Asian Americans have greater prevalence of metabolic syndrome despite lower body mass index

Evaluation of visceral adipose tissue thresholds for elevated metabolic syndrome risk across diverse populations: A systematic review

Beyond obesity, excess levels of visceral adipose tissue (VAT) significantly contribute to the risk of developing metabolic syndrome (MetS), although thresholds for increased risk vary based on population, regions of interest, and units of measure employed. We sought to determine whether a common threshold exists that is indicative of heightened MetS risk across all populations, accounting for sex, age, BMI, and race/ethnicity. A systematic literature review was conducted in September 2023, presenting threshold values for elevated MetS risk. Standardization equations harmonized the results from DXA, CT, and MRI systems to facilitate a comparison of threshold variations across studies. A total of 52 papers were identified. No single threshold could accurately indicate elevated risk for both males and females across varying BMI, race/ethnicity, and age groups. Thresholds fluctuated from 70 to 165.9 cm2, with reported values consistently lower in females. Generally, premenopausal females and younger adults manifested elevated risks at lower VAT compared to their older counterparts. Notably, Asian populations exhibited elevated risks at lower VAT areas (70-136 cm2) compared to Caucasian populations (85.6-165.9 cm2). All considered studies reported associations of VAT without accommodating covariates. No single VAT area threshold for elevated MetS risk was discernible post-harmonization by technology, units of measure, and region of interest. This review summarizes available evidence for MetS risk assessment in clinical practice. Further exploration of demographic-specific interactions between VAT area and other risk factors is imperative to comprehensively delineate overarching MetS risk.

The Moderating Role of Collectivism on Physical Activity and Family Support: A Cross-Sectional Design

BACKGROUND

An important value among Korean Americans is collectivism or giving a group priority over the individual. This value, family support, and demographic characteristics have been reported to influence health behaviors among this group. Yet, no study has examined how collectivism, family support, and demographic characteristics interact with each other and then influence physical activity among Korean American adults. The purpose of the study was to examine the association between family support and physical activity, and the moderating role of demographic characteristics and collectivism on this association among Korean American adults.

METHODS

A descriptive, cross-sectional study was conducted with a sample of 110 Korean American adults 18 years and older, residing in a Southwestern city in the United States. Self-administered questionnaires were used to measure demographics, collectivism, family support, and physical activity.

RESULTS

Data analysis using a zero-inflated negative binomial regression model revealed a positive relationship between family support and physical activity, while age and gender were moderators of the relationship between family support and physical activity. Collectivism was positively related to physical activity and moderated the relationship between family support and physical activity.

CONCLUSION

These findings indicate the significance of collectivism and family support that influence Korean American adults' physical activity.

Cardiovascular Risk Factors Among Asian Americans: Perspectives on the Role of Acculturation in Cardiovascular Diseases Health Disparities

The growing prevalence of cardiovascular diseases in the United States (US) has disproportionately affected minority populations more than their white counterparts. A population that is often overlooked is the Asian American population, particularly Southeastern Asian immigrants. Despite having relatively favorable socioeconomic indicators compared to the general US population, Asian Americans, specifically Southeast Asian individuals, face a significant burden of traditional cardiovascular risk factors and are considered a high cardiovascular disease risk group. In addition, most studies have aggregated Asian populations into one major racial group rather than analyzing the different ethnicities among the Asian categorization. While some studies suggest that the acculturation process has some degree of impact on cardiovascular health, there has not been a widely-used tool to measure or ascertain the totality of acculturation. Instead, multiple proxies have been used to measure acculturation, and prior studies have argued for more culturally-tailored acculturation proxies. This paper aims to assess the implications of different acculturation measures on cardiovascular health among Asian Americans, particularly Southeastern Asian immigrants. The following proxies were expanded on in this paper: English spoken at home, length of stay in the US, religiosity and spirituality, and admixed family structures. Previous studies showed that as the length of stay in the US increases, the burden of cardiovascular risk factors increases. However, the impact of English spoken at home, religiosity, and admixed family structure are still inconclusive given the extent of current studies. While most studies suggest that an increase in acculturation increases the risk of cardiovascular disease, it is critical to note that acculturation is a multifaceted process. Therefore, more studies are necessary to appropriately examine the implications of various acculturation processes on cardiovascular risk factors in Asians, specifically Southeastern Asian individuals in the US.

Asthma heterogeneity among Asian American children: The California Health Interview Survey

BACKGROUND

The Asian American (AsA) population is heterogenous and rapidly growing; however, little is known regarding childhood asthma burden among AsA ethnic groups. The relation between obesity and asthma in AsA ethnic groups also remains unclear.

OBJECTIVE

To evaluate asthma prevalence and the relation of obesity to asthma risk among children in 7 AsA ethnic groups.

METHODS

We analyzed data from the California Health Interview Survey from 2011 to 2020. AsA ethnicities were self-reported. Body mass index z-scores, calculated from self-reported height/weight, were used to categorize children by obesity status, based on body mass index-for-age growth charts. Prevalence of self-reported lifetime doctor-diagnosed asthma and asthma attack in the last 12 months was calculated. We performed multivariable logistic regressions adjusting for age and sex.

RESULTS

Of 34,146 survey respondents, 12.2% non-Hispanic White and 12.5% AsA children reported lifetime asthma. Among AsA ethnic groups, however, lifetime asthma ranged from 5.1% (Korean American) to 21.5% (Filipino American). Non-Hispanic White children and AsA children had a similar lifetime asthma prevalence (adjusted odds ratio [aOR], 1.05; 95% CI, 0.71-1.55; P = .81), but prevalence was lower in Korean American children (aOR, 0.37; 95% CI, 0.19-0.73; P = .004) and higher in Filipino American children (aOR, 1.97; 95% CI, 1.22-3.17; P = .006). The lifetime asthma prevalence of different AsA ethnic groups persisted even when stratified by obesity status.

CONCLUSION

Childhood lifetime asthma prevalence varied among AsA ethnic groups, with lowest prevalence in Korean American children and highest prevalence in Filipino American. Further characterization of asthma burden among AsA ethnic groups may help guide asthma screening and prevention measures and offer new insights into asthma pathogenesis.

Risk of Sleep Apnea Is Associated with Abdominal Obesity Among Asian Americans: Comparing Waist-to-Hip Ratio and Body Mass Index

OBJECTIVE

This study examines associations between the risk of sleep apnea and abdominal obesity (assessed by waist-to-hip ratio (WHR)) and general obesity (assessed by body mass index (BMI)) in a sample of Chinese and Korean American immigrants.

METHODS

The dataset included Chinese and Korean participants aged 50-75 who were recruited from primary care physicians' clinics from April 2018 to June 2020 in the Baltimore-Washington D.C. Metropolitan area (n = 394). Abdominal obesity was determined if WHR ≥ 0.9 in men and WHR ≥ 0.85 in women. General obesity was determined if BMI ≥ 30. The risk of sleep apnea was determined by using the Berlin questionnaire. Poisson regression models examined associations between sleep apnea risk and obesity. Models controlled for socio-demographic risk factors.

RESULTS

Twelve percent of the study participants were classified as a high risk for sleep apnea, and 75% had abdominal obesity whereas 6.4% had general obesity. High risk of sleep apnea was positively associated with abdominal obesity (PR = 1.31, 95% CI: 1.17-1.47) and general obesity (PR = 2.19, 95% CI: 0.90-5.32), marginally significant at p < 0.1).

CONCLUSIONS

Chinese and Korean immigrants living in the USA who are at high risk of sleep apnea have higher abdominal obesity, even after accounting for sociodemographic characteristics. Abdominal obesity may be a better indicator than general obesity when examining the risk of sleep apnea among Asian Americans.

INFORMATION ON CLINICAL TRIAL

Name: Screening To Prevent ColoRectal Cancer (STOP CRC) among At-Risk Asian American Primary Care Patients NCT Number: NCT03481296; Date of registration: March 29, 2018 URL: https://clinicaltrials.gov/ct2/show/NCT03481296?term=Sunmin+Lee&draw=2&rank=1.

Reallocating time between device-measured 24-hour activities and cardiovascular risk in Asian American immigrant women: An isotemporal substitution model

The 24-hour day consists of physical activity (PA), sedentary behavior, and sleep, and changing the time spent on one activity affects the others. Little is known about the impact of such changes on cardiovascular risk, particularly in Asian American immigrant (AAI) women, who not only have a higher cardiovascular risk but also place greater cultural value on family and domestic responsibilities compared to other racial/ethnic groups. The purpose of this study was to evaluate the effects of reallocating 30 minutes of each 24-hour activity component for another on BMI, waist circumference, and blood pressure in AAI women. Seventy-five AAI women completed 7 days of hip and wrist actigraphy monitoring and were included in the analysis (age = 61.5±8.0 years, BMI = 25.5±3.6 kg/m2, waist circumference = 85.9±10.2 cm). Sleep was identified from wrist actigraphy data, and moderate-to-vigorous PA (MVPA), light PA, and sedentary behavior identified from hip actigraphy data. On average, the women spent 0.5 hours in MVPA, 6.2 hours in light PA, 10 hours in sedentary activities, and 5.3 hours sleeping within a 24-hour day. According to the isotemporal substitution models, replacing 30 minutes of sedentary behavior with MVPA reduced BMI by 1.4 kg/m2 and waist circumference by 4.0 cm. Replacing that same sedentary time with sleep reduced BMI by 0.5 kg/m2 and waist circumference by 1.4 cm. Replacing 30 minutes of light PA with MVPA decreased BMI by 1.6 kg/m2 and waist circumference by 4.3 cm. Replacing 30 minutes of light PA with sleep also reduced BMI by 0.8 kg/m2 and waist circumference by 1.7 cm. However, none of the behavioral substitutions affected blood pressure. Considering AAI women's short sleep duration, replacing their sedentary time with sleep might be a feasible strategy to reduce their BMI and waist circumference.

How acculturation contributes to a rise of diabetes in Hmong Americans

ABSTRACT

This article explores the reasons for the high prevalence of diabetes among Hmong Americans, who are at greater risk for diabetes compared with non-Hispanic White patients and have a higher prevalence of diabetes than other Asian Americans and other races. Knowledge of this issue may allow medical practitioners to identify, screen, and treat Hmong Americans more frequently and at earlier ages. Although better integration of healthcare services, access, and education are needed, earlier screening may help start the diabetes education process sooner; reduce hospital, ED, and office visits; reduce costs; and prevent end-organ damage.

Infant Body Composition in an Asian Pacific Islander Population

BACKGROUND

Normative infant body composition data using air displacement plethysmography (ADP) are from primarily Caucasian populations. Racial differences may exist.

OBJECTIVES

To describe body composition in Asian and Pacific Islander infants and compare them to previously published data on Caucasian infants.

DESIGN

Body composition was measured using ADP with the PEA POD® Infant Body Composition System in 249 healthy full-term newborns in a predominately Asian and Pacific Islander population in Hawaii within the first 3 days of life and compared to published data on Caucasian infants with multiple t-tests adjusted for false discovery rate.

RESULTS

There were no differences in percent body fat between Asian, Pacific Islander, or mixed race Asian Pacific Islander infants. Both Asian and Pacific Islander infants had significantly higher percent body fat than Caucasians from Italy in Europe (13.2% and 11.8% vs 8.9%, p < 0.01 among males, 15.3% and 15.6% vs 8.7%, p < 0.01 among females) but not when compared to Caucasians from New York.

CONCLUSIONS

Racial and geographical differences in body composition exist at birth between Asian and Pacific Islanders and other Caucasian cohorts. Previously published ADP nomograms must be interpreted with caution. Future studies are needed to investigate the impact of environmental, perinatal, and genetic factors on infant body composition and its relationship to future cardiometabolic morbidity. Efforts to address racial disparities in cardiometabolic disease measures must also address pre-conceptual maternal health, which may have long-term implications on future body composition in offspring.

Clinical implications of changes in metabolic syndrome status after kidney transplantation: a nationwide prospective cohort study

BACKGROUND

Metabolic syndrome (MetS) is prevalent in patients with end-stage kidney disease, and kidney transplantation is expected to modify the metabolic status. However, whether changes in metabolic status at the time of transplantation affect recipient outcomes remains unclear.

METHODS

We analyzed 4187 recipients registered in a nationwide prospective cohort from 2014 to 2020. MetS was defined as the presence of three or more components of the metabolic syndrome. Patients were classified based on the pre- and post-transplant MetS status: MetS-free, MetS-developed, MetS-recovered and MetS-persistent. Study outcomes were occurrence of death-censored graft loss and a composite of cardiovascular events and death.

RESULTS

Among recipients without pre-transplant MetS, 19.6% (419/2135) developed post-transplant MetS, and MetS disappeared in 38.7% (794/2052) of the recipients with pre-transplant MetS. Among the four groups, the MetS-developed group showed the worst graft survival rate, and the MetS-persistent group had a poorer composite event-free survival rate. Compared with the MetS-free group, the MetS-developed group was associated with an increased risk of graft loss [adjusted hazard ratio (aHR) 2.35; 95% confidence interval (CI) 1.17-4.98] and the risk of graft loss increased with increasing numbers of dysfunctional MetS components. MetS-persistent was associated with increased risks of cardiovascular events and death (aHR 2.46; 95% CI 1.12-5.63), but changes in the number of dysfunctional MetS components was not.

CONCLUSION

Kidney transplantation significantly alters the metabolic status. Newly developed MetS after transplantation was associated with an increased risk of graft loss, whereas persistent MetS exposure before and after transplantation was associated with increased risks cardiovascular events and patient survival.

Cardiovascular-Kidney-Metabolic Health: A Presidential Advisory From the American Heart Association

Cardiovascular-kidney-metabolic health reflects the interplay among metabolic risk factors, chronic kidney disease, and the cardiovascular system and has profound impacts on morbidity and mortality. There are multisystem consequences of poor cardiovascular-kidney-metabolic health, with the most significant clinical impact being the high associated incidence of cardiovascular disease events and cardiovascular mortality. There is a high prevalence of poor cardiovascular-kidney-metabolic health in the population, with a disproportionate burden seen among those with adverse social determinants of health. However, there is also a growing number of therapeutic options that favorably affect metabolic risk factors, kidney function, or both that also have cardioprotective effects. To improve cardiovascular-kidney-metabolic health and related outcomes in the population, there is a critical need for (1) more clarity on the definition of cardiovascular-kidney-metabolic syndrome; (2) an approach to cardiovascular-kidney-metabolic staging that promotes prevention across the life course; (3) prediction algorithms that include the exposures and outcomes most relevant to cardiovascular-kidney-metabolic health; and (4) strategies for the prevention and management of cardiovascular disease in relation to cardiovascular-kidney-metabolic health that reflect harmonization across major subspecialty guidelines and emerging scientific evidence. It is also critical to incorporate considerations of social determinants of health into care models for cardiovascular-kidney-metabolic syndrome and to reduce care fragmentation by facilitating approaches for patient-centered interdisciplinary care. This presidential advisory provides guidance on the definition, staging, prediction paradigms, and holistic approaches to care for patients with cardiovascular-kidney-metabolic syndrome and details a multicomponent vision for effectively and equitably enhancing cardiovascular-kidney-metabolic health in the population.

Measuring Racial Differences in Obesity Risk Factors in Non-Hispanic Black and White Men Aged 20 Years or Older

Obesity prevalence in the United States has increased drastically in the last two decades. Racial differences in obesity have emerged with the increase in obesity, with temporal trends because of individual, socioeconomic, and environmental factors, eating behaviors, lack of exercise, etc., raising questions about understanding the mechanisms driving these racial differences in the prevalence of obesity among non-Hispanic Black (NHB) and non-Hispanic White (NHW) men. Although many studies have measured obesity using body mass index (BMI), little is known about waist circumference (WC). This study examines variations in obesity among NHW and NHB using BMI and WC. We used National Health and Nutrition Examination Surveys (1999-2016) with a sample of 9,000 NHW and 3,913 NHB men aged 20 years or older. To estimate the association between the prevalence of obesity (BMI ≥30) and race, we applied modified Poisson regression; to explore and decompose racial differences, we used Oaxaca-Blinder decomposition (OBD). We found that NHW had higher abdominal obesity (WC ≥102) than NHB, but NHB were more likely to be obese (BMI ≥30) during most years, with some fluctuations. Modified Poisson regression showed that NHB had a higher prevalence of obesity (prevalence ratio [PR]: 1.11, 95% confidence interval [CI] = [1.04, 1.18]) but lower abdominal obesity (PR: 0.845; 95% CI = [0.801, 0.892]) than NHW. OBD showed that age, access to health care, smoking, and drinking contributed to the differences in abdominal obesity. The study identifies a significant increase in obesity among men over the last two decades; generalized obesity (based on BMI) was more problematic for NHB men, but abdominal obesity was more problematic for NHW men.

Epicardial fat in patients with metabolic syndrome: A systematic review and meta-analysis

PURPOSE

Abnormally increased epicardial fat appears to be associated with an additional risk of major adverse cardiovascular events (MACEs) in the context of metabolic syndrome (MetS). However, evidence on the relationship between epicardial fat volumes (EFVs), epicardial fat thickness (EFT) and MetS remains inconsistent.

METHODS

Specific searches of electronic databases from 1 January 2000 to 31 October 2022 were independently performed by two researchers. In this study, two quantification measures of epicardial fat were included: comparison of total computed tomography-based EFVs and EFT between two groups (individuals with and without MetS), estimating standardized mean difference (SMD) with corresponding 95 % confidence intervals (CIs) through a random-effects model analysis. The heterogeneity in the included studies was explored by meta-regression and subgroup analyses.

RESULTS

The EFVs were significantly increased in MetS subjects compared with non-MetS subjects (SMD: 1.07, 95 % CI: 0.69-1.45, p < 0.001), and the EFT was also significantly larger in MetS patients than in the Non-MetS (SMD: 1.12, 95 % CI: 0.84-1.41, p < 0.001). We compared the Caucasian and American subgroups with the Asian and African subgroups, and the EFT was greater in the former subgroups (SMD: 1.32, 95 % CI: 0.44-2.20, p < 0.001). When comparing the EFT among the age subgroups, there was a significant SMD between adolescents and adults or elderly individuals (SMD: 1.21, 95 % CI: 0.84-1.52, p < 0.001).

CONCLUSIONS

MetS patients tend to present greater EFT near the right ventricular free wall and greater total EFVs. Increased epicardial fat, an imaging biomarker, independently affects the onset of MetS.

Assessment of Corrected QT Interval and QT Dispersion in Patients with Uncomplicated Metabolic Syndrome

Aim

Metabolic syndrome (MS) itself has become a new entity being a constellation of physiological, biochemical, metabolic, and clinical factors that have been related to an increased risk of cardiovascular diseases, type 2 diabetes mellitus (T2DM), and morbidity and mortality. The burden of MS is increasing all over the world with the current prevalence being 30%. The QT interval and QT dispersion (QTd) have been long associated with ventricular arrhythmia and sudden cardiac deaths. The association between QT and diabetes and healthy subjects has been clearly studied, but the association between QT and uncomplicated MS has not been very well defined.

Methods

A total of 400 patients visiting the medicine clinics were assessed for blood pressure, anthropometric measurements, fasting serum lipid profile, FBS, and electrocardiogram (ECG). The patients diagnosed with uncomplicated MS as per the International Diabetic Federation (IDF) criteria were included in the study. QT interval in the ECG was recorded, and the relationship between various parameters of an uncomplicated MetS and the QT interval was recorded.

Results

Our study revealed more females with uncomplicated MS as compared to males and increasing burden as age progressed. Body mass index (BMI), waist circumference (WC), hip circumference (HC), WHP, systolic blood pressure (SBP), Diastolic blood pressure (DBP), Fasting blood sugar (FBS), serum cholesterol, triglyceride (TG), and low-density lipoprotein (LDL) levels were positively correlated with QT values.

Conclusion

QT interval, a strong predictor of malignant ventricular arrhythmias and sudden cardiac deaths, is associated with uncomplicated MS.

Trends in Prevalence of Gout Among US Asian Adults, 2011-2018

Importance

Gout disparities among Black individuals in the US have recently been explained by socioclinical factors; however, no information is available among Asian individuals living in Western countries, despite their disproportionately worsening metabolic health.

Objective

To determine the prevalence of gout and serum urate concentrations according to race and ethnicity and to explore the association of social determinants of health and clinical factors.

Design, Setting, and Participants

This is a population-based, cross-sectional analysis. Data from a nationally representative sample of US adults were obtained from the National Health and Nutrition Examination Survey (NHANES) (2011-2018) in which Asian race data were collected (primary). Data from the UK Biobank (2006-2021) were used for replication of the Asian vs White differences. Data analysis was performed from December 2021 to September 2022.

Main Outcomes and Measures

Race-specific gout prevalence and serum urate levels.

Results

A total of 22 621 participants from NHANES (2011-2018) were included in the analysis (mean [SD] age, 49.8 [17.8] years; 10 948 male participants [48.4%]). In 2017 to 2018, gout affected 12.1 million US individuals, with its crude prevalence increasing from 3.6% (95% CI, 2.8%-4.5%) in 2011 to 2012 to 5.1% (95% CI, 4.2%-5.9%) in 2017 to 2018 (P for trend = .03); this trend was no longer significant after age adjustment (P for trend = .06) or excluding Asian individuals (P for trend = .11). During the same period, age- and sex-adjusted prevalence among Asian Americans doubled from 3.3% (95% CI, 2.1%-4.5%) to 6.6% (95% CI, 4.4%-8.8%) (P for trend = .007) to numerically exceed all other racial and ethnic groups in 2017 to 2018, with age- and sex-adjusted odds ratio (ORs) of 1.61 (95% CI, 1.03-2.51) and a socioclinical factor-adjusted multivariable OR of 2.62 (95% CI, 1.59-4.33) for Asian vs White individuals. The latest age- and sex-adjusted gout prevalence among US individuals aged 65 years and older was 10.0% among White individuals and 14.8% among Asian individuals (including 23.6% of Asian men). Serum urate concentrations also increased between 2011 and 2018 among US Asian individuals (P for trend = .009). The Asian vs White disparity was also present in the UK Biobank.

Conclusions and Relevance

The findings of this study suggest that the prevalence of gout among Asian individuals numerically surpassed that for all other racial and ethnic groups in 2017 to 2018. This Asian vs White disparity did not appear to be associated with socioclinical factors.

Assessing the clinical utility of major indices for nonalcoholic fatty liver disease in East Asian populations

Nonalcoholic fatty liver disease (NAFLD) is currently the most common form of chronic liver disease. The growing prevalence of NAFLD is strongly associated with the high incidence of metabolic syndrome. NAFLD affects as much as 19% of the US population with a disproportionate impact on minority racial groups such as Asian Americans. If not promptly managed, NAFLD may progress to more feared complications. Liver indices for NAFLD screening have been proposed but were often developed using study populations with different anthropometrics than patients of East Asian descent. This review compares the accuracy of five indices for NAFLD screening in Asian cohorts. The Fatty Liver Index performed well in multiple large-scale community studies, although other indices may be more suited for specific patient cohorts. This is important, as the utilization of liver indices could accelerate screening for NAFLD for early management and to reduce liver disease-related health disparities among Asian Americans.

Does Metabolic Syndrome Impact the Risk of Reoperation, Revision, or Complication After Primary Total Knee Arthroplasty?

BACKGROUND

Metabolic syndrome (MetS) is an increasingly frequent condition characterized by insulin resistance, abdominal obesity, hypertension, and dyslipidemia. This study evaluated implant survivorship, complications, and clinical outcomes of primary TKAs performed in patients who have MetS.

METHODS

Utilizing our institutional total joint registry, 2,063 primary TKAs were performed in patients with a diagnosis of MetS according to the World Health Organization criteria. MetS patients were matched 1:1 based on age, sex, and surgical year to those who did not have the condition. The World Health Organization's body mass index (BMI) classification was utilized to evaluate the effect of obesity within MetS patients. Kaplan-Meier methods were utilized to determine implant survivorship. Clinical outcomes were assessed with Knee Society scores. The mean follow-up was 5 years.

RESULTS

MetS and non-MetS patients did not have significant differences in 5-year implant survivorship free from any reoperation (P = .7), any revision (P = .2), and reoperation for periprosthetic joint infection (PJI; P = .2). When stratifying, patients with MetS and BMI >40 had significantly decreased 5-year survivorship free from any revision (95 versus 98%, respectively; hazard ratio = 2.1, P = .005) and reoperation for PJI (97 versus 99%, respectively; hazard ratio = 2.2, P = .02). Both MetS and non-MetS groups experienced significant improvements in Knee Society Scores (77 versus 78, respectively; P < .001) that were not significantly different (P = .3).

CONCLUSION

MetS did not significantly increase the risk of any reoperation after TKA; however, MetS patients with BMI >40 had a two-fold risk of any revision and reoperation for PJI. These results suggest that obesity is an important condition within MetS criteria and remains an independent risk factor.

LEVEL OF EVIDENCE

Level 3, Case-control study.

A Causal and Inverse Relationship between Plant-Based Diet Intake and in a Two-Sample Mendelian Randomization Study

A plant-based diet (PBD) has been reported to be linked to metabolic syndrome (MetS) risk in observational studies, but not in causal association studies. We aimed to examine the hypothesis that high PBD exhibited a causal and inverse association with MetS and its components using two-sample Mendelian randomization (MR). PBD was clustered according to food intake, which was assessed by semi-quantitative food frequency questionnaires using a principal component analysis. The instrumental variables were generated using the genome-wide association study (GWAS) of a High-PBD group (≥67th percentiles) after adjusting for the covariates related to MetS, with a significance level of p < 5 × 10^-5 and linkage disequilibrium (r² < 0.001), in a city hospital-based cohort (n = 58,701). The causal association of the PBD intake with MetS risk was examined with a two-sample MR approach in the rural plus Ansan/Ansung cohorts (n = 13,598). The High-PBD group showed higher energy, fat, protein, cholesterol, fiber, sodium, calcium, vitamin C and D, and flavonoid intake than the Low-PBD group. The High-PBD group showed a lower risk of MetS, waist circumference, hyperglycemia, hypo-HDL-cholesterolemia, and hypertriglyceridemia using an inverse-variance weighted method (p < 0.05). Low-PBD intake significantly elevated only waist circumference in weighted-median analysis (p < 0.05). No heterogeneity, horizontal pleiotropy, or single genetic variant influenced the causal relationship. In conclusion, low PBD appeared to be causally positively related to MetS risk and its components, but not hypertension. Therefore, Korean-style PBD may be beneficial for decreasing MetS risk in Asian adults.

Association of Acculturation with Cardiovascular Risk Factors in Asian-American Subgroups

Objective

This cross-sectional study aims to better understand the heterogeneous associations of acculturation level on CV risk factors among disaggregated Asian subgroups. We hypothesize that the association between acculturation level and CV risk factors will differ significantly by Asian subgroup.

Methods

We used the National Health Interview Survey (NHIS), a nationally representative US survey, years 2014-18. Acculturation was defined using: (a) years in the US, (b) US citizenship status, and (c) level of English proficiency. We created an acculturation index, categorized into low vs. high (scores of 0-3 and 4, respectively). Self-reported CV risk factors included diabetes, high cholesterol, hypertension, obesity, tobacco use, and sufficient physical activity. Rao-Scott Chi Square was used to compare age-standardized, weighted prevalence of CV risk factors between Asian subgroups. We used logistic regression analysis to assess associations between acculturation and CV risk factors, stratified by Asian subgroup.

Results

The study sample consisted of 6,051 adults ≥ 18 years of age (53.9% female; mean age 46.6 [SE 0.33]). The distribution by race/ethnicity was Asian Indian 26.9%, Chinese 22.8%, Filipino 18.1%, and other Asian 32.3%. The association between acculturation and CV risk factors differed by Asian subgroups. From multivariable adjusted models, high vs. low acculturation was associated with: high cholesterol amongst Asian Indian (OR=1.57, 95% CI: 1.11, 2.37) and other Asian (OR=1.48, 95% CI: 1.10, 2.01) adults, obesity amongst Filipino adults (OR= 1.62, 95% CI: 1.07, 2.45), and sufficient physical activity amongst Chinese (OR= 1.54, 95% CI: 1.09, 2.19) and Filipino adults (OR=1.58, 95% CI: 1.10, 2.27).

Conclusion

This study demonstrates that acculturation is heterogeneously associated with higher prevalence of CV risk factors among Asian subgroups. More studies are needed to better understand these differences that can help to inform targeted, culturally specific interventions.

The role of behavioral science in addressing cardiovascular health disparities: A narrative review of efforts, challenges, and future directions

Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality in the United States. Despite improvements in the prevention and treatment of CVD over the past 20 years, racial/ethnic minority groups including non-Hispanic Blacks, Hispanic/Latinos, and some Asian subgroups (e.g., Asian Indians, Filipinos) experience higher rates of CVD risk factors and morbidity and mortality from CVD than non-Hispanic Whites. Therefore, addressing cardiovascular health disparities is an immediate priority. Behavioral science can play an important role in reducing disparities by capitalizing on expertise in human behavior change, social determinants of health, and implementation science. In this narrative review, we describe the efforts made within behavioral science to address CVD health disparities. We review current interventions to reduce CVD health disparities and provide practical recommendations that can be used as the field moves forward. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Acculturation, Physical Activity, and Metabolic Syndrome in Asian American Adults

INTRODUCTION

Asian Americans (AsAms) have a high prevalence of metabolic syndrome (MetS) and are one of the least physically active racial groups in America. The purpose of this study was to examine the relationship between MetS and moderate-to-vigorous physical activity (MVPA) among AsAm adults and whether acculturation modifies this relationship.

METHOD

Data were from 2,259 AsAms participating in the 2011-2016 National Health and Nutrition Examination Survey. Physical activity (PA) was self-reported as minutes of weekly MVPA. Acculturation included nativity, length of residency in America, and language preference. The International Diabetes Federation criteria was used to determine the presence of MetS.

RESULTS

About 64.4% of AsAms did not meet the PA recommendation (MVPA ≥150 min/week). The prevalence of MetS was 39.2%. The odds of having MetS were greater among AsAms who did not meet MVPA recommendations compared with those who did meet MVPA recommendations (odds ratio [OR] = 1.5, 95% confidence interval [CI] = [1.11, 2.07]). When stratified by acculturation, this association remained statistically significant in the groups who immigrated to America more than 15 years ago and who spoke English only.

CONCLUSION

MVPA reduces MetS risk in AsAm adults, especially among more acculturated AsAms. Culturally adapted programs are warranted to promote PA and adequate knowledge of disease prevention in this population.

A Technology-Enhanced Physical Activity Intervention: A Feasibility Study

Using a single-group, pre-posttest design, we evaluated feasibility and acceptability of a technology-enhanced physical activity intervention in 43 midlife (aged 35-64) first-generation Korean American adults who were physically inactive. The intervention consisted of bi-weekly education sessions for 4 weeks, monthly small group walks for the following 8 weeks, and weekly reminder text messages during the entire intervention period. A 100% retention rate, 93% adherence, and 88.4% satisfaction supported the feasibility and acceptability of the intervention. Paired t-tests revealed the intervention was successful and effective as demonstrating a significant increase in self-efficacy and moderate physical activity and improved cardiometabolic health. This easy and motivation enhancing intervention has a wide potential applicability for other ethnic groups. Further intervention research is suggested in a large sample, multisite, for a longer-term with a randomized controlled trial design, which may lead us to narrow the gap in physical activity engagement and cardiometabolic health disparities.

The Racial Disparities in the Epidemic of Metabolic Syndrome With Increased Age: A Study From 28,049 Chinese and American Adults

BACKGROUND

Previous studies have revealed ethnic disparities in the prevalence of metabolic syndrome (MetS); however, the literature regarding aging-related patterns of disparities in MetS and its components remains limited.

METHODS

This cross-sectional study recruited 28,049 subjects, consisting of one Chinese race and three American races, 18-85 years of age, from the National Health and Nutrition Examination Survey (NHANES, 1999-2018) of the United States, and the Guangdong Gut Microbiome Project (GGMP, 2018) of China. MetS was defined in accordance with the National Cholesterol Education Program Adult Treatment Panel III. A modified sliding-window-based algorithm was used to depict the trajectories of the prevalence of MetS with increased age. Logistic regression analysis was performed to investigate associations between MetS and its components.

RESULTS

The prevalence of MetS increased non-linearly with age, with growth speed reaching its maximum at approximately 40-50 years. Chinese subjects exhibited a lower prevalence of MetS than non-Hispanic whites, non-Hispanic blacks, and Mexican Americans in all age groups. The two most prevalent components in Chinese subjects were reduced high-density lipoprotein cholesterol levels (42.0%) and elevated blood pressure (49.5%), and elevated triglyceride levels (36.3-49.5%) and abdominal obesity (55.8-55.9%) in Americans. Before 40 years of age, the top two MetS-associated components were abdominal obesity and elevated triglyceride levels in all races, while after 40 years, the prominent associations between MetS and its components varied among the different races and age groups.

CONCLUSIONS

Although racial disparities in the epidemic of MetS varied with increased age, abdominal obesity and elevated triglyceride levels were the top two MetS-associated components in all younger adults of different races.

Generalizability of ORIENT-11 trial results to a US standard of care cohort with advanced non-small-cell lung cancer

Aim: This retrospective study estimated efficacy and safety of sintilimab + pemetrexed + platinum (SPP) versus placebo + pemetrexed + platinum (PPP) in untreated locally advanced/metastatic, nonsquamous non-small-cell lung cancer (NSCLC), after adjusting each ORIENT-11 trial patient's contribution to ORIENT-11 data based on characteristics of a target US population. Materials & methods: The target US population (n = 557) was selected from a real-world deidentified advanced NSCLC database based on key ORIENT-11 eligibility criteria. Inverse probability weights for ORIENT-11 patients (n = 397) relative to US patients were calculated. Efficacy and safety of SPP versus PPP were adjusted by inverse probability weights. Results: After adjustment, progression-free survival remained superior for SPP. Other efficacy and safety outcomes were consistent. Conclusion: These results provide evidence on how the effects observed with SPP in ORIENT-11 could translate to a US population with untreated locally advanced/metastatic nonsquamous NSCLC.

Obesity epidemic through the prism of evolutionary processes

Currently, obesity has become one of the most serious public health problems. It takes millions of lives worldwide every year due to its association with numerous diseases and leads to significant social and economic losses. It is generally accepted that obesity is the result of the interaction of genes and environment, and the predisposition to it lies in our evolutionary past. This review discusses the role of adipose tissue in human evolution, the factors specifying a person’s predisposition to obesity, the main hypotheses for obesity origin, and potential prevention and treatment strategies arising from them. The evolutionary significance of visceral adipose tissue and some ethnic and sex characteristics associated with its distribution are also considered.

The effects of acculturation and environment on lifestyle behaviors in Korean immigrants: the mediating role of acculturative stress and body image discrepancy

OBJECTIVES

Despite high rates of cardiometabolic diseases in Korean immigrants (KIs), little is known about cultural and environmental factors contributing to lifestyle behaviors. The purpose of this cross-sectional study was to examine the relationships among acculturation, environment, and lifestyle behaviors (dietary behavior, physical activity, and sedentary behavior) through culturally sensitive psychological mediators, body image discrepancy and acculturative stress in middle-aged KIs.

DESIGN

A cross-sectional study was conducted. KIs aged 30-65 years were recruited online and at Korean community centers and churches in the Northeastern US Participants completed validated measures of dietary behavior (the Nutrition Subscale of the Health Promoting Lifestyle Profile (HPLP) II), physical activity (the International Physical Activity Questionnaire (IPAQ) - short form), and sedentary behavior (the Sedentary Behavior Questionnaire). Acculturative stress was measured by the Acculturative Stress Index and body image discrepancy was measured by the Stunkard Figure Rating Scale. Acculturation was defined as a latent variable measured by Korean and American orientation (Vancouver Index of Acculturation), age of immigration to the US, length of residency in the US, and English proficiency. Data were analyzed with structural equation modeling (SEM).

RESULTS

The sample included 361 KIs (mean age = 41.77 ±10.28 years, 48.1% female, and 46.4% overweight or obese). In the SEM model, acculturation had significant indirect effects on dietary behavior, physical activity, and sedentary behavior through body image discrepancy. Acculturative stress mediated the relationship between acculturation and sedentary behavior. Greater environmental support for physical activity and better healthy food accessibility were related to higher levels of physical activity and healthier dietary behavior, respectively.

CONCLUSION

In our study, acculturation and environmental support for physical activity and healthy food simultaneously influenced KIs' lifestyle behaviors. Addressing an unhealthy body image and acculturative stress may be additional strategies for lifestyle intervention programs to prevent cardiometabolic diseases in KIs.

Impact of pre-pregnancy body mass index and gestational weight gain on the risk of maternal and infant pregnancy complications in Korean women

BACKGROUND/OBJECTIVE

Healthy weight maintenance before and during pregnancy has a significant effect on pregnancy outcomes; however, there are no specific guidelines for gestational weight gain in pregnant Korean women. Therefore, we investigated the impact of pre-pregnancy body mass index (BMI) and gestational weight gain on the risk of maternal and infant pregnancy complications in pregnant Korean women.

METHODS

Study participants comprised 3454 singleton pregnant women from the Korean Pregnancy Outcome Study who had baseline examination and pregnancy outcome data. Maternal pre-pregnancy BMI and gestational weight gain were categorized according to the Asia-pacific regional guidelines and the Institute of Medicine recommendations, respectively. The primary outcome was any adverse outcomes, defined as the presence of one or more of the following: hypertensive disorders of pregnancy, gestational diabetes mellitus, peripartum depressive symptom, cesarean delivery, delivery complications, preterm birth, small or large weight infant, neonatal intensive care unit admission, or a congenital anomaly. Multiple logistic regression models were applied to examine the independent and combined impact of pre-pregnancy BMI and gestational weight gain on the risk of maternal and infant outcomes.

RESULTS

Obesity before pregnancy significantly increased the risk of perinatal adverse outcomes by more than 2.5 times [odds ratio (OR): 2.512, 95% confidence interval (CI): 1.817-3.473]. Compared to that in women with appropriate gestational weight gain, women with excessive weight gain had a 36.4% incremental increase in the risk of any adverse outcomes [OR: 1.364, 95% CI: 1.115-1.670]. Moreover, women who were overweight or obese before pregnancy and had excessive gestational weight gain had a three-fold increase in the risk of adverse outcomes [OR: 3.460, 95% CI: 2.210-5.417].

CONCLUSION

This study highlights the need for appropriate weight recommendations before and during pregnancy to prevent perinatal complications in Korean women of childbearing age.

Predictive value of WHO vs. IAP BMI charts for identification of metabolic risk in Indian children and adolescents

OBJECTIVES

Owing to increase in prevalence of obesity and metabolic syndrome in Indian children and adolescents, this study is conducted to assess the predictive value of IAP 2015 and WHO 2007 BMI for age cut-offs in identifying metabolic risk in Indian children.

METHODS

Cross-sectional multicentric school-based study on 9-18-year-old healthy children (n=1,418) randomly selected from three states of India.

RESULTS

WHO 2007 and IAP 2015 charts classified 222 (15.7%) and 271 (19.1%) as overweight/obese, respectively. A total of 192 (13.5%) subjects had metabolic risk. Of these 47 (25%) and 36 (18.75%) were classified as having normal body mass index (BMI) by WHO and IAP, respectively. In identifying metabolic risk, IAP 2015 and WHO 2007 charts showed a sensitivity of 81.3 and 75%, negative predictive value 96.5% as against 94.8%, positive predictive value 57.5 and 64.8%, and specificity of 89.7 and 91.6%, respectively.

CONCLUSIONS

Owing to obesity epidemic and high metabolic risk in Indians, IAP 2015 charts (as against the WHO 2007 references) which had a higher sensitivity in identifying metabolic risk may be more suitable in Indian children and adolescents.

Postmenopausal Chinese-Singaporean Women Have a Higher Ratio of Visceral to Subcutaneous Adipose Tissue Volume than Caucasian Women of the Same Age and BMI

Central fat accumulation is a significant determinant of cardio-metabolic health risk, known to differ between ethnically distinct human populations. Despite evidence for preferential central adiposity in Asian populations, the proportional distribution between the subcutaneous and visceral compartments in Chinese postmenopausal women has not been thoroughly investigated. For this analysis, volumetrically quantified subcutaneous and visceral adipose tissue (SAT, VAT) in the pelvic and abdominal regions of postmenopausal Asian (Chinese-Singaporean) and Caucasian (German) women matched for age and Body Mass Index (BMI) was undertaken, to examine such differences between the two groups. Volumes were calculated from segmentations of magnetic resonance imaging datasets of the abdomen and pelvis. Despite SAT, VAT, and the corresponding total adipose tissue (TAT) being similar between the groups, VAT/SAT and VAT/TAT were higher in the Asian group (by 24.5% and 18.2%, respectively, each p = 0.02). Further, VAT/SAT and VAT/TAT were positively correlated with BMI in the Caucasian group only (p = 0.02 and p = 0.01, respectively). We concluded that VAT is proportionally higher in the non-obese Asian women, compared to the Caucasian women of matched age and BMI. This conclusion is in agreement with existing literature showing higher abdominal adiposity in Asian populations. Additionally, in the Asian group, BMI did not correlate with visceral adiposity on a significant level. Further analysis is required to examine the extent to which this increased VAT may impact cardio-metabolic health. There is, however, a need to emphasize healthy lifestyle behaviors in non-obese post-menopausal women of Chinese ancestry.

Lean Yet Unhealthy: Asian American Adults Had Higher Risks for Metabolic Syndrome than Non-Hispanic White Adults with the Same Body Mass Index: Evidence from NHANES 2011-2016

(1) Background: Despite having consistently lower rates of obesity than other ethnic groups, Asian Americans (AAs) are more likely to be identified as metabolically obese, suggesting an ethnic-specific association between BMI and cardiometabolic outcomes. The goal of this study was to provide an estimate of metabolic syndrome (MetS) prevalence among AAs using national survey data and to compare this rate to that of non-Hispanic Whites (NHWs) over the BMI continuum. (2) Methods: Using the NHANES 2011–2016 data, we computed age-adjusted, gender-specific prevalence of MetS and its individual components for three BMI categories. Furthermore, we conducted multivariate binary logistic regression to examine the risk of MetS in AAs compared to NHWs, controlling for sociodemographic and lifestyle factors. The analysis sample consisted of 2121 AAs and 6318 NHWs. (3) Results: Among AAs, the prevalence of MetS and its components increased with higher BMI levels, with overall prevalence being 5.23% for BMI < 23, 38.23% for BMI of 23–27.4, and 77.68% for BMI ≥ 27.5 in men; and 18.61% for BMI < 23, 47.82% for BMI of 23–27.4, and 67.73% for BMI ≥ 27.5 in women. We also found that for those with a BMI > 23, AAs had a higher predicted risk of MetS than their NHW counterparts of the same BMI level, in both men and women. (4) Conclusions: Our findings support the use of lower BMI ranges for defining overweight and obesity in Asian populations, which would allow for earlier and more appropriate screening for MetS and may better facilitate prevention efforts.

Race/ethnicity-associated blood DNA methylation differences between Japanese and European American women: an exploratory study

BACKGROUND

Racial/ethnic disparities in health reflect a combination of genetic and environmental causes, and DNA methylation may be an important mediator. We compared in an exploratory manner the blood DNA methylome of Japanese Americans (JPA) versus European Americans (EUA).

METHODS

Genome-wide buffy coat DNA methylation was profiled among healthy Multiethnic Cohort participant women who were Japanese (JPA; n = 30) or European (EUA; n = 28) Americans aged 60-65. Differentially methylated CpGs by race/ethnicity (DM-CpGs) were identified by linear regression (Bonferroni-corrected P < 0.1) and analyzed in relation to corresponding gene expression, a priori selected single nucleotide polymorphisms (SNPs), and blood biomarkers of inflammation and metabolism using Pearson or Spearman correlations (FDR < 0.1).

RESULTS

We identified 174 DM-CpGs with the majority of hypermethylated in JPA compared to EUA (n = 133), often in promoter regions (n = 48). Half (51%) of the genes corresponding to the DM-CpGs were involved in liver function and liver disease, and the methylation in nine genes was significantly correlated with gene expression for DM-CpGs. A total of 156 DM-CpGs were associated with rs7489665 (SH2B1). Methylation of DM-CpGs was correlated with blood levels of the cytokine MIP1B (n = 146). We confirmed some of the DM-CpGs in the TCGA adjacent non-tumor liver tissue of Asians versus EUA.

CONCLUSION

We found a number of differentially methylated CpGs in blood DNA between JPA and EUA women with a potential link to liver disease, specific SNPs, and systemic inflammation. These findings may support further research on the role of DNA methylation in mediating some of the higher risk of liver disease among JPA.

A Simple Clinical Risk Score to Predict Post-Discharge Mortality in Chinese Patients Hospitalized with Heart Failure

BACKGROUND

Cardiovascular diseases are the leading causes of death in China. However, present efforts to identify the risk factors for death in patients hospitalized with heart failure (HF) are primarily focused on in-hospital mortality and 30-day mortality in the United States. Thus, a model similar to the model used for predicting the risk in patients considered for cardiovascular surgical procedures is needed to evaluate the risk of the patients admitted with a diagnosis of HF.

OBJECTIVE

To identify variables that can predict post-discharge one-year HF mortality and develop a risk score to assess the risk of dying within one year.

METHODS

In the present study, 1,742 Chinese patients with HF were randomly divided into two groups: a derivation sample group and a test sample group. A Markov Chain Monte Carlo simulation method was used to identify variables that can predict the one-year post-discharge mortality. Variables with a frequency of >1% in the bivariate analysis and that were considered clinically meaningful were eligible for further modeling analyses. The posterior probability that a variable was statistically and significantly associated with the outcome was calculated as the total number of times that the variable's 95% CI did not overlap with 1 (i.e., the reference point) divided by the total number of iterations. A variable with a probability of 0.9 or higher was considered a robust risk factor for predicting the outcome, and this was included in the final variable list. The level of statistical significance adopted was 5%.

RESULTS

Five variables that could robustly predict the one-year post-discharge mortality were identified: age, female gender, New York Heart Association functional classification score >3, left atrial diameter, and body mass index. Both derivation and test models had a receiver operating curve area of 0.79. These selected variables were used to assess the one-year HF mortality risk score, and these were divided into three groups (low, moderate, and high). The high-risk group corresponds to nearly 86% of the deaths, while the moderate group corresponds to 12% of the deaths.

CONCLUSION

A simple 5-variable risk score can be used to assess the one-year post-discharge mortality of hospitalized Chinese patients with HF.

Incidental finding of lipaemia retinalis on diabetic retinal screening

SUMMARY

A 37-year-old female of South Asian origin was referred to our diabetes clinic for evaluation of an unusual finding during her retinal screening. Her retinal blood vessels appeared white in contrast to the normal pink-red colour. She had type I hyperlipidaemia, confirmed by genotype, and was recently diagnosed with diabetes, secondary to pancreatic insufficiency, for which she had suboptimal control and multiple hospitalisations with recurrent pancreatitis. On examination, she had multiple naevi on her skin; the rest of the examination was unremarkable. The patient did not report any visual disturbances and had intact visual acuity. Investigations showed raised total cholesterol (12.5 mmol/L) and triglycerides (57.7 mmol/L). Following evaluation, the patient was diagnosed with lipaemia retinalis, secondary to type I hyperlipidaemia. The patient was managed conservatively to reduce the cholesterol and triglyceride burdens. However, therapies with orlistat, statin, fibrates and cholestyramine failed. Only a prudent diet, omega-3 fish oil, medium-chain triglycerides oil and glycaemic control optimised with insulin showed some improvements in her lipid profile. Unfortunately, this led her to becoming fat-soluble vitamin deficient; hence, she was treated with appropriate supplementation. She was also recently started on treatment with volanesorsen. Following this, her lipid parameters improved and lipaemia retinalis resolved.

LEARNING POINTS

Lipaemia retinalis is an uncommon incidental finding of type I hyperlipidaemia that may not affect vision. Management of associated dyslipidaemia is challenging with minimal response to conventional treatment. Increased awareness of lipaemia retinalis and specialist management is needed as part of regular patient monitoring and personalised management.

Dynamic changes in metabolic health status in Chinese adults: Multiple population-based surveys in Shanghai, China

AIMS/INTRODUCTION

Metabolic syndrome (MS) has been increasing worldwide. The secular change in MS components, however, remains unclear. This study aimed to examine the dynamic change in metabolic health status in Chinese adults.

MATERIALS AND METHODS

Three population-based surveys using multistage stratified sampling were performed in Chinese aged 35-74 years in Shanghai in 2002-2003 (n = 12,302), 2009 (n = 7,400), and 2017 (n = 19,023). MS was defined according to the Adult Treatment Panel III criteria for Asian-Americans. Generalized Estimating Equations and Cochran-Armitage Trend Test was used to assess the prevalence trend over the years.

RESULTS

The prevalence of MS doubled in Chinese adults over the period (P for trend < 0.001). The largest increase occurred in younger men. Among MS components, the prevalence of high waist-circumference (HWC), high blood glucose (HBG) and high blood pressure (HBP) increased in all subjects, whereas the prevalence of high triglycerides (HTG) and low high-density lipoprotein cholesterol (LHC) increased in men but decreased in women. The increase in HBP contributed most to elevated MS, followed by HBG and HWC, resulting in the HBP-HBG-HWC the most common cluster of MS components. Metabolically unhealthy overweight also grew over the period.

CONCLUSIONS

Metabolic health status has been exacerbating in Chinese adults and may increase burden of non-communicable diseases.

Obesity and anastomotic leak rates in colorectal cancer: a meta-analysis

PURPOSE

Anastomotic leak (AL) following colorectal cancer resection is associated with considerable morbidity and mortality with an impact on recurrence rates and survival. The impact of obesity on AL rates is debated. This meta-analysis aims to investigate the relationship between obesity and AL.

METHODS

A search was conducted of the PubMed/MEDLINE, and Web of Science databases and included studies were split into Western and Asian groups based on population-specific body mass index (BMI) ranges for obesity. A meta-analysis was performed to assess the impact of obesity on AL rate following colorectal cancer resection.

RESULTS

Two thousand three hundred and four articles were initially screened. Thirty-one studies totaling 32,953 patients were included. Patients with obesity had a statistically significant increase in AL rate in all Western and Asian study groups. However, this increase was only clinically significant in the rectal anastomotic subgroups-Western: 10.8% vs 8.4%, OR 1.57 (1.01-2.44) and Asian: 9.4% vs 7.4%, OR 1.58 (1.07-2.32).

CONCLUSIONS

The findings of this analysis confirm that obesity is a significant risk factor for anastomotic leak, particularly in rectal anastomoses. This effect is thought to be primarily mediated via technical difficulties of surgery although metabolic and immunological factors may also play a role. Obesity in patients undergoing restorative CRC resection should be discussed and considered as part of the pre-operative counselling.

A Pilot Study to Promote Active Living among Physically Inactive Korean American Women

A 4-week lifestyle program called Women's Active Living for Koreans (WALK) was designed for Korean American women to promote physical activity (PA). In a pilot-controlled trial, 40 women were randomized to WALK-regular or WALK-plus. WALK-plus involved joining an online community via a social media app. WALK-plus performed significantly higher numbers of days of muscle-strengthening activities than WALK-regular at the post-intervention visit. Both groups increased vigorous activities and walking and decreased sedentary behaviors on weekdays. WALK program showed great potential in improving PA and decreasing sedentary behaviors. Online social networking may have an additional effect on PA among this population.

Ethnic group differences in obesity in Asian Americans in California, 2013-2014

Background

Obesity has been generally understudied in Asian Americans. It is important to identify subgroups of Asian Americans at high risk of obesity to help develop targeted interventions for those subgroups. This study aimed to examine the disparities in obesity among Asians (i.e., Chinese, Filipino, Japanese, Korean, and Vietnamese) living in California.

Methods

A sample of Adult Americans in California (n = 47,970) including Asian American adults (n = 3810) aged 18 years or older were obtained from the 2013–2014 California Health Interview Survey (the U.S. nation’s largest state cross-sectional health survey). Body mass index was calculated using self-reported height and weight. Weight status was determined using the WHO Asian BMI cut points in 4 categories: < 18.5 kg/m² (underweight), 18.5–22.9 kg/m² (normal weight), 23–27.5 kg/m² (overweight), and ≥ 27.5 kg/m² (obese). Multiple logistic regression analyses were used to estimate odds ratio (OR) and 95% confidence interval (CI) after adjustment for covariates.

Results

Overall, the prevalence of Asians was 23.3% for obesity and 40.0% for overweight. The obesity prevalence was higher in Asians who were males, aged 45–64 years old, had higher family income, were current smokers, never got married, had lower education level, had an insufficient level of physical activity, and had more frequent consumption of fast foods. After adjusting for other factors, compared to Whites, being Hispanics and Blacks were associated with higher odds of obesity (OR = 1.47, 95%CI = 1.31–1.65; OR = 2.04, 95%CI = 1.65–2.53, respectively); being Chinese, Korean, and Vietnamese were associated with lower odds of obesity (OR = 0.28, 95%CI = 0.18–0.45; OR = 0.14, 95%CI = 0.04–0.46; OR = 0.28, 95%CI = 0.14–0.58, respectively). Compared to Chinese, being Japanese and Filipino were associated with higher odds of obesity (OR = 2.75, 95%CI = 1.52–4.95; OR = 2.90, 95%CI = 1.87–4.49, respectively).

Conclusions

The prevalence of adult obesity was high among Asian Americans in California. Ethnic/racial disparities in obesity among Asian Americans in California were observed in 2013–2014. Compared to Whites, being Chinese, Korean, Vietnamese were associated with lower odds of obesity. Among Asians, compared to Chinese, being Japanese and being Filipino were associated with higher odds of obesity. These findings can help design better interventions to reduce racial and ethnic disparities in obesity, especially for Asian Americans.

Comparative Analysis of Metabolic Syndrome Diagnostic Criteria and Its Effects on Prevalence in a Multiethnic Population

Background: Accurate prevalence measurement and diagnosis to prevent type 2 diabetes mellitus and cardiovascular disease cannot occur without consistent diagnostic criteria that can be applied to varying populations. Objective: The objective of this study was to determine the prevalence of metabolic syndrome in Caucasian, Filipino, Native Hawaiian, and Japanese populations utilizing different definitions. Methods: This study utilized cross-sectional study data from the Native Hawaiian/Multiethnic Health Research Project, collected from a population living in Kohala, Hawai'i. The National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATPII), International Diabetes Federation (IDF), and World Health Organization (WHO) definitions were utilized, and each of the 1452 participants were evaluated on the criteria for metabolic syndrome based on all three definitions. Additionally, the average biomarker values associated with the diagnosis were taken for each ethnic group represented in the study and compared with Caucasians. Results: The overall prevalence of metabolic syndrome in this population varied from 22.31% to 39.05% using the different definitions. Ethnic disparities also occur, implying that certain populations are more prone to having severe abnormalities than others-shown when comparing the average biomarker values associated with metabolic syndrome diagnosis. Of all ethnic groups included in the study, Caucasians had the lowest prevalence of metabolic syndrome, while part-Hawaiians had the highest prevalence. Additionally, within the same ethnic group, the definitions yielded varying prevalence values. Conclusions: This implies that discrepancies exist among the criteria alone. Implications of this study revolve around not only the correct definition to apply to the population being studied but also the most accurate way to detect certain biomarker abnormalities to accurately assess the prevalence of metabolic syndrome in a multiethnic population.

Air pollution-associated blood pressure may be modified by diet among children in Guangzhou, China

OBJECTIVES

To assess the associations between long-term air pollution exposure and blood pressure in children, and to explore the modifying effects of diet on prehypertension and hypertension.

METHODS

We evaluated 7225 primary school children aged 6-12 years from Guangzhou, China, in 2017. The blood pressure was measured objectively. The individual 1-year average concentration of particles with an aerodynamic diameter of 2.5 μm or less or 10 μm or less (PM2.5, PM10), sulfur dioxide (SO2), and ozone (O3) before each blood pressure measurement were calculated by inverse distance weighting interpolation according to each home address. Generalized linear mixed-effects models were used to examine the health effects and potential effect modifications by diet factors after adjusting for covariates.

RESULTS

The results showed that the estimated increase in mean SBP was 0.92 mmHg (95% CI 0.05-1.79) per interquartile range increase in O3. An interquartile range increase in the 1-year mean of SO2 and O3 was associated with odds ratios of 1.26 (95% CI 1.04-1.52) and 1.20 (95% CI 1.06-1.35) for prehypertension, respectively. In addition, an interquartile range increase in PM2.5, SO2, and O3 exposure was positively associated with hypertension, with odds ratios of 1.33 (95% CI 1.11-1.61), 1.70 (95% CI 1.33-2.16), and 1.48 (95% CI 1.20-1.83), respectively. Stronger effect estimates between PM2.5, SO2, and O3 concentration on prehypertension were exhibited among subgroups of children with a higher intake of sugar-sweetened beverages.

CONCLUSION

Long-term exposure to PM2.5, SO2, and O3 were associated with higher blood pressure levels in children, and dietary intake might modify these associations.

Health Literacy, Knowledge, and Risk Factors for Fatty Liver Disease among Asian American and Pacific Islanders and Latinos in Los Angeles

BACKGROUND

Fatty liver disease (FLD) is associated with increased risk for hepatocellular carcinoma (HCC) and is associated with rising rates of diabetes and obesity. The prevalence of FLD is rising among Asian American and Pacific Islanders (AAPIs) and Latinos. This study examined health literacy, knowledge, and risk factors for FLD among AAPIs and Latinos in Los Angeles.

METHODS

Data from in-person interviews and clinical measures (body mass index (BMI), body fat percentage, and blood pressure) were obtained from adults aged 18-82 years at four health fairs from November 2018 to March 2019. Interviews assessed knowledge about FLD, access to health resources, and satisfaction with current physician. Correct responses to knowledge questions were summed to generate a FLD knowledge score. Linear regression models were used to examine the association between knowledge score and age, sex, and race/ethnicity.

RESULTS

A total of 102 subjects were AAPI and 33 were Latino. Over 65% of participants had heard of FLD but demonstrated limited knowledge about FLD. Only 24% of subjects reported receiving FLD resources in their preferred language. Most subjects failed to identify several risk factors and key symptoms of FLD. Mean knowledge score for subjects who had heard of FLD was 7.58 (95% CI 7.15-8.01) out of a possible 16 points, and for those who had not who had not heard of FLD it was 5.71 (5.00-6.42) (p <0.0001).

CONCLUSIONS

A lack of culturally competent resources and effective communication strategies between physicians and patients regarding FLD contributes to a lower awareness about the increased risk of FLD among AAPIs and Latinos. Future studies should investigate optimal methods to educate these communities about FLD and its associations with HCC.

Gestational Weight Gain and Long-term Maternal Obesity Risk: A Multiple-Bias Analysis

BACKGROUND

Lifecourse research provides an important framework for chronic disease epidemiology. However, data collection to observe health characteristics over long periods is vulnerable to systematic error and statistical bias. We present a multiple-bias analysis using real-world data to estimate associations between excessive gestational weight gain and mid-life obesity, accounting for confounding, selection, and misclassification biases.

METHODS

Participants were from the multiethnic Study of Women's Health Across the Nation. Obesity was defined by waist circumference measured in 1996-1997 when women were age 42-53. Gestational weight gain was measured retrospectively by self-recall and was missing for over 40% of participants. We estimated relative risk (RR) and 95% confidence intervals (CI) of obesity at mid-life for presence versus absence of excessive gestational weight gain in any pregnancy. We imputed missing data via multiple imputation and used weighted regression to account for misclassification.

RESULTS

Among the 2,339 women in this analysis, 937 (40%) experienced obesity in mid-life. In complete case analysis, women with excessive gestational weight gain had an estimated 39% greater risk of obesity (RR = 1.4, CI = 1.1, 1.7), covariate-adjusted. Imputing data, then weighting estimates at the guidepost values of sensitivity = 80% and specificity = 75%, increased the RR (95% CI) for obesity to 2.3 (2.0, 2.6). Only models assuming a 20-point difference in specificity between those with and without obesity decreased the RR.

CONCLUSIONS

The inference of a positive association between excessive gestational weight gain and mid-life obesity is robust to methods accounting for selection and misclassification bias.

Electronic dental record-based surveillance of non-communicable conditions

OBJECTIVE

The objective of the study is to demonstrate that electronic dental records (EDRs) can be used to mine meaningful public health information.

STUDY DESIGN

Retrospective electronic dental chart-based reporting of disease prevalence.

METHODS

Using dental EDRs (N = 104,768), the authors assessed the prevalence of common non-communicable medical conditions among unique patients seen at a United States (U.S.) dental college.

RESULTS

The prevalence of following conditions in patients visiting a U.S. dental college increased steadily with increasing age: hypertension, angina, stroke, myocardial infarction, congestive heart failure, diabetes, cancer, kidney disease, thyroid disease, and allergies. Prevalence of these conditions was several-fold higher in the 66+ years group than among younger adults. Prevalence of many of the assessed conditions approximated published national estimates.

CONCLUSIONS

In addition to the indispensable use of EDRs in dental education and patient management, EDRs can be mined to report on prevalence of non-communicable medical conditions among patients/population receiving dental care. Completeness and accuracy of entered information will significantly improve the usefulness of EDR for disease surveillance and research applications.

Prevention of atherosclerotic cardiovascular disease in South Asians in the US: A clinical perspective from the National Lipid Association

It is now well recognized that South Asians living in the US (SAUS) have a higher prevalence of atherosclerotic cardiovascular disease (ASCVD) that begins earlier and is more aggressive than age-matched people of other ethnicities. SA ancestry is now recognized as a risk enhancer in the US cholesterol treatment guidelines. The pathophysiology of this is not fully understood but may relate to insulin resistance, genetic and dietary factors, lack of physical exercise, visceral adiposity and other, yet undiscovered biologic mechanisms. In this expert consensus document, we review the epidemiology of ASCVD in this population, enumerate the challenges faced in tackling this problem, provide strategies for early screening and education of the community and their healthcare providers, and offer practical prevention strategies and culturally-tailored dietary advice to lower the rates of ASCVD in this cohort.

Racial-Ethnic Disparities in Obesity and Biological, Behavioral, and Sociocultural Influences in the United States: A Systematic Review

For a comprehensive understanding of high-level obesity in the USA, we studied the trends of obesity prevalence since 2007, and related biological, behavioral, and sociocultural factors in obesity racial/ethnic disparities. We searched PubMed, Embase, and national data archives for the studies using national survey data and published in English from January 1, 2007 to September 11, 2020. Forty-seven studies met the inclusion criteria and were systematically reviewed. After a short leveling-off during 2009-2012, the US national prevalence of obesity has steadily increased. Although women had higher racial/ethnic disparities in obesity and severe obesity than men, it decreased due to the significant drop in non-Hispanic black (NHB) women in the last 10 y. However, obesity and severe obesity prevalence increased in Mexican-American (MA) men, MA boys, and MA girls and became similar to or surpassing NHB groups. Substantial racial/ethnic disparities remained in the past decade. Even at the same level of BMI, MAs and non-Hispanic Asians had a higher percent of body fat and metabolic syndrome than other ethnic/racial groups. NHB's cultural preference for a large body significantly associated weight misperception and lower weight control practices. In addition to socioeconomic status, health behaviors, neighborhood environments, and early childhood health factors explained substantial racial/ethnic differences in obesity. Differences in biological, behavioral, and sociocultural characteristics should be considered in future public health intervention efforts to combat obesity in the USA.

Novel and traditional anthropometric indices for identifying metabolic syndrome in non-overweight/obese adults

Background

Metabolic syndrome (MetS) in non-overweight/obese people is insidiously associated with cardiovascular disease. Novel anthropometric indices can reflect central obesity better than the traditional anthropometric indices. Therefore, we hypothesize that these newly developed anthropometric indices can better identify MetS in non-overweight/obese people than conventional indices.

Methods

Cross-sectional data of sociodemographic, biochemical and anthropometric indices were collected from 2916 non-overweight/obese Chinese people. A body shape index (ABSI), body roundness index (BRI), waist-to-height ratio (WHtR), weight-adjusted-waist index (WWI) and abdominal volume index (AVI) were calculated. Partial correlation analysis was used to clarify the correlation between anthropometric indices and MetS variables. Binary logistic regression analysis was applied to assess the association between anthropometric indices and MetS and its components. Receiver-operating characteristic curve was used to identify the diagnostic ability of anthropometric indices for MetS and its components. The area under curve (AUC) difference between WHtR and each new anthropometric index was compared in pairs.

Results

After adjusting for covariates, AVI had the optimal ability of identifying MetS (AUC: 0.743 for male, 0.819 for female) and the strongest correlation with high-density lipoprotein cholesterol (HDL-C) (coe: − 0.227 for male, − 0.207 for female) and the highest odds rations (OR) with low HDL-C group (male: OR = 1.37, female: OR = 1.55). The WHtR was comparable to BRI in assessing MetS (AUC: 0.739 for male, 0.817 for female). WHtR or BRI could also well identify hypertension (AUC: 0.602 for male, 0.688 for female) and dysglycemia (AUC: 0.669 for male, 0.713 for female) and female’s high triglyceride level (AUC 0.712). The recognition ability of the two was equivalent. The ability of ABSI and WWI to identify MetS was weak.

Conclusions

AVI is the optimal anthropometric indices to identify MetS in non-overweight/obese Chinese adults. BRI and WHtR can also be considered as discriminators, while ABSI and WWI are weak discriminators. WHtR is easy to measure. So, it is recommended as an early preliminary screening method for the MetS in non-overweight/obese people.

Opportunities for Prevention of Gestational Diabetes Before 24 Weeks of Gestation

BACKGROUND

Gestational diabetes (GDM), increasingly prevalent worldwide, is related to growing pregnancy complications and long-term metabolic risks for the woman and the descendants. The aim of this study is to determine the optimal BMI ranges specific for age group and optimal gestational weight gain (GWG) at 24 weeks specific for different pre-BMI (pre-pregnancy body mass index) groups to avoid or reduce the incidence of GDM.

METHODS

A retrospective cohort study of 3104 pregnant women was conducted in Song Jiang district, Shanghai, China. A multivariate logistic regression analysis was performed with the purpose of determining the OR (odds ratio) of risk factors of GDM including GWG of 24 weeks, pre-BMI, advanced age, and first-degree relatives with DM. Optimal ranges of GWG or pre-BMI are defined as the interval corresponding to lowest or relative lower incidence of GDM.

RESULTS

ORs of pre-BMI, maternal age, GWG at 24 weeks, and first-degree relatives with DM were 1.250, 1.096, 1.142, and 2,098 separately. It is suggested for lowering the incidence of GDM that, to the utmost extent, 12 kg, 9 kg, and 8 kg for GWG at 24 weeks should be the ideal boundary for those pregnant women whose BMI was 15-21 kg/m², 21-23 kg/m², and 23-25 kg/m² respectively. Pre-BMI ≤22 kg/m² would be recommended for an expectant mother whose age is no more than 28 years old. Similarly, women whose age was above 28 years old would be advised to control their BMI below 20 kg/m².

CONCLUSION

Optimal GWG during pregnancy varies largely by diverse pre-BMI, and likewise, optimal pre-BMI varies a lot by different age group. Public health awareness should be promoted on the importance of having healthy pre-BMI, and achieving optimal weight gain during pregnancy to avoid or reduce the incidence of GDM, especially for those with first-degree relatives with DM.

Risk of metabolic syndrome and metabolic phenotypes in relation to biomarker-calibrated estimates of energy and protein intakes: an investigation from the Women's Health Initiative

BACKGROUND

Metabolic syndrome (MetS) is associated with increased mortality independent of BMI, resulting in discordant metabolic phenotypes, such as metabolically healthy obese and metabolically unhealthy normal-weight individuals. Studies investigating dietary intake in MetS have reported mixed results, due in part to the limitations of self-reported measures.

OBJECTIVES

To investigate the role of biomarker-calibrated estimates of energy and protein in MetS and metabolic phenotypes.

METHODS

Postmenopausal participants from the Women's Health Initiative (WHI) study who were free of MetS at baseline, had available data from FFQs at baseline, and had components of MetS at Year 3 (n = 3963) were included. Dietary energy and protein intakes were estimated using biomarker calibration methods. MetS was defined as 3 or more of the following: elevated serum triglycerides (≥150 mg/dL), low HDL cholesterol (<50 mg/dL), hypertension [systolic blood pressure (BP) ≥130 or diastolic BP ≥85 mmHg], elevated serum glucose (>100 mg/dL), and abdominal adiposity (waist circumference > 89 cm). Models were adjusted for age, WHI study component, race/ethnicity, education, income, smoking, recreational physical activity, disease history, and parity.

RESULTS

For every 10% increment in total calibrated energy intake, women were at a 1.37-fold elevated risk of MetS (95% CI, 1.15-1.63); a 10% increment in calibrated total protein intake was associated with a 1.21-fold elevated risk of MetS (95% CI, 1.00-1.47). Specifically, animal protein intake was associated with MetS (OR, 1.08; 95% CI, 1.02-1.14), whereas vegetable protein intake was not (OR, 0.99; 95% CI, 0.95-1.03). No differences were seen when examining metabolic phenotypes.

CONCLUSIONS

We found that higher calibrated total energy, total protein, and total animal protein intakes were strongly associated with MetS. If replicated in clinical trials, these results will have implications for the promotion of energy and animal protein restrictions for the reduction of MetS risks.

Race, Body Mass Index, and the Risk of Atrial Fibrillation: The Multi-Ethnic Study of Atherosclerosis

Background

Higher body mass index (BMI) is associated with increased risk of incident atrial fibrillation (AF), but it is not known whether this relationship varies by race/ethnicity.

Methods and Results

Eligible participants (6739) from MESA (Multi‐Ethnic Study of Atherosclerosis) were surveilled for incident AF using MESA hospital surveillance, scheduled MESA study ECG, and Medicare claims data. After a median 13.8 years of follow‐up, 970 participants (14.4%) had incident AF. With BMI modeled categorically in a Cox proportional hazards model, only those with grade II and grade III obesity had increased risks of AF (hazard ratio [HR], 1.50; 95% CI, 1.14–1.98, P=0.004 for grade II obesity and HR, 2.13; 95% CI, 1.48–3.05, P<0.0001 for grade III obesity). The relationship between BMI and AF risk was J‐shaped. However, the risk of AF as a function of BMI varied substantially by race/ethnicity (P value for interaction=0.02), with Chinese‐American participants having a much higher risk of AF with higher BMI and Black participants having minimal increased risk of AF with higher BMI.

Conclusions

Obesity is associated with an increased risk of incident AF, but the relationship between BMI and the risk of AF is J‐shaped and this relationship differs by race/ethnicity, such that Chinese‐American participants have a more pronounced increased risk of AF with higher BMI, while Black participants have minimal increased risk. Further exploration of the differential effects of BMI by race/ethnicity on cardiovascular outcomes is needed.

Alcohol Consumption, Cardiovascular-Related Conditions, and ALDH2*2 Ethnic Group Prevalence in Asian Americans

BACKGROUND

Little is known about the relationships between alcohol consumption and cardiovascular disease (CVD) and related chronic conditions in Asian Americans and how such risk relationships vary among their subgroups. We examine these relationships in Asian Americans and their moderation by ethnic prevalence of a variant the aldehyde dehydrogenase gene: ALDH2*2.

METHODS

Multiple logistic regression modeling was performed using a nationally representative sample of Asian-American adults aged 30 to 70 (n = 1,720) from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) Waves 2 (2004 to 2005) and 3 (2012 to 2013). Outcomes considered were diabetes, hypertension, high cholesterol, CVD, any of the 3 conditions (i.e., diabetes, high cholesterol, and CVD) documented to have a J-shaped relationship with drinking (CVDRC3), and any of the CVD-related conditions (ANYCVD). Demographic and socioeconomic characteristics, health insurance coverage, and other lifestyle risk factors (smoking and obesity/overweight) were adjusted. Analyses were stratified by gender.

RESULTS

Alcohol consumption level was positively associated only with hypertension in Asian males, with consuming 7 to 14 drinks per week associated with more than double the risk of lifetime abstinence. For females, alcohol consumption had a dose-response relationship with high cholesterol and CVDRC3. Membership in the higher ALDH2*2 ethnic group overall was associated with lower risk of CVD-related conditions. However, compared to abstainers in lower ALDH2*2 group, females in the higher ALDH2*2 group who consumed more than 7 drinks per week had a higher risk of diabetes, hypertension, CVDRC3, and ANYCVD.

CONCLUSIONS

Asian Americans may have increased risk of CVD-related conditions at relatively low alcohol consumption levels. Among Asian-American females, in particular, any amount of drinking may increase risk for high cholesterol or any of the CVD-related conditions previously documented to have a curvilinear relationship with drinking. These risks may be particularly elevated for those in ethnic groups with a high prevalence of ALDH2*2.

Vegetarian diets as a possible therapeutic approach to patients with metabolic syndrome: A brief review

Approximately 25% of the adult worldwide population is estimated to have metabolic syndrome. Vegetarian diets have demonstrated effectiveness in improving each risk factor for developing metabolic syndrome, as compared with conventional dietary patterns and are useful in the prevention of metabolic syndrome. The present study reviews published literature concluding that following a vegetarian diet with the adequate nutritional support appears to be a mean to improve patients’ metabolic condition and to decrease the risk of developing metabolic syndrome.

The IDF Definition Is Better Suited for Screening Metabolic Syndrome and Estimating Risks of Diabetes in Asian American Adults: Evidence from NHANES 2011-2016

OBJECTIVE

extensive effort has been made to better define metabolic syndrome (MetS). Whether current definitions accurately diagnose MetS and predict risk of cardiovascular disease (CVD) or diabetes in diverse ethnic groups remains largely unknown. The objective of this study was to compare the prevalence of MetS and risk of CVD and diabetes among Asian American adults using two MetS definitions, one proposed by the Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (ATP III) and one by the International Diabetes Federation (IDF).

METHODS

we obtained a nationally representative sample of 2121 Asian American adults in the noninstitutionalized civilian population of the United States from the National Health and Nutrition Examination Survey (2011-2016). We computed age-adjusted, gender-specific MetS prevalence and each MetS component using ATP III and IDF definitions.

RESULTS

based on the IDF definition, MetS prevalence was 39.26% among Asian American men and 39.66% among Asian American women included in the study sample. Based on the ATP III definition, MetS prevalence in our sample was 39.38% among men and 36.11% among women. We found good concordance between the IDF and the ATP III definitions in identifying MetS in Asian American adults. Those with MetS defined only by the IDF definition had significantly higher body mass index (BMI) and waist circumference than those with MetS defined only by the ATP III definition. The IDF definition also better predicted elevated fasting insulin.

CONCLUSIONS

the IDF definition is more pertinent than the ATP III definition for screening and estimating risk of CVD and diabetes in Asian American adults. Future studies should examine differences in MetS prevalence across Asian ethnic groups to facilitate the development of culturally tailored strategies improve MetS prevention and detection in Asian Americans.