Accuracy of anthropometric indexes of obesity to predict diabetes mellitus type 2 among men and women with hypertension

Waist-to-Height Ratio: A Sensitive Tool for Assessing the Need for Nutritional Risk Management in Elderly Populations from Brazil

INTRODUCTION

Nutritional status assessment commonly relies on body mass index (BMI), which overlooks lean mass and adipose tissue distribution. However, waist circumference (WC) and waist-to-height ratio (WHtR) provide additional insights into fat accumulation. By combining these indices, it may be possible to identify older adults needing weight management interventions.

OBJECTIVES

To assess the WC and WHtR as strategies for identifying individuals requiring weight management.

METHODS

A cross-sectional study was conducted with 509 elderly individuals in Northeast Brazil. Weight, height, hip circumference, and waist circumference were measured, and combined with indices such as BMI WC, WHR, and WHtR to identify those who require weight management. The DeLong test compared areas under the curves using receiver operating characteristic curves and statistical significance. Sensitivity, specificity, and positive and negative predictive values were calculated to verify usefulness for clinical application. A validation sample of 599 elderly individuals from the country's Southern region was used to confirm the results.

RESULTS

Both WC and WHtR showed adequate diagnostic accuracy with no statistically significant difference in AUCs. WHtR ≥ 0.50 had 92% sensitivity in identifying men and women requiring nutritional management. WC presented lower sensitivity but 93% specificity, useful for excluding elderly individuals from the nutritional risk category. These results were consistent in the validation sample.

CONCLUSION

WHtR is a valuable index for screening nutritional risk management in the elderly population, applicable to men and women. Conversely, WC performs better in excluding individuals who do not need nutritional risk management.

The correlation between proinsulin, true insulin, proinsulin: True insulin ratio, 25(OH) D3, waist circumference and risk of prediabetes in Hainan Han adults

Purpose

Diabetes mellitus is a kind of highly prevalent chronic disease in the world. The intervention measures on the risk factors of prediabetes contribute to control and reduce the occurrence of diabetes. This study aimed to investigate the correlation between proinsulin (PI), true insulin (TI), PI/TI, 25(OH) D3, waist circumference (WC), and risk of prediabetes.

Methods

In this cross-sectional study, 1662 subjects including 615 prediabetes and 1047 non-prediabetes were recruited. Spearman’s correlation analysis was used to explore the association of PI, TI, PI/TI, 25(OH) D3, and waist circumference with prediabetes. Odds ratios (OR) and 95% confidence intervals (CI) were calculated by logistic regression. Receiver-Operator Characteristic (ROC) curve was used to evaluate the risk of prediabetes.

Results

Our study showed that FPI, 2hPI, FTI, 2hTI, FPI/FTI, and WC could enhance the risk of prediabetes (OR 1.034; OR 1.007; OR 1.005; OR 1.002; OR 3.577, OR 1.053, respectively; all p< 0.001). Stratified analyses indicated that FPI/FTI associated with an increased risk of prediabetes in men (OR 2.080, p = 0.042). FTI have a weak association with prediabetes risk in men and women (OR 0.987, p = 0.001; OR 0.994, p = 0.004, respectively). 2hPI could decrease prediabetes in women (OR 0.995, p = 0.037). Interesting, the sensitivity (86.0%) and AUC (0.942, p< 0.001) of combination (FPI+FTI+2hPI+2hTI+25(OH) D3+WC) were higher than the diagnostic value of these alone diagnoses. The optimal cutoff point of FPI, FTI, 2hPI, 2hTI, 25(OH) D3, and WC for indicating prediabetes were 15.5 mU/l, 66.5 mU/l, 71.5 mU/l, 460.5 mU/l, 35.5 ng/ml, and 80.5 cm, respectively. What’s more, the combination (FPI+FTI+2hPI+2hTI+25(OH) D3+WC) significantly improved the diagnostic value beyond the alone diagnoses of prediabetes in men and women (AUC 0.771; AUC 0.760, respectively).

Conclusion

The FPI, 2hPI, FTI, 2hTI, FPI/FTI, and WC significantly associated with an increased risk of prediabetes. The combination of FPI, FTI, 2hPI, 2hTI, 25(OH) D3, and WC might be used as diagnostic indicators for prediabetes.

The Zinc Transporter Zip7 Is Downregulated in Skeletal Muscle of Insulin-Resistant Cells and in Mice Fed a High-Fat Diet

Background: The zinc transporter Zip7 modulates zinc flux and controls cell signaling molecules associated with glucose metabolism in skeletal muscle. The present study evaluated the role of Zip7 in cell signaling pathways involved in insulin-resistant skeletal muscle and mice fed a high-fat diet. Methods: Insulin-resistant skeletal muscle cells were prepared by treatment with an inhibitor of the insulin receptor, HNMPA-(AM)3 or palmitate, and Zip7 was analyzed along with pAkt, pTyrosine and Glut4. Similarly, mice fed normal chow (NC) or a high-fat diet (HFD) were also analyzed for protein expression of Glut4 and Zip7. An overexpression system for Zip7 was utilized to determine the action of this zinc transporter on several genes implicated in insulin signaling and glucose control. Results: We identified that Zip7 is upregulated by glucose in normal skeletal muscle cells and downregulated in insulin-resistant skeletal muscle. We also observed (as expected) a decrease in pAkt and Glut4 in the insulin-resistant skeletal muscle cells. The overexpression of Zip7 in skeletal muscle cells led to the modulation of key genes involved in the insulin signaling axis and glucose metabolism including Akt3, Dok2, Fos, Hras, Kras, Nos2, Pck2, and Pparg. In an in vivo mouse model, we identified a reduction in Glut4 and Zip7 in the skeletal muscle of mice fed a HFD compared to NC controls. Conclusions: These data suggest that Zip7 plays a role in skeletal muscle insulin signaling and is downregulated in an insulin-resistant, and HFD state. Understanding the molecular mechanisms of Zip7 action will provide novel opportunities to target this transporter therapeutically for the treatment of insulin resistance and type 2 diabetes.

Correlation between body mass index and ocular parameters

Purpose: To investigate the relationship between BMI and selected ocular parameters.

Subjects and methods: Fifty-three left eyes of normal weight subjects and 67 age-sex matched overweight subjects were studied. Inclusion criteria for the normal weight and overweight groups included BMI between 18.5–22.9 and 23.0–29.9 kg/m², respectively. Subjects with a history of systemic disease, ocular disease or surgery, or disability were excluded. All subjects underwent a medical history interview, arterial blood pressure, height, weight, waist circumference and hip circumference measurements, and BMI and waist-hip ratio calculation. The intraocular pressure (IOP) and anterior corneal curvature were measured by non-contact tonometry and corneal topography, respectively. Measurement of anterior and posterior segment parameters of the eye, including central corneal thickness, anterior chamber depth (ACD), anterior chamber angle, macular thickness (MT), ganglion cell thickness (GCT), retinal nerve fiber layer thickness, cup to disc ratio, and choroidal thickness was performed by enhanced depth-imaging optical coherence tomography.

Results: There was a positive correlation between ACD and BMI (Univariate analysis; β =0.198, P=0.030, Multivariate analysis; β =0.410, P=0.005) and between BMI and IOP (Univariate analysis; β =0.269, P=0.003). The IOP of the overweight group was found to be significantly higher than of the normal weight group (12.80±3.40 and 11.86±2.12 mm Hg, respectively, P=0.002). Also, there was a significant difference found between the GCT and the MT of the two groups (P=0.036 and 0.009, respectively).

Conclusion: It was found that BMI strongly correlated with ACD and IOP. Also, the degree of obesity was found to be a significant factor; therefore, the relationship between these ocular parameters and the severity of obesity should be further investigated.

KCNQ1 variants associate with hypertension in type 2 diabetes and affect smooth muscle contractility in vitro

KCNQ1 encodes a potassium voltage-gated channel and represents a susceptibility locus for type 2 diabetes mellitus (T2DM). Here, we explored the association between KCNQ1 polymorphisms and hypertension risk in individuals with T2DM, as well as the role of KCNQ1 in vascular smooth muscle cell contraction in vitro. To investigate the relationship between KCNQ1 and the risk of developing hypertension in patients with T2DM, we divided the T2DM cohort into hypertension (n = 452) and non-hypertension (n = 541) groups. The Mann-Whitney U test, chi-square test, and multivariate regression analyses were used to assess the clinical characteristics and genotypic frequencies. In vitro studies utilized the rat aortic smooth muscle A10 cell line. Patients in the hypertension group were significantly older at the time of enrollment and had higher levels of body mass index, waist-to-hip ratio, and triglyceride than those in the non-hypertension group. The KCNQ1 rs3864884 and rs12576239 genetic variants were associated with hypertension in T2DM. KCNQ1 expression was lower in the individuals with the CC versus the CT and TT genotypes. Smooth muscle cell contractility was inhibited by treatment with a KCNQ1 inhibitor. These results suggest that KCNQ1 might be associated with hypertension in individuals with T2DM.

Is waist circumference a better predictor of diabetes than body mass index or waist-to-height ratio in Iranian adults?

Background:

Several measures of adiposity have been used for predicting diabetes. The results of studies regarding superiority of waist circumference (WC) to body mass index (BMI) are inconsistent. This study designed to compare the ability of different anthropometric measures in predicting diabetes and to determine their optimal cut-off values.

Methods:

A population-based cross-sectional study was conducted with 1,000 representative sample among adults aged 20–80 years in Babol, the Northern Iran. The demographic data were collected in a household survey, and the anthropometric measures of weight, height, waist, and hip circumference were measured with a standard method. Fasting blood sugar (FBS) ≥126 mg/dl was considered as diabetes. receiver operating characteristic analysis was used to estimate the predictive ability of different anthropometric indexes and their optimal cut-off values for high FBS.

Results:

The overall prevalence rate of diabetes was 14.0% (14.4% in men vs. 13.5% in women, P = 0.65). The prevalence rate was significantly higher in older age (>60 years), low educated and obese (P = 0.001). The mean of BMI, WC, waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR) were significantly higher among diabetic in both sexes (P = 0.001). Among men, WC (area under the ROC curve [AUC] =0.64) and WHtR (AUC = 0.63) have slightly higher accuracy index compared with BMI (AUC = 0.62) or WHR (AUC = 0.60). In contrast, among women, WHtR (AUC = 0.69) and WC (AUC = 0.68) yielded slightly better predictive than BMI (AUC = 0.67). The optimal cut-off values obtained for BMI and WHtR were similar between two sexes (BMI = 24.95 kg/m² for men and BMI = 25.2 kg/m² for women, WHtR = 0.51 for both sexes) whereas the optimal cut-off value for WC was higher in men than women (98.5 cm men vs. 89.5 cm women).

Conclusions:

Overall WC and WHtR exhibited a slightly better discriminate performance than BMI for diabetes in both sexes, particularly in women.

High prevalence of overweight, obesity, and hypertension with increased risk to cardiovascular disorders among adults in northwest Ethiopia: a cross sectional study

BACKGROUND

Overweight and obesity are components of a defined cluster of risk factors for non-communicable diseases, once problems for only the high-income countries, in recent days became rampant in developing countries. Despite the lack of extensive data on metabolic and cardio vascular disorders in Ethiopia, the prevalence of obesity among young adults (15-24 years), in a cross sectional study conducted in 1997, was 0.7% for men and 6% for women. The prevalence of hypertension (HTN) was found to be 7.1% of the population. The objective of this study was to see the prevalence and association of overweight, obesity and HTN and to check if there was any agreement among the various anthropometric measurements in detecting overweight and obesity.

METHODS

This cross-sectional study was conducted in Gondar city, Northwest Ethiopia. A total of 68 participants with age >18 year were randomly selected and included. Data were collected using questionnaires and through physical measurements of weight, height and blood pressure, using the WHO recommendations.

RESULT

The prevalence of hypertension was 13.3% (9/68). The prevalence of overweight based on calculated body mass index (BMI) was 32.4% (22/68) while the prevalence of obesity was 16.2% (11/68). Body fat percentage (BFP) effectively classified all of the 'overweight' and 'obese' values according to the BMI as 'overweight/obese' (P = 0.016). Risk level classification with waist circumference enabled to correctly classify most (90.9%) and all of the 'overweight' and 'obese' BMI values as 'increased risk/substantially increased risk' (P < 0.001). Similarly, waist-to-height ratio (WHtR) was able to classify all 'overweight' and 'obese' BMI values as 'increased risk/substantially increased risk' (P < 0.001).

CONCLUSION

In conclusion, the current study was able to detect a high prevalence of overweight, obesity, and HTN among adult population in Gondar town. There is a prevalent high level of general adiposity and central obesity. WHtR and BFP were the most efficient measurements to identify all 'high risk' groups of individuals as 'high risk' irrespective of their gender. Further study is recommended to elucidate the risk factors and complications of obesity and overweight in the study area and beyond.

Effects of FTO RS9939906 and MC4R RS17782313 on obesity, type 2 diabetes mellitus and blood pressure in patients with hypertension

Background

Genetic variants of the FTO gene rs9939609 A/T and the MC4R gene rs17782313 C/T have been associated with obesity. Individuals with mutations in MC4R gene have lower blood pressure (BP), independently of obesity. This study aimed to investigate the association of FTO rs9939609 and MC4R rs17782313 with anthropometric indexes, BP, and type 2 diabetes mellitus among hypertensive patients.

Methods

We genotyped 217 individuals (86 men and 131 women) with hypertension (systolic or diastolic BP ≥ 140/90 mmHg or using antihypertensive drugs). Diabetes mellitus was diagnosed according to the American Diabetes Association criteria. Waist and neck circumferences (cm), Body Adiposity Index (BAI,%), Lipid Accumulation Product Index (LAP, cm.mmol.l) and body mass index (BMI, kg/m²) were analyzed using analysis of covariance or modified Poisson’s regression.

Results

Rare allele frequencies were 0.40 for A for FTO rs9939609 and 0.18 for C for MC4R rs17782313. A positive association of FTO rs9939609 and MC4R rs17782313 with BMI was observed in the overall sample. Among men and women, neck circumference was associated with the FTO genotype and, for women, MC4R genotype. In contrast, in men we found a negative association of MC4R rs17782313 with diastolic BP (TT 90.1 ±12.2, TC/CC 83.2 ±12.1; P = 0.03) and borderline association for systolic BP after controlling for age and BMI.

Conclusions

Common genetic variants of FTO rs9939609 have positive associations with BMI and neck circumference and MC4R rs17782313 in women, but a negative association with diastolic and mean blood pressure in men with hypertension.

Body condition scoring as a predictor of body fat in horses and ponies

Body condition scoring systems were originally developed to quantify flesh cover in food animals and are commonly used to evaluate body fat in Equidae. The relationship between concurrent estimates of body fat content (eTBF%, deuterium oxide dilution; range, 2.7-35.6%) and subjective appraisals of body 'fatness' (body condition score, BCS; range, 1.25-9/9), was investigated in 77 mature horses and ponies. Univariate (UVM, r(2)=0.79) and multivariable (MVM, r(2)=0.86) linear regression models described the association, where BCS and eTBF% were explanatory and outcome variables, respectively. Other measures (age, sex, breed, body mass, ultrasound-generated subcutaneous and abdominal retroperitoneal fat depths, withers height, heart and belly circumferences) were considered as potential confounders but only height, belly circumference and retroperitoneal fat depth remained in the final MVM. The association between BCS and eTBF% was logarithmic. Appraisal of the transformed regression (UVM), actual eTBF% values and 95%CIs of the model forecast, suggested that the power of log-transformed BCS as a predictor of eTBF% decreased as BCS increased. The receiver operating characteristic curve for the prediction of horses with an eTBF% of >20%, suggested that the UVM correctly classified 76% of horses using a 'cut-off' of BCS 6.83/9 (sensitivity, 82.5%; specificity, 70.8%). Negative values for eTBF% were obtained for two thin ponies which were excluded from analyses, and caution is advised in the application of deuterium dilution methodologies where perturbed tissue hydration could be predicted. The data suggest that BCS descriptors may warrant further consideration/refinement to establish more clinically-useful, sub-classifications for overweight/obese animals.