Hypertension and type 2 diabetes comorbidity in adults in the United States: risk of overall and regional adiposity

Mediating effect of BMI on the association of economic status and coexistence of hypertension and diabetes in Bangladesh: A counterfactual framework-based weighting approach

Background and Aims

Non-communicable diseases such as hypertension and diabetes are matters of huge concern worldwide, with an increasing trend in prevalence over the previous decade. First of all, this study aimed to evaluate the association between economic status (ES) and body mass index (BMI), ES and comorbidity of hypertension and diabetes, and BMI and comorbidity independently. Second, it explored the mediating role of BMI in the association between ES and comorbidity of hypertension and diabetes. Finally, it investigated whether the mediating effect differs with the place of residence, gender, and education levels.

Methods

A total of 11,291 complete cases from the Bangladesh demographic and health survey 2017-18 were utilized for this study. Survey-based binary logistic regression or multiple logistic regression was used to find the association among outcome, exposure, and mediator variables, and a counterfactual framework-based weighting approach was utilized for mediation analysis.

Results

Middle-income (adjusted odds ratio [AOR]: 1.696, 95% confidence interval [CI]: 1.219, 2.360) and rich (AOR: 2.770, CI: 2.054, 3.736) respondents were more likely to have comorbidity of hypertension and diabetes compared to the poor. The odds of comorbidity increased with the increase in BMI. A positive association was observed between ES and BMI. A significant mediating role of BMI in the association between ES and comorbidity was found. We observed that 19.85% (95% CI: 11.50%, 49.6%) and 20.35% (95% CI: 14.9%, 29.3%) of total effect was mediated by BMI for middle and rich respondents, respectively, compared to the poor.

Conclusions

The mediating role of BMI was greater for female, no or primary educated respondents, and respondents from rural areas. Therefore, the study will facilitate policymakers of Bangladesh and other countries with a similar set-up to decide on health policies regarding hypertension and diabetes.

GenomeMUSter mouse genetic variation service enables multitrait, multipopulation data integration and analysis

Hundreds of inbred mouse strains and intercross populations have been used to characterize the function of genetic variants that contribute to disease. Thousands of disease-relevant traits have been characterized in mice and made publicly available. New strains and populations including consomics, the collaborative cross, expanded BXD, and inbred wild-derived strains add to existing complex disease mouse models, mapping populations, and sensitized backgrounds for engineered mutations. The genome sequences of inbred strains, along with dense genotypes from others, enable integrated analysis of trait-variant associations across populations, but these analyses are hampered by the sparsity of genotypes available. Moreover, the data are not readily interoperable with other resources. To address these limitations, we created a uniformly dense variant resource by harmonizing multiple data sets. Missing genotypes were imputed using the Viterbi algorithm with a data-driven technique that incorporates local phylogenetic information, an approach that is extendable to other model organisms. The result is a web- and programmatically accessible data service called GenomeMUSter, comprising single-nucleotide variants covering 657 strains at 106.8 million segregating sites. Interoperation with phenotype databases, analytic tools, and other resources enable a wealth of applications, including multitrait, multipopulation meta-analysis. We show this in cross-species comparisons of type 2 diabetes and substance use disorder meta-analyses, leveraging mouse data to characterize the likely role of human variant effects in disease. Other applications include refinement of mapped loci and prioritization of strain backgrounds for disease modeling to further unlock extant mouse diversity for genetic and genomic studies in health and disease.

GenomeMUSter mouse genetic variation service enables multi-trait, multi-population data integration and analyses

Hundreds of inbred laboratory mouse strains and intercross populations have been used to functionalize genetic variants that contribute to disease. Thousands of disease relevant traits have been characterized in mice and made publicly available. New strains and populations including the Collaborative Cross, expanded BXD and inbred wild-derived strains add to set of complex disease mouse models, genetic mapping resources and sensitized backgrounds against which to evaluate engineered mutations. The genome sequences of many inbred strains, along with dense genotypes from others could allow integrated analysis of trait - variant associations across populations, but these analyses are not feasible due to the sparsity of genotypes available. Moreover, the data are not readily interoperable with other resources. To address these limitations, we created a uniformly dense data resource by harmonizing multiple variant datasets. Missing genotypes were imputed using the Viterbi algorithm with a data-driven technique that incorporates local phylogenetic information, an approach that is extensible to other model organism species. The result is a web- and programmatically-accessible data service called GenomeMUSter ( https://muster.jax.org ), comprising allelic data covering 657 strains at 106.8M segregating sites. Interoperation with phenotype databases, analytic tools and other resources enable a wealth of applications including multi-trait, multi-population meta-analysis. We demonstrate this in a cross-species comparison of the meta-analysis of Type 2 Diabetes and of substance use disorders, resulting in the more specific characterization of the role of human variant effects in light of mouse phenotype data. Other applications include refinement of mapped loci and prioritization of strain backgrounds for disease modeling to further unlock extant mouse diversity for genetic and genomic studies in health and disease.

The Effect of Mixture of Heavy Metals on Obesity in Individuals ≥50 Years of Age

Little is known about the association between a mixture of heavy metals and obesity among individuals ≥50 years of age with comorbidities. Thus, we identified the associations of serum cadmium (Cd), lead (Pb), and mercury (Hg) with obesity using linear regression models; weighted quantile sum (WQS) regression, quantile g-computation (qgcomp), and Bayesian kernel machine regression (BKMR) were conducted as secondary analyses. Of the 6434 subjects included in the analysis, 13.8% had obesity and 44.6% had abdominal obesity. In the logistic regression model, serum Hg was associated with obesity and abdominal obesity, and significant trends were observed for these heavy metal tertiles (p < 0.001). Serum Hg levels were also associated with body mass index (BMI) and waist circumference (WC). The WQS index was significantly associated with both obesity (OR = 1.43, 95% CI: 1.40-1.46) and abdominal obesity (β = 1.51, 95% CI: 1.48-1.54). The qgcomp index also found a significant association between heavy metals and both obesity (OR = 1.35, 95% CI: 1.12-1.63) and abdominal obesity (OR = 1.34, 95% CI: 1.12-1.60). Serum Hg was the most heavily weighed heavy metal in these models. In BKMR analysis, the overall effect of the mixture was significantly associated with obesity, BMI, and WC. Serum Hg showed positive trends and was observed as the most important factor associated with obesity, BMI, and WC. Our findings were largely robust to secondary analyses that used three novel mixture modeling approaches: WQS, qpcomp, and BKMR. Given increasing exposure to heavy metals, well-characterized cohorts of individuals aged ≥50 years are required to determine the mixed effects of heavy metals on obesity and related diseases.

Relationship between obesity indicators and hypertension-diabetes comorbidity among adults: a population study from Central China

OBJECTIVE

To identify the relationship between obesity indicators and hypertension-diabetes comorbidity (HDC) among adults in central China.

DESIGN AND SETTING

A cross-sectional study was conducted from 1 June 2015 to 30 September 2018 in 11 districts of Hubei Province, China.

PARTICIPANTS

A total of 29 396 participants aged 18 years or above were enrolled in the study. 2083 subjects with missing data were excluded. Eventually, 25 356 participants were available for the present analysis.

MAIN OUTCOME MEASURES

Data were subjected to univariable and multivariable logistic regression to examine the association between obesity indicators (body mass index (BMI), waist circumference (WC) and waist-to-height ratio (WHtR)) and HDC prevalence. Crude odds ratio and adjusted OR (AOR) with associated 95% CI were calculated.

RESULTS

Overall, 2.8% of the respondents had HDC. The odds of HDC prevalence increased with the BMI of the participants (18.5≤BMI (kg/m2)≤23.9-1; 24≤BMI (kg/m2)≤26.9-AOR: 5.66, 95% CI: 4.25 to 7.55; BMI (kg/m2)≥27-AOR: 7.96, 95% CI: 5.83 to 10.87). The risk of HDC also increased with the WHtR of participants (WHtR≤P25-1; P25≤WHtR≤P50-AOR: 1.73, 95% CI: 1.10 to 2.71; P50 ≤WHtR≤P75-AOR: 2.51, 95% CI: 1.60 to 3.92; WHtR≥P75-AOR: 3.22, 95% CI: 2.01 to 5.16). Stratified analysis by gender showed that high BMI and WHtR were risk factors of HDC in males and females. However, the odds of HDC prevalence increased only when WHtR≥P75 in males, whereas the probability of HDC increased when WHtR≥ P25 in females.

CONCLUSION

High BMI and WHtR can increase the risk of HDC among Chinese adults. Reasonable control of BMI and WHtR may be beneficial in preventing HDC. Females should focus on maintaining an optimal WHtR earlier.

Association of overweight and obesity with hypertension, diabetes and comorbidity among adults in Bangladesh: evidence from nationwide Demographic and Health Survey 2017-2018 data

OBJECTIVES

The study aimed to determine the association of overweight and obesity with hypertension, diabetes and comorbidity among the adults of Bangladesh.

STUDY DESIGN

This study used cross-sectional data from the nationally representative Bangladesh Demographic and Health Survey conducted in 2017-2018. The main outcome variables were hypertension, diabetes and comorbidity. Comorbidity was defined as the coexistence of hypertension and diabetes. Overweight and obesity, as measured by body mass index, were the main explanatory variables. The strength of the association was determined using the adjusted multiple logistic regression models.

SETTING

Rural and urban areas in Bangladesh.

PARTICIPANTS

The study included a total of 11 881 adults (5241 men and 6640 women) aged 18 years or older.

RESULTS

The prevalence of hypertension, diabetes and comorbidity among the sample population were 28.5%, 9.9% and 4.5%, respectively. Among the respondents, 20.1% were overweight and 4.1% were obese. The risk of hypertension was 2.47 times more likely in the overweight group (adjusted OR (AOR) 2.47; 95% CI 2.22 to 2.75) and 2.65 times more likely in the obese group (AOR 2.65; 95% CI 2.16 to 3.26) compared with the normal or underweight group. Adults who were overweight and obese had 59% (AOR 1.59; 95% CI 1.37 to 1.84) and 88% (AOR 1.88; 95% CI 1.46 to 2.42) higher odds of having diabetes, respectively, than normal or underweight adults. Moreover, the risk of comorbidity was 2.21 times higher in overweight adults (AOR 2.21; 95% CI 1.81 to 2.71) and 2.86 times higher in obese adults (AOR 2.86; 95% CI 2.09 to 3.91) compared with normal or underweight adults.

CONCLUSIONS

Using large-scale nationally representative data, we found that overweight and obesity were significantly associated with hypertension, diabetes and comorbidity. So, nationally representative data can be used for programme planning to prevent and treat these chronic conditions.

Prevalence of hypertension among individuals with diabetes and its determinants: Evidences from the National Family Health Survey 2015-16, India

BACKGROUND

The incidence of Diabetes mellitus (DM) has escalated in recent decades, and the risk of diabetes-related mortality has increased dramatically due to the co-existence of hypertension (HTN). DM and HTN, having similar aetiology and disease mechanism, are influenced by lifestyle factors and greatly contribute to critical health complications.

AIM

The present study attempted to explore the co-existence of DM-HTN and the potential determinants considering rapid upsurge of both the diseases.

SUBJECTS AND METHODS

National Family Health Survey data were used, which included 7092 adult diabetic individuals, to find out the prevalence rate of HTN in diabetic persons in India. Appropriate statistical analyses were performed to accomplish the study objectives.

RESULTS

Prevalence rate of HTN in diabetic individuals was approximately 37%. Higher BMI was associated with DM-HTN co-existence. In males, increased age, higher BMI, alcohol consumption, poorest wealth index, and non-smoking (tobacco) were the significant determinants of the co-existence of DM-HTN, while in females, they were increased age, higher BMI, and geographical region.

CONCLUSION

This study unveiled the significance of healthy lifestyle maintenance and equitable health care services to prevent HTN among the diabetics, along with promotion of the awareness and management of DM and HTN through appropriate pharmacological treatments.

Risk factors for hypertension and diabetes comorbidity in a Korean population: A cross-sectional study

BACKGROUND

Hypertension and diabetes are risk factors for severe cardiovascular disease and are prevalent comorbidities. No studies have examined the associations of various risk factors related to anthropometry, bone mineral density and body composition of specific body regions with hypertension and diabetes comorbidity (HDC). This study explored the association between HDC and various risk factors related to specific body regions.

METHOD

A total of 7,978 subjects (3,451 men and 4,527 women) aged ≥ 50 years were included in the analysis. A binary logistic regression analysis based on complex sample data analysis was conducted to examine associations between the normal and diabetes groups, between the normal and hypertension groups, and between the normal and HDC groups.

RESULTS

Among Korean adults aged ≥ 50 years, 11.27% of men and 10.05% of women had both diabetes and hypertension. The HDC prevalence was higher in men than in women. In men, waist-to-height ratio (WHtR, adjusted OR = 1.63 [1.22-2.18], adjusted p<0.001) exhibited a more significant association with HDC than other indices, left leg fat mass (adjusted OR = 0.61 [0.45-0.81], adjusted p = 0.0009) and right leg fat mass (adjusted OR = 0.60 [0.45-0.81], adjusted p = 0.0007) displayed strong negative associations with diabetes, and left leg lean mass (adjusted OR = 0.77 [0.67-0.89], adjusted p = 0.0002) and trunk fat mass (adjusted OR = 1.28 [1.07-1.52], adjusted p = 0.0062) were significantly associated with hypertension. In women, left leg fat mass (adjusted OR = 0.29 [0.22-0.39], adjusted p<0.0001) and right leg fat mass (adjusted OR = 0.32 [0.23-0.45], adjusted p<0.0001) exhibited strong negative associations with HDC, waist circumference (WC) (adjusted OR = 2.15 [1.40-3.30], adjusted p = 0.0005) showed a stronger association with diabetes than did other indices, and WC (adjusted OR = 1.39 [1.11-1.74], adjusted p = 0.0040) and WHtR (adjusted OR = 1.39 [1.09-1.76], adjusted p = 0.0075) were significantly associated with hypertension.

DISCUSSION

HDC was more strongly associated with fat and lean mass than diabetes and hypertension. The association between HDC and body fat variables was more robust in women than in men.

A Review of Interventional Trials in Youth-Onset Type 2 Diabetes: Challenges and Opportunities

INTRODUCTION

In recent decades, the dramatic rise of obesity among youth in the US has been accompanied by a rise in the prevalence of type 2 diabetes (T2D) in this population. This alarming trend underscores the importance of conducting trials to evaluate new therapies in children with T2D.

METHODS

A targeted review of peer-reviewed literature and trials registered on www.clinicaltrials.gov was conducted in January 2021 to identify pharmaceutical interventional studies in youth with T2D. Information regarding enrollment data, study design elements, subjects' baseline characteristics, and key treatment outcomes was documented.

RESULTS

Among the 16 clinical studies included in this review, only five appeared to meet projected enrollment targets in < 4 years. Although three other studies met recruitment targets, two took approximately 5 years to complete and the third took nearly 10 years.

CONCLUSIONS

Despite legislation requiring evaluation of pharmaceutical treatments in pediatric populations, surprisingly few interventional studies have been conducted in children with T2D. This review highlights that recruitment challenges may be impeding the conduct and completion of interventional studies. Consequently, few pharmaceutical treatments have been proven to be effective and approved for children with T2D. Metformin and liraglutide remain the only non-insulin treatments formally approved in the US for use in this population. More clinical research is needed to support regulatory decision-making as well as treatment decisions for children with T2D in clinical settings. Sponsors and investigators will need to implement strategies for improving trial enrollment as well as work with regulatory agencies to develop novel study designs that may require fewer patients.

Impact of Sociodemographic Characteristics, Lifestyle, and Obesity on Coexistence of Diabetes and Hypertension: A Structural Equation Model Analysis amongst Chinese Adults

BACKGROUND

In general, given the insufficient sample size, considerable literature has been found on single studies of diabetes and hypertension and few studies have been found on the coexistence of diabetes and hypertension (CDH) and its influencing factors with a large range of samples. This study aimed to establish a structural equation model for exploring the direct and indirect relationships amongst sociodemographic characteristics, lifestyle, obesity, and CDH amongst Chinese adults.

METHODS

A cross-sectional study was conducted in a representative sample of 25356 adults between June 1, 2015, and September 30, 2018, in Hubei province, China. Confirmatory factor analysis was initially conducted to test the latent variables. A structural equation model was then performed to analyse the association between latent variables and CDH.

RESULTS

The total prevalence of CDH was 2.8%. The model paths indicated that sociodemographic characteristics, lifestyle, and obesity were directly associated with CDH, and the effects were 0.187, 0.739, and 0.353, respectively. Sociodemographic characteristics and lifestyle were also indirectly associated with CDH, and the effects were 0.128 and 0.045, respectively. Lifestyle had the strongest effect on CDH (β = 0.784, P < 0.001), followed by obesity (β = 0.353, P < 0.001) and sociodemographic characteristics (β = 0.315, P < 0.001). All paths of the model were significant (P < 0.001).

CONCLUSION

CDH was significantly associated with sociodemographic characteristics, lifestyle, and obesity amongst Chinese adults. The dominant predictor of CDH was lifestyle. Targeting these results might develop lifestyle and weight loss intervention to prevent CDH according to the characteristics of the population.

Obesity and risk for hypertension and diabetes among Kenyan adults: Results from a national survey

ABSTRACT

Despite the anticipated growth in the global burden of obesity especially in low-income countries, limited data exist on the contribution of obesity to cardiometabolic diseases in Africa.We examined population-based samples of Kenyan adults who participated in the 2015 national chronic disease risk factor surveillance survey. Weight and height were measured, and body mass index (BMI) was calculated and used as a measure for general obesity. Waist circumference (WC), a clinical measure of central obesity was also measured. Logistic regression was used to assess the association between obesity with hypertension, diabetes, and dyslipidemia risk.Of the 4276 participants, the median (IQR) age was 36 (27-47) years, 41% were men. One-third (37%) of the participants were centrally obese, whereas 10% were generally obese. The odds for overweight and general obesity were highest among females, adults >40 years, and those in the highest wealth quartile. Central and general obesity, assessed by WC and BMI, were associated with hypertension and dyslipidemia but not diabetes for both sexes. Compared with adults of normal weight, individuals with a BMI of ≥30 kg/m2 had an odds ratio of 2.39 (95% confidence interval [CI], 1.82-3.12) for hypertension and 2.24 (95% CI, 1.70-2.96) for dyslipidemia.Obesity prevalence is high in Kenya and is associated with hypertension and dyslipidemia but not diabetes. Our findings indicate an urgent need to develop public health interventions to address obesity and prevent the development of comorbid conditions.

Phenotypic and genotypic changes in obesity and type 2 diabetes of male KK mice with aging

Research into the prevention and treatment of age-related metabolic diseases are important in the present-day situation of the aging population. We propose that an elderly diabetic mouse model may be useful to such research as it exhibits deterioration of glucose and lipid metabolism. Although the KK mouse strain is commonly used as a model of moderate obesity and type 2 diabetes, the utility of this strain as an elderly obese and diabetic model mouse for research into aging remains unclear. The present study aimed to investigate age-related changes of glucose and lipid metabolism in male KK mice fed a standard chow diet. We demonstrate that 40 weeks KK mice exhibit age-related dysfunctions, such as development of insulin resistance associated with pancreatic islet hypertrophy and decreased lipolysis in white adipose tissue (WAT) compared with 15 weeks KK mice. However, aging does not appear to cause mitochondrial dysfunction of brown adipose tissue. Unexpectedly, hyperglycemia, potential glucose uptake in insulin-sensitive organs, hepatic lipid accumulation, hypertrophy of adipocytes, and inflammation in epididymal WAT did not worsen but rather compensated in 40 weeks KK mice. Our data indicate that the use of male KK mice as an elderly obese and diabetic mouse model has some limitations and in order to represent a useful elderly obese and diabetic animal model, it may be necessary to induce deterioration of glucose and lipid metabolism in KK mice through breeding with high-sucrose or high-fat diets.

Glycosylation of IgG Associates with Hypertension and Type 2 Diabetes Mellitus Comorbidity in the Chinese Muslim Ethnic Minorities and the Han Chinese

Objectives: Hypertension and type 2 diabetes mellitus comorbidity (HDC) is common, which confers a higher risk of cardiovascular disease than the presence of either condition alone. Describing the underlying glycomic changes of immunoglobulin G (IgG) that predispose individuals to HDC may help develop novel protective immune-targeted and anti-inflammatory therapies. Therefore, we investigated glycosylation changes of IgG associated with HDC. Methods: The IgG N-glycan profiles of 883 plasma samples from the three northwestern Chinese Muslim ethnic minorities and the Han Chinese were analyzed by ultra-performance liquid chromatography instrument. Results: We found that 12 and six IgG N-glycan traits showed significant associations with HDC in the Chinese Muslim ethnic minorities and the Han Chinese, respectively, after adjustment for potential confounders and false discovery rate. Adding the IgG N-glycan traits to the baseline models, the area under the receiver operating characteristic curves (AUCs) of the combined models differentiating HDC from hypertension (HTN), type 2 diabetes mellitus (T2DM), and healthy individuals were 0.717, 0.747, and 0.786 in the pooled samples of Chinese Muslim ethnic minorities, and 0.828, 0.689, and 0.901 in the Han Chinese, respectively, showing improved discriminating performance than both the baseline models and the glycan-based models. Conclusion: Altered IgG N-glycan profiles were shown to associate with HDC, suggesting the involvement of inflammatory processes of IgG glycosylation. The alterations of IgG N-glycome, illustrated here for the first time in HDC, demonstrate a biomarker potential, which may shed light on future studies investigating their potential for monitoring or preventing the progression from HTN or T2DM towards HDC.

Prevalence of diabetes and hypertension and their interaction effects on cardio-cerebrovascular diseases: a cross-sectional study

BACKGROUND

Hypertension and diabetes mellitus are two of the major risk factors for cardio-cerebrovascular diseases (CVDs). Although prior studies have confirmed that the coexistence of the two can markedly increase the risk of CVDs, few studies investigated whether potential interaction effects of hypertension and diabetes can result in greater cardio-cerebrovascular damage. We aimed to investigate the prevalence of hypertension and diabetes and whether they both affect synergistically the risk of CVDs.

METHODS

A cross-sectional study was conducted by using a multistage stratified random sampling among communities in Changsha City, Hunan Province. Study participants aged > = 18 years were asked to complete questionnaires and physical examinations. Multivariate logistic regression models were performed to evaluate the association of diabetes, hypertension, and their multiplicative interaction with CVDs with adjustment for potential confounders. We also evaluated additive interaction with the relative excess risk ratio (RERI), attribution percentage (AP), synergy index (SI).

RESULTS

A total of 14,422 participants aged 18-98 years were collected (men = 5827, 40.7%). The prevalence was 22.7% for hypertension, 7.0% for diabetes, and 3.8% for diabetes with hypertension complication, respectively. Older age, women, higher educational level, unmarried status, obesity (central obesity) were associated with increased risk of hypertension and diabetes. We did not find significant multiplicative interaction of diabetes and hypertension on CVDs, but observed a synergistic additive interaction on coronary heart disease (SI, 1.43; 95% CI, 1.03-1.97; RERI, 1.94; 95% CI, 0.05-3.83; AP, 0.26; 95% CI, 0.06-0.46).

CONCLUSIONS

Diabetes and hypertension were found to be associated with a significantly increased risk of CVDs and a significant synergistic additive interaction of diabetes and hypertension on coronary heart disease was observed. Participants who were old, women, highly educated, unmarried, obese (central obese) had increased risk of diabetes and hypertension.

Projecting the prevalence of obesity in South Korea through 2040: a microsimulation modelling approach

OBJECTIVE

To project the prevalence of obesity in 2040 among individuals 19 years and older in South Korea.

DESIGN, SETTING, AND PARTICIPANTS

Using the 'Population Health Model-body mass index' (BMI) microsimulation model, the prevalence of obesity in Korean adults 19 years and older was projected until 2040. The model integrated individual survey data from the Korea Health Panel Survey of 2011 and 2012, population statistics based on resident registration, population projections and complete life tables categorised by sex and age. Birth rate, life expectancy and international migration were based on a medium growth scenario. The base population of Korean adults in 2012, devised through data aggregation, was 39 842 730. The prediction equations were formulated using BMI as the dependent variable; the individual's sex, age, smoking status, physical activity and preceding year's BMI were used as predictive factors.

OUTCOME MEASURE

BMI categorised by sex.

RESULTS

The median BMI for Korean adults in 2040 was expected to be 23.55 kg/m² (23.97 and 23.17 kg/m² for men and women, respectively). According to the Korean BMI classification, 70.05% of all adults were expected to be 'preobese' (ie, have BMIs 23-24.9 kg/m²) by 2040 (81.23% of men and 59.07% of women) and 24.88% to be 'normal'.

CONCLUSIONS

We explored the possibility of applying and expanding on the concept of microsimulation in the field of healthcare by combining data sources available in Korea and found that more than half of the adults in this study population will be preobese, and the proportions of 'obesity' and 'normal' will decrease compared with those in 2012. The results of our study will aid in devising healthy strategies and spreading public awareness for preventing this condition.

Association of Body Mass Index and Waist to Hip Ratio With Gallstone Disease in Patients Visiting Rural Tertiary Care Center in North India

Introduction. In India the prevalence of gall stone disease varies in different parts of India. Malhotra in 1996 conducted an epidemiological study in Indian Railway employees and showed that North Indians has 7 times higher prevalence of gall stones compared to South Indian employees. It is said that Gall bladder is a disease of "Fatty, Fertile, Females in their Forties". In our daily routine we observe that it is found not only in fatty females but common in average built patients also. Material and Methods. Study includes patients visiting to BPS GMC Khanpur Kalan with diagnosis of gall stone diseases and operated at our center with sample size of 135. Body mass index (BMI) and Waist to Hip ratio are calculated using their standard formulas. All data was compiled in IBM SPSS statistics (20.0). Result. Normal BMI is considered up to 25 and more than 50% patients lie in normal BMI range. Only 13% of cases lie in obese group that is BMI greater than 30. Waist to hip ratio, maximum patients that is BMI greater than 30. Waist to hip ratio, maximum patients that is (83%) lie in group more than 0.85. Minimum Waist to Hip ratio is .77 and maximum Waist to Hip ratio is 1.45. Out of 135 patients 90 patients are having high Waist to Hip ratio. Conclusion. Waist to Hip Ratio (abdominal adiposity) is better indicator of Gall stone diseases than BMI.

Development of cancer after bariatric surgery

BACKGROUND

Although bariatric surgery has been associated with a reduction in risk of obesity-related cancer, data on the effect of bariatric interventions on other cancers are limited.

OBJECTIVES

This study aimed to examine the relationship between bariatric interventions and the incidence of various cancers after bariatric surgery.

SETTING

Administrative statewide database.

METHODS

The New York Statewide Planning and Research Cooperative System database was used to identify all adult patients diagnosed with obesity between 2006 and 2012 and patients who underwent bariatric procedures without preexisting cancer diagnosis and alcohol or tobacco use. Subsequent cancer diagnoses were captured up to 2016. Multivariable proportional subdistribution hazard regression analysis was performed to compare the risk of having cancer among obese patients with and without bariatric interventions.

RESULTS

We identified 71,000 patients who underwent bariatric surgery and 323,197 patients without a bariatric intervention. Patients undergoing bariatric surgery were less likely to develop both obesity-related cancer (hazard ratio.91; 95% confidence interval, .85-.98; P = .013) and other cancers (hazard ratio .81; 95% confidence interval, .74-.89; P < .0001). Patients undergoing Roux-en-Y gastric bypass had a lower risk of developing cancers that are considered nonobesity related (hazard ratio .59; 95% confidence interval, .42-.83; P = .0029) compared with laparoscopic sleeve gastrectomy.

CONCLUSIONS

Bariatric surgery is associated with a decreased risk of obesity-related cancers. More significantly, we demonstrated the relationship between bariatric surgery and the reduction of the risk of some previously designated nonobesity-related cancers, as well. Reclassification of nonobesity-related cancers and expansion of bariatric indications for reducing the risk of cancer may be warranted.

Favorable 90-Day Mortality in Obese Caucasian Patients with Septic Shock According to the Sepsis-3 Definition

Septic shock is a frequent life-threatening condition and a leading cause of mortality in intensive care units (ICUs). Previous investigations have reported a potentially protective effect of obesity in septic shock patients. However, prior results have been inconsistent, focused on short-term in-hospital mortality and inadequately adjusted for confounders, and they have rarely applied the currently valid Sepsis-3 definition criteria for septic shock. This investigation examined the effect of obesity on 90-day mortality in patients with septic shock selected from a prospectively enrolled cohort of septic patients. A total of 352 patients who met the Sepsis-3 criteria for septic shock were enrolled in this study. Body-mass index (BMI) was used to divide the cohort into 24% obese (BMI ≥ 30 kg/m²) and 76% non-obese (BMI < 30 kg/m²) patients. Kaplan-Meier survival analysis revealed a significantly lower 90-day mortality (31% vs. 43%; p = 0.0436) in obese patients compared to non-obese patients. Additional analyses of baseline characteristics, disease severity, and microbiological findings outlined further statistically significant differences among the groups. Multivariate Cox regression analysis estimated a significant protective effect of obesity on 90-day mortality after adjustment for confounders. An understanding of the underlying physiologic mechanisms may improve therapeutic strategies and patient prognosis.

Sex-specific prevalence, inequality and associated predictors of hypertension, diabetes, and comorbidity among Bangladeshi adults: results from a nationwide cross-sectional demographic and health survey

OBJECTIVES

To determine the sex-specific prevalence, inequality and factors associated with healthcare utilisation for diabetes mellitus (DM), hypertension and comorbidity among the adult population of Bangladesh.

STUDY DESIGN

This study analysed cross-sectional nationwide Bangladesh Demographic and Health Survey data from 2011. Comorbidity was defined as the coexistence of both DM and hypertension. Several socioeconomic and demographic factors such as age, sex, education, geographic location, administrative division, employment status, education and wealth index were considered as major explanatory variables. Inequality in prevalence and healthcare utilisation was measured using the 'Lorenz curve'. Adjusted multiple logistic regression models were performed to observe the effects of different factors and reported as adjusted ORs (AORs) with 95% CIs. A p value of <0.05 was adopted as the level of statistical significance.

SETTING

The study was conducted in Bangladesh.

PARTICIPANTS

A total of 7521 adult participants with availability of biomarkers information were included.

RESULTS

The mean age of the study participants was 51.4 years (SD ±13.0). The prevalence of hypertension, diabetes and comorbidity were 29.7%, 11.0% and 4.5% respectively. Socioeconomic inequality was observed in the utilisation of healthcare services. A higher prevalence of hypertension and comorbidity was significantly associated with individuals aged >70 years (AOR 7.0, 95% CI 5.0 to 9.9; AOR 6.7, 95% CI 3.0 to 14.9). The risk of having hypertension, diabetes and comorbidity were significantly higher among more educated, unemployed as well as among individuals from Khulna division.

CONCLUSIONS

The study revealed a rising prevalence of hypertension, diabetes and comorbidity with inequality in service utilisation. A joint effort involving public, private and non-governmental organisations is necessary to ensure improved accessibility in service utilisation and to reduce the disease burden.

Sex-specific associations between body mass index and death before life expectancy: a comparative study from the USA and Sweden

BACKGROUND

Understanding the impact of obesity on premature mortality is critical, as obesity has become a global health issue.

OBJECTIVE

To contrast the relationship between body mass index (BMI) and premature death (all-cause; circulatory causes) in New York State (USA) and Northern Sweden.

METHODS

Baseline data were obtained between 1989 and 1999 via questionnaires (USA) and health exams (Sweden), with mortality data from health departments, public sources (USA) and the Swedish Death Register. Premature death was death before life expectancy based on sex and year of birth. Within country and sex, time to premature death was compared across BMI groups (18.5-24.9 kg/m² (reference), 25-29.9 kg/m², 30.0-34.9 kg/m², ≥35.0 kg/m²) using Proportional Hazards regression. Absolute risk (deaths/100,000 person-years) was compared for the same stratifications among nonsmokers.

RESULTS

60,600 Swedish (47.8% male) and 31,198 US subjects (47.7% male) were included. Swedish males with BMI≥30 had increased hazards (HR) of all-cause premature death relative to BMI 18.5-24.9 (BMI 30-34.9, HR = 1.71 (95% CI: 1.44, 2.02); BMI≥35, HR = 2.89 (2.16, 3.88)). BMI≥25 had increased hazards of premature circulatory death (BMI 25-29.9, HR = 1.66 (1.32, 2.08); BMI 30-34.9, HR = 3.02 (2.26, 4.03); BMI≥35, HR = 4.91 (3.05, 7.90)). Among US males, only BMI≥35 had increased hazards of all-cause death (HR = 1.63 (1.25, 2.14)), while BMI 30-34.9 (HR = 1.83 (1.20, 2.79)) and BMI≥35 (HR = 3.18 (1.96, 5.15)) had increased hazards for circulatory death. Swedish females showed elevated hazards with BMI≥30 for all-cause (BMI 30-34.9, HR = 1.42 (1.18, 1.71) and BMI≥35, HR = 1.61 (1.21, 2.15) and with BMI≥35 (HR = 3.11 (1.72, 5.63)) for circulatory death. For US women, increased hazards were observed among BMI≥35 (HR = 2.10 (1.60, 2.76) for all-cause and circulatory HR = 3.04 (1.75, 5.30)). Swedish males with BMI≥35 had the highest absolute risk of premature death (762/100,000 person-years).

CONCLUSIONS

This study demonstrates a markedly increased risk of premature death associated with increasing BMI among Swedish males, a pattern not duplicated among females.

An edible fungi Pleurotus ostreatus inhibits adipogenesis via suppressing expression of PPAR γ and C/EBP α in 3T3-L1 cells: In vitro validation of gene knock out of RNAs in PPAR γ using CRISPR spcas9

OBJECTIVE

Obesity is now well recognized as a disorder, one that is essentially preventable through changes in lifestyle. Obesity is also a main concern associated with expanded morbidity and mortality from many noncommunicable illnesses (NCDs). The study aimed to determine the antiobesity effect of Pleurotus ostreatus (PO) and its bioactive anthraquinone (AQ). The overall promoter genes CEBPα (CCAAT enhancer binding protein α) and PPARγ (Peroxisome proliferator activated receptor γ) in controlling the homeostasis of glucose was analysed using 3T3-L1 cell line. Finally, an insilico study was carried out using CRISPR software to identify the RNA's involved in adipogenesis especially of the control gene PPARγ.

MATERIALS AND METHODS

Preliminary screening of the edible fungi and their bio actives led to the marvellous discovery of side effect free agonists for treating obesity (adipogenesis). An edible fungi Pleurotus ostreatus (PO) were analysed in a screening platform with different series of tests for adipocyte differentiation, triglyceride analysis, lipolysis determination, glucose uptake assay, cytotoxicity assay and lipase activity followed by specific gene expression analysis. The gene knockout mechanism was also elucidated by CRISPR spcas 9 tool.

RESULTS

The antiadipogenic (antiobesity) activity of DMSO extract of PO were found to stimulate the insulin dependent uptake of glucose. The extract also decreased the levels of triglycerides and glycerol accumulation in differentiated adipocyte cells. The binding FABP4 (Fatty acid binding protein) and transport protein FATP1 (Fatty acid transport protein) along with the fat breaking LPL (lipoprotein lipase) was found to be inhibited after the PO treatment at varying concentration (0-300 μg/ml). CRISPR spcas9 genome editing software was used as an insilico approach in validating the efficiency of mouse embryonic and human adipogenic cell line (3T3-L1). These tool analysed and found 4 RNAs gene knock out possibilities in PPARγ and their efficiency for further treating obesity.

CONCLUSION

These novel finding contribute to the confirmation that edible fungi PO and it's bioactive AQ is an adequate supplement for constraining the lipid and triglycerides in differentiated mature adipocytes by reversing the fat deposition. Thereby, forbidding the enzymes linked with fat absorption. Besides, the CRISPR tool identified gene knock out possibilities of control gene PPARγ, will pave a way in further research for treating obesity.

Neck circumference as an indicator of elevated central adiposity in children

OBJECTIVE

We aimed to study the correlation between neck circumference (NC) and anthropometric adiposity indicators, and to determine cut-off points of NC for both sexes to identify elevated central adiposity in schoolchildren in western Mexico.

DESIGN

Cross-sectional study.

SETTING

Rural settings in western México.ParticipantsChildren from a convenience sample of six schools in Acatlán, Jalisco, Mexico (n 1802).

RESULTS

NC showed a strong positive correlation with all anthropometric adiposity indicators in both sexes, which were notably higher in boys regardless of age. Noteworthy, waist circumference displayed the highest significant correlation when analysed by both age and sex. As age increased, NC cut-off points to identify elevated central adiposity ranged from 25·7 to 30·1 cm for girls and from 27·5 to 31·7 cm for boys.

CONCLUSIONS

NC could be used as a simple, inexpensive and non-invasive indicator for central obesity assessment in Mexican schoolchildren.

Benefits of combination low-dose pioglitazone plus fish oil on aged type 2 diabetes mice

The elderly patients with type 2 diabetes suffer more adverse drug events than young adults due to pharmacokinetic and pharmacodynamic changes associated with aging. Reducing the risks of these medication-related problems are equally important for the clinical care of older type 2 diabetes patients. Pioglitazone is used for treating type 2 diabetes as an oral antidiabetic drug. Despite pioglitazone is used helpful insulin sensitizers, the accumulation of subcutaneous fat is considered a major adverse effect of pioglitazone therapy. We investigated to reduce the adverse effect of pioglitazone by combination with fish oil rich in eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) in aged diabetic KK mice. The accumulation of subcutaneous fat associated with high-dose pioglitazone is reduced by fish oil, suppressing lipogenesis and stimulating fatty acid β-oxidation in the liver. Our data suggest that adding fish oil to low-dose pioglitazone results in anti-diabetic efficacy similar to that of the high-dose without concomitant body weight gain.

Spiritual well-being, religious activity, and the metabolic syndrome: results from the Hispanic Community Health Study/Study of Latinos Sociocultural Ancillary Study

Sociocultural risk and protective factors for developing the metabolic syndrome (MetS), a risk factor for cardiovascular disease (CVD), have not been well studied in Hispanics/Latinos residing in the United States (U.S.). Religiosity and/or spirituality (R/S), important aspects of Hispanic/Latino culture, have been inversely associated with CVD and multiple CVD risk factors. Cross-sectional associations between dimensions of R/S and prevalent MetS, and its five individual components were examined using multiple logistic and linear regression, among 3278 U.S., middle-aged and older Hispanic/Latino adults from the Hispanic Community Health Study/Study of Latinos Sociocultural Ancillary Study. Dimensions of R/S were not associated with presence of the MetS. Certain dimensions of Spiritual Well-being (Meaning, Peace, Faith), and frequency of non-organizational religious activity were weakly but significantly associated with one or more MetS components including waist circumference, diastolic blood pressure, and systolic blood pressure. R/S variables were not associated with triglycerides, fasting glucose or HDL cholesterol levels. Prospective, longitudinal studies are needed to gain a deeper understanding of the nature of the relationship between R/S and health risk factors in U.S. Hispanics/Latinos.

Low-Carbohydrate Diets, Con: The Mythical Phoenix or Credible Science?

Low-carbohydrate diets are based on an alternative theory of obesity where dietary carbohydrate, particularly unprocessed sugars, causes hyperinsulinemia, leading to insulin resistance, obesity, and cardiovascular disease. In this model, carbohydrate is viewed as a "metabolic poison" and therefore is limited in the diet. This article systematically reviews and refutes the 6 major physiologic claims made by proponents of low-carbohydrate diets. Any benefits or advantages resulting from these diets must therefore be derived from factors other than those stated by the alternative theory.

‘Healthy Weight’ at What Cost? ‘Bulimia’ and a Discourse of Weight Control

Public health messages emphasizing ‘healthy weight’ link good health to a narrow range of body weights and stress energy regulation to achieve this. We examined whether women who practise bulimia deploy notions of ‘healthy weight’ in their talk about body management activities. Analysis is based on interviews with 15 women who practise bulimia and on material collected from cultural locations containing ‘health promotion’ advice. Poststructuralist discourse analysis revealed that slenderness was constituted as healthy in both sites and that the careful regulation of energy intake and output was similarly reified as a healthy practice. We conclude that a discourse of ‘healthy weight’ cannot be unhinged from a cultural imperative of slenderness for women, and that paradoxically ‘health’ practices provide a rationality that supports the practices of binge eating and compensating.

Association of a New Measure of Obesity with Hypertension and Health-Related Quality of Life

Background

Despite its shortcomings, body mass index (BMI) has traditionally been used to define obesity. Another recently introduced obesity measure, A Body Shape Index (ABSI), has been introduced to focus on abdominal obesity, but its applicability remains limited. We analyzed the statistical properties of the ABSI and propose a modified ABSI, the z-score of the log-transformed ABSI (LBSIZ), to improve its applicability. We also examined the sensitivity of the newly introduced index in diagnosing obesity based on the percentage of body fat and its ability to predict hypertension and impaired health-related quality of life (HRQOL).

Methods and Results

We transformed the ABSI to the LBSIZ in order to create a standard normalized obesity measure. All available data from the Korea National Health and Nutrition Examination Survey (KNHANES) (1998–2012) have shown BMI to be highly correlated with weight (r = 0.85 for women, r = 0.87 for men) and waist circumference (WC) (r = 0.86 for women, r = 0.85 for men), but the LBSIZ was found to be weakly correlated with weight (r = 0.001 for women, r = 0.0001 for men) and moderately correlated with WC (r = 0.51 for women, r = 0.52 for men). BMI showed an inverted U-shaped pattern when plotted against age, but a linear pattern was observed for the LBSIZ, indicating they are different kinds of obesity measures. Logistic regression showed that the odds ratio of obesity for the LBSIZ was 1.86 (95% confidence interval [CI] = 1.73–2.00) for males and 1.32 (95% CI = 1.24–1.40) for females after adjusting for weight, height, age, and year of participation in the KNHANES. While both BMI and the LBSIZ were significantly related to hypertension, the LBSIZ alone was significantly associated with impaired HRQOL.

Conclusions

The LBSIZ is a standard normalized obesity measure independent of weight, height, and BMI. LBSIZ is a new measure of abdominal obesity with the ability to predict hypertension and impaired HRQOL, irrespective of BMI.

The Prevalence of Diabetes and Prediabetes in the Adult Population of Jeddah, Saudi Arabia--A Community-Based Survey

BACKGROUND

Type 2 (T2DM) is believed to be common in Saudi Arabia, but data are limited. In this population survey, we determined the prevalence of T2DM and prediabetes.

MATERIALS AND METHODS

A representative sample among residents aged ≥ 18 years of the city of Jeddah was obtained comprising both Saudi and non-Saudi families (N = 1420). Data on dietary, clinical and socio-demographic characteristics were collected and anthropometric measurements taken. Fasting plasma glucose and glycated hemoglobin (HbA1c) were used to diagnose diabetes and prediabetes employing American Diabetes Association criteria. Multiple logistic regression analysis was used to identify factors associated with T2DM.

RESULTS

Age and sex standardized prevalence of prediabetes was 9.0% (95% CI 7.5-10.5); 9.4% (7.1-11.8) in men and 8.6% (6.6-10.6) in women. For DM it was 12.1% (10.7-13.5); 12.9% (10.7-13.5) in men and 11.4% (9.5-13.3) in women. The prevalence based on World Population as standard was 18.3% for DM and 11.9% for prediabetes. The prevalence of DM and prediabetes increased with age. Of people aged ≥50 years 46% of men and 44% of women had DM. Prediabetes and DM were associated with various measures of adiposity. DM was also associated with and family history of dyslipidemia in women, cardiovascular disease in men, and with hypertension, dyslipidemia and family history of diabetes in both sexes.

DISCUSSION

Age was the strongest predictor of DM and prediabetes followed by obesity. Of people aged 50 years or over almost half had DM and another 10-15% had prediabetes leaving only a small proportion of people in this age group with normoglycemia. Since we did not use an oral glucose tolerance test the true prevalence of DM and prediabetes is thus likely to be even higher than reported here. These results demonstrate the urgent need to develop primary prevention strategies for type 2 diabetes in Saudi Arabia.

Symptom profiles of subsyndromal depression in disease clusters of diabetes, excess weight, and progressive cerebrovascular conditions: a promising new type of finding from a reliable innovation to estimate exhaustively specified multiple indicators-multiple causes (MIMIC) models

Addressing subsyndromal depression in cerebrovascular conditions, diabetes, and obesity reduces morbidity and risk of major depression. However, depression may be masked because self-reported symptoms may not reveal dysphoric (sad) mood. In this study, the first wave (2,812 elders) from the New Haven Epidemiological Study of the Elderly (EPESE) was used. These population-weighted data combined a stratified, systematic, clustered random sample from independent residences and a census of senior housing. Physical conditions included progressive cerebrovascular disease (CVD; hypertension, silent CVD, stroke, and vascular cognitive impairment [VCI]) and co-occurring excess weight and/or diabetes. These conditions and interactions (clusters) simultaneously predicted 20 depression items and a latent trait of depression in participants with subsyndromal (including subthreshold) depression (11≤ Center for Epidemiologic Studies Depression Scale [CES-D] score ≤27). The option for maximum likelihood estimation with standard errors that are robust to non-normality and non-independence in complex random samples (MLR) in Mplus and an innovation created by the author were used for estimating unbiased effects from latent trait models with exhaustive specification. Symptom profiles reveal masked depression in 1) older males, related to the metabolic syndrome (hypertension-overweight-diabetes; silent CVD-overweight; and silent CVD-diabetes) and 2) older females or the full sample, related to several diabetes and/or overweight clusters that involve stroke or VCI. Several other disease clusters are equivocal regarding masked depression; a couple do emphasize dysphoric mood. Replicating findings could identify subgroups for cost-effective screening of subsyndromal depression.

Gallstone disease and obesity: a population-based study on abdominal fat distribution and gender differences

BACKGROUND

Existing evidence suggests the visceral fat is more metabolically active than subcutaneous fat. We aimed to investigate the value of subcutaneous (SAT) and visceral adipose tissue thickness (VAT) for prediction of gallstone disease (GSD) in general population by focus on gender differences and comparison with body mass index (BMI), waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR).

MATERIAL AND METHODS

In this cross-sectional survey, 1,494 subjects (51.4 % men), aged above 50, randomly selected from Golestan Cohort Study residing in Gonbad City, Iran, underwent anthropometric measurements and abdominal ultrasonography.

RESULTS

Prevalence of GSD was 17.8% (95% CI 15.9-19.8). Following adjustment for age and then other potential risk factors, all obesity indices, except for SAT, were associated with GSD in women with the highest odds ratio observed in WHtR (OR 1.52, 95% CI 1.22-1.89). In contrast, WHR was the only associated index in men (OR 1.49, 95% CI 1.08-2.06). The trend of increasing obesity measures across the quartiles with the risk of GSD was significant in subgroups of WHtR and BMI in women and WHR in men. No significant association was found between SAT and GSD in men or women.

CONCLUSIONS

The best anthropometric indicators of the risk of GSD may differ by gender. In men, WHR might be the only preferred index to estimate risk of GSD. WHtR, WHR, VAT and BMI are associated with GSD risk in women, although WHtR might better explain this risk. SAT is the poor indicator for identifying subjects with GSD in both genders.

Identification of Type 2 Diabetes Risk Factors Using Phenotypes Consisting of Anthropometry and Triglycerides based on Machine Learning

The hypertriglyceridemic waist (HW) phenotype is strongly associated with type 2 diabetes; however, to date, no study has assessed the predictive power of phenotypes based on individual anthropometric measurements and triglyceride (TG) levels. The aims of the present study were to assess the association between the HW phenotype and type 2 diabetes in Korean adults and to evaluate the predictive power of various phenotypes consisting of combinations of individual anthropometric measurements and TG levels. Between November 2006 and August 2013, 11,937 subjects participated in this retrospective cross-sectional study. We measured fasting plasma glucose and TG levels and performed anthropometric measurements. We employed binary logistic regression (LR) to examine statistically significant differences between normal subjects and those with type 2 diabetes using HW and individual anthropometric measurements. For more reliable prediction results, two machine learning algorithms, naive Bayes (NB) and LR, were used to evaluate the predictive power of various phenotypes. All prediction experiments were performed using a tenfold cross validation method. Among all of the variables, the presence of HW was most strongly associated with type 2 diabetes (p < 0.001, adjusted odds ratio (OR) = 2.07 [95% CI, 1.72-2.49] in men; p < 0.001, adjusted OR = 2.09 [1.79-2.45] in women). When comparing waist circumference (WC) and TG levels as components of the HW phenotype, the association between WC and type 2 diabetes was greater than the association between TG and type 2 diabetes. The phenotypes tended to have higher predictive power in women than in men. Among the phenotypes, the best predictors of type 2 diabetes were waist-to-hip ratio + TG in men (AUC by NB = 0.653, AUC by LR = 0.661) and rib-to-hip ratio + TG in women (AUC by NB = 0.73, AUC by LR = 0.735). Although the presence of HW demonstrated the strongest association with type 2 diabetes, the predictive power of the combined measurements of the actual WC and TG values may not be the best manner of predicting type 2 diabetes. Our findings may provide clinical information concerning the development of clinical decision support systems for the initial screening of type 2 diabetes.

Is the negative relationship between obesity and bone mineral content greater for older women?

Obesity and osteoporosis are two important body composition problems with increasing prevalences in aged populations. Traditionally, obesity has been regarded as being beneficial to bone health. However, the protective effect of obesity on osteoporosis has been questioned. In some recent studies, obesity, as defined by percentage body fat, was regarded as a risk factor for osteoporosis. The purpose of this study was to (1) evaluate the effect of waist circumference, a surrogate measure for abdominal obesity, on bone mineral content (BMC) and (2) examine whether the effect of waist circumference increases with advancing age. The study population is made up of women aged over 45 years who completed the body composition and bone mineral density examinations in the fifth Korea National Health and Nutrition Examination Survey in 2010. Subjects who take estrogen or are under medical treatment for osteoporosis were excluded. Stroke patients are also excluded. Femoral neck, total-hip, and whole-body BMC were measured by dual-energy X-ray absorptiometry. A total of 1,434 subjects were included in the analysis. Waist circumference was negatively associated with BMC in all tested regions after correction for weight, menopausal status, smoking, drinking, and exercise. In addition, the negative association between waist circumference and BMC in the femoral neck and total hip increases with age, after correction for confounding factors, showing an interaction effect between waist circumference and age on BMC. In conclusion, this study shows that the negative relationship between waist circumference and BMC in the femoral neck and total hip is greater for older women.

Body composition and hypertension: a comparative study involving women from maroon communities and from the general population of Alagoas State, Brazil

OBJECTIVE: This study investigated the body composition and prevalence of hypertension in maroon women from the State of Alagoas and compared these variables with those of non-maroon women from the same state. METHODS: The data were collected from two cross-sectional surveys done in 2005 and 2008. The first study included a representative sample of mothers of children aged 0 to 5 years from the State of Alagoas, and the second study included all women aged 18 to 60 years living in maroon communities (n=39) in the same state. Data were collected during home interviews. The prevalence ratio and respective 95% confidence interval given by the Poisson regression with robust adjustment of variance was used as the measure of association. RESULTS: The study assessed 1,631 maroon women and 1,098 non-maroon mothers. Maroon women had lower education level, more children, higher prevalence of hypertension and stunting, and higher age at menarche, body mass index, waist circumference, waist-to-height ratio, and waist-to-hip ratio. After adjustment for age, the following prevalences remained higher in maroon women: hypertension (PR=1.81; 95%CI: 1.49; 2.21), WC >80cm (PR=1.23 95%CI: 1.11; 1.37), WHtR >0.5 (PR=1.11; 95%CI: 1.02; 1.21), and WHR >0.85 (PR=1.64; 95%CI: 1.43; 1.88). CONCLUSION: Maroon women belong to lower socioeconomic classes than non-maroon women and are at greater risk of abdominal obesity and hypertension, characteristics that make them especially vulnerable to the morbidity and mortality caused by cardiovascular diseases, justifying the preferential implementation of measures of care.

Long-acting FGF21 has enhanced efficacy in diet-induced obese mice and in obese rhesus monkeys

Fibroblast growth factor 21 (FGF21), a hormone with short half-life, has consistently shown strong pharmacological efficacy. We first assessed the efficacy of murine recombinant FGF21 in C57BL6 lean mice for 5 wk. We then generated a long-acting FGF21 molecule by fusing a Fc to a variant of human recombinant FGF21 (hrFGF21) that contained two engineered mutations [L98R, P171G; Fc-FGF21(RG)] and tested it in C57BL6 diet-induced obese mice and obese rhesus monkeys. We compared its metabolic properties with those of the hrFGF21. Groups of diet-induced obese mice were treated for 36 d with different doses of hrFGF21 (01, 0.3, and 1 mg/kg twice daily) and with Fc-FGF21(RG) (2.3 mg/kg, every 5 d). Body weight, glucose, insulin, cholesterol, and triglyceride levels were decreased after treatment with either compound. A glucose tolerance test (GTT) was also improved. Obese rhesus monkeys were treated with hrFGF21 (once a day) and Fc-FGF21(RG) (once a week) in a dose-escalation fashion. Doses started at 0.1 and 0.3 mg/kg and ended at 3 and 5 mg/kg for hrFGF21 and Fc-FGF21(RG), respectively. Doses were escalated every 2 wk, and animals were followed up for a washout period of 3 wk. Body weight, glucose, insulin, cholesterol, and triglyceride levels and the GTT profile were decreased to a greater extent with Fc-FGF21(RG) than with hrFGF21. The PK-PD relationship of Fc-FGF21(RG) exposure and triglyceride reduction was also conducted with a maximum response model. In conclusion, in more than one species, Fc-FGF21(RG) chronically administered once a week showed similar or greater efficacy than hrFGF21 administered daily.

Obesity among Kuwaitis aged 50 years or older: prevalence, correlates, and comorbidities

OBJECTIVES

Obesity is a serious global health problem. Our objectives are to assess the prevalence of overweight and obesity among elderly Kuwaitis aged 50 or older, examine their sociodemographic correlates, and analyze the association between obesity and its comorbidities.

METHODS

A cross-sectional face-to-face interview survey using a structured questionnaire was conducted among 2,443 Kuwaiti men and women aged 50 or older. Height and weight were measured and body mass index (BMI) was calculated.

RESULTS

About 81% respondents were overweight of whom 46% were obese. Mean BMI was 30.0 (31.2 for women and 28.1 for men). Multinomial logistic regression analysis revealed that relatively young elderly Kuwaitis (50-59) were 1.7 and 2.2 times more likely to be overweight and obese, respectively, compared with those aged 70 or older. Married individuals had 2.3 times higher risk to be overweight or obese than non-married individuals. Women were 3.6 times more likely to suffer from obesity than men. Overweight and obesity were found to be independent risk factors for hypertension (OR = 1.3 and 1.9, respectively), diabetes (OR = 1.4), and osteoarthritis (OR = 1.8 and 1.6, respectively).

CONCLUSIONS

Prevalence of overweight and obesity is alarmingly high among elderly Kuwaitis. The associated disease burden is substantial. Stakeholders should address the problem and launch national extensive health-promoting campaigns targeting perceptible lifestyle changes.

Impact of Hypertension-Related Comorbidity on Health-Related Quality of Life

The aim of this study was to examine the impact of the most prevalent comorbid chronic diseases in hypertensives on health-related quality of life (HRQOL) in the general representative Korean population using the EuroQOL-5D (EQ-5D) and to assess this impact by sex and after controlling for sociodemographic factors. The effects of hypertension and comorbidity on HRQOL were examined using multiple linear regression models with Fourth Korean National Health and Nutrition Examination Survey data. In a total of 5736 adults, the prevalence of hypertension alone was 20.8%, and the prevalence rates of hypertension comorbid with diabetes mellitus (DM), cardiovascular disease (CVD), and musculoskeletal (MS) disease were 9.5%, 3.8%, and 33.5%, respectively. Females with hypertension and other comorbidity showed worse HRQOL scores, with the exception of hypertension and CVD, where males scored worse for HRQOL. After adjustment, subjects with comorbid DM, CVD, or MS experienced EQ-5D scores decreasing by 0.01, 0.09, and 0.05, respectively. Since comorbidity impairs HRQOL in hypertensives, health providers should consider comorbid diseases in hypertensives when developing methods of intervention to effectively manage hypertension.

Relationship Between Health-related Behavioral and Psychological Factors and Cardiovascular and Cerebrovascular Diseases Comorbidity Among Korean Adults With Diabetes

PURPOSE

This study aims to explore the relationships between health-related behavioral and psychological factors and cardiovascular and cerebrovascular diseases (CCVD) comorbidities among Korean adults with diabetes mellitus (DM).

METHODS

Data included in the Fourth Korean National Health and Nutrition Examination Survey were used. This study compared three groups: those diagnosed with DM only, DM and hypertension, DM, hypertension and CCVD using multinomial logistic regression analyses and the classification and regression tree (CART) model.

RESULTS

Weight control (OR = 4.01) and depression (OR = 2.37) are related with increased odds of having hypertension and CCVD comorbidity in those with DM. The CART model suggested that the high prevalence risk groups for hypertension or CCVD comorbidities were diabetic adults aged between 51 and 69 with a body mass index of 25 and above and those aged 70 and above.

CONCLUSION

For effective control of CCVD comorbidities among diabetic Korean adults, psychological support for depression and weight control need to be prioritized when managing DM. Weight control intervention needs to be reinforced for DM patients aged between 51 and 69 and that even if BMI is below 25, the occurrence of comorbidities needs to be carefully monitored for DM patients aged 70 or older.

ReishiMax, mushroom based dietary supplement, inhibits adipocyte differentiation, stimulates glucose uptake and activates AMPK

Background

Obesity is a health hazard which is closely associated with various complications including insulin resistance, hypertension, dyslipidemia, atherosclerosis, type 2 diabetes and cancer. In spite of numerous preclinical and clinical interventions, the prevalence of obesity and its related disorders are on the rise demanding an urgent need for exploring novel therapeutic agents that can regulate adipogenesis. In the present study, we evaluated whether a dietary supplement ReishiMax (RM), containing triterpenes and polysaccharides extracted from medicinal mushroom Ganoderma lucidum, affects adipocyte differentiation and glucose uptake in 3T3-L1 cells.

Methods

3T3-L1 pre-adipocytes were differentiated into adipocytes and treated with RM (0-300 μg/ml). Adipocyte differentiation/lipid uptake was evaluated by oil red O staining and triglyceride and glycerol concentrations were determined. Gene expression was evaluated by semi-quantitative RT-PCR and Western blot analysis. Glucose uptake was determined with [³H]-glucose.

Results

RM inhibited adipocyte differentiation through the suppresion of expression of adipogenic transcription factors peroxisome proliferator-activated receptor-γ (PPAR-γ), sterol regulatory element binding element protein-1c (SREBP-1c) and CCAAT/enhancer binding protein-α (C/EBP-α). RM also suppressed expression of enzymes and proteins responsible for lipid synthesis, transport and storage: fatty acid synthase (FAS), acyl-CoA synthetase-1 (ACS1), fatty acid binding protein-4 (FABP4), fatty acid transport protein-1 (FATP1) and perilipin. RM induced AMP-activated protein kinase (AMPK) and increased glucose uptake by adipocytes.

Conclusion

Our study suggests that RM can control adipocyte differentiation and glucose uptake. The health benefits of ReishiMax warrant further clinical studies.

Healthy weight - healthy blood pressure

World Hypertension Day is an initiative of the World Hypertension League. This year's theme is "Healthy weight - healthy blood pressure". According to the World Health Organization, more than one billion people worldwide are reported to be overweight and more than 300 million people are obese. Obesity is linked to hypertension, kidney diseases and other cardiovascular diseases. Through World Hypertension Day, the World Hypertension League, in partnership with national and international organizations, aims to raise the awareness of obesity and hypertension. Simple manoeuvres such as eating healthy, being physically active, and changing nutritional and dietary behaviours are recommended.

Comparison of body composition methods in overweight and obese Brazilian women

OBJECTIVE: The purpose of this study was to compare skinfold thickness (SKF) and bioelectrical impedance analysis (BIA) of body composition using three different equations against dual-energy X-ray absorptiometry (DXA) in overweight and obese Brazilian women. SUBJECTS AND METHOD: Thirty-four women (age 43.8 ± 10.9 years; body mass index [BMI] 32.1 ± 4.3 kg/m²) had percentage body fat (BF%), fat mass (FM) and fat-free mass (FFM) estimated by DXA, SKF and BIA (BIA-man: manufacturer's equation; and predictive obesity-specific equations of Segal and of Gray). Regression analysis, Bland-Altman plot analysis and intra-class correlation coefficient (ICC) were used to compare methods. RESULTS: Absolute agreement between DXA and BIA-man was poor for all measures of body composition (BF% -6.8% ± 3.7%, FM -3.1 ± 3.6 kg, FFM 5.7 ± 2.8 kg). BIA-Segal equation showed good absolute agreement with DXA for BF% (1.5% ± 1.5%), FM (1.0 ± 3.2 kg) and FFM (1.5 ± 2.6 kg), albeit the limits of agreement were wide. BIA-Gray equation showed good absolute agreement with DXA for FM (2.3 ± 4.1 kg), and smaller biases for BF% (0.05% ± 4.4%) and FFM (0.2 ± 2.9 kg), although wide limits of agreement. BIA-Gray and DXA showed the highest ICC among the pairs of methods. A good absolute agreement was observed between DXA and SKF for BF% (-2.3% ± 5.8%), FM (0.09 ± 4.7 kg), and FFM (2.4 ± 4.4 kg), although limits of agreement were wider and ICC between DXA and SKF for BF% indicated poor degree of reproducibility. CONCLUSION: These findings show that both BIA-Segal and BIA-Gray equations are suitable for BF%, FM and FFM estimations in overweight and obese women.

Improving on analyses of self-reported data in a large-scale health survey by using information from an examination-based survey

Common data sources for assessing the health of a population of interest include large-scale surveys based on interviews that often pose questions requiring a self-report, such as, 'Has a doctor or other health professional ever told you that you have health condition of interest?' or 'What is your (height/weight)?' Answers to such questions might not always reflect the true prevalences of health conditions (for example, if a respondent misreports height/weight or does not have access to a doctor or other health professional). Such 'measurement error' in health data could affect inferences about measures of health and health disparities. Drawing on two surveys conducted by the National Center for Health Statistics, this paper describes an imputation-based strategy for using clinical information from an examination-based health survey to improve on analyses of self-reported data in a larger interview-based health survey. Models predicting clinical values from self-reported values and covariates are fitted to data from the National Health and Nutrition Examination Survey (NHANES), which asks self-report questions during an interview component and also obtains clinical measurements during a physical examination component. The fitted models are used to multiply impute clinical values for the National Health Interview Survey (NHIS), a larger survey that obtains data solely via interviews. Illustrations involving hypertension, diabetes, and obesity suggest that estimates of health measures based on the multiply imputed clinical values are different from those based on the NHIS self-reported data alone and have smaller estimated standard errors than those based solely on the NHANES clinical data. The paper discusses the relationship of the methods used in the study to two-phase/two-stage/validation sampling and estimation, along with limitations, practical considerations, and areas for future research.

Association between obesity indices and blood pressure or hypertension: which index is the best?

Background

The association between obesity and blood pressure is well documented and a series of obesity indices are used as risk factors or indicators of blood pressure and/or the presence of hypertension.

Objective

The aim of the present study was to explore and determine which obesity index is the best indicator of blood pressure and the presence of hypertension among five frequently used simple anthropometric indices.

Methods

Subjects (n 29 079) were selected by cluster sampling from fourteen Chinese general populations. Weight, height, waist circumference (WC), hip circumference and blood pressure were measured for each participant. BMI, waist:hip ratio (WHR), waist:stature ratio (WSR) and conicity index (CI) were calculated. Pearson correlation, multiple logistic regression, multivariate linear regression and receiver-operating characteristic (ROC) curve analyses were used.

Results

A total of 13 558 men and 15 521 women were investigated. All five obesity indices were positively correlated with blood pressures and hypertension. After adjusting for age, WSR in men and BMI in women had the greatest association with the presence of hypertension, irrespective of the statistical method used. BMI had the strongest correlation with continuous blood pressures in both genders.

Conclusion

The present results indicate that hypertension is associated with different obesity indices in men and in women. The best indicator for hypertension is WSR in men while it is BMI in women.

Interethnic differences in the accuracy of anthropometric indicators of obesity in screening for high risk of coronary heart disease

BACKGROUND

Cut points for defining obesity have been derived from mortality data among Whites from Europe and the United States and their accuracy to screen for high risk of coronary heart disease (CHD) in other ethnic groups has been questioned.

OBJECTIVE

To compare the accuracy and to define ethnic and gender-specific optimal cut points for body mass index (BMI), waist circumference (WC) and waist-to-hip ratio (WHR) when they are used in screening for high risk of CHD in the Latin-American and the US populations.

METHODS

We estimated the accuracy and optimal cut points for BMI, WC and WHR to screen for CHD risk in Latin Americans (n=18 976), non-Hispanic Whites (Whites; n=8956), non-Hispanic Blacks (Blacks; n=5205) and Hispanics (n=5803). High risk of CHD was defined as a 10-year risk > or =20% (Framingham equation). The area under the receiver operator characteristic curve (AUC) and the misclassification-cost term were used to assess accuracy and to identify optimal cut points.

RESULTS

WHR had the highest AUC in all ethnic groups (from 0.75 to 0.82) and BMI had the lowest (from 0.50 to 0.59). Optimal cut point for BMI was similar across ethnic/gender groups (27 kg/m(2)). In women, cut points for WC (94 cm) and WHR (0.91) were consistent by ethnicity. In men, cut points for WC and WHR varied significantly with ethnicity: from 91 cm in Latin Americans to 102 cm in Whites, and from 0.94 in Latin Americans to 0.99 in Hispanics, respectively.

CONCLUSION

WHR is the most accurate anthropometric indicator to screen for high risk of CHD, whereas BMI is almost uninformative. The same BMI cut point should be used in all men and women. Unique cut points for WC and WHR should be used in all women, but ethnic-specific cut points seem warranted among men.

The relationship of body mass index and waist-hip ratio on the 9-year incidence of diabetes and hypertension in a predominantly African-origin population

PURPOSE

To provide 9-year incidence data for diabetes and hypertension and evaluate the relationship of body mass index (BMI) and waist-hip ratio (WHR) on these comorbidities in an African Caribbean population.

METHODS

This was a longitudinal, population-based cohort study, including 4,631 participants at baseline; 2,793 were reexamined at the 9-year follow-up. Diabetes was defined by self-reported history and/or glycosylated hemoglobin measurement; hypertension was defined as systolic blood pressure (BP) >or=140 mm Hg and/or diastolic BP >or=90 mm Hg and/or use of antihypertensive treatment. Incidence rates were based on persons without such conditions at baseline.

RESULTS

The 9-year incidence of hypertension (95% confidence interval) was higher in women (37.5% [34.0-41.2]) than men (30.6% [26.9-34.6]), whereas the incidence of diabetes was similar for both genders (14%). Body size was related to both conditions; however, the incidence of hypertension was more strongly associated with WHR, whereas diabetes had a stronger association with BMI.

CONCLUSIONS

Incidence rates for diabetes and hypertension were high in this cohort, and the relationship of BMI and WHR on these comorbidities was significant. These findings suggest the need to develop tailored interventions and preventive strategies in this African Caribbean and similar high-risk populations.

Adipose tissue infiltration in skeletal muscle: age patterns and association with diabetes among men of African ancestry

BACKGROUND

Although obesity is strongly associated with diabetes, the greater prevalence of diabetes in persons of African ancestry than in those of other ancestries cannot be explained simply by differences in total or central adiposity.

OBJECTIVE

We examined whether skeletal muscle composition is associated with diabetes in 1249 men of African ancestry aged >or=40 y.

DESIGN

Anthropometry and fasting serum glucose were measured, and lower-leg skeletal muscle composition was assessed with peripheral quantitative computerized tomography (pQCT).

RESULTS

The prevalence of diabetes in this population was high (21%). We observed an age-associated adipose tissue remodeling in skeletal muscle and greater intermuscular (IMAT) and lesser subcutaneous (SAT) adipose tissue area with advancing age (P < 0.0001). Multivariate stepwise logistic regression identified more IMAT and less SAT to be significantly associated with a greater prevalence of diabetes. Even among normal-weight men [body mass index (BMI; in kg/m(2)) < 25], diabetic men had significantly (P = 0.01) more IMAT than did those without diabetes. Greater IMAT was also associated with a greater prevalence of hyperglycemia in men with a family history of diabetes than in those without such history (P for interaction = 0.02).

CONCLUSIONS

These findings underscore the independent associations of subcutaneous and intermuscular fat among men of African ancestry, an effect that may be modified by a family history of diabetes. Further studies are needed to identify the genetic and physiologic mechanisms that influence the distribution and remodeling of adipose tissue in skeletal muscle with aging.'