, Estrella MM, Tereshchenko LG, Monroy-Trujillo JM, Parekh RS. Association of Abdominal Adiposity with Cardiovascular Mortality in Incident Hemodialysis. Am J Nephrol 2018; 48:406-414. [PMID: 30428465 DOI: 10.1159/000494281] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 09/27/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND The risk of cardiovascular mortality is high among adults with end-stage renal disease (ESRD) undergoing hemodialysis. Waist-to-hip ratio (WHR), a metric of abdominal adiposity, is a predictor of cardiovascular disease (CVD) and mortality in the general population; however, no studies have examined the association with CVD mortality, particularly sudden cardiac death (SCD), in incident hemodialysis. METHODS Among 379 participants incident (< 6 months) to hemodialysis enrolled in the Predictors of Arrhythmic and Cardiovascular Risk in ESRD study, we evaluated associations between WHR and risk of CVD mortality, SCD, and non-CVD mortality in Cox proportional hazards regression models. RESULTS At study enrollment, mean age was 55 years with 41% females, 73% African Americans, and 57% diabetics. Mean body mass index was 29.3 kg/m2, and mean WHR was 0.95. During a median follow-up time of 2.5 years, there were 35 CVD deaths, 15 SCDs, and 48 non-CVD deaths. Every 0.1 increase in WHR was associated with higher risk (hazard ratio [95% CI]) of CVD mortality (1.75 [1.06-2.86]) and SCD (2.45 [1.20-5.02]), but not non-CVD mortality (0.93 [0.59-1.45]), independently of demographics, body mass index, comorbidities, inflammation, and traditional CVD risk factors. CONCLUSIONS WHR is significantly associated with CVD mortality including SCD, independently of other CVD risk factors in incident hemodialysis. This simple, easily obtained bedside metric may be useful in dialysis patients for CVD risk stratification.
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Affiliation(s)
- Jessica Fitzpatrick
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Stephen M Sozio
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, Maryland, USA
| | - Bernard G Jaar
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, Maryland, USA
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
- Nephrology Center of Maryland, Baltimore, Maryland, USA
| | - Mara A McAdams-DeMarco
- Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, Maryland, USA
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Surgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - Michelle M Estrella
- Kidney Health Research Collaborative, Department of Medicine, University of California, San Francisco and Department of Medicine, San Francisco VA Medical Center, San Francisco, California, USA
| | - Larisa G Tereshchenko
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Ontario, USA
- Division of Cardiology, Department of Medicine, Oregon Health and Science University, Portland, Ontario, USA
| | - Jose M Monroy-Trujillo
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Rulan S Parekh
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada,
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA,
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA,
- Division of Nephrology, Department of Pediatrics and Medicine, The Hospital for Sick Children, University Health Network and University of Toronto, Toronto, Ontario, Canada,
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Easton JF, Stephens CR, Román-Sicilia H, Cesari M, Pérez-Zepeda MU. Anthropometric measurements and mortality in frail older adults. Exp Gerontol 2018; 110:61-66. [PMID: 29775746 DOI: 10.1016/j.exger.2018.05.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 03/09/2018] [Accepted: 05/14/2018] [Indexed: 10/16/2022]
Abstract
BACKGROUND As the number of older adults increases, so does the number of frail older adults. Although anthropometry has been widely used as a way to stratify the overall mortality risk of a person, the significance of these measurements becomes blurred in the case of frail older adults who have changes in body composition. Therefore, the aim of this study is to determine the association of anthropometric measurements (body mass index, knee-adjusted height body mass index, waist-to-hip ratio and calf circumference) with mortality risk in a group of older Mexican adults. METHODS This is a longitudinal analysis of the Mexican Health and Aging sub-sample (with biomarkers, n = 2573) from the first wave in 2001, followed-up to the last available wave in 2015. Only frail 50-year or older adults (Frailty Index with a cut-off value of 0.21 or higher, was used) were considered for this analysis (n = 1298). A survival analysis was performed with Kaplan-Meier curves and Cox regression models (unadjusted and adjusted for confounding). Socio-demographic, health risks, physical activity and comorbidities were variables used for adjusting the multivariate models. RESULTS From the total sample of 1298 older adults, 32.5% (n = 422) died during follow-up. The highest hazard ratio in the adjusted model was for calf circumference 1.31 (95% confidence interval 1.02-1.69, p = 0.034). Other measurements were not significant. CONCLUSIONS Anthropometric measurements have different significance in frail older adults, and these differences could have implications on adverse outcomes. Calf circumference has a potential value in predicting negative health outcomes.
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Affiliation(s)
- Jonathan F Easton
- C3 - Centro de Ciencias de la Complejidad, Universidad Nacional Autónoma de México, Ciudad de México, Mexico; Instituto de Ciencias Nucleares, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
| | - Christopher R Stephens
- C3 - Centro de Ciencias de la Complejidad, Universidad Nacional Autónoma de México, Ciudad de México, Mexico; Instituto de Ciencias Nucleares, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
| | - Heriberto Román-Sicilia
- C3 - Centro de Ciencias de la Complejidad, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
| | - Matteo Cesari
- Geriatric Unit, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community, University of Milan, Milan, Italy
| | - Mario Ulises Pérez-Zepeda
- Geriatric Epidemiologic Research Department, Instituto Nacional de Geriatría, Mexico; Instituto de Envejecimiento, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia.
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Central obesity and body fat, but not body mass index, are associated with the Pro12Ala polymorphism in the peroxisome proliferator-activated receptor γ gene in a population with a high consumption of saturated and trans-fatty acids. Nutr Res 2018; 57:28-35. [PMID: 30122193 DOI: 10.1016/j.nutres.2018.05.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 04/20/2018] [Accepted: 05/11/2018] [Indexed: 11/21/2022]
Abstract
The relationship of the Pro12Ala polymorphism in the peroxisome proliferator-activated receptor γ (PPARγ) gene with obesity and its modulation by dietary fat has been proposed, but the few studies addressing this issue have yielded controversial results. In a Mexican population characterized by high-fat consumption, we hypothesized that the Pro12Ala PPARγ genotype is related to obesity and this relationship is modulated by intake of saturated fatty acids (SFAs) and trans-fatty acids (TFAs). We recruited 69 adults for this cross-sectional study. The Pro12Ala PPARγ polymorphism was determined from blood genomic DNA by using real-time polymerase chain reaction. Univariate and multivariate logistic regression analyses were performed. Pro12Ala showed a positive association with central obesity (adjusted odds ratio, 7.38; 95% confidence interval, 1.19-45.77; P = .032) and percentage of body fat (%BF; adjusted odds ratio, 1.08; 95% confidence interval, 1.00-1.17; P = .048), suggesting that Pro12Ala carriers are more likely to have central obesity and a higher %BF than Pro12Pro carriers. A modifying effect was observed for the SFAs strata: we found a significant association between the Pro12Ala polymorphism and %BF in the high-SFA-intake stratum (P < .04), but not in the low-intake stratum (P > .7). No modifying effect was observed for the TFAs strata. In addition, the impact of total energy intake on obesity in Pro12Ala carriers seemed to be stronger than that in the wild-type genotype carriers. As hypothesized, our data demonstrated a relationship between the Pro12Ala PPARγ polymorphism and the presence of obesity, which is modulated by SFA intake but not TFA intake.
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Koppad AK, Kaulgud RS, Arun BS. A Study of Correlation of Neck Circumference with Framingham Risk Score as a Predictor of Coronary Artery Disease. J Clin Diagn Res 2017; 11:OC17-OC20. [PMID: 29207753 DOI: 10.7860/jcdr/2017/25710.10609] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 06/09/2017] [Indexed: 12/31/2022]
Abstract
Introduction It has been observed that metabolic syndrome is risk factor for Coronary Artery Disease (CAD) and exerts its effects through fat deposition and vascular aging. CAD has been acknowledged as a leading cause of death. In earlier studies, the metabolic risk has been estimated by Framingham risk score. Recent studies have shown that Neck Circumference (NC) has a good correlation with other traditional anthropometric measurements and can be used as marker of obesity. It also correlates with Framingham risk score, which is slightly more sophisticated measure of CAD risk. Aim To assess the risk of CAD in a subject based on NC and to correlate the NC to Framingham risk score. Materials and Methods The present cross-sectional study, done at Karnataka Institute of Medical Sciences, Hubli, Karnataka, India, includes 100 subjects. The study duration was of one year from 1st January 2015 to 31st December 2015. Anthropometric indices Body Mass Index (BMI) and NC were correlated with 10 year CAD risk as calculated by Framingham risk score. The correlation between BMI, NC, vascular age and Framingham risk score was calculated using Karl Pearson's correlation method. Results NC has a strong correlation with 10 year CAD risk (p≤0.001). NC was significantly greater in males as compared to females (p≤0.001). Males had greater risk of cardiovascular disease as reflected by higher 10 year Framingham risk score (p≤0.0035). Conclusion NC gives simple and easy prediction of CAD risk and is more reliable than traditional risk markers like BMI. NC correlates positively with 10 year Framingham risk score.
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Affiliation(s)
- Anand K Koppad
- Assistant Professor, Department of Medicine, Karnataka Institute of Medical Sciences, Hubli, Karnataka, India
| | - Ram S Kaulgud
- Assistant Professor, Department of Medicine, Karnataka Institute of Medical Sciences, Hubli, Karnataka, India
| | - B S Arun
- Assistant Professor, Department of Medicine, MVJ Medical College and Research Hospital, Hoskote, Karnataka, India
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Schafer MJ, Miller JD, LeBrasseur NK. Cellular senescence: Implications for metabolic disease. Mol Cell Endocrinol 2017; 455:93-102. [PMID: 27591120 PMCID: PMC5857952 DOI: 10.1016/j.mce.2016.08.047] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 08/03/2016] [Accepted: 08/29/2016] [Indexed: 12/19/2022]
Abstract
The growing burden of obesity- and aging-related diseases has hastened the search for governing biological processes. Cellular senescence is a stress-induced state of stable growth arrest strongly associated with aging that is aberrantly activated by obesity. The transition of a cell to a senescent state is demarcated by an array of phenotypic markers, and leveraging their context-dependent presentation is essential for determining the influence of senescent cells on tissue pathogenesis. Biomarkers of senescent cells have been identified in tissues that contribute to metabolic disease, including fat, liver, skeletal muscle, pancreata, and cardiovascular tissue, suggesting that pharmacological and behavioral interventions that alter their abundance and/or behavior may be a novel therapeutic strategy. However, contradictory findings with regard to a protective versus deleterious role of senescent cells in certain contexts emphasize the need for additional studies to uncover the complex interplay that defines multi-organ disease processes associated with obesity and aging.
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Affiliation(s)
- Marissa J Schafer
- Robert and Arlene Kogod Center on Aging, Mayo Clinic, Rochester, MN, 55905, USA; Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, 55905, USA
| | - Jordan D Miller
- Robert and Arlene Kogod Center on Aging, Mayo Clinic, Rochester, MN, 55905, USA; Department of Surgery, Mayo Clinic, Rochester, MN, 55905, USA; Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, 55905, USA
| | - Nathan K LeBrasseur
- Robert and Arlene Kogod Center on Aging, Mayo Clinic, Rochester, MN, 55905, USA; Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, 55905, USA.
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Signalling product healthiness through symbolic package cues: Effects of package shape and goal congruence on consumer behaviour. Appetite 2017; 109:73-82. [DOI: 10.1016/j.appet.2016.11.021] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 11/08/2016] [Accepted: 11/16/2016] [Indexed: 11/22/2022]
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Dhaliwal SS, Welborn TA. Absolute risk of cardiovascular disease events, and blood pressure- and lipid-lowering therapy in Australia. Med J Aust 2017; 206:51. [PMID: 28076745 DOI: 10.5694/mja16.00599] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 08/02/2016] [Indexed: 11/17/2022]
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Al-Rubean K, Youssef AM, Al Farsi Y, Al-Sharqawi AH, Bawazeer N, Al Otaibi MT, AlRumaih FI, Zaidi MS. Anthropometric cutoff values for predicting metabolic syndrome in a Saudi community: from the SAUDI-DM study. Ann Saudi Med 2017; 37:21-30. [PMID: 28151453 PMCID: PMC6148981 DOI: 10.5144/0256-4947.2017.21] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The prevalence of metabolic syndrome varies widely by ethnicity and by the criteria used in its definition. OBJECTIVE To identify the optimal cutoff values for waist circumference (WC), waist-to-hip ratio (WHR) and body mass index (BMI) for identifying metabolic syndrome among the Saudi population. DESIGN Nationwide household cross-sectional population-based survey. SETTING Thirteen health sectors in Saudi Arabia. SUBJECTS AND METHODS We used data for subjects in the Saudi Abnormal Glucose Metabolism and Diabetes Impact Study (SAUDI-DM), which was conducted from 2007 to 2009. Using International Diabetes Federation (IDF) criteria, metabolic syndrome and its different components were assessed using anthropometric measurements, blood pressure, fasting plasma glucose, triglycerides and HDL cholesterol. Receiver operating characteristic (ROC) curves were generated to assess sensitivity and specificity for different cutoff values of WC, WHR, and BMI. The Youden index was used to calculate the optimal cutoff value for each anthropometric measurement. MAIN OUTCOME MEASURE(S) Optimal cutoff value for WC, WHR, and BMI for identifying the risk of metabolic syndrome. RESULTS The prevalence of two or more risk factors for metabolic syndrome was observed in 43.42% of the total cohort of 12126 study participants >=18 years of age. The presence of two or more risk factors were significantly higher among men (46.81%) than women (40.53%) (P < .001). The optimal cutoff values for WC, WHR, and BMI were 92 cm, 0.89, and 25 kg/m2 for men and 87 cm, 0.81 and 28 kg/m2 for women for identifying the risk of metabolic syndrome. The prevalence of elevated triglycerides, blood pressure, and fasting plasma glucose significantly increased with age for both genders. CONCLUSIONS The proposed WC cutoff values were better than WHR and BMI in predicting metabolic syndrome and could be used for screening people at high risk for metabolic syndrome in the Saudi population. LIMITATIONS No direct measure of body fatness and fat distribution, cross-sectional design.
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Affiliation(s)
| | - Amira M. Youssef
- Department of Registry, King Saud University, Riyadh, Saudi Arabia
| | - Yousuf Al Farsi
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ahmad H. Al-Sharqawi
- Department of Biostatistics, Diabetes Center, King Saud University, Riyadh, Saudi Arabia
| | - Nahla Bawazeer
- Department of Nutrition, King Saud University, Riyadh, Saudi Arabia
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Mascherini G, Petri C, Calà P, Bini V, Galanti G. Lifestyle and resulting body composition in young athletes. Minerva Pediatr (Torino) 2016; 73:391-397. [PMID: 28006893 DOI: 10.23736/s2724-5276.16.04676-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Key aspects in a lifestyle analysis are physical activity level and eating habits. An unhealthy lifestyle results in fat mass increase and in a predisposition to non-communicable chronic diseases even in young age. The purpose of this study was to investigate the lifestyle and body composition in young athletes. METHODS The subjects underwent to an assessment of body composition and they completed two questionnaires, one concerning the level of physical activity and the other regarding eating habits. RESULTS One hundred fifty-two young athletes (63 females and 89 males) aged 8 to 18 years (13.4±2.5 years, height 159±14 cm) were enrolled in this study. 80.3% of subjects were normal weight (13.4±2.6 years) and 19.7% subjects (13.5±2.5 years) were overweight or obese. Greater sedentary behaviors were found in the overweight or obese participants compared to normal weight (618±125 vs. 523±89 min; P<0.001) and a lower consumption of milk and yoghurt (5.0±3.2 vs. 6.9±4.1 times/week; P=0.031). CONCLUSIONS Although competitive sports often increase physical activity levels in young people, this activity does not seem to reach the daily recommended amount of physical activity during youth. Therefore, it is necessary to have a comprehensive approach to create a primary prevention strategy from even a young age.
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Affiliation(s)
- Gabriele Mascherini
- Department of Sport and Exercise Medicine, University of Florence, Florence, Italy -
| | - Cristian Petri
- Department of Sport and Exercise Medicine, University of Florence, Florence, Italy
| | - Piergiuseppe Calà
- Department of Prevention, Food Security, Environmental and Public Health, University of Florence, Florence, Italy
| | - Vittorio Bini
- Department of Medicine, University of Perugia, Perugia, Italy
| | - Giorgio Galanti
- Department of Sport and Exercise Medicine, University of Florence, Florence, Italy
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Waller R, Smith AJ, O’Sullivan PB, Slater H, Sterling M, Alexandra McVeigh J, Straker LM. Pressure and cold pain threshold reference values in a large, young adult, pain-free population. Scand J Pain 2016; 13:114-122. [DOI: 10.1016/j.sjpain.2016.08.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 07/27/2016] [Accepted: 08/03/2016] [Indexed: 01/10/2023]
Abstract
Abstract
Background and aims
Currently there is a lack of large population studies that have investigated pain sensitivity distributions in healthy pain free people. The aims of this study were: (1) to provide sex-specific reference values of pressure and cold pain thresholds in young pain-free adults; (2) to examine the association of potential correlates of pain sensitivity with pain threshold values.
Methods
This study investigated sex specific pressure and cold pain threshold estimates for young pain free adults aged 21–24 years. A cross-sectional design was utilised using participants (n =617) from the Western Australian Pregnancy Cohort (Raine) Study at the 22-year follow-up. The association of site, sex, height, weight, smoking, health related quality oflife, psychological measures and activity with pain threshold values was examined. Pressure pain threshold (lumbar spine, tibialis anterior, neck and dorsal wrist) and cold pain threshold (dorsal wrist) were assessed using standardised quantitative sensory testing protocols.
Results
Reference values for pressure pain threshold (four body sites) stratified by sex and site, and cold pain threshold (dorsal wrist) stratified by sex are provided. Statistically significant, independent correlates of increased pressure pain sensitivity measures were site (neck, dorsal wrist), sex (female), higher waist-hip ratio and poorer mental health. Statistically significant, independent correlates of increased cold pain sensitivity measures were, sex (female), poorer mental health and smoking.
Conclusions
These data provide the most comprehensive and robust sex specific reference values for pressure pain threshold specific to four body sites and cold pain threshold at the dorsal wrist for young adults aged 21–24 years. Establishing normative values in this young age group is important given that the transition from adolescence to adulthood is a critical temporal period during which trajectories for persistent pain can be established.
Implications
These data will provide an important research resource to enable more accurate profiling and interpretation of pain sensitivity in clinical pain disorders in young adults. The robust and comprehensive data can assist interpretation of future clinical pain studies and provide further insight into the complex associations of pain sensitivity that can be used in future research.
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Affiliation(s)
- Robert Waller
- School of Physiotherapy and Exercise Science , Curtin University , Perth , Western Australia 6845 , Australia
| | - Anne Julia Smith
- School of Physiotherapy and Exercise Science , Curtin University , Perth , Western Australia 6845 , Australia
| | - Peter Bruce O’Sullivan
- School of Physiotherapy and Exercise Science , Curtin University , Perth , Western Australia 6845 , Australia
| | - Helen Slater
- School of Physiotherapy and Exercise Science , Curtin University , Perth , Western Australia 6845 , Australia
| | - Michele Sterling
- RECOVER Injury Research Centre, NHMRC Centre of Research Excellence in Road Traffic Injury , Menzies Health Institute , Griffith University , QLD , 4222 , Australia
| | - Joanne Alexandra McVeigh
- School of Physiotherapy and Exercise Science , Curtin University , Perth , Western Australia 6845 , Australia
| | - Leon Melville Straker
- School of Physiotherapy and Exercise Science , Curtin University , Perth , Western Australia 6845 , Australia
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Wang Z, Rowley K, Wang Z, Piers L, O'Dea K. Anthropometric indices and their relationship with diabetes, hypertension and dyslipidemia in Australian Aboriginal people and Torres Strait Islanders. ACTA ACUST UNITED AC 2016; 14:172-8. [PMID: 17446794 DOI: 10.1097/01.hjr.0000220580.34763.fb] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Australian indigenous people have a body shape and cardiovascular risk profiles different from that of other ethnic populations. This present study aims to examine the association of anthropometric indices with diabetes, hypertension and dyslipidemia, and to determine what indices can best predict these individual risk factors for the risk of cardiovascular disease (CVD). DESIGN A cross-sectional study of Australian Aboriginal people and Torres Strait Islanders. METHODS A total of 747 Australian Aboriginal people and 439 Torres Strait Islanders aged 25 years and over were examined between 1993 and 1997. Body weight, height, waist and hip circumferences, blood pressure, plasma glucose, triglycerides, total and high-density lipoprotein cholesterol were measured. RESULTS The best predictor of hypertension among five anthropometric indices was waist : height ratio for Australian Aboriginal people and waist circumference for Torres Strait Islanders. Waist : hip ratio (WHR) was the best predictor for both diabetes and dyslipidemia in both populations. In multivariate regression analyses, WHR and body mass index were independently associated with the 10-year predicted absolute probability of coronary heart disease (CHD) for Torres Strait Islanders. However, overall WHR appeared to be the best predictor of the estimated CHD risk for both populations. CONCLUSIONS This study shows that WHR was the best predictor for diabetes, dyslipidemia and absolute CHD risk in Australian Aboriginal people and Torres Strait Islanders. Incorporating WHR into routine health examinations in Australian indigenous people will enhance the evaluation of CVD risk.
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Affiliation(s)
- Zaimin Wang
- Centre for Chronic Disease, School of Medicine, University of Queensland, Royal Brisbane Hospital, Herston, Queensland, Australia.
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Chan LCK, Ware RS, Kesting J, Marczak M, Good D, Shaw JTE. Association between anthropometric measures of obesity and cardiovascular risk markers in a self-selected group of indigenous Australians. ACTA ACUST UNITED AC 2016; 14:515-7. [PMID: 17667640 DOI: 10.1097/hjr.0b013e3280117257] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background Indigenous Australians have a high prevalence of obesity and an unacceptably high rate of cardiovascular disease. Methods We conducted a cross-sectional analysis of 93 high-risk indigenous Australians to assess how strongly three anthropometric measures correlated with known cardiovascular risk factors. Results Both waist circumference and body mass index were strongly associated with important risk factors. The waist: hip ratio was less useful. Waist circumference was the only measure that significantly correlated with the urine albumin creatinine ratio (ρ = 0.14; P =0.04). Conclusion Measuring the waist circumference is a cheap, effective way of monitoring cardiovascular risk.
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Affiliation(s)
- Lionel C K Chan
- Discipline of Medicine, the Prince Charles Hospital, University of Queensland, Brisbane, Australia.
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McDonnold M, Mele LM, Myatt L, Hauth JC, Leveno KJ, Reddy UM, Mercer BM. Waist-to-Hip Ratio versus Body Mass Index as Predictor of Obesity-Related Pregnancy Outcomes. Am J Perinatol 2016; 33:618-24. [PMID: 26788786 PMCID: PMC5258113 DOI: 10.1055/s-0035-1569986] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Objective In nonpregnant populations the waist-to-hip ratio (WHR) is a better predictor of obesity-related outcomes than body mass index (BMI). Our objective was to determine, in pregnancy, the relationship between these measures of obesity, and large-for-gestational age (LGA) and cesarean delivery (CD). Methods This is a secondary analysis of data from the Combined Antioxidant and Preeclampsia Prediction Study. Women with a WHR of ≥ 0.85 and 0.80 to 0.84 at 9 to 16 weeks gestation were compared with those with a WHR < 0.80. Women with early pregnancy BMI ≥ 30.0 kg/m(2) (obese) and 25.0 to 29.9 kg/m(2) (overweight) were compared with those < 25.0 kg/m(2). LGA was defined as > 90% by Alexander nomogram. Univariable analysis, logistic regression, and receiver operating characteristic curves were used. Results Data from 2,276 women were analyzed. After correcting for potential confounders, only BMI ≥ 30 was significantly associated with LGA (adjusted odds ratio [aOR]: 2.07, 1.35-3.16) while BMI 25.0-29.9 (aOR: 1.5, 0.98-2.28), WHR 0.8-0.84 (aOR: 1.33, 0.83-2.13), and WHR ≥ 0.85 (aOR: 1.05, 0.67-1.65) were not. Risk for CD was increased for women with elevated WHR and with higher BMI compared with normal. Conclusion WHR is not associated with LGA. While BMI performed better than WHR, neither was a strong predictor of LGA or need for CD in low-risk nulliparous women.
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Affiliation(s)
- Mollie McDonnold
- Department of Obstetrics and Gynecology, University of Texas Medical Center, Galveston, Texas
| | - Lisa M Mele
- Biostatistics Center, The George Washington University, Washington, District of Columbia
| | - Leslie Myatt
- Department of Obstetrics and Gynecology, University of Cincinnati, Cincinnati, Ohio
| | - John C Hauth
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Kenneth J Leveno
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Uma M Reddy
- The Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
| | - Brian M Mercer
- Department of Obstetrics and Gynecology, Case Western Reserve University-MetroHealth Medical Center, Cleveland, Ohio
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Petri C, Mascherini G, Bini V, Anania G, Calà P, Toncelli L, Galanti G. Integrated total body composition versus Body Mass Index in young athletes. Minerva Pediatr 2016; 72:163-169. [PMID: 27057821 DOI: 10.23736/s0026-4946.16.04439-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The aim of this study was to assess if the evaluation of Body Mass Index is sufficient to define an overweight index in young athletes, or if a more effective evaluation is preferable in order to examine body fat mass, free-fat mass and hydration status in young athletes. METHODS Two hundred ninety-nine young athletes between the ages of 8 to 18 have been analyzed in this study. Data from evaluation in body composition of young athletes were studied and subdivided by age, sex and method used. In order to measure body composition in young people, the participants who attend our Department for sport eligibility examination, were evaluated through anthropometric measurements as far as, fat mass, fat-free mass and hydration status are concerned. RESULTS The statistical differences showed with Body Mass Index and body fat assessment reflect that more accurate evaluation is preferable: the normal-weight with Body Mass Index are 78.0%, overweight 18.7% and obese 3.3% respect to a 75.0%, 14.0% and 11.0% detected with a body fat evaluation (P<0.000); statistical differences have been found also subdividing the group per sex, higher in males (P=0.046) than to females (P<0.000). Bio-impedance data shown a statistical differences in young obese athletes. CONCLUSIONS The results obtained show clearly that the analysis of the Body Mass Index is not sufficient in young athletes. Therefore, for young athletes a full assessment of body composition would be appropriate to reduce classific-tion errors.
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Affiliation(s)
- Cristian Petri
- Department of Sports Medicine, University of Florence, Florence, Italy
| | | | - Vittorio Bini
- Department of Medicine, University of Perugia, Perugia, Italy
| | - Giuseppe Anania
- Department of Sports Medicine, University of Florence, Florence, Italy
| | - Piergiuseppe Calà
- Department of Prevention, Food Security, Environmental and Public Health, Tuscan Region, Florence, Italy
| | - Loira Toncelli
- Department of Sports Medicine, University of Florence, Florence, Italy
| | - Giorgio Galanti
- Department of Sports Medicine, University of Florence, Florence, Italy
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Dai Y, Wan X, Li X, Jin E, Li X. Neck circumference and future cardiovascular events in a high-risk population--A prospective cohort study. Lipids Health Dis 2016; 15:46. [PMID: 26946432 PMCID: PMC4779588 DOI: 10.1186/s12944-016-0218-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 03/02/2016] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The distribution of adipose tissue has been evaluated in relation to cardiovascular risk factors and biochemical components of the metabolic syndrome. Neck circumference (NC) has been shown to have a strong relationship with cardiovascular disease (CVD) and may be a novel indicator of CVD. The aim of this study was to compare the incidence of CVD events in cohorts with different NC distributions, and to correlate NC with future CVD events and relative mortality. METHODS A prospective cohort study was performed on 12,151 high-risk cardiology outpatients from 2004 until 2014. Anthropometric parameters like body mass index, NC, waist circumference, and hip circumference were measured at baseline and follow-up and compared in different cohorts with high, medium, and low NC. Fatal and non-fatal CVD events were compared in the follow-up study, and survival analysis was conducted. Independent Chi-square tests were performed to compare the incidence of CVD events and mortality among the cohorts and analyze the interactions. RESULTS The subjects comprised of 6696 women and 5819 men who completed a mean 8.8-year follow-up. All of the participants had two or more CVD risk factors at baseline. At the end of the study, 4049 CVD events had occurred in 2304 participants. The incidence of non-fatal CVD events was 14.08, 16,65, and 25.21 % in the low-NC, medium-NC, and high-NC cohorts, respectively (p < 0.001). The all-cause mortality was 9.77, 11.93, and 19.31 %, and CVD mortality, 4.00, 6.29, and 8.01 %, respectively (p < 0.001). Compared with baseline, the number of CVD risk factors in participants had increased from 2.6, 3.0, and 3.4 to 3.5, 4.1, and 4.7 in the low-, medium-, and high-NC cohorts (34, 36, and 38 %), respectively. The event-free survival rate was 95.32, 80.15, and 75.47 %, respectively. CONCLUSIONS A higher NC indicated a higher incidence of future fatal and non-fatal CVD events and all-cause mortality in both male and female high-risk participants. CVD risk factors increased more in the higher NC group. NC as a novel indicator of CVD showed good predictive ability for CVD events and mortality in a high-risk population.
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Affiliation(s)
- Yingnan Dai
- The Fourth Affiliated Hospital of Harbin Medical University, 37 Yiyuan Street, Habin, 150001, China
| | - Xiaojing Wan
- The Fourth Affiliated Hospital of Harbin Medical University, 37 Yiyuan Street, Habin, 150001, China
| | - Xin Li
- The Fourth Affiliated Hospital of Harbin Medical University, 37 Yiyuan Street, Habin, 150001, China
| | - Enze Jin
- The Fourth Affiliated Hospital of Harbin Medical University, 37 Yiyuan Street, Habin, 150001, China
| | - Xueqi Li
- The Fourth Affiliated Hospital of Harbin Medical University, 37 Yiyuan Street, Habin, 150001, China.
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Waist circumference compared with other obesity parameters as determinants of coronary artery disease in essential hypertension: a 6-year follow-up study. Hypertens Res 2016; 39:475-9. [PMID: 26865004 DOI: 10.1038/hr.2016.8] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 12/01/2015] [Accepted: 12/07/2015] [Indexed: 12/24/2022]
Abstract
This study aimed to assess the predictive role of body mass index (BMI), waist circumference (WC) and the waist-to-hip ratio (WHR) for the incidence of coronary artery disease (CAD) in a cohort of essential hypertensive patients. We followed up 2266 essential hypertensive individuals (mean age, 57.8 years; males, 1083; office blood pressure (BP), 143/89 mm Hg) who were free of cardiovascular disease for a mean period of 6 years. All subjects had at least one annual visit and, at baseline, underwent blood sampling and a complete echocardiographic study to determine the left ventricular (LV) mass index. CAD was defined as a history of myocardial infarction or significant coronary artery stenosis that was revealed by angiography or a coronary revascularization procedure. The incidence of CAD throughout the follow-up period was 2.33%. Hypertensive individuals who developed CAD (n=53) had a greater baseline WC (101.1±11.7 vs. 96.4±12 cm, P=0.005), WHR (0.94±0.07 vs. 0.89±0.08 cm, P<0.0001) and LV mass index (117±26.8 vs. 103.3±27 g m(-)(2), P<0.0001) compared with those without CAD at follow-up (n=2213), whereas no difference was observed compared with the baseline office BP and BMI values (P=NS for all). Using a multivariate Cox regression model, WC (hazard ratio (HR) 1.037, P=0.002) and LV mass index (HR 1.010, P=0.044) were found to be independent predictors of CAD. In essential hypertensive patients, WC could predict the future development of CAD, whereas BMI and WHR showed no independent prognostic value. These findings suggest that WC constitutes an easy clinical tool to assess risk in hypertension among individuals with obesity.
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Schmid D, Ricci C, Behrens G, Leitzmann MF. Adiposity and risk of thyroid cancer: a systematic review and meta-analysis. Obes Rev 2015; 16:1042-54. [PMID: 26365757 DOI: 10.1111/obr.12321] [Citation(s) in RCA: 142] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 08/11/2015] [Accepted: 08/11/2015] [Indexed: 11/30/2022]
Abstract
Thyroid cancer incidence has increased rapidly over time, as has obesity prevalence. A link between the two appears plausible, but the relation of adiposity to thyroid cancer remains incompletely understood. We performed a meta-analysis of adiposity measures and thyroid cancer using studies identified through October 2014. Twenty-one articles yielded data on 12,199 thyroid cancer cases. We found a statistically significant 25% greater risk of thyroid cancer in overweight individuals and a 55% greater thyroid cancer risk in obese individuals as compared with their normal-weight peers. Each 5-unit increase in body mass index (BMI), 5 kg increase in weight, 5 cm increase in waist or hip circumference and 0.1-unit increase in waist-to-hip ratio were associated with 30%, 5%, 5% and 14% greater risks of thyroid cancer, respectively. When evaluated by histologic type, obesity was significantly positively related to papillary, follicular and anaplastic thyroid cancers, whereas it revealed an inverse association with medullary thyroid cancer. Both general and abdominal adiposity are positively associated with thyroid cancer. However, relations with BMI vary importantly by tumour histologic type.
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Affiliation(s)
- D Schmid
- Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany
| | - C Ricci
- Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany
| | - G Behrens
- Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany
| | - M F Leitzmann
- Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany
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Weng L, Taylor KD, Chen YDI, Sopko G, Kelsey SF, Bairey Merz CN, Pepine CJ, Miller VM, Rotter JI, Gulati M, Goodarzi MO, Cooper-DeHoff RM. Genetic loci associated with nonobstructive coronary artery disease in Caucasian women. Physiol Genomics 2015; 48:12-20. [PMID: 26534935 DOI: 10.1152/physiolgenomics.00067.2015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 10/29/2015] [Indexed: 01/11/2023] Open
Abstract
Nonobstructive coronary artery disease (CAD) in women is associated with adverse cardiovascular (CV) outcomes; however, information regarding genetic variants that predispose women to nonobstructive CAD is lacking. Women from the Women's Ischemia Syndrome Evaluation (WISE) Study and the St. James Women Take Heart (WTH) Study were genotyped with the Cardio-MetaboChip. WISE enrolled women with symptoms and signs of ischemia referred for coronary angiography; WTH enrolled asymptomatic, community-based women without heart disease. Analyses were conducted with a case (WISE)--control (WTH) design and multivariate logistic regression models to investigate genetic variation associated with likelihood of nonobstructive CAD. One genetic marker, single nucleotide polymorphism (SNP) rs2301753 on chromosome 6 in RNF39, achieved chip-wide significance for nonobstructive CAD (P < 9.5 × 10(-7)). After adjusting for baseline characteristics, we found no variants achieved chip-wide significance. However, SNP rs2301753 on chromosome 6 in RNF39 was associated with reduced likelihood of nonobstructive CAD [odds ratio (OR) 0.42 and 95% confidence interval (CI) of 0.29 to 0.68], at a nominal level of P = 5.6 × 10(-6), while SNP rs12818945 in the ATP2B1 locus on chromosome 12 was associated with increased odds for nonobstructive CAD (OR 2.38 and 95% CI of 1.63 to 3.45) and nominal P = 5.8 × 10(-6). The functions of RNF39 and ATP2B1 raise the possibility that genes involved in cardio-dysfunction may contribute to nonobstructive CAD in Caucasian women and may provide insights into novel approaches for therapy and prevention. If replicated, incorporation of these genetic variants into diagnostic evaluation may identify women at high risk for nonobstructive CAD.
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Affiliation(s)
- Liming Weng
- Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics, University of Florida, College of Pharmacy, Gainesville, Florida
| | - Kent D Taylor
- Institute for Translational Genomics and Population Sciences and Department of Pediatrics and Los Angeles BioMedical Research Institute, Harbor-UCLA Medical Center, Torrance, California
| | - Yii-Der Ida Chen
- Institute for Translational Genomics and Population Sciences and Department of Pediatrics and Los Angeles BioMedical Research Institute, Harbor-UCLA Medical Center, Torrance, California
| | - George Sopko
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Sheryl F Kelsey
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - C Noel Bairey Merz
- Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Carl J Pepine
- Division of Cardiology, College of Medicine, University of Florida, Gainesville, Florida
| | - Virginia M Miller
- Departments of Surgery and Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota
| | - Jerome I Rotter
- Institute for Translational Genomics and Population Sciences and Department of Pediatrics and Los Angeles BioMedical Research Institute, Harbor-UCLA Medical Center, Torrance, California
| | - Martha Gulati
- Department of Medicine (Cardiology), The Ohio State University, Columbus, Ohio; and
| | - Mark O Goodarzi
- Division of Endocrinology, Diabetes and Metabolism, Cedars-Sinai Medical Center, Los Angeles, California
| | - Rhonda M Cooper-DeHoff
- Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics, University of Florida, College of Pharmacy, Gainesville, Florida; Division of Cardiology, College of Medicine, University of Florida, Gainesville, Florida;
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Orlic L, Mikolasevic I, Jakopcic I, Grskovic A, Jelic Pranjic I, Racki S, Stimac D. Body mass index: short- and long-term impact on kidney transplantation. Int J Clin Pract 2015; 69:1357-65. [PMID: 26268780 DOI: 10.1111/ijcp.12715] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 07/22/2015] [Indexed: 12/22/2022] Open
Abstract
AIM The topic of pretransplantation body mass index (BMI) is still a matter of controversy. The aim of this study was to investigate the influence of pretransplant BMI on short- and long-term outcomes in patients receiving kidney transplant. METHODS We have analysed 521 renal transplant recipients (RTRs). BMI was categorised as follows: less than or equal to 20, more than 20 to less than or equal to 25, more than 25 to less than or equal to 30 and more than 30 RESULTS: The distribution of the RTRs per category of BMI at baseline was: ≤ 20 (14.4%), > 20 to ≤ 25 (50.9%), > 25 ≤ 30 (26.9%) and > 30 (7.9%). In further analysis, the patients were stratified into four groups according to their pretransplant BMI values. There was no difference in the rates of delayed graft function between the four analysed groups of patients. Recipients with normal pre-transplant BMI were less likely to develop wound complications in comparison to the recipients with high BMI (p = 0.04) and obese recipients (p = 0.0001). RTRs with normal BMI were less likely to develop lymphoceles in comparison to the recipients with high BMI (p = 0.0003). Obese patients were more likely to develop lymphocele in comparison to the recipients with high BMI (p = 0.01). Obese recipients had a longer mean length of hospital stay in comparison to the recipients with normal BMI (p = 0.04). There was no significant difference regarding 1-year graft and patient survival, as well as because of acute rejection crisis between the investigated groups of recipients. We did not find any significant difference in 5-year patients and graft survival between those RTRs with BMI > 20 to ≤ 25 and to those recipients with BMI > 25. CONCLUSION Overweight and obese transplant candidates should not be excluded from kidney transplantation.
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Affiliation(s)
- L Orlic
- Department of Nephrology, Dialysis and Kidney Transplantation, UHC, Rijeka, Croatia
- School of Medicine, Rijeka, Croatia
| | - I Mikolasevic
- Department of Nephrology, Dialysis and Kidney Transplantation, UHC, Rijeka, Croatia
- School of Medicine, Rijeka, Croatia
- Department of Gastroenterology, UHC, Rijeka, Croatia
| | | | - A Grskovic
- School of Medicine, Rijeka, Croatia
- Department of Urology, UHC, Rijeka, Croatia
| | - I Jelic Pranjic
- Department of Nephrology, Dialysis and Kidney Transplantation, UHC, Rijeka, Croatia
| | - S Racki
- Department of Nephrology, Dialysis and Kidney Transplantation, UHC, Rijeka, Croatia
- School of Medicine, Rijeka, Croatia
| | - D Stimac
- School of Medicine, Rijeka, Croatia
- Department of Gastroenterology, UHC, Rijeka, Croatia
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Grant JF, Chittleborough CR, Taylor AW. Parental Midlife Body Shape and Association with Multiple Adult Offspring Obesity Measures: North West Adelaide Health Study. PLoS One 2015; 10:e0137534. [PMID: 26355742 PMCID: PMC4565704 DOI: 10.1371/journal.pone.0137534] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 08/19/2015] [Indexed: 11/28/2022] Open
Abstract
There is compelling evidence that parental weight is a strong determinant of offspring weight status. The study used cross-sectional self-reported and measured data from a longitudinal cohort of Australian adults (n = 2128) from Stage 3 (2008-10) of the North West Adelaide Health Study (1999-2003, baseline n = 4056) to investigate the association between midlife parental body shape and four indicators of obesity and fat distribution. The analysis used measured body mass index (BMI), waist circumference (WC), waist hip ratio (WHR) and waist height ratio (WHtR) of adult offspring, together with pictograms for recall of parental body shape. Compared to both parents being a healthy weight, offspring were more likely to be overweight or obese if both parents were an unhealthy weight at age 40 (OR 2.14, 95% CI 1.67-2.76) and further, those participants whose mother was an unhealthy weight were more likely to be overweight or obese themselves (OR 1.50, 95% CI 1.14-1.98). There were similar but lower results for those with an overweight/obese father (OR 1.44, 95% CI 1.08-1.93). The effect of one or both parents being overweight or obese tended to be stronger for daughters than for sons across BMI, WC and WHtR. BMI showed the strongest association with parental body shape (OR 2.14), followed by WC (OR 1.78), WHtR (OR 1.71) and WHR (OR 1.45). WHtR (42-45%) and BMI (35-36%) provided the highest positive predictive values for overweight/obesity from parental body shape. Parental obesity increases the risk of obesity for adult offspring, both for overall body shape and central adiposity, particularly for daughters. Pictograms could potentially be used as a screening tool in primary care settings to promote healthy weight among young adults.
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Affiliation(s)
- Janet F. Grant
- Population Research and Outcome Studies, Discipline of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
| | | | - Anne W. Taylor
- Population Research and Outcome Studies, Discipline of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
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Arjmand G, Shidfar F, Molavi Nojoomi M, Amirfarhangi A. Anthropometric Indices and Their Relationship With Coronary Artery Diseases. HEALTH SCOPE 2015. [DOI: 10.17795/jhealthscope-25120] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Foley DL, Mackinnon A, Morgan VA, Watts GF, Shaw JE, Magliano DJ, Castle DJ, McGrath JJ, Waterreus A, Galletly CA. Cardiovascular risk factor associations in adults with psychosis and adults in a national comparator sample. Aust N Z J Psychiatry 2015; 49:714-23. [PMID: 25586752 DOI: 10.1177/0004867414565476] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Antipsychotic drug treatment alters status on key risk factors for cardiovascular disease. The aim of this study was to test whether cardiovascular risk factor associations differ in adults with psychosis and adults from the general community. METHOD Data were analysed for those aged 25-64 years from a nationally representative psychosis sample (n = 1,457) and a national comparator sample (n = 8,866). The Pearson correlation coefficient was used to estimate the association among tobacco use, body mass index, waist circumference, diastolic and systolic blood pressure and fasting total-, LDL- and HDL-cholesterol, triglycerides and plasma glucose. The robust Levene test was used to test for sample differences in variance. RESULTS Correlations among cardiovascular risk indicators and between cardiovascular risk indicators and age were often significantly weaker in those with psychosis than in those from the national comparator sample. This was not due to a reduction in variance within the psychosis sample. CONCLUSIONS Risk prediction that synthesizes multivariate risk indicator data needs to be connected to verified cardiovascular morbidity and mortality in those with psychosis to determine if standard risk calculators adequately discriminate those at high, medium and low future risk of cardiovascular morbidity and mortality. Until then the clinical implications of low or absent correlations among cardiovascular risk indicators and their low or absent association with increasing age is unclear but may indicate that risk equations commonly used in the general population may not be applicable for those with treated psychosis.
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Affiliation(s)
- Debra L Foley
- Orygen, The National Centre for Excellence in Youth Mental Health, Centre for Youth Mental Health, University of Melbourne, Australia
| | - Andrew Mackinnon
- Orygen, The National Centre for Excellence in Youth Mental Health, Centre for Youth Mental Health, University of Melbourne, Australia
| | - Vera A Morgan
- Neuropsychiatric Epidemiology Research Unit, School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, Australia
| | - Gerald F Watts
- Lipid Disorders Clinic, Metabolic Research Centre and Department of Cardiovascular Medicine, Royal Perth Hospital & School of Medicine and Pharmacology, University of Western Australia, Perth, Australia
| | - Jonathan E Shaw
- Department of Clinical Diabetes and Epidemiology, Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - Dianna J Magliano
- Department of Clinical Diabetes and Epidemiology, Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - David J Castle
- St Vincent's Hospital, Melbourne & Department of Psychiatry, University of Melbourne, Australia
| | - John J McGrath
- Queensland Brain Institute, University of Queensland, St. Lucia & Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, Australia
| | - Anna Waterreus
- Neuropsychiatric Epidemiology Research Unit, School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, Australia
| | - Cherrie A Galletly
- Discipline of Psychiatry, School of Medicine, University of Adelaide & Ramsay Health Care SA, Mental Health Services & Northern Adelaide Local Health Network, Australia
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Mbatchou Ngahane BH, Nganda MM, Dzudie A, Luma H, Kamdem F, Ngote HR, Monkam Y, Kuaban C. Prevalence and determinants of excessive daytime sleepiness in hypertensive patients: a cross-sectional study in Douala, Cameroon. BMJ Open 2015; 5:e008339. [PMID: 26224018 PMCID: PMC4521539 DOI: 10.1136/bmjopen-2015-008339] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To determine the prevalence and determinants of excessive daytime sleepiness (EDS) among a group of sub-Saharan Africans living with hypertension. DESIGN A cross-sectional study. SETTING Cardiology outpatient unit of the Douala General Hospital in Cameroon. PARTICIPANTS Patients aged 15 years and over, being followed for hypertension between 1st January and 31st July 2013. Patients with unstable heart failure, stroke and head trauma were excluded. MAIN OUTCOME MEASURE EDS was the outcome of interest. It was defined as an Epworth sleeping scale greater or equal to 10. Logistic regression was used to identify factors associated with EDS. RESULTS A total of 411 patients participated in this study, with a sex ratio (male/female) of 0.58 and a mean age of 55.56 years. No patient was underweight and the mean body mass index was 30 kg/m(2). Controlled blood pressure was found in 92 (22.4%) patients. The prevalence of EDS was 62.78% (95% CI 58.08 to 67.47). The factors independently associated with EDS were: type 2 diabetes (OR 2.51; 95% CI 1 to 6.29), obesity (OR 2.75; 95% CI 1.52 to 4.97), snoring (OR 7.92; 95% CI 4.43 to 14.15) and uncontrolled blood pressure (OR 4.34; 95% CI 2.24 to 8.40). CONCLUSIONS A significant proportion of hypertensive patients suffer from EDS and present a high risk of sleep apnoea. Preventive measures targeted on weight loss, type 2 diabetes and snoring should be considered among these patients.
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Affiliation(s)
- Bertrand Hugo Mbatchou Ngahane
- Department of Internal Medicine, Douala General Hospital, Douala, Cameroon
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Motto Malea Nganda
- Department of Internal Medicine, Douala General Hospital, Douala, Cameroon
| | - Anastase Dzudie
- Department of Internal Medicine, Douala General Hospital, Douala, Cameroon
- Faculty of Medicine, University of Cape Town, Cape Town, South Africa
| | - Henry Luma
- Department of Internal Medicine, Douala General Hospital, Douala, Cameroon
| | - Félicité Kamdem
- Department of Internal Medicine, Douala General Hospital, Douala, Cameroon
| | - Henri Roger Ngote
- Department of Internal Medicine, Douala General Hospital, Douala, Cameroon
| | - Yves Monkam
- Department of Internal Medicine, Douala General Hospital, Douala, Cameroon
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Analysis of Pediatric Waist to Hip Ratio Relationship to Metabolic Syndrome Markers. J Pediatr Health Care 2015; 29:319-24. [PMID: 25620719 DOI: 10.1016/j.pedhc.2014.12.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 12/17/2014] [Accepted: 12/23/2014] [Indexed: 11/22/2022]
Abstract
PURPOSE Waist to hip ratio (WHR) is a valid assessment tool to determine risk for the development or presence of metabolic syndrome, diabetes, and cardiovascular disease in adults. Evidence-based research on its validity with children and adolescents is limited. A retrospective analysis was conducted to determine if WHR in overweight and obese pediatric patients is associated with metabolic syndrome laboratory markers. METHODS Retrospective chart reviews were performed for 754 patients ages 6 to 17 years who were enrolled in a weight management program. Data collected included WHR, laboratory markers for metabolic disorder, body mass index, demographics, presence of acanthosis nigricans, and Tanner stage. RESULTS WHR and high-density lipoprotein were negatively correlated, r (N = 597) = -0.20, p < .001. WHR and triglycerides were positively correlated, r (N = 597) = 0.19, p < .001, as were WHR and low-density lipoprotein, r (N = 596) = 0.09, p = .03, and WHR and insulin, r (N = 414) = 0.16, p = .001. In a subject sample with very restricted range, a one-way analysis of variance found a significant effect of WHR on body mass index percentile, F (1, 754) = 22.43, p < .001, η(2) = 0.03. CONCLUSIONS Increased WHR correlated in children and adolescents with known indicators that could be suggestive of increased risk for metabolic syndrome, specifically low high-density lipoprotein, high low-density lipoprotein, triglycerides, and insulin. These results suggest that evaluation of WHR may be a useful tool to indicate risk for developing metabolic syndrome and diabetes in children and adolescents.
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Mahmood D, Jahan K, Habibullah K. Primary prevention with statins in cardiovascular diseases: A Saudi Arabian perspective. J Saudi Heart Assoc 2015; 27:179-91. [PMID: 26136632 PMCID: PMC4481463 DOI: 10.1016/j.jsha.2014.09.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2014] [Revised: 09/15/2014] [Accepted: 09/22/2014] [Indexed: 02/08/2023] Open
Abstract
Cardiovascular disease (CVD) constitutes one of the major causes of deaths and disabilities, globally claiming 17.3 million lives a year. Incidence of CVD is expected to rise to 25 million by 2030, and Saudi Arabia, already witnessing a rapid rise in CVDs, is no exception. Statins are the drugs of choice in established CVDs. In the recent past, evidence was increasingly suggesting benefits in primary prevention. But over the last decade Saudi Arabia has a witnessed significant rise in CVD-related deaths. Smoking, high-fat, low-fiber dietary intake, lack of exercise, sedentary life, high blood cholesterol and glucose levels were reported as frequent CVD-risk factors among Saudis, who may therefore be considered for primary prevention with statin. The prevalence of dyslipidemia, in particular, indicates that treatment should be directed at reducing the disorder with lipid-modifying agents and therapeutic lifestyle changes. The recent American College of Cardiology (ACC)/American Heart Association (AHA) guidelines has reported lowering the low-density lipoprotein cholesterol (LDL-C) target levels, prescribed by the 2011 European Society of Cardiology (ESC)/the European Atherosclerosis Society (EAS). The new ACC/AHA guidelines have overemphasized the use of statin while ignoring lipid targets, and have recommended primary prevention with moderate-intensity statin to individuals with diabetes aged 40-75 years and with LDL-C 70-189 mg/dL. Treatment with statin was based on estimated 10-year atherosclerotic-CVD (ASCVD) risk in individuals aged 40-75 years with LDL-C 70 to 189 mg/dL and without clinical ASCVD or diabetes. Adoption of the recent ACC/AHA guidelines will lead to inclusion of a large population for primary prevention with statins, and would cause over treatment to some who actually would not need statin therapy but instead should have been recommended lifestyle modifications. Furthermore, adoption of this guideline may potentially increase the incidences of statin intolerance and side-effects. On the other hand, the most widely used lipid management guideline, the 2011 ESC/EAC guidelines, targets lipid levels at different stages of disease activity before recommending statins. Hence, the 2011 ESC/EAC still offers a holistic and pragmatic approach to treating lipid abnormalities in CVD. Therefore, it is the 2011 ESC/EAC guidelines, and not the recent ACC/AHA guidelines, that should be adopted to draw guidance on primary prevention of CVD in Saudi Arabia.
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Affiliation(s)
- D. Mahmood
- Unaizah College of Pharmacy, Qassim University, Saudi Arabia
| | - K. Jahan
- Department of Pharmacology, Faculty of Pharmacy, Hamdard University, Hamdard Nagar, New Delhi 110062, India
| | - K. Habibullah
- Unaizah College of Pharmacy, Qassim University, Saudi Arabia
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Millar SR, Perry IJ, den Broeck JV, Phillips CM. Optimal central obesity measurement site for assessing cardiometabolic and type 2 diabetes risk in middle-aged adults. PLoS One 2015; 10:e0129088. [PMID: 26042771 PMCID: PMC4456242 DOI: 10.1371/journal.pone.0129088] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Accepted: 05/05/2015] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES Despite recommendations that central obesity assessment should be employed as a marker of cardiometabolic health, no consensus exists regarding measurement protocol. This study examined a range of anthropometric variables and their relationships with cardiometabolic features and type 2 diabetes in order to ascertain whether measurement site influences discriminatory accuracy. In particular, we compared waist circumference (WC) measured at two sites: (1) immediately below the lowest rib (WC rib) and (2) between the lowest rib and iliac crest (WC midway), which has been recommended by the World Health Organisation and International Diabetes Federation. MATERIALS AND METHODS This was a cross-sectional study involving a random sample of 2,002 men and women aged 46-73 years. Metabolic profiles and WC, hip circumference, pelvic width and body mass index (BMI) were determined. Correlation, logistic regression and area under the receiver operating characteristic curve analyses were used to evaluate obesity measurement relationships with metabolic risk phenotypes and type 2 diabetes. RESULTS WC rib measures displayed the strongest associations with non-optimal lipid and lipoprotein levels, high blood pressure, insulin resistance, impaired fasting glucose, a clustering of metabolic risk features and type 2 diabetes, in both genders. Rib-derived indices improved discrimination of type 2 diabetes by 3-7% compared to BMI and 2-6% compared to WC midway (in men) and 5-7% compared to BMI and 4-6% compared to WC midway (in women). A prediction model including BMI and central obesity displayed a significantly higher area under the curve for WC rib (0.78, P=0.003), Rib/height ratio (0.80, P<0.001), Rib/pelvis ratio (0.79, P<0.001), but not for WC midway (0.75, P=0.127), when compared to one with BMI alone (0.74). CONCLUSIONS WC rib is easier to assess and our data suggest that it is a better method for determining obesity-related cardiometabolic risk than WC midway. The clinical utility of rib-derived indices, or alternative WC measurements, deserves further investigation.
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Affiliation(s)
- Seán R. Millar
- HRB Centre for Health and Diet Research, Department of Epidemiology and Public Health, University College Cork, Cork, Ireland
| | - Ivan J. Perry
- HRB Centre for Health and Diet Research, Department of Epidemiology and Public Health, University College Cork, Cork, Ireland
| | - Jan Van den Broeck
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Catherine M. Phillips
- HRB Centre for Health and Diet Research, Department of Epidemiology and Public Health, University College Cork, Cork, Ireland
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Blackford K, Jancey J, Lee AH, James AP, Howat P, Hills AP, Anderson A. A randomised controlled trial of a physical activity and nutrition program targeting middle-aged adults at risk of metabolic syndrome in a disadvantaged rural community. BMC Public Health 2015; 15:284. [PMID: 25885657 PMCID: PMC4419409 DOI: 10.1186/s12889-015-1613-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 03/04/2015] [Indexed: 11/17/2022] Open
Abstract
Background Approximately 70% of Australian adults aged over 50 are overweight or obese, with the prevalence significantly higher in regional/remote areas compared to cities. This study aims to determine if a low-cost, accessible lifestyle program targeting insufficiently active adults aged 50-69 y can be successfully implemented in a rural location, and whether its implementation will contribute to the reduction/prevention of metabolic syndrome, or other risk factors for type 2 diabetes, and cardiovascular disease. Methods/Design This 6-month randomised controlled trial will consist of a nutrition, physical activity, and healthy weight intervention for 50–69 year-olds from a disadvantaged rural community. Five hundred participants with central obesity and at risk of metabolic syndrome will be recruited from Albany and surrounding areas in Western Australia (within a 50 kilometre radius of the town). They will be randomly assigned to either the intervention (n = 250) or wait-listed control group (n = 250). The theoretical concepts in the study utilise the Self-Determination Theory, complemented by Motivational Interviewing. The intervention will include a custom-designed booklet and interactive website that provides information, and encourages physical activity and nutrition goal setting, and healthy weight management. The booklet and website will be supplemented by an exercise chart, calendar, newsletters, resistance bands, accelerometers, and phone and email contact from program staff. Data will be collected at baseline and post-intervention. Discussion This study aims to contribute to the prevention of metabolic syndrome and inter- related chronic illnesses: type 2 diabetes mellitus, cardiovascular disease, and some cancers; which are associated with overweight/obesity, physical inactivity, and poor diet. This large rural community-based trial will provide guidelines for recruitment, program development, implementation, and evaluation, and has the potential to translate findings into practice by expanding the program to other regional areas in Australia. Trial registration Australian and New Zealand Clinical Trials Registry [ACTRN12614000512628, registration date 14th May 2014]. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-1613-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Krysten Blackford
- Collaboration for Evidence, Research and Impact in Public Health, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia. .,Centre for Behavioural Research in Cancer Control, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia. .,School of Public Health, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia.
| | - Jonine Jancey
- Collaboration for Evidence, Research and Impact in Public Health, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia. .,Centre for Behavioural Research in Cancer Control, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia. .,School of Public Health, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia.
| | - Andy H Lee
- Collaboration for Evidence, Research and Impact in Public Health, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia. .,Centre for Behavioural Research in Cancer Control, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia. .,School of Public Health, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia.
| | - Anthony P James
- School of Public Health, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia.
| | - Peter Howat
- Collaboration for Evidence, Research and Impact in Public Health, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia. .,Centre for Behavioural Research in Cancer Control, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia. .,School of Public Health, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia.
| | - Andrew P Hills
- School of Exercise and Nutrition Sciences, Queensland University of Technology, GPO Box 2434, Brisbane, QLD, 4001, Australia.
| | - Annie Anderson
- Centre for Public Health Nutrition Research, Division of Cancer Research, Ninewells Medical School, Level 7, Mailbox 7, Dundee, DD1 9SY, UK.
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Arcot J, Kim J, Trollor J, Brodaty H, Crawford J, Sachdev P. Anthropometric indices in a community-dwelling Australian population aged 70-90 years: The Sydney Memory and Ageing Study. Nutr Diet 2015. [DOI: 10.1111/1747-0080.12140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Jayashree Arcot
- Food Science and Technology Group; School of Chemical Engineering; University of New South Wales; Sydney New South Wales Australia
| | - Jihee Kim
- Food Science and Technology Group; School of Chemical Engineering; University of New South Wales; Sydney New South Wales Australia
| | - Julian Trollor
- Brain and Ageing Research Program; School of Psychiatry; Faculty of Medicine; University of New South Wales; Sydney New South Wales Australia
- Department of Developmental Disability Neuropsychiatry; School of Psychiatry; Faculty of Medicine; University of New South Wales; Sydney New South Wales Australia
| | - Henry Brodaty
- Brain and Ageing Research Program; School of Psychiatry; Faculty of Medicine; University of New South Wales; Sydney New South Wales Australia
- Primary Dementia Collaborative Research Centre; School of Psychiatry; Faculty of Medicine; University of New South Wales; Sydney New South Wales Australia
| | - John Crawford
- Brain and Ageing Research Program; School of Psychiatry; Faculty of Medicine; University of New South Wales; Sydney New South Wales Australia
| | - Perminder Sachdev
- Brain and Ageing Research Program; School of Psychiatry; Faculty of Medicine; University of New South Wales; Sydney New South Wales Australia
- Primary Dementia Collaborative Research Centre; School of Psychiatry; Faculty of Medicine; University of New South Wales; Sydney New South Wales Australia
- School of Psychiatry; Neuropsychiatric Institute; Prince of Wales Hospital; Sydney New South Wales Australia
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Adebimpe WO, Omobuwa O, Omisore AG, Adeoye O. Obesity indices as predictors of pattern of self-reported arthritis among elderly women in Southwestern Nigeria. SAGE Open Med 2015; 3:2050312115572039. [PMID: 26770766 PMCID: PMC4679216 DOI: 10.1177/2050312115572039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2014] [Accepted: 12/31/2014] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES This study assessed obesity indices and pattern of arthritis among elderly women in Osun State, Southwestern Nigeria. METHODS The cross-sectional descriptive study was carried out among 350 elderly women selected by multistage sampling technique. Research instruments used in data collection were semi-structured, interviewer-administered pre-tested questionnaires that were analyzed using the Statistical Package for Social Sciences software version 17.0. RESULTS The mean age of the participants was 69.1 (±1.4) years. A total of 232 (66.3%) of them had complaints of joint pains (Awoka as expressed in the local language). Pattern of arthritis showed that 172 (74.0%) had recurrent joint pains, while 35 (15.1%) had joint swelling; the knee joint was mostly affected. A total of 97 (28.0%) were overweight while 84 (24.0%) were obese. Obese women were twice more likely to have arthritis when compared to the nonobese (odds ratio: 2.4, 95% confidence interval: 1.8-9.4, p = 0.001). CONCLUSION There is a need to give high priority to weight reduction strategies targeted at the elderly and the entire population.
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Affiliation(s)
- Wasiu O Adebimpe
- Department of Community Medicine, College of Health Sciences, Osun State University, Osogbo, Nigeria
| | - Olubukunola Omobuwa
- Department of Community Medicine, College of Health Sciences, Osun State University, Osogbo, Nigeria
| | - Akinlolu G Omisore
- Department of Community Medicine, College of Health Sciences, Osun State University, Osogbo, Nigeria
| | - Oluwatosin Adeoye
- Department of Community Medicine, LAUTECH Teaching Hospital, Ogbomosho, Nigeria
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Cure P, Hoffman HJ, Cure-Cure C. Parity and diabetes risk among hispanic women from Colombia: cross-sectional evidence. Diabetol Metab Syndr 2015; 7:7. [PMID: 25729439 PMCID: PMC4343264 DOI: 10.1186/s13098-015-0001-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 01/17/2015] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE The association between parity and type 2 diabetes has been studied in developed countries and in Singapore and Chinese women but not in Hispanics. Herein we evaluated the association between parity (number of live births) with diabetes in a group of Hispanic postmenopausal women from Colombia. RESEARCH DESIGN AND METHODS Herein we evaluated the association between parity and diabetes in a population of 1,795 women from Colombia. Women were divided in birth categories (0 [referent], 1 or 2, 3-5, 6 or > births). Medical history of diabetes and anthropometric characteristics were recorded. Logistic regressions were performed in order to find the association between parity and diabetes in bivariable and multivariable models after controlling for age, body mass index (BMI), waist hip ratio (WHR) and diabetes family history, among other variables. RESULTS In our study, there was an association between parity and diabetes after adjusting for age, BMI and diabetes family history in the multiparous women groups when compared to the women with no births (Referent group) [1-2 births vs. referent OR 5.2 (95 CI 1.2-22.9), 3-5 births vs. referent OR 5.5 (1.3-23.0) and ≥6 births vs. referent OR 7.5 (1.8-31.8), respectively]. The association was maintained in two of the groups in the multivariable analysis [OR 5.0 (1.1-22.9) and 5.3 (1.2-23.5)], for 1 or 2 births and 6 or > births versus 0 births, respectively. Positive diabetes family history and WHR were also associated with an increased risk of diabetes [OR 4.6 (3.0-7.0) and 4.1 (2.0-8.1), respectively]. CONCLUSIONS In postmenopausal Hispanic women, multiparity, as well as a positive family history of diabetes and a high waist-hip ratio were associated with higher diabetes risk.
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Affiliation(s)
- Pablo Cure
- />Children’s National Health System, 111 Michigan Avenue, NW Washington DC, 20010 USA
- />The George Washington University, Washington DC, USA
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de Cabo R, Carmona-Gutierrez D, Bernier M, Hall MN, Madeo F. The search for antiaging interventions: from elixirs to fasting regimens. Cell 2014; 157:1515-26. [PMID: 24949965 DOI: 10.1016/j.cell.2014.05.031] [Citation(s) in RCA: 240] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Indexed: 10/25/2022]
Abstract
The phenomenon of aging is an intrinsic feature of life. Accordingly, the possibility to manipulate it has fascinated humans likely since time immemorial. Recent evidence is shaping a picture where low caloric regimes and exercise may improve healthy senescence, and several pharmacological strategies have been suggested to counteract aging. Surprisingly, the most effective interventions proposed to date converge on only a few cellular processes, in particular nutrient signaling, mitochondrial efficiency, proteostasis, and autophagy. Here, we critically examine drugs and behaviors to which life- or healthspan-extending properties have been ascribed and discuss the underlying molecular mechanisms.
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Affiliation(s)
- Rafael de Cabo
- Translational Gerontology Branch, National Institute on Aging, National Institutes of Health, Baltimore, Maryland 21224, USA.
| | | | - Michel Bernier
- Translational Gerontology Branch, National Institute on Aging, National Institutes of Health, Baltimore, Maryland 21224, USA
| | - Michael N Hall
- Biozentrum, University of Basel, Basel 4056, Switzerland
| | - Frank Madeo
- Institute of Molecular Biosciences, University of Graz, Graz 8010, Austria.
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