A new predictive equation for evaluating women body fat percentage and obesity-related cardiovascular disease risk

Change in body size associated with all-cause mortality in an older Chinese population

OBJECTIVE

Evidence of an association between a change in body size and the risk of all-cause mortality is limited among older populations. We explored the association of a change in body size over three years with the risk of all-cause mortality in an older Chinese population.

METHODS

A total of 5134 participants from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) were recruited. Cox proportional-hazards models were used to assess the association of changes in body mass index (BMI) and body fat percentage (BF%) with risk of all-cause mortality, using hazard ratios (HRs) and 95% confidence intervals (CIs).

RESULTS

Of the 5134 participants (median age, 81 years; 2716 women [52.90%]), 1494 deaths were observed over a median of 4.08 years of follow-up. Compared with participants with stable body size (change within 5%), those with more than a 10% decrease in BMI or BF% had 36% and 46% higher risks, respectively, of all-cause mortality (HR = 1.36, 95% CI: 1.17-1.59; and HR = 1.46, 95% CI: 1.25-1.72); also, those with more than a 10% increase in BMI or BF% had 22% and 17% higher risks of all-cause mortality (HR = 1.22, 95% CI: 1.05-1.41; and HR = 1.17, 95% CI: 1.02-1.35).

CONCLUSIONS

This prospective cohort study of older adults suggests that a dramatic change in body size was positively associated with a higher risk of all-cause mortality. More attention should be paid to the effects of a dramatic change in body size, particularly a dramatic decrease in body size, among the Chinese population.

Thermal simulation of the lower limb in vascular medicine: A proof-of-concept by using computed tomography images

Simulations of physiology based on patient-specific anatomical structures have several potential applications in medicine. A few fields, such as radiotherapy and neurophysiology already utilize such methods in clinical practice, yet a number of disciplines could benefit from similar technologies, especially when imaging data is already available. The major problem in patient-specific simulation is the data conversion to simulation-compatible form i.e., data preparation and the coupling of the underlying physics to the anatomical model. In this work we present such a methodology in the context of vascular medicine, consisting of a three-dimensional blood flow-temperature simulation model of the lower limb built from computed tomography data. We also simulate a clinical condition of chronic limb-threatening ischemia, a severe complication of peripheral arterial disease. This proof-of-concept model simulates the limb's surface temperature with respect to the vascular structure. The methodology, depicting accurate patient anatomy, is a promising step towards individualized physiological simulations in vascular medicine, although more research and validation are required. Such a model could eventually outline a deeper understanding of the relation between vascular changes and peripheral thermal behavior.

[Body composition models based on anthropometry, systematic literature review]

Introduction

The body composition determination is carried out through measurement methods that require the use of specialized equipment that is difficult to acquire and manipulate. Therefore, different authors have developed mathematical models for its calculation. The target of this review was to analyze the work carried out on mathematical models of body composition variables from different anthropometric measurements, answering the following questions: what is the corporal variable that the model predicts?, what are the input variables for model development?, how is the patients typification in each model?, what data analysis method has been used?, and how has been the model evaluated? The search was limited to journals found in repositories in the areas of Medicine, Nursing, Biochemistry, Biology, Health, Pharmacology, Immunology, Engineering, and Mathematics. Four hundred and twenty-four articles were found, which were reduced to 30 by applying the systematic literature review process. The analyzed studies are oriented to the prediction of variables related to body fat mass. The evaluation results found for fat-free mass, fat mass and metabolic rate differ according to the comparison technique and the body segments analyzed. The evaluation is mainly based on the intraclass correlation, the Pearson correlation and the coefficient of determination (r2), and they present a good correlation for the population under study.

Prediction of body fat percentage: Development and validation of new anthropometric equations

INTRODUCTION

The aim of this study was to test the validity of existing equations, retrieved from the literature, in the Algerian adult population. To develop, and validate, new predictive equations for body fat percentage (%BF) using simple and easy-to-measure anthropometric parameters.

METHODS

This is a cross-sectional study including 877 Algerian adults who underwent a body composition assessment by the direct segmental multi-frequency bioelectrical impedance technique (Inbody-770). Participants were randomly divided into two groups: the development group (n = 577) and the validation group (n = 300). To develop the equations, multiple linear regression models were analyzed. The predictive performance of the developed equations was compared with the direct technique. The following validation tests were used: Student's t-test for paired samples, correlation, and Bland-Altman diagram. Diagnostic accuracy has also been assessed.

RESULTS

Four existing equations were tested, and all showed statically significant bias. Four new equations were developed; all had satisfactory predictive performance, with a correlation coefficient ranging from 0.72 to 0.94 in men and 0.87 to 0.93 in women. The best-fitting equation was based on body mass index, waist-to-hip ratio, and chest circumference. The diagnostic accuracy of this equation was 96.7% in men and 95.3% in women.

CONCLUSION

The newly developed equations based on anthropometric parameters can serve as a simple tool for the accurate prediction of BF% in adult subjects, at both individual and epidemiological levels.

LIFEHOUSE’s Functional Nutrition Examination (Physical Exam, Anthropometrics, and Selected Biomarkers) Informs Personalized Wellness Interventions

Each individual has a unique and interacting set of genetic, lifestyle, and environmental factors that are reflected in their physical exam and laboratory biomarkers and significantly impact their experience of health. Patterns of nutrient deficiency signs and biomarker levels below health-promoting thresholds have been identified in national nutrition surveys. However, identifying these patterns remains a challenge in clinical medicine for many reasons, including clinician training and education, clinical time restraints, and the belief that these signs are both rare and recognizable only in cases of severe nutritional deficiencies. With an increased interest in prevention and limited resources for comprehensive diagnostic evaluations, a functional nutrition evaluation may augment patient-centered screening evaluations and personalized wellness programs. During LIFEHOUSE, we have documented physical exam, anthropometric, and biomarker findings that may increase the recognition of these wellness-challenging patterns in a population of 369 adult employees working in two occupational areas: administrative/sales and manufacturing/warehouse. Distinct and significant physical exam differences and constellations of biomarker abnormalities were identified. We present these patterns of physical exam findings, anthropometrics, and advanced biomarkers to assist clinicians in diagnostic and therapeutic interventions that may stem the loss of function that precedes the development of the non-communicable chronic diseases of aging.

New BMI Cut-Off Points for Obesity in Middle-Aged and Older Adults in Clinical Nutrition Settings in Italy: A Cross-Sectional Study

Obesity is a major health problem defined as an excess accumulation of body fat (BF). The World Health Organization (WHO) usually relies on a body mass index (BMI) ≥ 30 kg/m2 as an indicator of obesity. Due to changes in body composition that occur across the lifespan, with an increase in BF and a decrease in lean mass, we aimed to test the validity of this BMI cut-off point for adiposity in middle-aged and older adults. This cross-sectional study, composed of 4800 adults of mixed gender aged between 40 and 80 years, included (according to the WHO BMI classification) 1087 normal-weight, 1826 overweight, and 1887 obese individuals who were referred to the Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Italy. The sample was then categorized by adiposity status based on the total BF% as measured by dual-energy X-ray absorptiometry (DXA), and the best sensitivity and specificity were attained for predicting obesity according to the receiver operating characteristic curve (ROC) analysis. In a real-world clinical setting, a new BMI cut-off point (BMI = 27.27 kg/m2) has been identified for predicting obesity in middle-aged and older adults. Obesity guidelines in Italy therefore need to be revised accordingly.

The Effects of Zinc and Selenium Supplementation on Body Composition and Thyroid Function in Individuals with Overweight or Obesity: A Systematic Review

People with obesity have been found to have lower zinc (Zn) and selenium (Se) circulatory levels and abnormal thyroid function than people with normal weight. Studies about the effects of Zn and Se supplementation on body composition and thyroid function of overweight-obese people showed inconsistent results. A systematic review of randomized controlled trials was conducted to determine the effects of Ζn supplementation, Se supplementation, and their combination on body composition and thyroid function of individuals with overweight or obesity. Databases of PubMed, ScienceDirect, and Cochrane, were searched from inception to February 27, 2022, to identify relevant articles. For the assessment of the methodological quality of the studies, the Jadad scale was used. After screening the articles, thirteen studies were finally included and were analyzed using the strength of the evidence approach. Regarding the effectiveness of Zn supplementation on body composition, moderate evidence was found, while the effects of Se were found to be mixed. Zn supplementation was found to affect the thyroid function of people with overweight or obesity by increasing their free triiodothyronine (FT3) levels. However, this result is based only on one study among hypothyroid patients. At this point, the effectiveness of Zn, Se, and their combination, on the body composition and the thyroid function of people with overweight or obesity cannot safely be determined because of the controversial results, small number, and the limitations of the identified studies. The results of this systematic review must be interpreted with caution due to the limitations detected.

Why primary obesity is a disease?

Obesity must be considered a real pathology. In the world wide, obesity represent one of the major public health issue associated with increased morbidity and mortality. Overweight or obesity, in fact, significantly increases the risk of contracting diseases, such as: arterial hypertension, dyslipidemia, type 2 diabetes mellitus, coronary heart disease, cerebral vasculopathy, gallbladder lithiasis, arthropathy, ovarian polycytosis, sleep apnea syndrome, and some neoplasms. Despite numerous informative campaigns, unfortunately, the fight against obesity does not seem to work: in the last years, the prevalence continued to increase. The progressive and rapid increase in the incidence of obesity, which has characterized most of the economically advanced countries in the last decade, has been the main stimulus for the research of the mechanisms underlying this pathology and the related disorders. The aims of this review is to provide a revision of the literature in order to define obesity as diseases, secondly to highlight the limits and the inaccuracy of common tools used for the diagnosis of obesity, and as a third thing to strengthen the concept of the complexity of obesity as a disease among political health care providers. Obesity may be viewed as a multifactorial pathology and chronic low-grade inflammatory disease. In fact, people affected by obesity have greater risk of developing comorbility and morbility, respect to healthy. Hence, the absolute therapeutic benefit is directly proportional to the basic risk. So, internationally interest on early diagnosis of obesity is growing to avoid under- and overdiagnosis consequences. Therefore, the consequences are an aggravation of the disease and an increase in obesity related pathology like diabetes, cardiovascular disease, and cancer. The most widely used parameter for diagnosis, body mass index (BMI) is not suitable for assessing the body fat. In fact, several studies demonstrate that BMI alone cannot define obesity, which consists not so much in weight gain as in excess fat mass. The use of suitable tools for the assessment of fat mass percentage combined with clinical and genetic analysis allowed to identify different phenotypes of obesity, which explain the various paradoxes of obesity. It is essential to adopt all possible strategies to be able to combat obesity, ameliorate the suffering of patients, and reduce the social and treatment costs of obesity.

Anthropometric measures of central adiposity are highly concordant with predictors of cardiovascular disease risk in HIV patients

Background

Body fat redistribution and metabolic abnormalities found in HIV patients receiving highly active antiretroviral therapy (HAART) contribute to an atherogenic profile, increasing cardiovascular disease risk.

Objective

We aimed to evaluate adiposity measures/indexes and propose cutoffs associated with predictors of cardiovascular disease risk in HIV patients on HAART.

Design

To evaluate cardiovascular disease risk in this cross-sectional study, we conducted electrocardiogram exams and stress electrocardiography, measured the ankle brachial index and blood pressure arterial hypertension, conducted lipid biochemical tests, and measured blood glucose. We measured circumferences [waist (WC), hip, thigh, calf, neck, trunk] and skinfold thicknesses (biceps, triceps, subscapular, suprailiac), conducted bioelectrical impedance analysis (BIA), and calculated indexes [body mass index, waist-to-hip ratio, waist-to-thigh ratio, waist-to-calf ratio, waist-to-height ratio (WHtR), trunk-to-arm ratio, body mass index corrected for body fat mass, Body Adiposity Index, conicity index, body shape index, fat mass (percentage), and phase angle]. For evaluating the performance of all adiposity measures/indexes, we used receiver operating characteristic (ROC) curves.

Results

Measures of central adiposity WC and WHtR showed the best performances-WC area under the curve (AUC) for men: 0.83 (95% CI: 0.78, 0.89; P < 0.05); WC AUC for women: 0.86 (95% CI: 0.81, 0.91; P < 0.05); WHtR AUC for men: 0.83 (95% CI: 0.78, 0.88; P < 0.05); and WHtR AUC for women: 0.85 (95% CI: 0.80, 0.91; P < 0.05). All adiposity measures/indexes presented different cutoffs from those proposed for the HIV seronegative population. The cutoffs for WC were 87.75 cm (sensitivity: 82.2%; specificity: 75.5%) for men and 90.5 cm (sensitivity: 84.0%; specificity: 73.0%) for women.

Conclusions

The measures/indexes of central adiposity presented excellent associations with predictors of cardiovascular disease risk, and the use of the cutoffs proposed in the present study aims to contribute to the early identification of increasing risk of cardiovascular diseases, enabling interventions. This trial was registered at the Brazilian clinical trials registry Registro brasileiro de ensaios clínicos (Rebec) as RBR-9rcxbq.

Relationship between Height-Weight Difference Index and Body-Fat Percentage Estimated by Bioelectrical Impedance Analysis in Thai Adults

Introduction

The height-weight difference index (HWDI) is a new indicator for evaluating obesity status. While body-fat percentage (BF%) is considered to be the most accurate obesity evaluation tool, it is a more expensive method and more difficult to measure than the others.

Objective

Our objectives were to find the relationship between HWDI and BF% and to find a BF% prediction model from HWDI in relation to age and gender.

Method

Bioelectrical impedance analysis was used to measure BF% in 2,771 healthy adult Thais. HWDI was calculated as the difference between height and weight. Pearson's correlation coefficient was used to assess the relationship between HWDI and BF%. Multiple linear and nonlinear regression analysis were used to construct the BF% prediction model.

Results

HWDI and BF% were found to be inverse which related to a tendency toward a linear relationship. Results of a multivariate linear regression analysis, which included HWDI and age as variables in the model, predicted BF% to be 34.508 − 0.159 (HWDI) + 0.161 (age) for men and 53.35 − 0.265 (HWDI) + 0.132 (age) for women.

Conclusions

The prediction model provides an easy-to-use obesity evaluation tool that should help awareness of underweight and obesity conditions.

Sleep quality and duration is related with diet and obesity in young adolescent living in Sicily, Southern Italy

The aim of this study was to evaluate the association between sleeping habits, Mediterranean diet pattern, and weight status in an adolescent population. The sample consisted of 1586 individuals aged 11–14 years attending 15 secondary schools of Sicily, Southern Italy. School were randomly selected and the data collected during two school years. Anthropometric data was collected and body composition was assessed by bioelectrical impedance analysis. Demographic information, sleep duration, pediatric daytime sleepiness questionnaire (PDSS), physical activity and dietary habits (including adherence to the Mediterranean Diet using the KIDMED score) were further collected. The mean age was 12±0.7 and about 24% were overweight and obese. An inverse correlation between total sleep time and body mass index (β=−0.829, P=0.021), fat mass (β=−0.526, P=0.025), and waist circumference (β=−0.426, P=0.045) was found. Similar results were found for weekdays sleep time, while an inverse relationship was found with PDSS score. Adherence to Mediterranean Diet was higher in under/normal weight adolescent with a significant linear association between the KIDMED score and the PDSS, weekdays sleep time and total sleep time. Sleep duration was also associated positively with fruits and vegetable intake and negatively with sweet and snack consumption and eating outside habits. Short sleep duration and poor sleep were associated with an increase in BMI and fat mass as well as to unhealthy eating behaviors. These findings suggest that sleep patterns could be a potential target for obesity prevention programs in young adolescence.

Association of body composition and eating behavior in the normal weight obese syndrome

AIM

Our aim was to identify psychological and behavioral characteristics of women affected by normal weight obese (NWO) syndrome.

METHODS

Anthropometric, body composition, eating behavior and physical activity were evaluated in 79 women.

RESULTS

48.10 % of the subjects were found to be normalweight obese (NWO), 22.79 % normalweight lean (NWL), and 29.11 % pre-obese-obese (PreOB/OB) according to BMI and body composition. Significant differences (p < 0.001) among the groups were identified on analysis of the subscales of the Eating Disorder Inventory-2 (EDI-2), suggesting progressively increased presence of psychopathology relative to body composition. In a further analysis, results of the subscales of the EDI-2 were compared with body composition parameters, revealing that BMI co-varied with body composition variables and psychological responses. %TBFat co-varied exclusively with body composition variables (height, weight, BMI, KgTBFat, and a decrease of KgTBLean (R (2) = 0.96; Q (2) = 0.94). The NWO was discriminated from PreOB/OB group (compared to BMI) only on the basis of body composition variables (R (2) = 0.68; Q (2) = 0.60).

CONCLUSION

NWO women appeared to find themselves at a cognitive crossroads, attaining intermediate scores on the EDI-2 between normal weight lean women and pre-obese or obese women, in particular in terms of drive for thinness and body dissatisfaction. The NWO syndrome not only conveys an increased risk of cardiovascular and metabolic disease, but may also significantly overlap with other eating disorders in terms of psychological symptomatology, the correct identification of which may be the key in the successful management of these patients.

TRIAL REGISTRATION

ClinicalTrials.gov NCT01890070.

New obesity classification criteria as a tool for bariatric surgery indication

Obesity plays relevant pathophysiological role in the development of health problems, arising as result of complex interaction of genetic, nutritional, and metabolic factors. Due to the role of adipose tissue in lipid and glucose metabolism, and low grade inflammation, it is necessary to classify obesity on the basis of body fat composition and distribution, rather than the simply increase of body weight, and the Body Mass Index. The new term of adiposopathy (‘‘sick fat’’) clearly defines the pathogenic role of adipose tissue. Four phenotypes of obese individuals have been described: (1) normal weight obese (NWO); (2) metabolically obese normal weight; (3) metabolically healthy obese; and (4) metabolically unhealthy obese or “at risk” obese. Moreover, sarcopenic obesity has been related to all the phenotypes. The category of normal weight lean, represented by metabolically healthy normal weight has been classified to distinguish from NWO. It is crucial to recommend a bariatric surgery taking into account adiposopathy and sick fat that occurs with the expansion of fat mass, changing the inflammatory and metabolic profile of the patient. Body fat percentage and genetic polymorphism have to be evaluated to personalize the best bariatric surgery intervention.

Body composition indices and predicted cardiovascular disease risk profile among urban dwellers in Malaysia

Objectives. This study aims to compare various body composition indices and their association with a predicted cardiovascular disease (CVD) risk profile in an urban population in Kuala Lumpur, Malaysia. Methods. A cross-sectional survey was conducted in metropolitan Kuala Lumpur, Malaysia, in 2012. Households were selected using a simple random-sampling method, and adult members were invited for medical screening. The Framingham Risk Scoring algorithm was used to predict CVD risk, which was then analyzed in association with body composition measurements, including waist circumference, waist-hip ratio, waist-height ratio, body fat percentage, and body mass index. Results. Altogether, 882 individuals were included in our analyses. Indices that included waist-related measurements had the strongest association with CVD risk in both genders. After adjusting for demographic and socioeconomic variables, waist-related measurements retained the strongest correlations with predicted CVD risk in males. However, body mass index, waist-height ratio, and waist circumference had the strongest correlation with CVD risk in females. Conclusions. The waist-related indicators of abdominal obesity are important components of CVD risk profiles. As waist-related parameters can quickly and easily be measured, they should be routinely obtained in primary care settings and population health screens in order to assess future CVD risk profiles and design appropriate interventions.

Individually tailored screening of susceptibility to sarcopenia using p53 codon 72 polymorphism, phenotypes, and conventional risk factors

BACKGROUND AND AIM

p53 activity plays a role in muscle homeostasis and skeletal muscle differentiation; all pathways that lead to sarcopenia are related to p53 activities. We investigate the allelic frequency of the TP53 codon 72 in exon 4 polymorphism in the Italian female population and the association with appendicular skeletal muscle mass index in normal weight (NW), normal weight obese (NWO), and preobese-obese (Preob-Ob) subjects.

METHODS

We evaluated anthropometry, body composition, and p53 polymorphism in 140 women distinguished in NW, NWO, and Preob-Ob.

RESULTS

*Arg/*Arg genotype increases sarcopenia risk up to 20% (*Arg/*Arg genotype OR = 1.20; 95% CI = 0.48-2.9; *proallele carriers OR = 0.83; 95% CI = 0.83-2.06). The risk of being sarcopenic for *Arg/*Arg genotype in NWO and Preob-Ob is 31% higher than NW carriers of *proallele (RR = 0,31, 95% CI = 0,15-0,66, P = 0,0079). We developed a model able to predict sarcopenia risk based on age, body fat, and p53 polymorphism.

CONCLUSION

Our study evidences that genotyping TP53 polymorphism could be a useful new genetic approach, in association with body composition evaluations, to assess sarcopenia risk.