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Wang J, Ye Y, Chen X, Hu X, Peng Y. Trends in statin use for the primary prevention of atherosclerotic cardiovascular disease among US adults by demographic characteristics, 1999-2020. Eur J Clin Pharmacol 2024; 80:1305-1315. [PMID: 38802638 DOI: 10.1007/s00228-024-03699-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 05/02/2024] [Indexed: 05/29/2024]
Abstract
PURPOSE Atherosclerotic cardiovascular disease (ASCVD) is a leading cause of mortality worldwide. Statins, which are effective in preventing ASCVD, are underused, particularly for primary prevention. This study examined trends in statin use for primary ASCVD prevention from 1999 to 2020, focusing on demographic variations. METHODS Utilizing data from the National Health and Nutrition Examination Survey, the present study includes individuals aged 18 years and older who had a greater than 10% risk of ASCVD over 10 years, and excluded patients with existing ASCVD. Subgroup analyses by demographic categories were performed. We calculated the changes in statin usage and used linear and quadratic tests to assess the linear and nonlinear trends in those changes. RESULTS A total of 10,037 participants were included. Statin usage increased from 16.16% in 1999 to 36.24% in 2010, and 41.74% in 2020 (quadratic P-value < 0.001). In the 18-44 years age group, statin usage increased from 2.52% in 1999 to 8.14% in 2020 (linear P-value = 0.322), showing no significant linear trend. In the "never-married" group, statin usage increased from 19.16% in 1999 to 30.05% in 2020 (linear P-value = 0.256). CONCLUSION Statin usage has shown a positive trend among populations requiring primary prevention for ASCVD. Currently, health policies are proving effective. However, the overall statin usage rate remains less than 50%. Additionally, young and never-married individuals should also receive special attention regarding statin usage as primary treatment for ASCVD.
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Affiliation(s)
- Junwen Wang
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, China
| | - Yuyang Ye
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, China
| | - Xuefeng Chen
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, China
| | - Xinru Hu
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, China
| | - Yong Peng
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, China.
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Amoroso M, Augustin S, Moosmang S, Gashaw I. Non-invasive biomarkers prognostic of decompensation events in NASH cirrhosis: a systematic literature review. J Mol Med (Berl) 2024; 102:841-858. [PMID: 38753041 PMCID: PMC11213726 DOI: 10.1007/s00109-024-02448-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 02/23/2024] [Accepted: 04/17/2024] [Indexed: 06/29/2024]
Abstract
Liver cirrhosis due to nonalcoholic steatohepatitis (NASH) is a life-threatening condition with increasing incidence world-wide. Although its symptoms are unspecific, it can lead to decompensation events such as ascites, hepatic encephalopathy, variceal hemorrhage, and hepatocellular carcinoma (HCC). In addition, an increased risk for cardiovascular events has been demonstrated in patients with NASH. Pharmacological treatments for NASH cirrhosis are not yet available, one of the reasons being the lack in surrogate endpoints available in clinical trials of NASH cirrhosis. The feasibility of non-invasive prognostic biomarkers makes them interesting candidates as possible surrogate endpoints if their change following treatment would result in better outcomes for patients in future clinical trials of NASH cirrhosis. In this systematic literature review, a summary of the available literature on the prognostic performance of non-invasive biomarkers in terms of cardiovascular events, liver-related events, and mortality is outlined. Due to the scarcity of data specific for NASH cirrhosis, this review includes studies on NAFLD whose evaluation focuses on cirrhosis. Our search strategy identified the following non-invasive biomarkers with prognostic value in studies of NASH patients: NAFLD fibrosis score (NFS), Fibrosis-4 (FIB-4), aspartate aminotransferase (AST) to platelet ratio index (APRI), enhanced liver fibrosis (ELF™), BARD (BMI, AST/ALT (alanine aminotransferase) ratio, diabetes), Hepamet Fibrosis Score (HFS), liver enzymes (AST + ALT), alpha-fetoprotein, platelet count, neutrophil to lymphocyte ratio (NLR), Lysyl oxidase-like (LOXL) 2, miR-122, liver stiffness, MEFIB (liver stiffness measured with magnetic resonance elastography (MRE) + FIB-4), and PNPLA3 GG genotype. The aim of the present systematic literature review is to provide the reader with a summary of the non-invasive biomarkers with prognostic value in NASH cirrhosis and give an evaluation of their utility as treatment monitoring biomarkers in future clinical trials.
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Affiliation(s)
| | | | - Sven Moosmang
- Boehringer Ingelheim Pharma GmbH, Ingelheim, Germany
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Cao T, Zhu Q, Tong C, Halengbieke A, Ni X, Tang J, Han Y, Li Q, Yang X. Establishment of a machine learning predictive model for non-alcoholic fatty liver disease: A longitudinal cohort study. Nutr Metab Cardiovasc Dis 2024; 34:1456-1466. [PMID: 38508988 DOI: 10.1016/j.numecd.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 01/25/2024] [Accepted: 02/10/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND AND AIMS Non-alcoholic fatty liver disease (NAFLD) is a common chronic liver disease, which lacks effective drug treatments. This study aimed to construct an eXtreme Gradient Boosting (XGBoost) prediction model to identify or evaluate potential NAFLD patients. METHODS AND RESULTS We conducted a longitudinal study of 22,140 individuals from the Beijing Health Management Cohort. Variable filtering was performed using the least absolute shrinkage and selection operator. Random Over Sampling Examples was used to address imbalanced data. Next, the XGBoost model and the other three machine learning (ML) models were built using balanced data. Finally, the variable importance of the XGBoost model was ranked. Among four ML algorithms, we got that the XGBoost model outperformed the other models with the following results: accuracy of 0.835, sensitivity of 0.835, specificity of 0.834, Youden index of 0.669, precision of 0.831, recall of 0.835, F-1 score of 0.833, and an area under the curve of 0.914. The top five variables with the greatest impact on the onset of NAFLD were aspartate aminotransferase, cardiometabolic index, body mass index, alanine aminotransferase, and triglyceride-glucose index. CONCLUSION The predictive model based on the XGBoost algorithm enables early prediction of the onset of NAFLD. Additionally, assessing variable importance provides valuable insights into the prevention and treatment of NAFLD.
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Affiliation(s)
- Tengrui Cao
- School of Public Health, Capital Medical University, NO. 10 Xitoutiao, Youanmenwai, Fengtai District, Beijing 100069, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, NO. 10 Xitoutiao, Youanmenwai, Fengtai District, Beijing 100069, China.
| | - Qian Zhu
- School of Public Health, Capital Medical University, NO. 10 Xitoutiao, Youanmenwai, Fengtai District, Beijing 100069, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, NO. 10 Xitoutiao, Youanmenwai, Fengtai District, Beijing 100069, China; Office for Cancer Registry, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
| | - Chao Tong
- Beijing Center for Disease Prevention and Control, Beijing 100013, China.
| | - Aheyeerke Halengbieke
- School of Public Health, Capital Medical University, NO. 10 Xitoutiao, Youanmenwai, Fengtai District, Beijing 100069, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, NO. 10 Xitoutiao, Youanmenwai, Fengtai District, Beijing 100069, China.
| | - Xuetong Ni
- School of Public Health, Capital Medical University, NO. 10 Xitoutiao, Youanmenwai, Fengtai District, Beijing 100069, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, NO. 10 Xitoutiao, Youanmenwai, Fengtai District, Beijing 100069, China.
| | - Jianmin Tang
- School of Public Health, Capital Medical University, NO. 10 Xitoutiao, Youanmenwai, Fengtai District, Beijing 100069, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, NO. 10 Xitoutiao, Youanmenwai, Fengtai District, Beijing 100069, China.
| | - Yumei Han
- Science and Education Section, Beijing Physical Examination Center, No. 59, Beiwei Road, Xicheng District, Beijing 100050, China.
| | - Qiang Li
- Science and Education Section, Beijing Physical Examination Center, No. 59, Beiwei Road, Xicheng District, Beijing 100050, China.
| | - Xinghua Yang
- School of Public Health, Capital Medical University, NO. 10 Xitoutiao, Youanmenwai, Fengtai District, Beijing 100069, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, NO. 10 Xitoutiao, Youanmenwai, Fengtai District, Beijing 100069, China.
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Satish P, Avenatti E, Patel J, Agarwala A. Understanding the spectrum of cardiovascular risk in women - A primer for prevention. Prog Cardiovasc Dis 2024; 84:34-42. [PMID: 38710313 DOI: 10.1016/j.pcad.2024.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Accepted: 05/01/2024] [Indexed: 05/08/2024]
Abstract
Cardiovascular disease (CVD) is the leading cause of death in women worldwide and the lifetime risk of CVD in women is similar to men. However, the pathophysiology of CVD varies between women and men necessitating a sex-specific understanding of cardiovascular (CV) risk. A belief that women have a lower CVD risk than men, and an underrepresentation in clinical research for many years has led to a paucity of evidence in the prevention and management of CVD in women. Many recent efforts have tried to bridge the gap. As a result, we now know that traditional risk factors impact CVD risk differently in women when compared with men. There are also numerous sex-specific and pregnancy related risk factors that modify the risk and can predict the future development of CVD in women. This is important as risk calculators, in general, tend to misclassify risk in young women with nontraditional CVD risk factors. To address this, guidelines have introduced the concept of risk enhancers that can suggest a higher risk. The use of coronary artery calcium score can further accurately delineate risk in these women, leading to an appropriate matching of therapy to underlying risk. This review discusses implementation strategies that are essential to mitigate disparities in CVD outcomes and optimizing CVD risk in women.
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Affiliation(s)
- Priyanka Satish
- Center for Cardiovascular Prevention, Ascension Texas Cardiovascular, Dell Medical School, University of Texas, Austin, USA
| | - Eleonora Avenatti
- Center for Cardiovascular Prevention, Ascension Texas Cardiovascular, Dell Medical School, University of Texas, Austin, USA
| | - Jaideep Patel
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Anandita Agarwala
- Center for Cardiovascular Disease Prevention, Baylor Scott and White Health Heart Hospital Baylor Plano, Plano, TX, USA.
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Gadgil MD, Cheng J, Herrington DM, Kandula NR, Kanaya AM. Adipose tissue-derived metabolite risk scores and risk for type 2 diabetes in South Asians. Int J Obes (Lond) 2024; 48:668-673. [PMID: 38245659 PMCID: PMC11058083 DOI: 10.1038/s41366-023-01457-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 12/13/2023] [Accepted: 12/21/2023] [Indexed: 01/22/2024]
Abstract
BACKGROUND South Asians are at higher risk for type 2 diabetes (T2D) than many other race/ethnic groups. Ectopic adiposity, specifically hepatic steatosis and visceral fat may partially explain this. Our objective was to derive metabolite risk scores for ectopic adiposity and assess associations with incident T2D in South Asians. METHODS We examined 550 participants in the Mediators of Atherosclerosis in South Asians Living in America (MASALA) cohort study aged 40-84 years without known cardiovascular disease or T2D and with metabolomic data. Computed tomography scans at baseline assessed hepatic attenuation and visceral fat area, and fasting serum specimens at baseline and after 5 years assessed T2D. LC-MS-based untargeted metabolomic analysis was performed followed by targeted integration and reporting of known signals. Elastic net regularized linear regression analyses was used to derive risk scores for hepatic steatosis and visceral fat using weighted coefficients. Logistic regression models associated metabolite risk score and incident T2D, adjusting for age, gender, study site, BMI, physical activity, diet quality, energy intake and use of cholesterol-lowering medication. RESULTS Average age of participants was 55 years, 36% women with an average body mass index (BMI) of 25 kg/m2 and 6% prevalence of hepatic steatosis, with 47 cases of incident T2D at 5 years. There were 445 metabolites of known identity. Of these, 313 metabolites were included in the MET-Visc score and 267 in the MET-Liver score. In most fully adjusted models, MET-Liver (OR 2.04 [95% CI 1.38, 3.03]) and MET-Visc (OR 2.80 [1.75, 4.46]) were associated with higher odds of T2D. These associations remained significant after adjustment for measured adiposity. CONCLUSIONS Metabolite risk scores for intrahepatic fat and visceral fat were strongly related to incident T2D independent of measured adiposity. Use of these biomarkers to target risk stratification may help capture pre-clinical metabolic abnormalities.
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Affiliation(s)
- Meghana D Gadgil
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco School of Medicine, 1545 Divisadero Street, Suite 320, San Francisco, CA, 94143, USA.
| | - Jing Cheng
- Department of Preventive and Restorative Dentistry, University of California, San Francisco School of Dentistry, 707 Parnassus Ave, #1026, San Francisco, CA, 94143, USA
| | - David M Herrington
- Section on Cardiovascular Medicine, Department of Internal Medicine, Wake Forest School of Medicine; Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Namratha R Kandula
- Division of General Internal Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, 750 N. Lakeshore Dr. 6h Floor, Chicago, IL, 60611, USA
| | - Alka M Kanaya
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco School of Medicine, 1545 Divisadero Street, Suite 320, San Francisco, CA, 94143, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco School of Medicine, 550 16th Street, Second Floor, San Francisco, CA, 94158, USA
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Seetharaman S, Allen I, Gadgil M, Srinivasan S, Topor L, Kanaya A. Predictors of weight and waist gain in US South Asians: Findings from the Mediators of Atherosclerosis in South Asians Living in America (MASALA) Study. RESEARCH SQUARE 2024:rs.3.rs-4054151. [PMID: 38585953 PMCID: PMC10996820 DOI: 10.21203/rs.3.rs-4054151/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
Background Weight and waist gain are significant concerns in adulthood. Both weight and waist gain are particularly important among South Asians, a high-risk group known to develop chronic cardiometabolic complications at any body mass index compared to other racial and ethnic groups. Objective The aim of this study was to investigate factors predicting weight and waist gain in a longitudinal cohort of US South Asians, a high-risk group for developing obesity-related complications. Methods We used data from Mediators of Atherosclerosis in South Asians Living in America study (MASALA) exam 1 (2010-2013) and exam 2 (2015-2018), with a mean 4.8 years of follow-up. Results Of 634 participants studied (42.7% women, mean age 55 years, BMI 25.7 kg/m2, weight 70.4 kg at exam 1), 34.7% had gained ≥5% weight and 32.3% gained ≥5% waist at exam 2. In the adjusted models, older age, higher number of years of US residence, and having diabetes were associated with lower odds of weight gain; being female and having higher adiponectin were associated with higher odds of weight gain. Being female, employed full or part time, or retired were associated with lower odds of waist gain. Being single, separated/divorced, having a higher leptin and a higher C-reactive protein level were associated with higher odds of waist gain. Conclusions South Asian subgroups with higher risk of weight and/or waist gain may benefit from targeted interventions to improve health outcomes.
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Affiliation(s)
| | | | - Meghana Gadgil
- University of California, San Francisco School of Medicine
| | | | - Lisa Topor
- Warren Alpert Medical School at Brown University
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Carrillo-Larco RM, Guzman-Vilca WC, Xu X, Bernabe-Ortiz A. Mean age and body mass index at type 2 diabetes diagnosis: Pooled analysis of 56 health surveys across income groups and world regions. Diabet Med 2024; 41:e15174. [PMID: 37422703 DOI: 10.1111/dme.15174] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 06/27/2023] [Accepted: 07/03/2023] [Indexed: 07/10/2023]
Abstract
BACKGROUND Screening for type 2 diabetes mellitus (T2DM) targets people aged 35+ years and those with overweight/obesity. With mounting evidence on young-onset T2DM and T2DM patients with lean phenotypes, it is worth revising the screening criteria to include younger and leaner adults. We quantified the mean age and body mass index (BMI; kg/m2 ) at T2DM diagnosis in 56 countries. METHODS Descriptive cross-sectional analysis of WHO STEPS surveys. We analysed adults (25-69 years) with new T2DM diagnosis (not necessarily T2DM onset) as per fasting plasma glucose ≥126 mg/dL measured during the survey. For people with new T2DM diagnosis, we summarized the mean age and the proportion of each five-year age group; also, we summarized the mean BMI and the proportion of mutually exclusive BMI categories. RESULTS There were 8695 new T2DM patients. Overall, the mean age at T2DM diagnosis was 45.1 years in men and 45.0 years in women; and the mean BMI at T2DM diagnosis was 25.2 in men and 26.9 in women. Overall, in men, 10.3% were 25-29 years and 8.5% were 30-34 years old; in women, 8.6% and 12.5% were 25-29 years and 30-34 years old, respectively. 48.5% of men and 37.3% of women were in the normal BMI category. CONCLUSIONS A non-negligible proportion of new T2DM patients were younger than 35 years. Many new T2DM patients were in the normal weight range. Guidelines for T2DM screening may consider revising the age and BMI criteria to incorporate young and lean adults.
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Affiliation(s)
- Rodrigo M Carrillo-Larco
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- Emory Global Diabetes Research Center, Emory University, Atlanta, Georgia, USA
| | - Wilmer Cristobal Guzman-Vilca
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- School of Medicine "Alberto Hurtado", Universidad Peruana Cayetano Heredia, Lima, Peru
- Sociedad Científica de Estudiantes de Medicina Cayetano Heredia (SOCEMCH), Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Xiaolin Xu
- Department of Big Data in Health Science School of Public Health, and Center of Clinical Big Data and Analytics of The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Antonio Bernabe-Ortiz
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Universidad Cientifica del Sur, Lima, Peru
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Gulyani P, Rawat P, Elmi Y, Gupta S, Wan CS. Barriers and facilitators of lifestyle management among adult South Asian migrants living with chronic diseases: A mixed-methods systematic review. Diabetes Metab Syndr 2024; 18:102944. [PMID: 38281447 DOI: 10.1016/j.dsx.2024.102944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 01/05/2024] [Accepted: 01/08/2024] [Indexed: 01/30/2024]
Abstract
BACKGROUND AND AIM South Asian migrants have a higher prevalence of chronic diseases than Caucasians. Despite much literature that has explored challenges in chronic disease management amongst the South Asian population in the past decades, their chronic disease management is still suboptimal. Understanding their determinants of disease management behaviour using the Theoretical Domains Framework will inform the development of a culturally sensitive intervention relevant to consumer-end-users. This study aimed to synthesise qualitative and quantitative studies on chronic disease management among adult South Asian immigrants. METHODS A mixed-methods systematic review was conducted using electronic databases. The Mixed Methods Appraisal Tool assessed the quality of the included studies. Quantitative data were transformed into qualitative data and analysed thematically. Subthemes were mapped in the Theoretical Domains Framework presenting barriers and facilitators under each theme. RESULTS 18293 studies were identified, of which 37 studies were included. The barriers and facilitators identified were categorised into four overarching themes: patient-provider interaction and relationship (e.g., complex language use by health professionals), the impact of migration (e.g., weather conditions had an impact on engagement with physical activity), heritage-based practices (e.g., an obligation to consume energy-dense food in social gatherings), and chronic disease management strategies (e.g., lack understanding of appropriate disease management strategies). CONCLUSION This review provides a comprehensive understanding of the complexity of chronic disease management among South Asian migrants and insights into developing multifaceted interventions to address barriers to chronic disease management, guiding the healthcare professionals in helping overcome South Asians perceived barriers to managing chronic disease in the host countries.
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Affiliation(s)
- Purva Gulyani
- Department of Sport, Exercise and Nutrition Sciences, La Trobe University, Bundoora, Australia; Diet Yumm, Craigieburn, Victoria, Australia.
| | | | - Yusra Elmi
- Diet Yumm, Craigieburn, Victoria, Australia
| | - Sabrina Gupta
- Department of Public Health, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Ching Shan Wan
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne & Australian Catholic University, Australia; National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Australia
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Kanaya AM. Diabetes in South Asians: Uncovering Novel Risk Factors With Longitudinal Epidemiologic Data: Kelly West Award Lecture 2023. Diabetes Care 2024; 47:7-16. [PMID: 38117990 PMCID: PMC10733655 DOI: 10.2337/dci23-0068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 10/03/2023] [Indexed: 12/22/2023]
Abstract
South Asian populations have a higher prevalence and earlier age of onset of type 2 diabetes and atherosclerotic cardiovascular diseases than other race and ethnic groups. To better understand the pathophysiology and multilevel risk factors for diabetes and cardiovascular disease, we established the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study in 2010. The original MASALA study cohort (n = 1,164) included 83% Asian Indian immigrants, with an ongoing expansion of the study to include individuals of Bangladeshi and Pakistani origin. We have found that South Asian Americans in the MASALA study had higher type 2 diabetes prevalence, lower insulin secretion, more insulin resistance, and an adverse body composition with higher liver and intermuscular fat and lower lean muscle mass compared with four other U.S. race and ethnic groups. MASALA study participants with diabetes were more likely to have the severe hyperglycemia subtype, characterized by β-cell dysfunction and lower body weight, and this subtype was associated with a higher incidence of subclinical atherosclerosis. We have found several modifiable factors for cardiometabolic disease among South Asians including diet and physical activity that can be influenced using specific social network members and with cultural adaptations to the U.S. context. Longitudinal data with repeat cardiometabolic measures that are supplemented with qualitative and mixed-method approaches enable a deeper understanding of disease risk and resilience factors. Studying and contrasting Asian American subgroups can uncover the causes for cardiometabolic disease heterogeneity and reveal novel methods for prevention and treatment.
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Affiliation(s)
- Alka M. Kanaya
- Division of General Internal Medicine, Departments of Medicine, Epidemiology, and Biostatistics, University of California, San Francisco, San Francisco, CA
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Cao Y, Luo P, Tang H, Li P, Wang G, Li W, Song Z, Su Z, Sun X, Yi X, Fu Z, Cui B, Zhu S, Zhu L. Insulin resistance levels predicted metabolic improvement and weight loss after metabolic surgery in Chinese patients with type 2 diabetes. Surg Obes Relat Dis 2024; 20:80-90. [PMID: 37739868 DOI: 10.1016/j.soard.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 07/12/2023] [Accepted: 08/05/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND The causes for failure of metabolic improvement and inadequate weight loss after metabolic surgery (MS) in Chinese patients with type 2 diabetes (T2D) have not been fully elucidated. The effect of insulin resistance (IR) on the outcome of T2D, hypertension, hyperlipidemia, and obesity after MS in Chinese patients with T2D and a body mass index (BMI) of 25-32.5 kg/m2 warrants further study. OBJECTIVES Patients with T2D and a BMI of 25-32.5 kg/m2 who underwent MS between July 2019 and June 2021 were included. SETTING University hospital, China. METHODS IR levels were evaluated with the glucose disposal rate (GDR). Improvement of T2D, hypertension, and hyperlipidemia was assessed with the composite triple endpoint (CTEP), and weight loss was assessed with the percent of total weight loss (%TWL). Partial correlation analysis, binary logistic regression analysis, multiple linear regression analysis, receiver operating characteristic curve (ROC) analysis, and subgroup analysis were used to analyze the relationship between the CTEP, %TWL at 1 year postoperative, and GDR preoperative. RESULTS This study analyzed the data of 51 patients with T2D and a BMI of 25-32.5 kg/m2 (30 men and 21 women) with a mean preoperative GDR of 3.72 ± 1.48 mg/kg/min. Partial correlation coefficients between CTEP, %TWL, and GDR were .303 (P = .041) and .449 (P = .001), respectively. The preoperative GDR was significantly positively correlated with CTEP (OR = 1.610, P = .024) and %TWL (β = 1.38, P = .003). The preoperative GDR predicted cutoff values of 4.36 and 5.35 mg/kg/min for CTEP attainment and %TWL ≥ 20%, respectively. CONCLUSION IR levels predicted metabolic improvement and weight loss 1 year after MS in Chinese patients with T2D and a BMI of 25-32.5 kg/m2.
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Affiliation(s)
- Yaoquan Cao
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, China
| | - Ping Luo
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, China
| | - Haibo Tang
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, China
| | - Pengzhou Li
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, China
| | - Guohui Wang
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, China
| | - Weizheng Li
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, China
| | - Zhi Song
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, China
| | - Zhihong Su
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, China
| | - Xulong Sun
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, China
| | - Xianhao Yi
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, China
| | - Zhibing Fu
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, China
| | - Beibei Cui
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, China
| | - Shaihong Zhu
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, China
| | - Liyong Zhu
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, China.
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Builes-Montaño CE, Pérez-Giraldo E, Castro-Sánchez S, Rojas-Henao NA, Santos-Sánchez OM, Restrepo-Gutiérrez JC. Metabolic disorders across the body mass index spectrum in a Colombian population with nonalcoholic fatty liver disease. REVISTA DE GASTROENTEROLOGIA DE MEXICO (ENGLISH) 2024; 89:64-69. [PMID: 37088640 DOI: 10.1016/j.rgmxen.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 09/22/2022] [Indexed: 04/25/2023]
Abstract
BACKGROUND AND AIMS The relationship between obesity and nonalcoholic fatty liver disease (NAFLD) has long been established, and the prevalence of both conditions has grown together. Recent interest in NAFLD in nonobese individuals has led to an increasing number of studies, especially in Asia. Despite the fact that the prevalence of NAFLD in Latin America is one of the highest in the world, there is a lack of information on lean NAFLD populations from the region. The aim of the present study was to assess the risk of metabolic comorbidities across the whole body mass index spectrum when nonalcoholic steatohepatitis (NASH) was first diagnosed in a Latin American population. METHODS A single-center, cross-sectional study on Colombian patients newly diagnosed with NAFLD, within the time frame of 2010-2020, compared their metabolic biochemical profile, liver enzymes, risk of prevalent metabolic abnormalities, and liver disease. RESULTS Data from 300 patients were collected. Ninety-two percent of the patients were men and the median patient age was 47 (IQR 20) years. We found no significant differences in the biochemical, metabolic profile, or liver enzyme plasma concentration between lean, overweight, and obese individuals. Obese patients had significantly higher LDL cholesterol, and a higher risk of dyslipidemia (OR 1.86, 95% CI 1.14-3.05). Every 1kg increase in body weight increased the risk of having NASH by 2% (95% CI 2-4). CONCLUSIONS We evaluated the metabolic risk across the entire body mass index spectrum in a Colombian cohort with NAFLD and presented the characteristics of what we believe is the first Latin American lean NAFLD population to be described.
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Affiliation(s)
- C E Builes-Montaño
- Departamento de Medicina Interna, Sección de Endocrinología y Metabolismo, Facultad de Medicina, Universidad de Antioquia, Antioquia, Colombia; Departamento de Medicina Interna, Sección de Endocrinología, Hospital Pablo Tobón Uribe, Medellín, Antioquia, Colombia.
| | - E Pérez-Giraldo
- Facultad de Medicina, Universidad de Antioquia, Antioquia, Colombia
| | - S Castro-Sánchez
- Facultad de Medicina, Universidad de Antioquia, Antioquia, Colombia
| | - N A Rojas-Henao
- Escuela de Ciencias Farmacológicas y Alimentarias, Universidad de Antioquia, Antioquia, Colombia
| | - O M Santos-Sánchez
- Unidad de Hepatología y Trasplante de Hígado, Hospital Pablo Tobón Uribe, Medellín, Antioquia, Colombia
| | - J C Restrepo-Gutiérrez
- Departamento de Medicina Interna, Sección de Gastrohepatología, Facultad de Medicina, Universidad de Antioquia, Antioquia, Colombia
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Khan SS, Coresh J, Pencina MJ, Ndumele CE, Rangaswami J, Chow SL, Palaniappan LP, Sperling LS, Virani SS, Ho JE, Neeland IJ, Tuttle KR, Rajgopal Singh R, Elkind MSV, Lloyd-Jones DM. Novel Prediction Equations for Absolute Risk Assessment of Total Cardiovascular Disease Incorporating Cardiovascular-Kidney-Metabolic Health: A Scientific Statement From the American Heart Association. Circulation 2023; 148:1982-2004. [PMID: 37947094 DOI: 10.1161/cir.0000000000001191] [Citation(s) in RCA: 25] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
Cardiovascular-kidney-metabolic (CKM) syndrome is a novel construct recently defined by the American Heart Association in response to the high prevalence of metabolic and kidney disease. Epidemiological data demonstrate higher absolute risk of both atherosclerotic cardiovascular disease (CVD) and heart failure as an individual progresses from CKM stage 0 to stage 3, but optimal strategies for risk assessment need to be refined. Absolute risk assessment with the goal to match type and intensity of interventions with predicted risk and expected treatment benefit remains the cornerstone of primary prevention. Given the growing number of therapies in our armamentarium that simultaneously address all 3 CKM axes, novel risk prediction equations are needed that incorporate predictors and outcomes relevant to the CKM context. This should also include social determinants of health, which are key upstream drivers of CVD, to more equitably estimate and address risk. This scientific statement summarizes the background, rationale, and clinical implications for the newly developed sex-specific, race-free risk equations: PREVENT (AHA Predicting Risk of CVD Events). The PREVENT equations enable 10- and 30-year risk estimates for total CVD (composite of atherosclerotic CVD and heart failure), include estimated glomerular filtration rate as a predictor, and adjust for competing risk of non-CVD death among adults 30 to 79 years of age. Additional models accommodate enhanced predictive utility with the addition of CKM factors when clinically indicated for measurement (urine albumin-to-creatinine ratio and hemoglobin A1c) or social determinants of health (social deprivation index) when available. Approaches to implement risk-based prevention using PREVENT across various settings are discussed.
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13
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Ding Y, Deng Q, Yang M, Niu H, Wang Z, Xia S. Clinical Classification of Obesity and Implications for Metabolic Dysfunction-Associated Fatty Liver Disease and Treatment. Diabetes Metab Syndr Obes 2023; 16:3303-3329. [PMID: 37905232 PMCID: PMC10613411 DOI: 10.2147/dmso.s431251] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 10/10/2023] [Indexed: 11/02/2023] Open
Abstract
Obesity,and metabolic dysfunction-associated fatty liver disease (MAFLD) have reached epidemic proportions globally. Obesity and MAFLD frequently coexist and act synergistically to increase the risk of adverse clinical outcomes (both hepatic and extrahepatic). Type 2 diabetes mellitus (T2DM) is the most important risk factor for rapid progression of steatohepatitis and advanced fibrosis. Conversely, the later stages of MAFLD are associated with an increased risk of T2DM incident. According to the proposed criteria, MAFLD is diagnosed in patients with liver steatosis and in at least one in three: overweight or obese, T2DM, or signs of metabolic dysregulation if they are of normal weight. However, the clinical classification and correlation between obesity and MAFLD is more complex than expected. In addition, treatment for obesity and MAFLD are associated with a reduced risk of T2DM, suggesting that liver-based treatments could reduce the risk of developing T2DM. This review describes the clinical classification of obesity and MAFLD, discusses the clinical features of various types of obesity and MAFLD, emphasizes the role of visceral obesity and insulin resistance (IR) in the development of MAFLD,and summarizes the existing treatments for obesity and MAFLD that reduce the risk of developing T2DM.
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Affiliation(s)
- Yuping Ding
- Department of Gastroenterology and Hepatology, Characteristic Medical Center of the Chinese People’s Armed Police Force, Tianjin, 300162, People’s Republic of China
- Tianjin Key Laboratory of Hepatopancreatic Fibrosis and Molecular Diagnosis & Treatment, Tianjin, 300162, People’s Republic of China
| | - Quanjun Deng
- Department of Gastroenterology and Hepatology, Characteristic Medical Center of the Chinese People’s Armed Police Force, Tianjin, 300162, People’s Republic of China
- Tianjin Key Laboratory of Hepatopancreatic Fibrosis and Molecular Diagnosis & Treatment, Tianjin, 300162, People’s Republic of China
| | - Mei Yang
- Department of Gastroenterology and Hepatology, Characteristic Medical Center of the Chinese People’s Armed Police Force, Tianjin, 300162, People’s Republic of China
- Tianjin Key Laboratory of Hepatopancreatic Fibrosis and Molecular Diagnosis & Treatment, Tianjin, 300162, People’s Republic of China
| | - Haiyan Niu
- Department of Gastroenterology and Hepatology, Characteristic Medical Center of the Chinese People’s Armed Police Force, Tianjin, 300162, People’s Republic of China
- Tianjin Key Laboratory of Hepatopancreatic Fibrosis and Molecular Diagnosis & Treatment, Tianjin, 300162, People’s Republic of China
| | - Zuoyu Wang
- Department of Gastroenterology and Hepatology, Characteristic Medical Center of the Chinese People’s Armed Police Force, Tianjin, 300162, People’s Republic of China
- Tianjin Key Laboratory of Hepatopancreatic Fibrosis and Molecular Diagnosis & Treatment, Tianjin, 300162, People’s Republic of China
| | - Shihai Xia
- Department of Gastroenterology and Hepatology, Characteristic Medical Center of the Chinese People’s Armed Police Force, Tianjin, 300162, People’s Republic of China
- Tianjin Key Laboratory of Hepatopancreatic Fibrosis and Molecular Diagnosis & Treatment, Tianjin, 300162, People’s Republic of China
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Zhou J, He R, Shen Z, Zhang Y, Gao X, Dejiquzong D, Xiao X, Zhang T, Yang D, Wang Y, Song H, Guo Y, Li S, Chen G, Yin J, Zhao X. Altitude and metabolic syndrome in China: Beneficial effects of healthy diet and physical activity. J Glob Health 2023; 13:04061. [PMID: 37394907 DOI: 10.7189/jogh.13.04061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2023] Open
Abstract
Background The correlation between altitude and metabolic syndrome has not been extensively studied, and the mediation effects of diet and physical activity remain unclear. We evaluated the cross-sectional correlations between altitude and metabolic syndrome and the possible mediation effects of diet and physical activity in China. Methods We included 89 485 participants from the China Multi-Ethnic Cohort. We extracted their altitude information from their residential addresses and determined if they had metabolic syndrome by the presence of three or more of the following components: abdominal obesity, reduced high-density lipoprotein cholesterol (HDL-C), elevated triglycerides, elevated glucose, and high blood pressure at recruitment. We conducted multivariable logistic regression and mediation analyses for all and separately for Han ethnic participants. Results The participants had a mean age of 51.67 years and 60.56% were female. The risk difference of metabolic syndrome was -3.54% (95% confidence interval (CI) = -4.24, -2.86) between middle and low altitudes, -1.53% (95%CI = -2.53, -0.46) between high and low altitudes, and 2.01% (95% CI = 0.92, 3.09) between high and middle altitudes. Of the total estimated effect between middle and low altitude, the effect mediated by increased physical activity was -0.94% (95% CI = -1.04, -0.86). Compared to low altitude, the effects mediated by a healthier diet were -0.40% (95% CI = -0.47, -0.32) for middle altitude and -0.72% (95% CI = -0.87, -0.58) for high altitude. Estimates were similar in the Han ethnic group. Conclusions Living at middle and high altitudes was significantly associated with lower risk of metabolic syndrome compared to low altitude, with middle altitude having the lowest risk. We found mediation effects of diet and physical activity.
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Affiliation(s)
- Junmin Zhou
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
- Joint first authorship
| | - Ruifeng He
- Tibet Center for Disease Control and Prevention, Lhasa, China
- Joint first authorship
| | - Zhuozhi Shen
- Chongqing Municipal Center for Disease Control and Prevention, Chongqing, China
| | - Yan Zhang
- School of Public Health, Guizhou Medical University, Guiyang, China
| | - Xufang Gao
- Chengdu Center for Disease Control & Prevention, Chengdu, China
| | | | - Xiong Xiao
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Tao Zhang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Dan Yang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Yufei Wang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Huan Song
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China
- Med-X Center for Informatics, Sichuan University, Chengdu, China
| | - Yuming Guo
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Shanshan Li
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Gongbo Chen
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Jianzhong Yin
- School of Public Health, Kunming Medical University, Kunming, China
- Baoshan College of Traditional Chinese Medicine, Baoshan, China
| | - Xing Zhao
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
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O'Brien MJ, Zhang Y, Bailey SC, Khan SS, Ackermann RT, Ali MK, Benoit SR, Imperatore G, Holliday CS, Bullard KM. Screening for Prediabetes and Diabetes: Clinical Performance and Implications for Health Equity. Am J Prev Med 2023; 64:814-823. [PMID: 37171231 PMCID: PMC10188199 DOI: 10.1016/j.amepre.2023.01.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 01/05/2023] [Accepted: 01/06/2023] [Indexed: 05/13/2023]
Abstract
INTRODUCTION In 2021, the U.S. Preventive Services Task Force (USPSTF) recommended prediabetes and diabetes screening for asymptomatic adults aged 35-70 years with overweight/obesity, lowering the age from 40 years in its 2015 recommendation. The USPSTF suggested considering earlier screening in racial and ethnic groups with high diabetes risk at younger ages or lower BMI. This study examined the clinical performance of these USPSTF screening recommendations as well as alternative age and BMI cutoffs in the U.S. adult population overall, and separately by race and ethnicity. METHODS Nationally representative data were collected from 3,243 nonpregnant adults without diagnosed diabetes in January 2017-March 2020 and analyzed from 2021 to 2022. Screening eligibility was based on age and measured BMI. Collectively, prediabetes and undiagnosed diabetes were defined by fasting plasma glucose ≥100 mg/dL or hemoglobin A1c ≥5.7%. The sensitivity, specificity, and predictive values of alternate screening criteria were examined overall, and by race and ethnicity. RESULTS The 2021 criteria exhibited marginally higher sensitivity (58.6%, 95% CI=55.5, 61.6 vs 52.9%, 95% CI=49.7, 56.0) and lower specificity (69.3%, 95% CI=65.7, 72.2 vs 76.4%, 95% CI=73.3, 79.2) than the 2015 criteria overall, and within each racial and ethnic group. Screening at lower age and BMI thresholds resulted in even greater sensitivity and lower specificity, especially among Hispanic, non-Hispanic Black, and Asian adults. Screening all adults aged 35-70 years regardless of BMI yielded the most equitable performance across all racial and ethnic groups. CONCLUSIONS The 2021 USPSTF screening criteria will identify more adults with prediabetes and diabetes in all racial and ethnic groups than the 2015 criteria. Screening all adults aged 35-70 years exhibited even higher sensitivity and performed most similarly by race and ethnicity, which may further improve early detection of prediabetes and diabetes in diverse populations.
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Affiliation(s)
- Matthew J O'Brien
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Ilinois; Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Ilinois; Chicago Center for Diabetes Translation Research, Northwestern University Feinberg School of Medicine and University of Chicago Pritzker School of Medicine, Chicago, Ilinois; Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Ilinois.
| | - Yan Zhang
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Stacy C Bailey
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Ilinois; Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Ilinois
| | - Sadiya S Khan
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Ilinois; Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Ilinois
| | - Ronald T Ackermann
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Ilinois; Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Ilinois; Chicago Center for Diabetes Translation Research, Northwestern University Feinberg School of Medicine and University of Chicago Pritzker School of Medicine, Chicago, Ilinois
| | - Mohammed K Ali
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia; Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia; Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, Georgia
| | - Stephen R Benoit
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Giuseppina Imperatore
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Christopher S Holliday
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kai McKeever Bullard
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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16
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Kandula NR, Islam N, Needham BL, Ahmed N, Thorpe L, Kershaw KN, Chen E, Zakai NA, Kanaya AM. A multilevel framework to investigate cardiovascular health disparities among South Asian immigrants in the United States. Ann Epidemiol 2023; 81:24-30.e1. [PMID: 36898570 PMCID: PMC10101928 DOI: 10.1016/j.annepidem.2023.02.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 02/20/2023] [Accepted: 02/28/2023] [Indexed: 03/11/2023]
Abstract
PURPOSE Prior studies of cardiovascular health (CVH) disparities among immigrants of South Asian origin in the United States have examined South Asians as one homogenous group, focused primarily on Indian-origin immigrants, and examined risk at the individual level. METHODS We present current knowledge and evidence gaps about CVH in the three largest South Asian-origin populations in the United States-Bangladeshi, Indian, and Pakistani-and draw on socioecological and lifecourse frameworks to propose a conceptual framework for investigating multilevel risk and protective factors of CVH across these groups. RESULTS The central hypothesis is that CVH disparities among South Asian populations exist due to differences in structural and social determinants, including lived experiences like discrimination, and that acculturation strategies and resilience resources (e.g., neighborhood environment, education, religiosity, social support) ameliorate stressors to act as health protective factors. RESULTS Conclusions: Our framework advances conceptualization of the heterogeneity and drivers of cardiovascular disparities in diverse South Asian-origin populations. We present specific recommendations to inform the design of future epidemiologic studies on South Asian immigrant health and the development of multilevel interventions to reduce CVH disparities and promote well-being.
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Affiliation(s)
- Namratha R Kandula
- Department of Medicine, Feinberg School of Medicine Northwestern University, Chicago, IL; Department of Preventive Medicine, Feinberg School of Medicine Northwestern University, Chicago, IL.
| | - Nadia Islam
- Department of Population Health, NYU Grossman School of Medicine, New York, NY
| | - Belinda L Needham
- Department of Epidemiology and Center for Social Epidemiology and Population Health, University of Michigan, Ann Arbor
| | - Naheed Ahmed
- Department of Population Health, NYU Grossman School of Medicine, New York, NY
| | - Lorna Thorpe
- Department of Population Health, NYU Grossman School of Medicine, New York, NY
| | - Kiarri N Kershaw
- Department of Preventive Medicine, Feinberg School of Medicine Northwestern University, Chicago, IL
| | - Edith Chen
- Institute for Policy Research and Department of Psychology, Northwestern University, Chicago, IL
| | - Neil A Zakai
- Department of Medicine, Larner College of Medicine, University of Vermont, Burlington; Department of Pathology & Laboratory Medicine, Larner College of Medicine, University of Vermont, Burlington
| | - Alka M Kanaya
- Department of Medicine, Epidemiology & Biostatistics, University of California, San Francisco
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Vijayan M, Deshpande K, Anand S, Deshpande P. Risk Amplifiers for Vascular Disease and CKD in South Asians: When Intrinsic β-Cell Dysfunction Meets a High-Carbohydrate Diet. Clin J Am Soc Nephrol 2023; 18:681-688. [PMID: 36758530 PMCID: PMC10278793 DOI: 10.2215/cjn.0000000000000076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
South Asians, comprising almost one fourth of the world population, are at higher risk of type 2 diabetes mellitus, hypertension, cardiovascular disease, and CKD compared with other ethnic groups. This has major public health implications in South Asia and in other parts of the world to where South Asians have immigrated. The interplay of various modifiable and nonmodifiable risk factors confers this risk. Traditional models of cardiometabolic disease progression and CKD evaluation may not be applicable in this population with a unique genetic predisposition and phenotype. A wider understanding of dietary and lifestyle influences, genetic and metabolic risk factors, and the pitfalls of conventional equations estimating kidney function in this population are required in providing care for kidney diseases. Targeted screening of this population for metabolic and vascular risk factors and individualized management plan for disease management may be necessary. Addressing unhealthy dietary patterns, promoting physical activity, and medication management that adheres to cultural factors are crucial steps to mitigate the risk of cardiovascular disease and CKD in this population. In South Asian countries, a large rural and urban community-based multipronged approach using polypills and community health workers to decrease the incidence of these diseases may be cost-effective.
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Affiliation(s)
- Madhusudan Vijayan
- Barbara T. Murphy Division of Nephrology, Department of Medicine, Icahn School of Medicine at the Mount Sinai Hospital, New York, New York
- Institute for Critical Care Medicine, Icahn School of Medicine at the Mount Sinai Hospital, New York, New York
| | - Kavita Deshpande
- Department of Family Medicine, La Maestra Community Health Centers, San Diego, California
| | - Shuchi Anand
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Priya Deshpande
- Barbara T. Murphy Division of Nephrology, Department of Medicine, Icahn School of Medicine at the Mount Sinai Hospital, New York, New York
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18
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Builes-Montaño C, Pérez-Giraldo E, Castro-Sánchez S, Rojas-Henao N, Santos-Sánchez O, Restrepo-Gutiérrez J. Trastornos metabólicos en el espectro completo del índice de masa corporal en una población colombiana con enfermedad de hígado graso no alcohólico. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2023. [DOI: 10.1016/j.rgmx.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
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Agarwala A, Satish P, Al Rifai M, Mehta A, Cainzos-Achirica M, Shah NS, Kanaya AM, Sharma GV, Dixon DL, Blumenthal RS, Natarajan P, Nasir K, Virani SS, Patel J. Identification and Management of Atherosclerotic Cardiovascular Disease Risk in South Asian Populations in the U.S. JACC. ADVANCES 2023; 2:100258. [PMID: 38089916 PMCID: PMC10715803 DOI: 10.1016/j.jacadv.2023.100258] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 11/15/2022] [Accepted: 12/13/2022] [Indexed: 12/20/2023]
Abstract
South Asians (SAs, individuals with ancestry from Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, and Sri Lanka) are among the fastest growing ethnic subgroups in the United States. SAs typically experience a high prevalence of diabetes, abdominal obesity, and hypertension, among other cardiovascular disease risk factors, which are often under recognized and undermanaged. The excess coronary heart disease risk in this growing population must be critically assessed and managed with culturally appropriate preventive services. Accordingly, this scientific document prepared by a multidisciplinary group of clinicians and investigators in cardiology, internal medicine, pharmacy, and SA-centric researchers describes key characteristics of traditional and nontraditional cardiovascular disease risk factors, compares and contrasts available risk assessment tools, discusses the role of blood-based biomarkers and coronary artery calcium to enhance risk assessment and prevention strategies, and provides evidenced-based approaches and interventions that may reduce coronary heart disease disparities in this higher-risk population.
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Affiliation(s)
- Anandita Agarwala
- Center for Cardiovascular Disease Prevention, Baylor Scott and White Health Heart Hospital Baylor Plano, Plano, Texas, USA
| | - Priyanka Satish
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Mahmoud Al Rifai
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, South Asian Cardiovascular Health Initiative (SACHI), Baltimore, Maryland, USA
| | - Anurag Mehta
- Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Miguel Cainzos-Achirica
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, South Asian Cardiovascular Health Initiative (SACHI), Baltimore, Maryland, USA
- Institut Hospital del Mar d’Investigacions Mediques (IMIM), Barcelona, Spain
- Hospital del Mar, Parc Salut Mar, Barcelona, Spain
| | - Nilay S. Shah
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Alka M. Kanaya
- Division of General Internal Medicine, University of California San Francisco, San Francisco, California, USA
| | - Garima V. Sharma
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, South Asian Cardiovascular Health Initiative (SACHI), Baltimore, Maryland, USA
| | - Dave L. Dixon
- Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
- Department of Pharmacotherapy & Outcomes Science, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Roger S. Blumenthal
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, South Asian Cardiovascular Health Initiative (SACHI), Baltimore, Maryland, USA
| | - Pradeep Natarajan
- Cardiovascular Disease Initiative Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
- Cardiovascular Research Center Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
- Center for Outcomes Research, Houston Methodist, Houston, Texas, USA
| | - Salim S. Virani
- Aga Khan University, Karachi, Pakistan
- Texas Heart Institute, Baylor College of Medicine, Houston, Texas, USA
| | - Jaideep Patel
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, South Asian Cardiovascular Health Initiative (SACHI), Baltimore, Maryland, USA
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Shah MK, Gandrakota N, Gujral UP, Islam N, Narayan KMV, Ali MK. Cardiometabolic Risk in Asian Americans by Social Determinants of Health: Serial Cross-sectional Analyses of the NHIS, 1999-2003 to 2014-2018. J Gen Intern Med 2023; 38:571-581. [PMID: 36418646 PMCID: PMC9971386 DOI: 10.1007/s11606-022-07933-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 11/01/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Diabetes and hypertension are common in Asian Americans and vary by subgroup. There may be further variation by social determinants of health (SDOHs), but few studies have examined this previously. OBJECTIVE To examine the associations of SDOHs and diabetes and hypertension within and across Asian subgroups in the USA DESIGN: Series cross-sectional analyses SETTING: National Health Interview Surveys (NHIS) from 1999 to 2018 PARTICIPANTS: Asian-American adults (Chinese, Filipino, Asian Indian, and Other Asian [Korean, Vietnamese, Japanese, and other]) MEASUREMENTS: Self-reported diabetes and hypertension prevalence in pooled 5-year increments over 1999-2018 and multivariable regression models to assess the adjusted prevalence of diabetes or hypertension by poverty, marital status, education, and years in the USA, adjusting for age, sex, BMI, and health insurance status RESULTS: From 1999-2003 to 2014-2018, the age- and sex-adjusted prevalence of diabetes increased for Other Asians (absolute change: 4.6%) but not for other subgroups; age- and sex-adjusted hypertension prevalence significantly increased for Asian Indians and Other Asians (absolute change: 5-7.5%). For Filipinos, high school education or less was associated with an increase in diabetes prevalence over time (difference from 1999-2003 to 2014-2018: +6.0 (95% CI: 2.0-10.0)), while for Asian Indians, college education or higher was associated with an increase in diabetes prevalence for the same period (difference: +2.7 (95% CI: 0.01-5.4). Differences over the 2 time periods (1999-2003 and 2014-2018) show that Filipino and Other Asians, who lived in the USA for ≥10 years, increased in diabetes prevalence. Similar variations in associations of SDOHs by Asian subgroup were seen for hypertension. LIMITATIONS Self-reported primary outcomes and multi-year data were pooled due to small sample sizes. CONCLUSIONS The influence of SDOHs on cardiometabolic risk is not uniform among Asian Americans, implying tailored strategies may be needed for different population subgroups. PRIMARY FUNDING SOURCE NIH.
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Affiliation(s)
- Megha K Shah
- Department of Family and Preventive Medicine, Emory University School of Medicine, Dunwoody, GA, USA.
| | - Nikhila Gandrakota
- Department of Family and Preventive Medicine, Emory University School of Medicine, Dunwoody, GA, USA
| | - Unjali P Gujral
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Nadia Islam
- Department of Population Health, NYU School of Medicine, New York, NY, USA
| | - K M Venkat Narayan
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Mohammed K Ali
- Department of Family and Preventive Medicine, Emory University School of Medicine, Dunwoody, GA, USA
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, GA, USA
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21
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Shah NS, Luncheon C, Kandula NR, Khan SS, Pan L, Gillespie C, Loustalot F, Fang J. Heterogeneity in Obesity Prevalence Among Asian American Adults. Ann Intern Med 2022; 175:1493-1500. [PMID: 36191316 DOI: 10.7326/m22-0609] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Obesity increases the risk for metabolic and cardiovascular disease, and this risk occurs at lower body mass index (BMI) thresholds in Asian adults than in White adults. The degree to which obesity prevalence varies across heterogeneous Asian American subgroups is unclear because most obesity estimates combine all Asian Americans into a single group. OBJECTIVE To quantify obesity prevalence in Asian American subgroups among U.S. adults using both standard BMI categorizations and categorizations tailored to Asian populations. DESIGN Cross-sectional. SETTING United States, 2013 to 2020. PARTICIPANTS The analytic sample included 2 882 158 adults aged 18 years or older in the U.S. Behavioral Risk Factor Surveillance System surveys (2013 to 2020). Participants self-identified as non-Hispanic White ([NHW] n = 2 547 965); non-Hispanic Black ([NHB] n = 263 136); or non-Hispanic Asian ([NHA] n = 71 057), comprising Asian Indian (n = 13 916), Chinese (n = 11 686), Filipino (n = 11 815), Japanese (n = 12 473), Korean (n = 3634), and Vietnamese (n = 2618) Americans. MEASUREMENTS Obesity prevalence adjusted for age and sex calculated using both standard BMI thresholds (≥30 kg/m2) and BMI thresholds modified for Asian adults (≥27.5 kg/m2), based on self-reported height and weight. RESULTS Adjusted obesity prevalence (by standard categorization) was 11.7% (95% CI, 11.2% to 12.2%) in NHA, 39.7% (CI, 39.4% to 40.1%) in NHB, and 29.4% (CI, 29.3% to 29.5%) in NHW participants; the prevalence was 16.8% (CI, 15.2% to 18.5%) in Filipino, 15.3% (CI, 13.2% to 17.5%) in Japanese, 11.2% (CI, 10.2% to 12.2%) in Asian Indian, 8.5% (CI, 6.8% to 10.5%) in Korean, 6.5% (CI, 5.5% to 7.5%) in Chinese, and 6.3% (CI, 5.1% to 7.8%) in Vietnamese Americans. The prevalence using modified criteria (BMI ≥27.5 kg/m2) was 22.4% (CI, 21.8% to 23.1%) in NHA participants overall and 28.7% (CI, 26.8% to 30.7%) in Filipino, 26.7% (CI, 24.1% to 29.5%) in Japanese, 22.4% (CI, 21.1% to 23.7%) in Asian Indian, 17.4% (CI, 15.2% to 19.8%) in Korean, 13.6% (CI, 11.7% to 15.9%) in Vietnamese, and 13.2% (CI, 12.0% to 14.5%) in Chinese Americans. LIMITATION Body mass index estimates rely on self-reported data. CONCLUSION Substantial heterogeneity in obesity prevalence exists among Asian American subgroups in the United States. Future studies and public health efforts should consider this heterogeneity. PRIMARY FUNDING SOURCE National Heart, Lung, and Blood Institute.
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Affiliation(s)
- Nilay S Shah
- Division of Cardiology, Department of Medicine, and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois (N.S.S., S.S.K.)
| | - Cecily Luncheon
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, and Bizzell Group, Atlanta, Georgia (C.L.)
| | - Namratha R Kandula
- Department of Preventive Medicine and Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois (N.R.K.)
| | - Sadiya S Khan
- Division of Cardiology, Department of Medicine, and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois (N.S.S., S.S.K.)
| | - Liping Pan
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia (L.P.)
| | - Cathleen Gillespie
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia (C.G., F.L., J.F.)
| | - Fleetwood Loustalot
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia (C.G., F.L., J.F.)
| | - Jing Fang
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia (C.G., F.L., J.F.)
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22
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Eslam M, El-Serag HB, Francque S, Sarin SK, Wei L, Bugianesi E, George J. Metabolic (dysfunction)-associated fatty liver disease in individuals of normal weight. Nat Rev Gastroenterol Hepatol 2022; 19:638-651. [PMID: 35710982 DOI: 10.1038/s41575-022-00635-5] [Citation(s) in RCA: 78] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/13/2022] [Indexed: 12/12/2022]
Abstract
Metabolic (dysfunction)-associated fatty liver disease (MAFLD) affects up to a third of the global population; its burden has grown in parallel with rising rates of type 2 diabetes mellitus and obesity. MAFLD increases the risk of end-stage liver disease, hepatocellular carcinoma, death and liver transplantation and has extrahepatic consequences, including cardiometabolic disease and cancers. Although typically associated with obesity, there is accumulating evidence that not all people with overweight or obesity develop fatty liver disease. On the other hand, a considerable proportion of patients with MAFLD are of normal weight, indicating the importance of metabolic health in the pathogenesis of the disease regardless of body mass index. The clinical profile, natural history and pathophysiology of patients with so-called lean MAFLD are not well characterized. In this Review, we provide epidemiological data on this group of patients and consider overall metabolic health and metabolic adaptation as a framework to best explain the pathogenesis of MAFLD and its heterogeneity in individuals of normal weight and in those who are above normal weight. This framework provides a conceptual schema for interrogating the MAFLD phenotype in individuals of normal weight that can translate to novel approaches for diagnosis and patient care.
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Affiliation(s)
- Mohammed Eslam
- Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital and University of Sydney, Sydney, New South Wales, Australia.
| | - Hashem B El-Serag
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Sven Francque
- Department of Gastroenterology and Hepatology, Antwerp University Hospital, Antwerp, Belgium.,Laboratory of Experimental Medicine and Paediatrics (LEMP), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Shiv K Sarin
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Lai Wei
- Hepatopancreatobiliary Center, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China
| | - Elisabetta Bugianesi
- Department of Medical Sciences, Division of Gastroenterology and Hepatology, A.O. Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Jacob George
- Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital and University of Sydney, Sydney, New South Wales, Australia.
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23
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Herrington G, Riche DM. Part I: Interactive case: Hyperlipidemia management for special populations. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2022. [DOI: 10.1002/jac5.1688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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24
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Wang Z, He Y, Li L, Zhang M, Ruan H, Zhu Y, Wei X, Wei J, Chen X, He S. New metabolic health definition might not be a reliable predictor for mortality in the nonobese Chinese population. BMC Public Health 2022; 22:1629. [PMID: 36038857 PMCID: PMC9422146 DOI: 10.1186/s12889-022-14062-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 08/22/2022] [Indexed: 11/17/2022] Open
Abstract
Background Recently, a new metabolic health (MH) definition was developed from NHANES-III. In the origin study, the definition may stratify mortality risks in people who are overweight or normal weight. We aimed to investigate the association between the new MH definition and all-cause mortality in a nonobese Chinese population. Methods The data were collected in 1992 and then again in 2007 from the same group of 1157 participants. The association between the new MH definition and all-cause mortality were analyzed by Cox regression models with overlap weighting according to propensity score (PS) as primary analysis. Results At baseline in 1992, 920 (79.5%) participants were categorized as MH, and 237 (20.5%) participants were categorized as metabolically unhealthy (MUH) based on this new definition. During a median follow-up of 15 years, all-cause mortality occurred in 17 (1.85%) participants in MH group and 13 (5.49%) in MUH group, respectively. In the crude sample, Kaplan–Meier analysis demonstrated a significantly higher all-cause mortality in MUH group when compared to MH group (log-rank p = 0.002), and MUH was significantly associated with increased all-cause mortality when compared to MH with HR at 3.04 (95% CI: 1.47–6.25, p = 0.003). However, Kaplan–Meier analysis with overlap weighting showed that the cumulative incidence of all-cause mortality was not significantly different between MH and MUH groups (adjusted p = 0.589). Furthermore, in the primary multivariable Cox analysis with overlap weighting, adjusted HR for all-cause mortality was 1.42 (95% CI: 0.49—4.17, p = 0.519) in MUH group in reference to MH group. Other additional PS analyses also showed the incidence of all-cause mortality was not significantly different between the two groups. Conclusion The new MH definition may be not appropriate for mortality risk stratification in non-obese Chinese people. Further investigations are needed. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-14062-3.
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Affiliation(s)
- Ziqiong Wang
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Yan He
- Department of Interventional Operating Room, Mianyang People's Hospital, Mianyang, China
| | - Liying Li
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Muxin Zhang
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, 610041, China.,Department of Cardiology, First People's Hospital, Longquanyi District, Chengdu, China
| | - Haiyan Ruan
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, 610041, China.,Department of Cardiology, Hospital of Traditional Chinese Medicine, Shuangliu District, Chengdu, China
| | - Ye Zhu
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Xin Wei
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, 610041, China.,Department of Cardiology and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China
| | - Jiafu Wei
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Xiaoping Chen
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Sen He
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, 610041, China.
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25
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Ke C, Narayan KMV, Chan JCN, Jha P, Shah BR. Pathophysiology, phenotypes and management of type 2 diabetes mellitus in Indian and Chinese populations. Nat Rev Endocrinol 2022; 18:413-432. [PMID: 35508700 PMCID: PMC9067000 DOI: 10.1038/s41574-022-00669-4] [Citation(s) in RCA: 71] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/24/2022] [Indexed: 02/08/2023]
Abstract
Nearly half of all adults with type 2 diabetes mellitus (T2DM) live in India and China. These populations have an underlying predisposition to deficient insulin secretion, which has a key role in the pathogenesis of T2DM. Indian and Chinese people might be more susceptible to hepatic or skeletal muscle insulin resistance, respectively, than other populations, resulting in specific forms of insulin deficiency. Cluster-based phenotypic analyses demonstrate a higher frequency of severe insulin-deficient diabetes mellitus and younger ages at diagnosis, lower β-cell function, lower insulin resistance and lower BMI among Indian and Chinese people compared with European people. Individuals diagnosed earliest in life have the most aggressive course of disease and the highest risk of complications. These characteristics might contribute to distinctive responses to glucose-lowering medications. Incretin-based agents are particularly effective for lowering glucose levels in these populations; they enhance incretin-augmented insulin secretion and suppress glucagon secretion. Sodium-glucose cotransporter 2 inhibitors might also lower blood levels of glucose especially effectively among Asian people, while α-glucosidase inhibitors are better tolerated in east Asian populations versus other populations. Further research is needed to better characterize and address the pathophysiology and phenotypes of T2DM in Indian and Chinese populations, and to further develop individualized treatment strategies.
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Affiliation(s)
- Calvin Ke
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
- Department of Medicine, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.
- Centre for Global Health Research, Unity Health Toronto, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.
- Asia Diabetes Foundation, Shatin, Hong Kong SAR, China.
| | - K M Venkat Narayan
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Nutrition and Health Sciences Program, Graduate Division of Biological and Biomedical Sciences, Laney Graduate School, Emory University, Atlanta, GA, USA
- Department of Medicine, School of Medicine, Emory University, Atlanta, GA, USA
| | - Juliana C N Chan
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
- Asia Diabetes Foundation, Shatin, Hong Kong SAR, China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Prabhat Jha
- Centre for Global Health Research, Unity Health Toronto, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Baiju R Shah
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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26
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Shi M, Wang C, Mei H, Temprosa M, Florez JC, Tripputi M, Merino J, Lipworth L, Shu X, Gerszten RE, Wang TJ, Beckman JA, Gamboa JL, Mosley JD, Ferguson JF. Genetic Architecture of Plasma Alpha-Aminoadipic Acid Reveals a Relationship With High-Density Lipoprotein Cholesterol. J Am Heart Assoc 2022; 11:e024388. [PMID: 35621206 PMCID: PMC9238724 DOI: 10.1161/jaha.121.024388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 04/13/2022] [Indexed: 11/16/2022]
Abstract
Background Elevated plasma levels of alpha-aminoadipic acid (2-AAA) have been associated with the development of type 2 diabetes and atherosclerosis. However, the nature of the association remains unknown. Methods and Results We identified genetic determinants of plasma 2-AAA through meta-analysis of genome-wide association study data in 5456 individuals of European, African, and Asian ancestry from the Framingham Heart Study, Diabetes Prevention Program, Jackson Heart Study, and Shanghai Women's and Men's Health Studies. No single nucleotide polymorphisms reached genome-wide significance across all samples. However, the top associations from the meta-analysis included single-nucleotide polymorphisms in the known 2-AAA pathway gene DHTKD1, and single-nucleotide polymorphisms in genes involved in mitochondrial respiration (NDUFS4) and macrophage function (MSR1). We used a Mendelian randomization instrumental variable approach to evaluate relationships between 2-AAA and cardiometabolic phenotypes in large disease genome-wide association studies. Mendelian randomization identified a suggestive inverse association between increased 2-AAA and lower high-density lipoprotein cholesterol (P=0.005). We further characterized the genetically predicted relationship through measurement of plasma 2-AAA and high-density lipoprotein cholesterol in 2 separate samples of individuals with and without cardiometabolic disease (N=98), and confirmed a significant negative correlation between 2-AAA and high-density lipoprotein (rs=-0.53, P<0.0001). Conclusions 2-AAA levels in plasma may be regulated, in part, by common variants in genes involved in mitochondrial and macrophage function. Elevated plasma 2-AAA associates with reduced levels of high-density lipoprotein cholesterol. Further mechanistic studies are required to probe this as a possible mechanism linking 2-AAA to future cardiometabolic risk.
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Affiliation(s)
- Mingjian Shi
- Department of Biomedical InformaticsVanderbilt University Medical CenterNashvilleTN
| | - Chuan Wang
- Division of Cardiovascular MedicineDepartment of MedicineVanderbilt University Medical CenterNashvilleTN
| | - Hao Mei
- Department of Data ScienceSchool of Population HealthUniversity of Mississippi Medical CenterJacksonMS
| | - Marinella Temprosa
- Department of Biostatistics and BioinformaticsMilken Institute School of Public HealthGeorge Washington UniversityRockvilleMD
| | - Jose C. Florez
- Center for Genomic Medicine and Diabetes UnitMassachusetts General HospitalBostonMA
- Programs in Metabolism and Medical & Population GeneticsBroad InstituteCambridgeMA
- Department of MedicineHarvard Medical SchoolBostonMA
| | - Mark Tripputi
- Department of Biostatistics and BioinformaticsMilken Institute School of Public HealthGeorge Washington UniversityRockvilleMD
| | - Jordi Merino
- Center for Genomic Medicine and Diabetes UnitMassachusetts General HospitalBostonMA
- Programs in Metabolism and Medical & Population GeneticsBroad InstituteCambridgeMA
- Department of MedicineHarvard Medical SchoolBostonMA
| | - Loren Lipworth
- Division of EpidemiologyDepartment of MedicineVanderbilt University Medical CenterNashvilleTN
| | - Xiao‐Ou Shu
- Division of EpidemiologyDepartment of MedicineVanderbilt University Medical CenterNashvilleTN
| | - Robert E. Gerszten
- Division of Cardiovascular MedicineBeth Israel Deaconess Medical CenterBostonMA
- Broad Institute of Harvard and MITCambridgeMA
| | - Thomas J. Wang
- Department of MedicineUT Southwestern Medical CenterDallasTX
| | - Joshua A. Beckman
- Division of Cardiovascular MedicineDepartment of MedicineVanderbilt University Medical CenterNashvilleTN
| | - Jorge L. Gamboa
- Division of Clinical PharmacologyDepartment of MedicineVanderbilt University Medical CenterNashvilleTN
| | - Jonathan D. Mosley
- Department of Biomedical InformaticsVanderbilt University Medical CenterNashvilleTN
- Division of Clinical PharmacologyDepartment of MedicineVanderbilt University Medical CenterNashvilleTN
| | - Jane F. Ferguson
- Division of Cardiovascular MedicineDepartment of MedicineVanderbilt University Medical CenterNashvilleTN
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27
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Kanaya AM, Hsing AW, Panapasa SV, Kandula NR, Araneta MRG, Shimbo D, Wang P, Gomez SL, Lee J, Narayan KMV, Mau MKLM, Bose S, Daviglus ML, Hu FB, Islam N, Jackson CL, Kataoka-Yahiro M, Kauwe JSK, Liu S, Ma GX, Nguyen T, Palaniappan L, Setiawan VW, Trinh-Shevrin C, Tsoh JY, Vaidya D, Vickrey B, Wang TJ, Wong ND, Coady S, Hong Y. Knowledge Gaps, Challenges, and Opportunities in Health and Prevention Research for Asian Americans, Native Hawaiians, and Pacific Islanders: A Report From the 2021 National Institutes of Health Workshop. Ann Intern Med 2022; 175:574-589. [PMID: 34978851 PMCID: PMC9018596 DOI: 10.7326/m21-3729] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Asian Americans (AsA), Native Hawaiians, and Pacific Islanders (NHPI) comprise 7.7% of the U.S. population, and AsA have had the fastest growth rate since 2010. Yet the National Institutes of Health (NIH) has invested only 0.17% of its budget on AsA and NHPI research between 1992 and 2018. More than 40 ethnic subgroups are included within AsA and NHPI (with no majority subpopulation), which are highly diverse culturally, demographically, linguistically, and socioeconomically. However, data for these groups are often aggregated, masking critical health disparities and their drivers. To address these issues, in March 2021, the National Heart, Lung, and Blood Institute, in partnership with 8 other NIH institutes, convened a multidisciplinary workshop to review current research, knowledge gaps, opportunities, barriers, and approaches for prevention research for AsA and NHPI populations. The workshop covered 5 domains: 1) sociocultural, environmental, psychological health, and lifestyle dimensions; 2) metabolic disorders; 3) cardiovascular and lung diseases; 4) cancer; and 5) cognitive function and healthy aging. Two recurring themes emerged: Very limited data on the epidemiology, risk factors, and outcomes for most conditions are available, and most existing data are not disaggregated by subgroup, masking variation in risk factors, disease occurrence, and trajectories. Leveraging the vast phenotypic differences among AsA and NHPI groups was identified as a key opportunity to yield novel clues into etiologic and prognostic factors to inform prevention efforts and intervention strategies. Promising approaches for future research include developing collaborations with community partners, investing in infrastructure support for cohort studies, enhancing existing data sources to enable data disaggregation, and incorporating novel technology for objective measurement. Research on AsA and NHPI subgroups is urgently needed to eliminate disparities and promote health equity in these populations.
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Affiliation(s)
- Alka M Kanaya
- University of California, San Francisco, San Francisco, California (A.M.K., S.L.G., T.N., J.Y.T.)
| | - Ann W Hsing
- Stanford University, Stanford, California (A.W.H., P.W., L.P.)
| | | | | | | | - Daichi Shimbo
- Columbia University Irving Medical Center, New York, New York (D.S.)
| | - Paul Wang
- Stanford University, Stanford, California (A.W.H., P.W., L.P.)
| | - Scarlett L Gomez
- University of California, San Francisco, San Francisco, California (A.M.K., S.L.G., T.N., J.Y.T.)
| | - Jinkook Lee
- University of Southern California, Los Angeles, California (J.L., V.W.S.)
| | | | | | - Sonali Bose
- Icahn School of Medicine at Mount Sinai, New York, New York (S.B., B.V.)
| | | | - Frank B Hu
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts (F.B.H.)
| | - Nadia Islam
- New York University Grossman School of Medicine, New York, New York (N.I., C.T.)
| | - Chandra L Jackson
- National Institute of Environmental Health Sciences, National Institutes of Health, Bethesda, Maryland (C.L.J.)
| | | | | | - Simin Liu
- Brown University, Providence, Rhode Island (S.L.)
| | - Grace X Ma
- Temple University, Philadelphia, Pennsylvania (G.X.M.)
| | - Tung Nguyen
- University of California, San Francisco, San Francisco, California (A.M.K., S.L.G., T.N., J.Y.T.)
| | | | - V Wendy Setiawan
- University of Southern California, Los Angeles, California (J.L., V.W.S.)
| | - Chau Trinh-Shevrin
- New York University Grossman School of Medicine, New York, New York (N.I., C.T.)
| | - Janice Y Tsoh
- University of California, San Francisco, San Francisco, California (A.M.K., S.L.G., T.N., J.Y.T.)
| | | | - Barbara Vickrey
- Icahn School of Medicine at Mount Sinai, New York, New York (S.B., B.V.)
| | - Thomas J Wang
- University of Texas Southwestern Medical Center, Dallas, Texas (T.J.W.)
| | - Nathan D Wong
- University of California, Irvine, Irvine, California (N.D.W.)
| | - Sean Coady
- National Heart, Lung, and Blood Institute, Bethesda, Maryland (S.C., Y.H.)
| | - Yuling Hong
- National Heart, Lung, and Blood Institute, Bethesda, Maryland (S.C., Y.H.)
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28
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Kondal D, Patel SA, Ali MK, Mohan D, Rautela G, Gujral UP, Shivashankar R, Anjana RM, Gupta R, Kapoor D, Vamadevan AS, Mohan S, Kadir MM, Mohan V, Tandon N, Prabhakaran D, Narayan KMV. Cohort Profile: The Center for cArdiometabolic Risk Reduction in South Asia (CARRS). Int J Epidemiol 2022; 51:e358-e371. [PMID: 35138386 PMCID: PMC9749725 DOI: 10.1093/ije/dyac014] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 01/28/2022] [Indexed: 01/21/2023] Open
Affiliation(s)
- Dimple Kondal
- Public Health Foundation of India, New Delhi, India,Centre for Chronic Disease Control, New Delhi, India
| | - Shivani A Patel
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Mohammed K Ali
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Deepa Mohan
- Madras Diabetes Research Foundation, Chennai, India
| | | | - Unjali P Gujral
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | | | - Ruby Gupta
- Public Health Foundation of India, New Delhi, India
| | - Deksha Kapoor
- All India Institute of Medical Sciences, New Delhi, India
| | - Ajay S Vamadevan
- Centre for Chronic Disease Control, New Delhi, India,Healthcare management, Goa Institute of Management, Sanquelim, Goa, India
| | | | | | | | - Nikhil Tandon
- All India Institute of Medical Sciences, New Delhi, India
| | - Dorairaj Prabhakaran
- Corresponding author. Public Health Foundation of India, Plot no 47, Sector 44, Gurgaon, Haryana 122002, India. E-mail:
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DeLacey S, Josefson JL. A Mini-Review of Pediatric Anthropometrics as Predictors of Future Insulin Resistance. Front Endocrinol (Lausanne) 2022; 13:826430. [PMID: 35185801 PMCID: PMC8848350 DOI: 10.3389/fendo.2022.826430] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 01/07/2022] [Indexed: 12/16/2022] Open
Abstract
The impact of rising rates of childhood obesity is far reaching. Metabolic syndrome in children is increasing, yet for most children the consequences of excess adiposity will manifest in adulthood. Excess early fat accrual is a risk factor for future insulin resistance. However, certain types of fat and patterns of fat distribution are more relevant than others to metabolic risk. Therefore, adiposity measures are important. The link between childhood obesity and future insulin resistance was initially established with body mass index (BMI), but BMI is an in imperfect measure of adiposity. It is worthwhile to evaluate other anthropometrics as they may more accurately capture metabolic risk. While measures such as waist to height ratio are established as superior screening measures in adulthood - the findings are not as robust in pediatrics. Emerging evidence suggests that alternative anthropometrics may be slightly superior to BMI in identifying those youth most at risk of developing insulin resistance, but the clinical significance of that superiority appears limited. Increasing study is needed in longitudinal and varied cohorts to identify which pediatric anthropometric best predicts adult insulin resistance. We review alternative anthropometrics as predictors of future insulin resistance and identify current gaps in knowledge and potential future directions of inquiry.
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Affiliation(s)
- Sean DeLacey
- Department of Pediatrics, Division of Endocrinology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, United States
- Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- *Correspondence: Sean DeLacey,
| | - Jami L. Josefson
- Department of Pediatrics, Division of Endocrinology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, United States
- Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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Xu Y, Yi Q, Shan S, Zhou J, Li S, Hou L, Ye X, Ying J, Song P, An L. Chinese famine exposure in early life and metabolic obesity phenotype in middle age: Results from the China health and retirement longitudinal study. Front Endocrinol (Lausanne) 2022; 13:975824. [PMID: 36204102 PMCID: PMC9531307 DOI: 10.3389/fendo.2022.975824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 09/01/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To assess the association between early life exposure to famine and the risk of metabolic obesity phenotypes among adults in middle age. METHODS The study selected two comparison groups. Comparison A consisted of a non-exposed group born between 1963-1965 from the China Health and Retirement Longitudinal Study (CHARLS) 2015 wave (N=862) and a fetal-exposed group born between 1959-1961 from the 2011 wave (N=507). Comparison B consisted of an early childhood-exposed group born between 1955-1957 from the 2011 wave (N=830) and a fetal-exposed group born between 1959-1961 from the 2015 wave (N=552). Multivariable logistic regressions were conducted to explore the associations between different periods of famine exposure and obesity, metabolic health status, and metabolic obesity phenotypes, with stratification by sex. RESULTS Compared with the non-exposed group, participants exposed to famine in the fetal period had a significantly lower risk of overweight/obesity (OR: 0.78, 95%CI: 0.63-0.97) and a higher risk of metabolically unhealthy status (OR: 1.73, 95%CI: 1.34-2.23) and metabolically unhealthy non-obesity (MUNO) (OR: 2.12, 95%CI: 1.46-3.08) at the age of 50-52 years. In the sex-stratified analysis, males exposed to famine in the fetal period had a significantly lower risk of overweight/obesity (OR: 0.59, 95%CI: 0.43-0.80) and metabolically healthy obesity (MHO) (OR: 0.56, 95%CI: 0.37-0.85), while such associations were not found in females. Compared with the early childhood exposure group, participants in the fetal exposure group had a significantly lower risk of metabolic unhealthy status (OR: 0.65, 95%CI: 0.51-0.85) and MUNO (OR: 0.50, 95%CI: 0.35-0.72). Those associations were observed in both males and females. CONCLUSION Exposure to famine in early life increased the risk of metabolically unhealthy status in adulthood. Different metabolic subtypes should be identified at an early stage and followed by classification, intervention, and treatment.
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Affiliation(s)
- Yunhan Xu
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China
- School of Public Health, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, China
| | - Qian Yi
- School of Public Health, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, China
| | - Shiyi Shan
- School of Public Health, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, China
| | - Jiali Zhou
- School of Public Health, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, China
| | - Shuting Li
- School of Public Health, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, China
| | - Leying Hou
- School of Public Health, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, China
| | - Xinxin Ye
- School of Public Health, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, China
- Department of Sport and Exercise Science, College of Education, Zhejiang University, Hangzhou, China
| | - Jiayao Ying
- School of Public Health, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, China
| | - Peige Song
- School of Public Health, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, China
- Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
- *Correspondence: Lin An, ; Peige Song,
| | - Lin An
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China
- *Correspondence: Lin An, ; Peige Song,
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Redondo MJ, Balasubramanyam A. Toward an Improved Classification of Type 2 Diabetes: Lessons From Research into the Heterogeneity of a Complex Disease. J Clin Endocrinol Metab 2021; 106:e4822-e4833. [PMID: 34291809 PMCID: PMC8787852 DOI: 10.1210/clinem/dgab545] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Accumulating evidence indicates that type 2 diabetes (T2D) is phenotypically heterogeneous. Defining and classifying variant forms of T2D are priorities to better understand its pathophysiology and usher clinical practice into an era of "precision diabetes." EVIDENCE ACQUISITION AND METHODS We reviewed literature related to heterogeneity of T2D over the past 5 decades and identified a range of phenotypic variants of T2D. Their descriptions expose inadequacies in current classification systems. We attempt to link phenotypically diverse forms to pathophysiology, explore investigative methods that have characterized "atypical" forms of T2D on an etiological basis, and review conceptual frameworks for an improved taxonomy. Finally, we propose future directions to achieve the goal of an etiological classification of T2D. EVIDENCE SYNTHESIS Differences among ethnic and racial groups were early observations of phenotypic heterogeneity. Investigations that uncover complex interactions of pathophysiologic pathways leading to T2D are supported by epidemiological and clinical differences between the sexes and between adult and youth-onset T2D. Approaches to an etiological classification are illustrated by investigations of atypical forms of T2D, such as monogenic diabetes and syndromes of ketosis-prone diabetes. Conceptual frameworks that accommodate heterogeneity in T2D include an overlap between known diabetes types, a "palette" model integrated with a "threshold hypothesis," and a spectrum model of atypical diabetes. CONCLUSION The heterogeneity of T2D demands an improved, etiological classification scheme. Excellent phenotypic descriptions of emerging syndromes in different populations, continued clinical and molecular investigations of atypical forms of diabetes, and useful conceptual models can be utilized to achieve this important goal.
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Affiliation(s)
- Maria J Redondo
- Section of Diabetes and Endocrinology, Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA
- Texas Children’s Hospital, Houston, TX 77030, USA
| | - Ashok Balasubramanyam
- Division of Diabetes, Endocrinology and Metabolism, Baylor College of Medicine, Houston, TX 77030, USA
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Normal weight obesity and unaddressed cardiometabolic health risk-a narrative review. Int J Obes (Lond) 2021; 45:2141-2155. [PMID: 34007010 DOI: 10.1038/s41366-021-00858-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 04/27/2021] [Accepted: 04/30/2021] [Indexed: 02/06/2023]
Abstract
Normal weight obesity (NWO) is defined as having a normal body mass index (BMI), but a high body fat mass. There is growing interest in individuals with NWO, which is an underdiagnosed and understudied group, because of their increased risk for cardiometabolic morbidity and mortality. In this review, we summarized the definition, prevalence, etiology, pathophysiology, and cardiovascular outcomes seen in NWO. We have also summarized the available literature on interventions for NWO. There is a wide variation in the body fat percent cutoffs used to diagnose excess body fat. Hence, the prevalence rates of NWO vary between different populations and studies. It is estimated that about 30 million Americans have NWO and the worldwide prevalence ranges from 4.5% to 22%. Genetics, diet, and physical activity are related to NWO. However, etiological factors are not clear. Changes in body composition, inflammation, oxidative stress are present in NWO in comparison to normal weight lean (NWL) who have a normal BMI and normal body fat amount. Furthermore, cardiometabolic changes are observed and some are subclinical. Thus, screening for NWO will enhance the primary prevention of cardiovascular disease. Due to the use of various body fat percent cutoffs and methods to measure body fat, it is challenging to compare between studies. Researchers working in this field should ideally work towards developing standard body fat percent cutoffs for diagnosing NWO. There are many gaps in the literature on NWO unlike for overt obesity and future studies should explore the etiology, molecular mechanisms, and adipose tissue changes of NWO as well as conduct well planned and executed randomized controlled trials testing dietary, physical, and behavioral interventions for NWO in both males and females of different racial and age groups.
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Gujral UP, Kanaya AM. Epidemiology of diabetes among South Asians in the United States: lessons from the MASALA study. Ann N Y Acad Sci 2021; 1495:24-39. [PMID: 33216378 PMCID: PMC8134616 DOI: 10.1111/nyas.14530] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 10/19/2020] [Accepted: 10/21/2020] [Indexed: 02/06/2023]
Abstract
South Asian individuals in the United States are at an increased risk of type 2 diabetes (T2DM); however, the mechanisms behind this are not well understood. The Mediators of Atherosclerosis in South Asians Living in America (MASALA) study is the only longitudinal cohort of South Asians in the United States and provides key insights as to the epidemiology of T2DM in South Asians. Evidence from the MASALA study suggests that South Asians experience a disproportionately high burden of prevalent and incident T2DM compared with members of other race/ethnic groups. Higher insulin resistance in South Asians, even with low body mass index (BMI), more impairment in insulin secretion, and greater deposition of ectopic fat likely play a role in T2DM etiology. Furthermore, South Asian migrants to the United States experience a range of factors related to acculturation, social networks, and religious beliefs, which may impact physical activity and dietary practices. Interventions to prevent T2DM in South Asians should include a focus on cultural factors related to health and should consider the complete mechanistic pathway and the relative contributions of insulin resistance, β cell dysfunction, and ectopic fat deposition on T2DM development in South Asians, particularly in those with lower BMI.
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Affiliation(s)
- Unjali P. Gujral
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Alka M. Kanaya
- Division of General Internal Medicine, University of California, San Francisco, San Francisco, CA
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Song Y, Lee HS, Baik SJ, Jeon S, Han D, Choi SY, Chun EJ, Han HW, Park SH, Sung J, Jung HO, Lee JW, Chang HJ. Comparison of the effectiveness of Martin's equation, Friedewald's equation, and a Novel equation in low-density lipoprotein cholesterol estimation. Sci Rep 2021; 11:13545. [PMID: 34188076 PMCID: PMC8241859 DOI: 10.1038/s41598-021-92625-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 06/14/2021] [Indexed: 01/29/2023] Open
Abstract
Low-density-lipoprotein cholesterol (LDL-C) is the main target in atherosclerotic cardiovascular disease (ASCVD). We aimed to validate and compare a new LDL-C estimation equation with other well-known equations. 177,111 samples were analysed from two contemporary population-based cohorts comprising asymptomatic Korean adults who underwent medical examinations. Performances of the Friedewald (FLDL), Martin (MLDL), and Sampson (SLDL) equations in estimating direct LDL-C by homogenous assay were assessed by measures of concordance (R2, RMSE, and mean absolute difference). Analyses were performed according to various triglyceride (TG) and/or LDL-C strata. Secondary analyses were conducted within dyslipidaemia populations of each database. MLDL was superior or at least similar to other equations regardless of TG/LDL-C, in both the general and dyslipidaemia populations (RMSE = 11.45/9.20 mg/dL; R2 = 0.88/0.91; vs FLDL: RMSE = 13.66/10.42 mg/dL; R2 = 0.82/0.89; vs SLDL: RMSE = 12.36/9.39 mg/dL; R2 = 0.85/0.91, per Gangnam Severance Hospital Check-up/Korea Initiatives on Coronary Artery Calcification data). MLDL had a slight advantage over SLDL with the lowest MADs across the full spectrum of TG levels, whether divided into severe hyper/non-hyper to moderate hypertriglyceridaemia samples or stratified by 100-mg/dL TG intervals, even up to TG values of 500-600 mg/dL. MLDL may be a readily adoptable and cost-effective alternative to direct LDL-C measurement, irrespective of dyslipidaemia status. In populations with relatively high prevalence of mild-to-moderate hypertriglyceridaemia, Martin's equation may be optimal for LDL-C and ASCVD risk estimation.
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Affiliation(s)
- Youhyun Song
- Department of Family Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Korea
| | - Hye Sun Lee
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Korea
| | - Su Jung Baik
- Healthcare Research Team, Health Promotion Center, Gangnam Severance Hospital, 211 Eunju-ro, Gangnam-gu, Seoul, 06273, Korea
| | - Soyoung Jeon
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Korea
| | - Donghee Han
- Department of Imaging and Medicine, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Su-Yeon Choi
- Division of Cardiology, Seoul National University Healthcare System Gangnam Center, Seoul National University College of Medicine, Seoul, Korea
| | - Eun Ju Chun
- Department of Radiology, Seoul National University Bundang Hospital, Seoul, Korea
| | - Hae-Won Han
- Department of Internal Medicine, Gangnam Heartscan Clinic, Seoul, Korea
| | - Sung Hak Park
- Department of Radiology, Gangnam Heartscan Clinic, Seoul, Korea
| | - Jidong Sung
- Division of Cardiology, Department of Medicine, Sungkyunkwan University School of Medicine, Heart Stroke & Vascular Institute, Samsung Medical Center, Seoul, Korea
| | - Hae Ok Jung
- Division of Cardiology, Cardiovascular Center, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Ji Won Lee
- Department of Family Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Korea.
| | - Hyuk-Jae Chang
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea.
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Ho EY, Leung G, Chao MT, Chan D, Hsieh E, Pritzker S, Chi HL, Huang S, Ruan Q, Seligman HK. Integrative Nutritional Counseling Combining Chinese Medicine and Biomedicine for Chinese Americans with Type 2 Diabetes: A Mixed-Methods Feasibility Study. J Altern Complement Med 2021; 27:657-668. [PMID: 33979531 DOI: 10.1089/acm.2020.0558] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Objectives: This study describes the development and feasibility of Integrative Nutritional Counseling (INC), a Chinese medicine (CM)+biomedicine-based nutrition curriculum for Chinese Americans with type 2 diabetes. Although Chinese Americans often incorporate CM principles into their diet, scant research has explored how to integrate CM with biomedical nutrition standards in a culturally appropriate manner or if such a program could improve diabetes self-management. Design: This is a 1-month pre-post study design including three points of contact: baseline, in-person class, and 1-month follow-up. Subjects: Participants (n = 15) were Cantonese-speaking/reading Chinese Americans diagnosed with type 2 diabetes who had used some form of CM/medicinal foods in the last 12 months. Interventions and Outcome Measures: The INC program included baseline surveys and a CM intake interview conducted by a licensed acupuncturist. The acupuncturist generated a CM diagnosis, which was shared with the participant, and used this diagnosis to tailor brief nutrition education. To bolster this brief education, a bilingual registered dietitian provided a 2-h group education class in Cantonese to all participants, during which time participants also received a Chinese/English INC booklet. Participants completed surveys immediately after the class and at 1-month follow-up, with qualitative exit interviews. Results: Participants reported improved attitudes and dietary habits aligning directly with INC, and improvement in biomedically valued measures of type 2 diabetes, such as weight loss, and CM-valued measures of digestion/elimination and hot/cold feeling. Satisfaction with INC was high, but challenges included confusion with some INC information, structural barriers, and comorbidities. Conclusions: Chinese Americans with type 2 diabetes and interventionists found integrative nutrition approaches acceptable and feasible. Future research should examine INC with a larger population and explore optimal delivery of INC given reported challenges.
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Affiliation(s)
- Evelyn Y Ho
- Department of Communication Studies, University of San Francisco, San Francisco, CA, USA.,Asian American Research Center on Health, San Francisco, CA, USA
| | - Genevieve Leung
- Department of Rhetoric & Language, University of San Francisco, San Francisco, CA, USA
| | - Maria T Chao
- Division of General Internal Medicine, University of California San Francisco, San Francisco, CA, USA.,Osher Center for Integrative Medicine, University of California San Francisco, San Francisco, CA, USA.,Center for Vulnerable Populations, University of California San Francisco, San Francisco, CA, USA
| | - Donald Chan
- UT Southwestern Medical School, Dallas, TX, USA
| | - Elaine Hsieh
- Asian American Research Center on Health, San Francisco, CA, USA.,Department of Nutrition and Public Health, University of Saint Joseph, West Hartford, CT, USA
| | - Sonya Pritzker
- Department of Anthropology, University of Alabama, Tuscaloosa, AL, USA
| | - Han-Lin Chi
- School of Nursing, University of California, San Francisco, San Francisco, CA, USA
| | - Siyuan Huang
- Asia Pacific Studies Program, University of San Francisco, San Francisco, CA, USA
| | - Qiao Ruan
- David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Hilary K Seligman
- Division of General Internal Medicine, University of California San Francisco, San Francisco, CA, USA.,Center for Vulnerable Populations, University of California San Francisco, San Francisco, CA, USA
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Bancks MP, Bertoni AG, Carnethon M, Chen H, Cotch MF, Gujral UP, Herrington D, Kanaya AM, Szklo M, Vaidya D, Kandula NR. Association of Diabetes Subgroups With Race/Ethnicity, Risk Factor Burden and Complications: The MASALA and MESA Studies. J Clin Endocrinol Metab 2021; 106:e2106-e2115. [PMID: 33502458 PMCID: PMC8063247 DOI: 10.1210/clinem/dgaa962] [Citation(s) in RCA: 25] [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: 08/02/2020] [Indexed: 01/28/2023]
Abstract
INTRODUCTION There are known disparities in diabetes complications by race and ethnicity. Although diabetes subgroups may contribute to differential risk, little is known about how subgroups vary by race/ethnicity. METHODS Data were pooled from 1293 (46% female) participants of the Mediators of Atherosclerosis in South Asians Living in America (MASALA) and the Multi-Ethnic Study of Atherosclerosis (MESA) who had diabetes (determined by diabetes medication use, fasting glucose, and glycated hemoglobin [HbA1c]), including 217 South Asian, 240 non-Hispanic white, 125 Chinese, 387 African American, and 324 Hispanic patients. We applied k-means clustering using data for age at diabetes diagnosis, body mass index, HbA1c, and homeostatic model assessment measures of insulin resistance and beta cell function. We assessed whether diabetes subgroups were associated with race/ethnicity, concurrent cardiovascular disease risk factors, and incident diabetes complications. RESULTS Five diabetes subgroups were characterized by older age at diabetes onset (43%), severe hyperglycemia (26%), severe obesity (20%), younger age at onset (1%), and requiring insulin medication use (9%). The most common subgroup assignment was older onset for all race/ethnicities with the exception of South Asians where the severe hyperglycemia subgroup was most likely. Risk for renal complications and subclinical coronary disease differed by diabetes subgroup and, separately, race/ethnicity. CONCLUSIONS Racial/ethnic differences were present across diabetes subgroups, and diabetes subgroups differed in risk for complications. Strategies to eliminate racial/ethnic disparities in complications may need to consider approaches targeted to diabetes subgroup.
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Affiliation(s)
- Michael P Bancks
- Wake Forest School of Medicine, Winston-Salem, NC, USA
- Correspondence: Mike Bancks, PhD, MPH, Wake Forest School of Medicine, Division of Public Health Sciences, Department of Epidemiology & Prevention, Medical Center Boulevard, Winston-Salem, NC, 27157, USA.
| | | | | | - Haiying Chen
- Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Mary Frances Cotch
- National Eye Institute of the National Institutes of Health, Bethesda, MD, USA
| | - Unjali P Gujral
- Emory University Rollins School of Public Health, Atlanta, GA, USA
| | | | - Alka M Kanaya
- University of California, San Francisco, San Francisco, CA, USA
| | - Moyses Szklo
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Dhananjay Vaidya
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Narayan KMV, Kondal D, Kobes S, Staimez LR, Mohan D, Gujral UP, Patel SA, Anjana RM, Shivashankar R, Ali MK, Chang HH, Kadir M, Prabhakaran D, Daya N, Selvin E, Tandon N, Hanson R, Mohan V. Incidence of diabetes in South Asian young adults compared to Pima Indians. BMJ Open Diabetes Res Care 2021; 9:9/1/e001988. [PMID: 33771765 PMCID: PMC8006824 DOI: 10.1136/bmjdrc-2020-001988] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 02/09/2021] [Accepted: 02/18/2021] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION South Asians (SA) and Pima Indians have high prevalence of diabetes but differ markedly in body size. We hypothesize that young SA will have higher diabetes incidence than Pima Indians at comparable body mass index (BMI) levels. RESEARCH DESIGN AND METHODS We used prospective cohort data to estimate age-specific, sex, and BMI-specific diabetes incidence in SA aged 20-44 years living in India and Pakistan from the Center for Cardiometabolic Risk Reduction in South Asia Study (n=6676), and compared with Pima Indians, from Pima Indian Study (n=1852). RESULTS At baseline, SA were considerably less obese than Pima Indians (BMI (kg/m2): 24.4 vs 33.8; waist circumference (cm): 82.5 vs 107.0). Age-standardized diabetes incidence (cases/1000 person-years, 95% CI) was lower in SA than in Pima Indians (men: 14.2, 12.2-16.2 vs 37.3, 31.8-42.8; women: 14.8, 13.0-16.5 vs 46.1, 41.2-51.1). Risk of incident diabetes among 20-24-year-old Pima men and women was six times (relative risk (RR), 95% CI: 6.04, 3.30 to 12.0) and seven times (RR, 95% CI: 7.64, 3.73 to 18.2) higher as compared with SA men and women, respectively. In those with BMI <25 kg/m2, however, the risk of diabetes was over five times in SA men than in Pima Indian men. Among those with BMI ≥30 kg/m2, diabetes incidence in SA men was nearly as high as in Pima men. SA and Pima Indians had similar magnitude of association between age, sex, BMI, and insulin secretion with diabetes. The effect of family history was larger in SA, whereas that of insulin resistance was larger in Pima Indians CONCLUSIONS: In the background of relatively low insulin resistance, higher diabetes incidence in SA is driven by poor insulin secretion in SA men. The findings call for research to improve insulin secretion in early natural history of diabetes.
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Affiliation(s)
| | - Dimple Kondal
- Public Health Foundation of India, New Delhi, Delhi, India
| | - Sayuko Kobes
- National Institute of Diabetes and Digestive and Kidney Diseases Phoenix Epidemiology and Clinical Research Branch, Phoenix, Arizona, USA
| | | | - Deepa Mohan
- Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | | | | | | | | | | | | | | | | | - Natalie Daya
- Center for Teaching and Learning, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Elizabeth Selvin
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Nikhil Tandon
- All India Institute of Medical Sciences, New Delhi, India
| | - Robert Hanson
- National Institute of Diabetes and Digestive and Kidney Diseases Phoenix Epidemiology and Clinical Research Branch, Phoenix, Arizona, USA
| | - Viswanathan Mohan
- Diabetology, Dr Mohan's Diabetes Specialities Centre Gopalapuram, Chennai, India
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Discordance between Body-Mass Index and Body Adiposity Index in the Classification of Weight Status of Elderly Patients with Stable Coronary Artery Disease. J Clin Med 2021; 10:jcm10050943. [PMID: 33804367 PMCID: PMC7957704 DOI: 10.3390/jcm10050943] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 02/24/2021] [Accepted: 02/24/2021] [Indexed: 12/14/2022] Open
Abstract
Background and Aims: Body-mass index (BMI) is a popular method implemented to define weight status. However, describing obesity by BMI may result in inaccurate assessment of adiposity. The Body Adiposity Index (BAI) is intended to be a directly validated method of estimating body fat percentage. We set out to compare body weight status assessment by BMI and BAI in a cohort of elderly patients with stable coronary artery disease (CAD). Methods: A total of 169 patients with stable CAD were enrolled in an out-patient cardiology clinic. The National Research Council (US) Committee on Diet and Health classification was used for individuals older than 65 years as underweight BMI < 24 kg/m2, normal weight BMI 24–29 kg/m2, overweight BMI 29–35 kg/m2, and obesity BMI > 35 kg/m2. In case of BAI, we used sex- and age-specific classification of weight status. In addition, body fat was estimated by bioelectrical impedance analysis (BImpA). Results: Only 72 out of 169 patients (42.6%) had concordant classification of weight status by both BMI and BAI. The majority of the patients had their weight status either underestimated or overestimated. There were strong positive correlations between BMI and BImpA (FAT%) (R = 0.78 p < 0.001); BAI and BImpA (FAT%) (R = 0.79 p < 0.001); and BMI and BAI (R = 0.67 p < 0.001). BMI tended to overestimate the rate of underweight, normal weight or overweight, meanwhile underestimating the rate of obesity. Third, BMI exhibited an average positive bias of 14.4% compared to the reference method (BImpA), whereas BAI exhibited an average negative bias of −8.3% compared to the reference method (BImpA). Multivariate logistic regression identified independent predictors of discordance in assessing weight status by BMI and BAI: BImpA (FAT%) odds ratio (OR) 1.29, total body water (%) OR 1.61, fat mass index OR 2.62, and Controlling Nutritional Status (CONUT) score OR 1.25. Conclusions: There is substantial rate of misclassification of weight status between BMI and BAI. These findings have significant implications for clinical practice as the boundary between health and disease in malnutrition is crucial to accurately define criteria for intervention. Perhaps BMI cut-offs for classifying weight status in the elderly should be revisited.
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Han MAT, Yu Q, Tafesh Z, Pyrsopoulos N. Diversity in NAFLD: A Review of Manifestations of Nonalcoholic Fatty Liver Disease in Different Ethnicities Globally. J Clin Transl Hepatol 2021; 9:71-80. [PMID: 33604257 PMCID: PMC7868692 DOI: 10.14218/jcth.2020.00082] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 11/17/2020] [Accepted: 12/05/2020] [Indexed: 12/11/2022] Open
Abstract
Globally, the rise in prevalence of obesity and metabolic syndrome as a whole has been linked to increased access to processed foods, such as refined sugars and saturated fats. Consequently, nonalcoholic fatty liver disease (NAFLD) is on the rise in both developed and developing nations. However, much is still unknown on the NAFLD phenotype with regards to the effect of ethnic diversity. Despite similarities in dietary habits, it appears that certain ethnicities are more protected against NAFLD than others. However, manifestations of the same genetic polymorphisms in different groups of people increase those individuals' predisposition to NAFLD. Diets from different regions have been associated with a lower prevalence of NAFLD and have even been linked to regression of hepatic steatosis. Socioeconomic variations amongst different regions of the world also contribute to NAFLD prevalence and associated complications. Thus, a thorough understanding of ethnic variability in NAFLD is essential to tailoring treatment recommendations to patients of different backgrounds.
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Affiliation(s)
| | | | | | - Nikolaos Pyrsopoulos
- Correspondence to: Nikolaos Pyrsopoulos, Division of Gastroenterology and Hepatology, Rutgers New Jersey Medical School, 185 South Orange Avenue, H-536, Newark, NJ 07103, USA. Tel: +1-973-972-5252, E-mail:
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Kwok S, Adam S, Ho JH, Iqbal Z, Turkington P, Razvi S, Le Roux CW, Soran H, Syed AA. Obesity: A critical risk factor in the COVID-19 pandemic. Clin Obes 2020; 10:e12403. [PMID: 32857454 PMCID: PMC7460880 DOI: 10.1111/cob.12403] [Citation(s) in RCA: 152] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/04/2020] [Accepted: 08/07/2020] [Indexed: 12/12/2022]
Abstract
Obesity is an emerging independent risk factor for susceptibility to and severity of coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Previous viral pandemics have shown that obesity, particularly severe obesity (BMI > 40 kg/m2 ), is associated with increased risk of hospitalization, critical care admission and fatalities. In this narrative review, we examine emerging evidence of the influence of obesity on COVID-19, the challenges to clinical management from pulmonary, endocrine and immune dysfunctions in individuals with obesity and identify potential areas for further research. We recommend that people with severe obesity be deemed a vulnerable group for COVID-19; clinical trials of pharmacotherapeutics, immunotherapies and vaccination should prioritize inclusion of people with obesity.
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Affiliation(s)
- See Kwok
- Cardiovascular Trials UnitManchester University NHS Foundation TrustManchesterUK
- Faculty of BiologyMedicine and Health, University of ManchesterManchesterUK
| | - Safwaan Adam
- Faculty of BiologyMedicine and Health, University of ManchesterManchesterUK
- Department of EndocrinologyChristie NHS Foundation TrustManchesterUK
| | - Jan Hoong Ho
- Cardiovascular Trials UnitManchester University NHS Foundation TrustManchesterUK
- Faculty of BiologyMedicine and Health, University of ManchesterManchesterUK
| | - Zohaib Iqbal
- Cardiovascular Trials UnitManchester University NHS Foundation TrustManchesterUK
- Faculty of BiologyMedicine and Health, University of ManchesterManchesterUK
| | - Peter Turkington
- Department of Respiratory MedicineSalford Royal NHS Foundation TrustSalfordUK
| | - Salman Razvi
- Cardiovascular Research CentreInstitute of Genetic Medicine, Newcastle UniversityNewcastle upon TyneUK
| | - Carel W. Le Roux
- Diabetes Complications Research CentreUniversity College DublinDublinIreland
| | - Handrean Soran
- Cardiovascular Trials UnitManchester University NHS Foundation TrustManchesterUK
- Faculty of BiologyMedicine and Health, University of ManchesterManchesterUK
| | - Akheel A. Syed
- Faculty of BiologyMedicine and Health, University of ManchesterManchesterUK
- Department of DiabetesEndocrinology and Obesity Medicine, Salford Royal NHS Foundation TrustSalfordUK
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Rauchwerk A, Vipperman-Cohen A, Padmanabhan S, Parasram W, Burt KG. The Case for a Health at Every Size Approach for Chronic Disease Risk Reduction in Women of Color. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2020; 52:1066-1072. [PMID: 32948446 DOI: 10.1016/j.jneb.2020.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 08/10/2020] [Accepted: 08/12/2020] [Indexed: 06/11/2023]
Abstract
The conventional approach to chronic disease management in women of color is a dieting-for-weight-loss approach, which has not been proven to be effective. The purpose of this article is to highlight the shortcomings of the dieting-for-weight-loss approach and demonstrate the potential efficacy of the Health at Every Size approach when working with women of color to prevent and address chronic diseases. The article's areas of focus are weight stigma, bias, and size discrimination; the implications of differing weight perceptions and motivations for change; and weight as the primary determinant of health and biological factors affecting weight.
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Affiliation(s)
- Autumn Rauchwerk
- Program in Nutrition, Health, and Behavior Studies, Teachers College, Columbia University, New York, NY
| | - Anne Vipperman-Cohen
- Program in Nutrition, Health, and Behavior Studies, Teachers College, Columbia University, New York, NY
| | - Sridevi Padmanabhan
- Program in Nutrition, Health, and Behavior Studies, Teachers College, Columbia University, New York, NY
| | - Woheema Parasram
- Program in Nutrition, Health, and Behavior Studies, Teachers College, Columbia University, New York, NY
| | - Kate G Burt
- Dietetics, Foods, and Nutrition, Department of Health Sciences, Lehman College, City University of New York, New York, NY.
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Cao X, Gu Y, Bian S, Zhang Q, Meng G, Liu L, Wu H, Zhang S, Wang Y, Zhang T, Wang X, Sun S, Wang X, Jia Q, Song K, Niu K. Association between eating speed and newly diagnosed nonalcoholic fatty liver disease among the general population. Nutr Res 2020; 80:78-88. [PMID: 32736293 DOI: 10.1016/j.nutres.2020.06.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 04/09/2020] [Accepted: 06/17/2020] [Indexed: 12/11/2022]
Abstract
Fast eating speed is a risk factor for obesity, which is also closely related to nonalcoholic fatty liver disease (NAFLD), suggesting that fast eating speed may contribute to the development of NAFLD. But the extent to which obesity may mediate the association between eating speed and NAFLD is uncertain. We hypothesized that obesity plays a mediating role in the association between eating speed and prevalence of NAFLD in the general population. A cross-sectional study (n = 23,611) was conducted in a general population sample from Tianjin, China. We measured anthropometrics and biochemical variables. The self-reported eating speed per meal was recorded and classified into 4 categories: slow, medium, relatively fast, and very fast. NAFLD was diagnosed by liver ultrasonography. Multiple logistic regression analysis was used to assess the associations between the eating speed and the prevalence of NAFLD, as well as the mediation effects of obesity on the association between eating speed and NAFLD. The prevalence of newly diagnosed NAFLD was 19.0%. After adjusting for potentially confounding factors, the odds ratios (95% confidence interval) of NAFLD across categories of eating speed were 1.00 (reference), 1.39 (1.18-1.64), 1.71 (1.45-2.01), and 2.04 (1.70-2.46). All these significant odds ratios were attenuated to be nonsignificant by adjustment for body mass index and/or waist circumference. This is the first study to demonstrate that eating speed is not independently associated with increased risk of NAFLD.
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Affiliation(s)
- Xingqi Cao
- Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, Tianjin, China
| | - Yeqing Gu
- Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, Tianjin, China
| | - Shanshan Bian
- The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Qing Zhang
- Health Management Centre, Tianjin Medical University General Hospital, Tianjin, China
| | - Ge Meng
- Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, Tianjin, China; Department of Toxicology and Sanitary Chemistry, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Li Liu
- Health Management Centre, Tianjin Medical University General Hospital, Tianjin, China
| | - Hongmei Wu
- Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, Tianjin, China
| | - Shunming Zhang
- Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, Tianjin, China
| | - Yawen Wang
- Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, Tianjin, China
| | - Tingjing Zhang
- Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, Tianjin, China
| | - Xuena Wang
- Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, Tianjin, China
| | - Shaomei Sun
- Health Management Centre, Tianjin Medical University General Hospital, Tianjin, China
| | - Xing Wang
- Health Management Centre, Tianjin Medical University General Hospital, Tianjin, China
| | - Qiyu Jia
- Health Management Centre, Tianjin Medical University General Hospital, Tianjin, China
| | - Kun Song
- Health Management Centre, Tianjin Medical University General Hospital, Tianjin, China
| | - Kaijun Niu
- Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, Tianjin, China; Health Management Centre, Tianjin Medical University General Hospital, Tianjin, China; Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China; Center for International Collaborative Research on Environment, Nutrition and Public Health, Tianjin, China.
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Lin X, Xu Y, Xu J, Pan X, Song X, Shan L, Zhao Y, Shan PF. Global burden of noncommunicable disease attributable to high body mass index in 195 countries and territories, 1990-2017. Endocrine 2020; 69:310-320. [PMID: 32488838 DOI: 10.1007/s12020-020-02352-y] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 05/15/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE The increasing burden of noncommunicable diseases (NCDs) attributable to high body mass index (BMI) represents both a threat and an opportunity for intervention. Estimates of the global latest trend of high BMI-related NCDs and its association with socioeconomic status can facilitate strategic intervention and inform further research. METHODS This global burden of disease study extracted global, regional, and national data on death and disability-adjusted life years (DALYs) attributable to high BMI-related NCDs from the GBD Study 2017. Secondary analyses were performed by year, age, sex, and specific causes of death and DALYs. The 2017 Socio-demographic Index (SDI) was used as an indicator of national socioeconomic status. The association between age-standardized death or DALYs rate and socioeconomic status were analyzed. RESULTS Worldwide, 4.7 million deaths and 147.7 million DALYs of NCDs were related to high BMI in 2017, with a projection to 5.5 million deaths and 176.9 million DALYs in 2025. Globally, high BMI-related burden showed an increasing trend with males being more heavily impacted overall. The trend and magnitude of high BMI-related disease burden varied substantially in different geographical and socioeconomic regions. Specifically, the low-middle, middle, and high-middle SDI countries were associated with a higher burden. The leading three causes of DALYs attributable to high BMI in 2017 were ischemic heart diseases, stroke, and diabetes mellitus. CONCLUSIONS High BMI-related burden of NCDs is worsening, particularly in developing countries. Our findings may enhance public awareness of interventions to reduce the diseases burden caused by high BMI.
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Affiliation(s)
- Xiling Lin
- Department of Endocrinology and Metabolism, the Second Affiliated Hospital of ZheJiang University School of Medicine, 88 Jiefang Road, Hangzhou, Zhejiang, 310009, China
| | - Yufeng Xu
- Department of Ophthalmology, the Second Affiliated Hospital of ZheJiang University School of Medicine, 88 Jiefang Road, Hangzhou, Zhejiang, 310009, China
| | - Jingya Xu
- Department of Endocrinology and Metabolism, the Second Affiliated Hospital of ZheJiang University School of Medicine, 88 Jiefang Road, Hangzhou, Zhejiang, 310009, China
| | - Xiaowen Pan
- Department of Endocrinology and Metabolism, the Second Affiliated Hospital of ZheJiang University School of Medicine, 88 Jiefang Road, Hangzhou, Zhejiang, 310009, China
| | - Xiaoxiao Song
- Department of Endocrinology and Metabolism, the Second Affiliated Hospital of ZheJiang University School of Medicine, 88 Jiefang Road, Hangzhou, Zhejiang, 310009, China
| | - Lizhen Shan
- Department of Endocrinology and Metabolism, the Second Affiliated Hospital of ZheJiang University School of Medicine, 88 Jiefang Road, Hangzhou, Zhejiang, 310009, China
| | - Yiming Zhao
- Department of Endocrinology and Metabolism, the Second Affiliated Hospital of ZheJiang University School of Medicine, 88 Jiefang Road, Hangzhou, Zhejiang, 310009, China
| | - Peng-Fei Shan
- Department of Endocrinology and Metabolism, the Second Affiliated Hospital of ZheJiang University School of Medicine, 88 Jiefang Road, Hangzhou, Zhejiang, 310009, China.
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Iyer DG, Shah NS, Hastings KG, Hu J, Rodriguez F, Boothroyd DB, Krishnan AV, Falasinnu T, Palaniappan L. Years of Potential Life Lost Because of Cardiovascular Disease in Asian-American Subgroups, 2003-2012. J Am Heart Assoc 2020; 8:e010744. [PMID: 30890022 PMCID: PMC6509739 DOI: 10.1161/jaha.118.010744] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Asian‐American subgroups (Asian‐Indian, Chinese, Filipino, Korean, Japanese, and Vietnamese) display varied cardiovascular disease mortality patterns, especially at younger ages. This study aims to examine the years of potential life lost because of ischemic heart disease and cerebrovascular disease among the 6 largest Asian‐American subgroups compared with non‐Hispanic whites. Methods and Results We used National Center for Health Statistics Multiple Causes of Death mortality files from 2003 to 2012 to calculate race‐specific life expectancy, mean years of potential life lost, and years of potential life lost per 100 000 population for each Asian subgroup and non‐Hispanic whites. Asian‐American subgroups display heterogeneity in cardiovascular disease burden. Asian‐Indians had a high burden of ischemic heart disease; Asian‐Indian men lost 724 years per 100 000 population in 2012 and a mean of 17 years to ischemic heart disease. Respectively, Vietnamese and Filipino men and women lost a mean of 17 and 16 years of life to cerebrovascular disease; Filipino men lost 352 years per 100 000 population in 2012. All Asian subgroups for both sexes had higher years of life lost to cerebrovascular disease compared with non‐Hispanic whites. Conclusions Cardiovascular disease burden varies among Asian subgroups, and contributes to greater premature mortality in certain subgroups. Asian‐Indian and Filipino populations have the highest years of life lost because of ischemic heart disease and Filipino and Vietnamese have the highest years of life lost because of cerebrovascular disease. Analysis of risk factors and development of subgroup‐specific interventions are required to address these health disparities.
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Affiliation(s)
- Divya G Iyer
- 1 University of Connecticut School of Medicine Farmington CT
| | - Nilay S Shah
- 2 Division of Primary Care and Population Health Stanford University School of Medicine Stanford CA
| | - Katherine G Hastings
- 2 Division of Primary Care and Population Health Stanford University School of Medicine Stanford CA
| | - Jiaqi Hu
- 2 Division of Primary Care and Population Health Stanford University School of Medicine Stanford CA
| | - Fatima Rodriguez
- 3 Division of Cardiovascular Medicine Stanford University Stanford CA
| | - Derek B Boothroyd
- 4 Quantitative Sciences Unit Stanford University School of Medicine Stanford CA
| | - Aruna V Krishnan
- 2 Division of Primary Care and Population Health Stanford University School of Medicine Stanford CA
| | - Titilola Falasinnu
- 5 Division of Epidemiology Department of Health Research & Policy Stanford University School of Medicine Stanford CA
| | - Latha Palaniappan
- 2 Division of Primary Care and Population Health Stanford University School of Medicine Stanford CA
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Narayan KMV, Kanaya AM. Why are South Asians prone to type 2 diabetes? A hypothesis based on underexplored pathways. Diabetologia 2020; 63:1103-1109. [PMID: 32236731 PMCID: PMC7531132 DOI: 10.1007/s00125-020-05132-5] [Citation(s) in RCA: 82] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 03/03/2020] [Indexed: 02/07/2023]
Abstract
South Asians have a high prevalence of type 2 diabetes, even at a lower BMI. This review sets out our perspective and hypothesis on the reasons for this. Emerging data from epidemiological studies indicate that South Asians may have a lower ability to secrete insulin, and thus may have less compensatory reserves when challenged with unhealthy lifestyles. Thus, insulin resistance may not be the primary driver of type 2 diabetes in this population. Furthermore, data also suggest that South Asians, on average, have lower muscle mass, and may have a specific propensity to ectopic hepatic fat accumulation and for intramyocellular fat deposition, which cause further disruption in insulin action. We hypothesise that the high diabetes susceptibility in South Asians is evolutionarily set through dual parallel and/or interacting mechanisms: reduced beta cell function and impaired insulin action owing to low lean mass, which is further accentuated by ectopic fat deposition in the liver and muscle. These areas warrant further research.
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Affiliation(s)
- K M Venkat Narayan
- Emory Global Diabetes Research Center, Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, CNR Room 7043, Atlanta, GA, 30329, USA.
- Department of Medicine, School of Medicine, Emory University, Atlanta, GA, USA.
| | - Alka M Kanaya
- Department of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
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Kandula NR, Bernard V, Dave S, Ehrlich-Jones L, Counard C, Shah N, Kumar S, Rao G, Ackermann R, Spring B, Siddique J. The South Asian Healthy Lifestyle Intervention (SAHELI) trial: Protocol for a mixed-methods, hybrid effectiveness implementation trial for reducing cardiovascular risk in South Asians in the United States. Contemp Clin Trials 2020; 92:105995. [PMID: 32220632 PMCID: PMC8011000 DOI: 10.1016/j.cct.2020.105995] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 03/17/2020] [Accepted: 03/22/2020] [Indexed: 10/24/2022]
Abstract
Intensive lifestyle interventions targeting diet and physical activity are recommended for reducing atherosclerotic cardiovascular disease (ASCVD) risk in adults. However, existing interventions often do not reach immigrant populations because of a mismatch between the social, cultural, and environmental context of immigrants and Western bio behavioral models which underpin evidence-based lifestyle interventions. The South Asian Healthy Lifestyle Intervention (SAHELI) study is a type 1 hybrid design randomized controlled trial aimed at reducing ASCVD risk in South Asian Americans, a group at higher ASCVD risk than whites and other Asian Americans. The objective is to evaluate the clinical effectiveness and implementation potential of a community-based, culturally-adapted lifestyle intervention for South Asian adults. Participants (n = 550) will be randomized to printed healthy lifestyle education materials or SAHELI, a group-based lifestyle change program that includes weekly classes for 16 weeks and 4 booster classes though month 11. SAHELI integrates evidence-based behavior change strategies with culturally-adapted strategies and group motivational interviewing to improve diet, physical activity, and stress management. Follow-up assessments will occur at 6 and 12 months. We hypothesize that the SAHELI intervention group will have greater improvements in clinical ASCVD risk factors (weight, blood pressure, glycated hemoglobin, and lipids), physical activity, and psychosocial outcomes than the print material group at 6- and 12- months. We will use mixed-methods to examine SAHELI's potential for reach, adoption, implementation, and maintenance from the perspective of multiple stakeholders. This study offers the potential to increase the reach and effectiveness of evidence-based lifestyle interventions for South Asian adults at increased risk for ASCVD.
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Affiliation(s)
- Namratha R Kandula
- Feinberg School of Medicine, Division of General Internal Medicine, Northwestern University, Chicago, IL, United States; Feinberg School of Medicine, Department of Preventive Medicine, Northwestern University, Chicago, IL, United States.
| | - Veronica Bernard
- Feinberg School of Medicine, Division of General Internal Medicine, Northwestern University, Chicago, IL, United States.
| | - Swapna Dave
- Feinberg School of Medicine, Division of General Internal Medicine, Northwestern University, Chicago, IL, United States.
| | - Linda Ehrlich-Jones
- Feinberg School of Medicine, Department of Physical Medicine & Rehabilitation, Northwestern University, Chicago, IL, United States; Shirley Ryan AbilityLab, Chicago, IL, United States.
| | | | - Nirav Shah
- Northshore University HealthSystem, Skokie Hospital, Skokie, IL, United States.
| | - Santosh Kumar
- Metropolitan Asian Family Services, Chicago, IL, United States.
| | - Goutham Rao
- Case Western Reserve University, Cleveland, OH, United States.
| | - Ronald Ackermann
- Feinberg School of Medicine, Division of General Internal Medicine, Northwestern University, Chicago, IL, United States.
| | - Bonnie Spring
- Feinberg School of Medicine, Department of Preventive Medicine, Northwestern University, Chicago, IL, United States.
| | - Juned Siddique
- Feinberg School of Medicine, Department of Preventive Medicine, Northwestern University, Chicago, IL, United States.
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Zheng Q, Lin W, Liu C, Zhou Y, Chen T, Zhang L, Zhang X, Yu S, Wu Q, Jin Z, Zhu Y. Prevalence and epidemiological determinants of metabolically obese but normal-weight in Chinese population. BMC Public Health 2020; 20:487. [PMID: 32293373 PMCID: PMC7161294 DOI: 10.1186/s12889-020-08630-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 04/01/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND There is metabolic heterogeneity in normal-weight individuals, however, there has been limited research in the Chinese population. This study aimed to investigate the prevalence, distribution and epidemiological determinants of metabolically obese but normal-weight (MONW) in a Chinese population. METHODS A total of 17,876 normal-weight individuals were recruited from 37,815 individuals in Zhejiang province in southeastern China. Normal-weight was defined as a body mass index (BMI) of 18.5-23.9 kg/m2. Metabolically abnormal traits were assessed by metabolic syndrome criteria from the International Diabetes Federation (IDF) in 2015. MONW was defined as individuals who had at least two metabolically abnormal trait but normal weight. Multiple logistic regression was used to investigate MONW risk factors, adjusting for potential confounders. RESULTS The prevalence of metabolic abnormality was 34.1% in normal-weight individuals, and the overall prevalence of MONW was 16.1% in the general population. Different MONW distributions were found between men and women depending on age. Compared with women, men had a significantly higher MONW prevalence among those aged < 45 years old, and there was a lower prevalence for those aged ≥50 years old. Higher BMI or waist circumference (WC), central obesity, menopause, and family histories of hypertension, diabetes, and cardiovascular diseases, increased MONW risk. Higher education levels, regular alcohol drinking, and balanced or vegetarian food preferences reduced MONW risk. CONCLUSIONS Normal-weight individuals have metabolic heterogeneity in China. The MONW distribution between men and women depends on age. BMI, WC, dietary factors, and family history of chronic diseases, are associated with metabolic status.
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Affiliation(s)
- Qianqian Zheng
- Department of Epidemiology & Biostatistics, School of Public Health, Zhejiang University, Hangzhou, 310058, Zhejiang, China
| | - Weihua Lin
- Hangzhou MetaWell Technology Co., Hangzhou, China
| | - Chengguo Liu
- Putuo District People's Hospital, Zhoushan, 316100, Zhejiang, China
| | - Yaohan Zhou
- Department of Epidemiology & Biostatistics, School of Public Health, Zhejiang University, Hangzhou, 310058, Zhejiang, China
| | - Tianhui Chen
- Department of Cancer Prevention, Zhejiang Cancer Hospital, Hangzhou, 310022, Zhejiang Province, China
| | - Liqun Zhang
- Putuo District People's Hospital, Zhoushan, 316100, Zhejiang, China
| | - Xuhui Zhang
- Hangzhou Center for Disease Control and Preventio, Hangzhou, 310051, Zhejiang, China
| | - Senhai Yu
- Daicun Town Community Health Service Center, Xiaoshan District, Hangzhou, Zhejiang, China
| | - Qiong Wu
- Department of Epidemiology & Biostatistics, School of Public Health, Zhejiang University, Hangzhou, 310058, Zhejiang, China
| | - Ziqi Jin
- Department of Epidemiology & Biostatistics, School of Public Health, Zhejiang University, Hangzhou, 310058, Zhejiang, China
| | - Yimin Zhu
- Department of Epidemiology & Biostatistics, School of Public Health, Zhejiang University, Hangzhou, 310058, Zhejiang, China.
- Department of Respiratory Diseases, Sir Run Run Shaw Hospital Affiliated to School of Medicine, Zhejiang University, Hangzhou, 310020, Zhejiang, China.
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Association between body size-metabolic phenotype and nonalcoholic steatohepatitis and significant fibrosis. J Gastroenterol 2020; 55:330-341. [PMID: 31535207 DOI: 10.1007/s00535-019-01628-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 09/03/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Body size-metabolic phenotype may help predict whether or not individuals with nonalcoholic fatty liver disease (NAFLD) develop advanced liver disease. We studied the association of body size-metabolic phenotype with nonalcoholic steatohepatitis (NASH) and significant fibrosis. METHODS Our cross-sectional study included 559 subjects (mean age of 53 years; women 51%) with biopsy-proven NAFLD. Clinical, genetic, and histological characteristic features of NAFLD were evaluated. The metabolically unhealthy phenotype was defined by the presence of two or more metabolic components, while body size was categorized based on body mass index: obese (≥ 25 kg/m2) or non-obese (< 25 kg/m2). Body size-metabolic phenotypes were divided into four study groups: (1) non-obese metabolic syndrome (MS)-, (2) non-obese MS+ , (3) obese MS-, and (4) obese MS+. RESULTS Obese MS- and non-obese MS+ groups demonstrated comparable levels of insulin resistance, adipose tissue insulin resistance indexes, and visceral adipose tissue (VAT) areas. The VAT area was significantly higher in the obese MS+ group versus obese MS- group. However, the VAT to subcutaneous adipose tissue (SAT) ratio was highest in the non-obese MS+ group. There was no difference in histology between the non-obese MS+, obese MS-, and obese MS+ groups. Multivariate analyses adjusted for age, sex, smoking status, PNPLA3, TM6SF2, and VAT/SAT areas demonstrated an independent and dose-dependent relationship between the body size-metabolic phenotype and NASH or significant fibrosis. CONCLUSION The non-obese MS+ group displayed similar degree of hepatic histological severity compared to their obese MS- counterparts. Metabolic milieu beyond obesity may play a pathogenic role in non-obese MS+ individuals who develop NASH with significant hepatic fibrosis. CLINICAL TRIAL NUMBER NCT02206841.
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Maffetone PB, Laursen PB. Revisiting the Global Overfat Pandemic. Front Public Health 2020; 8:51. [PMID: 32158742 PMCID: PMC7052125 DOI: 10.3389/fpubh.2020.00051] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 02/11/2020] [Indexed: 01/03/2023] Open
Abstract
The previously described overfat pandemic, estimated to be 62-76% worldwide, is comprised of individuals with excess body fat sufficient to impair health. The overfat condition is common in those who are overweight and obese, and can also occur in significant numbers of normal-weight non-obese individuals. Being overfat increases the risk for a wide spectrum of common cardiovascular and metabolic (cardiometabolic) abnormalities, chronic diseases and physical impairment. In some ethnicities, up to 40% or more of those who are normal-weight and non-obese may be overfat, a figure twice that used in the original global overfat estimates. In addition to the rates of overfat outpacing overweight and obesity, non-White populations outnumber Whites 6:1, with the recently estimated overfat prevalence being low when considering ethnicities such as Asians, Chinese, Africans and Latin Americans, including these individuals living among predominantly White populations. An awareness of the extent of the overfat pandemic is important because excess body fat can precede cardiometabolic risk factors, chronic diseases, and physical disabilities, and can reduce quality of life and increase healthcare expenditure. The purpose of this Perspective is to demonstrate that the global overfat prevalence of 62-76% may be considerably underestimated.
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Huang MY, Wang MY, Lin YS, Lin CJ, Lo K, Chang IJ, Cheng TY, Tsai SY, Chen HH, Lin CY, Liu SJ, Chien KL, Yeh TL. The Association between Metabolically Healthy Obesity, Cardiovascular Disease, and All-Cause Mortality Risk in Asia: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17041320. [PMID: 32092849 PMCID: PMC7068615 DOI: 10.3390/ijerph17041320] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 02/09/2020] [Accepted: 02/14/2020] [Indexed: 12/13/2022]
Abstract
We investigated the association among metabolically healthy obesity (MHO), cardiovascular disease (CVD)risk, and all-cause mortality in the Asian population. We searched databases from inception to 16 November, 2019 and pooled data using a random-effects model. Subgroup analysis was conducted according to the following comparison groups: MHNW (without overweight or underweight participants) and MHNO (non-obese, including overweight and underweight participants). Nineteen studies were included. The mean Newcastle-Ottawa Scale score was 7.8. Participants with MHO had a significantly higher CVD risk (odds ratio (OR) = 1.36, 95% confidence interval (CI) = 1.13-1.63) and significantly lower risk of all-cause mortality (OR = 0.88, 95% CI = 0.78-1.00) than the comparison group. Subgroup analyses revealed participants with MHO had a significantly higher CVD risk than MHNW participants (OR = 1.61; 95% CI = 1.24-2.08; I2 = 73%), but there was no significant difference compared with MHNO participants (OR, 1.04; 95% CI, 0.80-1.36; I2 = 68%). Participants with MHO had a significantly lower risk of all-cause mortality (OR = 0.83; 95% CI = 0.78-0.88; I2 = 9%) than MHNO participants, but a borderline significantly higher risk of all-cause mortality than MHNW participants (OR = 1.30; 95% CI = 0.99-1.72; I2 = 0%). The CVD risk and all-cause mortality of the MHO group changed depending on the control group. Thus, future studies should select control groups carefully.
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Affiliation(s)
- Ming-Yuan Huang
- Department of Family Medicine, Taipei MacKay Memorial Hospital, No. 92, Section 2, Zhongshan North Road, Taipei City 10449, Taiwan; (M.-Y.H.); (S.-Y.T.)
- Department of Medicine, MacKay Medical College, No. 46, Sec. 3, Zhongzheng Rd., Sanzhi Dist., New Taipei City 25245, Taiwan; (H.-H.C.); (C.-Y.L.)
- Hospice and Palliative Care Center, MacKay Memorial Hospital, No. 45, Minsheng Rd., Tamsui District, New Taipei City 25160, Taiwan
| | - Mu-Yi Wang
- Post Graduate Year, Taipei MacKay Memorial Hospital, No. 92, Section 2, Zhongshan North Road, Taipei City 10449, Taiwan; (M.-Y.W.); (Y.-S.L.); (K.L.); (I.-J.C.); (T.-Y.C.)
| | - Yu-Sheng Lin
- Post Graduate Year, Taipei MacKay Memorial Hospital, No. 92, Section 2, Zhongshan North Road, Taipei City 10449, Taiwan; (M.-Y.W.); (Y.-S.L.); (K.L.); (I.-J.C.); (T.-Y.C.)
| | - Chien-Ju Lin
- Department of Family Medicine, Hsinchu MacKay Memorial Hospital, No. 690, Section 2, Guangfu Road, East District, Hsinchu City 30071, Taiwan;
| | - Kai Lo
- Post Graduate Year, Taipei MacKay Memorial Hospital, No. 92, Section 2, Zhongshan North Road, Taipei City 10449, Taiwan; (M.-Y.W.); (Y.-S.L.); (K.L.); (I.-J.C.); (T.-Y.C.)
| | - I-Jen Chang
- Post Graduate Year, Taipei MacKay Memorial Hospital, No. 92, Section 2, Zhongshan North Road, Taipei City 10449, Taiwan; (M.-Y.W.); (Y.-S.L.); (K.L.); (I.-J.C.); (T.-Y.C.)
| | - Ting-Yao Cheng
- Post Graduate Year, Taipei MacKay Memorial Hospital, No. 92, Section 2, Zhongshan North Road, Taipei City 10449, Taiwan; (M.-Y.W.); (Y.-S.L.); (K.L.); (I.-J.C.); (T.-Y.C.)
| | - Szu-Ying Tsai
- Department of Family Medicine, Taipei MacKay Memorial Hospital, No. 92, Section 2, Zhongshan North Road, Taipei City 10449, Taiwan; (M.-Y.H.); (S.-Y.T.)
| | - Hsin-Hao Chen
- Department of Medicine, MacKay Medical College, No. 46, Sec. 3, Zhongzheng Rd., Sanzhi Dist., New Taipei City 25245, Taiwan; (H.-H.C.); (C.-Y.L.)
- Department of Family Medicine, Hsinchu MacKay Memorial Hospital, No. 690, Section 2, Guangfu Road, East District, Hsinchu City 30071, Taiwan;
- MacKay Junior College of Medicine, Nursing, and Management, No. 92, Shengjing Rd., Beitou Dist., Taipei City 11260, Taiwan
| | - Chien-Yu Lin
- Department of Medicine, MacKay Medical College, No. 46, Sec. 3, Zhongzheng Rd., Sanzhi Dist., New Taipei City 25245, Taiwan; (H.-H.C.); (C.-Y.L.)
- Department of Pediatrics, Hsinchu MacKay Memorial Hospital, Hsinchu 30071, Taiwan
| | - Shu Jung Liu
- Department of Medical Library, MacKay Memorial Hospital, No. 45, Minsheng Rd., Tamsui District, New Taipei City 25160, Taiwan;
| | - Kuo-Liong Chien
- Department of Internal Medicine, National Taiwan University Hospital, No. 7, Zhongshan S. Rd., Zhongzheng Dist., Taipei City 10002, Taiwan;
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, Room 517, No.17, Xu-Zhou Rd., Taipei City 10055, Taiwan
| | - Tzu-Lin Yeh
- Department of Family Medicine, Hsinchu MacKay Memorial Hospital, No. 690, Section 2, Guangfu Road, East District, Hsinchu City 30071, Taiwan;
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, Room 517, No.17, Xu-Zhou Rd., Taipei City 10055, Taiwan
- Correspondence: ; Tel.: +886-3-688-9595
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