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Lugner M, Rawshani A, Helleryd E, Eliasson B. Identifying top ten predictors of type 2 diabetes through machine learning analysis of UK Biobank data. Sci Rep 2024; 14:2102. [PMID: 38267466 PMCID: PMC10808323 DOI: 10.1038/s41598-024-52023-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 01/12/2024] [Indexed: 01/26/2024] Open
Abstract
The study aimed to identify the most predictive factors for the development of type 2 diabetes. Using an XGboost classification model, we projected type 2 diabetes incidence over a 10-year horizon. We deliberately minimized the selection of baseline factors to fully exploit the rich dataset from the UK Biobank. The predictive value of features was assessed using shap values, with model performance evaluated via Receiver Operating Characteristic Area Under the Curve, sensitivity, and specificity. Data from the UK Biobank, encompassing a vast population with comprehensive demographic and health data, was employed. The study enrolled 450,000 participants aged 40-69, excluding those with pre-existing diabetes. Among 448,277 participants, 12,148 developed type 2 diabetes within a decade. HbA1c emerged as the foremost predictor, followed by BMI, waist circumference, blood glucose, family history of diabetes, gamma-glutamyl transferase, waist-hip ratio, HDL cholesterol, age, and urate. Our XGboost model achieved a Receiver Operating Characteristic Area Under the Curve of 0.9 for 10-year type 2 diabetes prediction, with a reduced 10-feature model achieving 0.88. Easily measurable biological factors surpassed traditional risk factors like diet, physical activity, and socioeconomic status in predicting type 2 diabetes. Furthermore, high prediction accuracy could be maintained using just the top 10 biological factors, with additional ones offering marginal improvements. These findings underscore the significance of biological markers in type 2 diabetes prediction.
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Affiliation(s)
- Moa Lugner
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Araz Rawshani
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Edvin Helleryd
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Björn Eliasson
- Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
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Maffulli N, Cuozzo F, Migliorini F, Oliva F. The tendon unit: biochemical, biomechanical, hormonal influences. J Orthop Surg Res 2023; 18:311. [PMID: 37085854 PMCID: PMC10120196 DOI: 10.1186/s13018-023-03796-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 04/12/2023] [Indexed: 04/23/2023] Open
Abstract
The current literature has mainly focused on the biology of tendons and on the characterization of the biological properties of tenocytes and tenoblasts. It is still not understood how these cells can work together in homeostatic equilibrium. We put forward the concept of the "tendon unit" as a morpho-functional unit that can be influenced by a variety of external stimuli such as mechanical stimuli, hormonal influence, or pathological states. We describe how this unit can modify itself to respond to such stimuli. We evidence the capability of the tendon unit of healing itself through the production of collagen following different mechanical stimuli and hypothesize that restoration of the homeostatic balance of the tendon unit should be a therapeutic target.
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Affiliation(s)
- Nicola Maffulli
- Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, Queen Mary University of London, 275 Bancroft Road, London, E1 4DG, England
- School of Pharmacy and Bioengineering, Keele University Faculty of Medicine, Thornburrow Drive, Stoke On Trent, England
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081, Baronissi, SA, Italy
| | - Francesco Cuozzo
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081, Baronissi, SA, Italy
| | - Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany.
- Department of Orthopaedic and Trauma Surgery, Eifelklinik St. Brigida, 52152, Simmerath, Germany.
| | - Francesco Oliva
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081, Baronissi, SA, Italy
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Haque W, Grandhi GR, Kanaya AM, Kandula NR, Nasir K, Al Rifai M, Uddin SMI, Fedeli U, Sattar N, Blumenthal RS, Blaha MJ, Cainzos-Achirica M. Implications of the 2019 American College of Cardiology/American Heart Association Primary Prevention Guidelines and potential value of the coronary artery calcium score among South Asians in the US: The Mediators of Atherosclerosis in South Asians Living in America (MASALA) study. Atherosclerosis 2021; 334:48-56. [PMID: 34481175 DOI: 10.1016/j.atherosclerosis.2021.08.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 07/15/2021] [Accepted: 08/18/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND AIMS South Asian (SA) ethnicity is associated with an increased risk of atherosclerotic cardiovascular disease (ASCVD). However, the implications of considering SA ethnicity as a "risk-enhancing factor" per recent American College of Cardiology/American Heart Association guidelines are not fully understood. METHODS We used data from the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study, a community-based cohort study of individuals of SA ancestry living in the US. The Pooled Cohort Equations were used to estimate 10-year ASCVD risk. Metabolic risk factors and coronary artery calcium (CAC) scores were assessed. RESULTS Among 1114 MASALA participants included (median age 56 years, 48% women), 28% were already using a statin at baseline, 25% had prevalent diabetes, and 59% qualified for 10-year ASCVD risk assessment for statin allocation purposes. The prevalence of low, borderline, intermediate, and high estimated ASCVD risk was 65%, 11%, 20% and 5%, respectively. Among participants at intermediate risk, 30% had CAC = 0 and 37% had CAC>100, while among participants at borderline risk, 54% had CAC = 0 and 13% had CAC>100. Systematic consideration of intermediate and, particularly, of borderline risk individuals as statin candidates would enrich the statin-consideration group with CAC = 0 participants up to 35%. Prediabetes and abdominal obesity were highly prevalent across all estimated risk strata, including among those with CAC = 0. CONCLUSIONS Our findings suggest that systematic consideration of borderline risk SAs as statin candidates might result in considerable overtreatment, and further risk assessment with CAC may help better personalize statin allocation in these individuals. Early, aggressive lifestyle interventions aimed at reducing the risk of incident diabetes should be strongly recommended in US SAs, particularly among those considered candidates for statin therapy for primary prevention. Longitudinal studies are needed to confirm the favorable prognosis of CAC = 0 in SAs.
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Affiliation(s)
- Waqas Haque
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Gowtham R Grandhi
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Department of Medicine, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Alka M Kanaya
- University of California San Francisco, San Francisco, CA, USA
| | | | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
| | - Mahmoud Al Rifai
- Department of Cardiology, Baylor School of Medicine, Houston, TX, USA
| | - S M Iftekhar Uddin
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Ugo Fedeli
- Department of Epidemiology, Azienda Zero, Veneto Region, Italy
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland, UK
| | - Roger S Blumenthal
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Michael J Blaha
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Department of Epidemiology and Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Miguel Cainzos-Achirica
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA.
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You Y, Zhou H, Han J, Zhu Y, Zan D, Zhang Q. Anthropometry did not approach adequate predictive accuracies for detecting elevated fasting plasma glucose or hemoglobin A1c levels among Chinese children aged 7-9 years. J Diabetes Investig 2021; 12:781-789. [PMID: 32881410 PMCID: PMC8089013 DOI: 10.1111/jdi.13395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 06/13/2020] [Accepted: 08/24/2020] [Indexed: 02/05/2023] Open
Abstract
AIMS/INTRODUCTION Elevated concentrations of fasting plasma glucose (FPG) or hemoglobin A1c (HbA1c) are well-established independent risk factors for progression to diabetes, cardiovascular comorbidities and mortality. Most previous studies on the relationships of anthropometric measures with hyperglycemia were carried out among adults and adolescents, but few data are available for the performance predication of the predictors for diagnosing elevated FPG or HbA1c among young children. MATERIALS AND METHODS Involving 5,556 students of aged 7-9 years, a school-based cross-sectional survey was carried out between March and June 2019 in Shenzhen, China. Receiver operating characteristic curve analysis was utilized. RESULTS The median was 4.6 (interquartile range [IQR] 4.3-4.8) mmol/L for FPG and 5.3% (IQR 5.1-5.5%) for HbA1c levels for all participants. For detecting elevated FPG, weight (0.651, IQR 0.583-0.719) and waist circumference (0.650, IQR 0.584-0.717) showed the highest area under the curve and 95% confidence interval, followed by body mass index and the z-score of body mass index (both 0.635, IQR 0.567-0.703); other anthropometric measures showed poorer diagnostic efficiencies or no ability. For detecting elevated HbA1c, lower efficiencies for the Conicity Index (0.651, IQR 0.583-0.719), waist-to-height ratio, waist-to-hip ratio and waist-to-chest ratio were shown. The correlations of FPG and HbA1c levels with anthropometric indices were weak (Spearman's r ≤ 0.179). CONCLUSIONS None of the evaluated anthropometric indicators approached an adequate predictive accuracy for the detection of elevated FPG or HbA1c levels in Shenzhen children aged 7-9 years. The current study did not recommend anthropometry screening for prediabetes in young children.
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Affiliation(s)
- Ying‐Bin You
- Institute of Low Carb MedicineBaoan Central Hospital of Shenzhenthe Fifth Affiliated Hospital of Shenzhen UniversityShenzhenChina
- Department of Preventive MedicineShantou University Medical CollegeShantouChina
| | - Hua Zhou
- Institute of Low Carb MedicineBaoan Central Hospital of Shenzhenthe Fifth Affiliated Hospital of Shenzhen UniversityShenzhenChina
| | - Jing Han
- Institute of Low Carb MedicineBaoan Central Hospital of Shenzhenthe Fifth Affiliated Hospital of Shenzhen UniversityShenzhenChina
| | - Yan‐Hui Zhu
- Institute of Low Carb MedicineBaoan Central Hospital of Shenzhenthe Fifth Affiliated Hospital of Shenzhen UniversityShenzhenChina
| | - Ding Zan
- Institute of Low Carb MedicineBaoan Central Hospital of Shenzhenthe Fifth Affiliated Hospital of Shenzhen UniversityShenzhenChina
| | - Qing‐Ying Zhang
- Department of Preventive MedicineShantou University Medical CollegeShantouChina
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Yu EA, Finkelstein JL, Brannon PM, Bonam W, Russell DG, Glesby MJ, Mehta S. Nutritional assessment among adult patients with suspected or confirmed active tuberculosis disease in rural India. PLoS One 2020; 15:e0233306. [PMID: 32442216 PMCID: PMC7244113 DOI: 10.1371/journal.pone.0233306] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 05/01/2020] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Our study goal was to evaluate a set of nutritional indicators among adults with confirmed or suspected active tuberculosis disease in southern India, given the limited literature on this topic. Study objectives were to assess the: I) double burden of malnutrition at individual and population levels; II) relative performance of anthropometric indicators (body mass index, waist circumference) in diabetes screening; and III) associations between vitamin D and metabolic abnormalities. DESIGN Cross-sectional study. SETTING Hospital in rural southern India. PARTICIPANTS Among adult patients (n = 834), we measured anthropometry, body composition, and biomarkers (vitamin D, glycated hemoglobin, hemoglobin) of nutritional status. Subsets of participants provided blood and sputum samples. RESULTS Among participants, 91.7% had ≥ 1 malnutrition indicator; 34.6% had both undernutrition and overnutrition indicators. Despite the fact that >80% of participants would be considered low-risk in diabetes screening based on low body mass index and waist circumference, approximately one-third had elevated glycated hemoglobin (≥ 5.7%). The lowest quintile of serum 25-hydroxyvitamin D was associated with an increased risk of glycated hemoglobin ≥ 5.7% (adjusted risk ratio 1.61 [95% CI 1.02, 2.56]) compared to the other quintiles, adjusting for age and trunk fat. CONCLUSIONS Malnutrition and diabetes were prevalent in this patient population; since both can predict poor prognosis of active tuberculosis disease, including treatment outcomes and drug resistance, this emphasizes the importance of dual screening and management of under- and overnutrition-related indicators among patients with suspected or active tuberculosis disease. Further studies are needed to determine clinical implications of vitamin D as a potential modifiable risk factor in metabolic abnormalities, and whether population-specific body mass index and waist circumference cut-offs improve diabetes screening.
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Affiliation(s)
- Elaine A. Yu
- Division of Nutritional Sciences, Cornell University, Ithaca, New York, United States of America
| | - Julia L. Finkelstein
- Division of Nutritional Sciences, Cornell University, Ithaca, New York, United States of America
| | - Patsy M. Brannon
- Division of Nutritional Sciences, Cornell University, Ithaca, New York, United States of America
| | - Wesley Bonam
- Arogyavaram Medical Centre, Madanapalle, Andhra Pradesh, India
| | - David G. Russell
- Department of Microbiology and Immunology, College of Veterinary Medicine, Cornell University, Ithaca, New York, United States of America
| | - Marshall J. Glesby
- Weill Cornell Medical College, New York, New York, United States of America
| | - Saurabh Mehta
- Division of Nutritional Sciences, Cornell University, Ithaca, New York, United States of America
- Institute for Nutritional Sciences, Global Health, and Technology, Cornell University, Ithaca, New York, United States of America
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Ding J, Chen X, Bao K, Yang J, Liu N, Huang W, Huang P, Huang J, Jiang N, Cao J, Cheng N, Wang M, Hu X, Zheng S, Bai Y. Assessing different anthropometric indices and their optimal cutoffs for prediction of type 2 diabetes and impaired fasting glucose in Asians: The Jinchang Cohort Study. J Diabetes 2020; 12:372-384. [PMID: 31642584 DOI: 10.1111/1753-0407.13000] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 10/06/2019] [Accepted: 10/16/2019] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND To study the association between anthropometric measurements and the risk of diabetes and impaired fasting glucose (IFG) and compare body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR) to determine the best indicator and its optimal cutoffs for predicting type 2 diabetes and IFG. METHODS A Chinese prospective (2011-2019) cohort named the Jingchang cohort that included 48 001 participants was studied. Using Cox proportional hazard models, hazard ratios (HRs) for incident type 2 diabetes or IFG per 1 SD change in BMI, WC, and WHtR were calculated. Area under the curve (AUC) was compared to identify the best anthropometric variable and its optimal cutoff for predicting diabetes. RESULTS The association of BMI, WC, and WHtR with type 2 diabetes or IFG risk was positive in the univariate and multivariable-adjusted Cox proportional hazard models. Of all three indexes, the AUC of BMI was largest and that of WC was smallest. The derived cutoff values for BMI, WC, and WHtR were 24.6 kg/m2 , 89.5 cm, and 0.52 in men and 23.4 kg/m2 , 76.5 cm, and 0.47 in women for predicting diabetes, respectively. The derived cutoff values for BMI, WC, and WHtR were 23.4 kg/m2 , 87.5 cm, and 0.50 in men and 22.5 kg/m2 , 76.5 cm, and 0.47 in women for predicting IFG, respectively. [Correction added on 14 April 2020, after first online publication: '0' has been deleted from 'WC,0' in the first sentence.]. CONCLUSIONS Our derived cutoff points were lower than the values specified in the most current Asian diabetes guidelines. We recommend a cutoff point for BMI in Asians of 23 kg/m2 and for WC a cutoff point of 89 cm in men and 77 cm in women to define high-risk groups for type 2 diabetes; screening should be considered for these populations.
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Affiliation(s)
- Jie Ding
- Department of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou, China
| | - Xiaoliang Chen
- Department of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou, China
| | - Kaifang Bao
- Department of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou, China
| | - Jingli Yang
- Department of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou, China
| | - Nian Liu
- Department of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou, China
| | - Wenya Huang
- Department of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou, China
| | - Peiyao Huang
- Department of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou, China
| | - Junjun Huang
- Department of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou, China
| | - Nan Jiang
- Department of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou, China
| | - Jianing Cao
- Department of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou, China
| | - Ning Cheng
- Department of Basic Medicine, Lanzhou University, Lanzhou, China
| | - Minzhen Wang
- Department of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou, China
| | - Xiaobin Hu
- Department of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou, China
| | - Shan Zheng
- Department of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou, China
| | - Yana Bai
- Department of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou, China
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Obesity indicators that best predict type 2 diabetes in an Indian population: insights from the Kerala Diabetes Prevention Program. J Nutr Sci 2020; 9:e15. [PMID: 32328239 PMCID: PMC7163399 DOI: 10.1017/jns.2020.8] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 03/13/2020] [Indexed: 01/16/2023] Open
Abstract
Obesity indicators are known to predict the presence of type 2 diabetes mellitus (T2DM); however, evidence for which indicator best identifies undiagnosed T2DM in the Indian population is still very limited. In the present study we examined the utility of different obesity indicators to identify the presence of undiagnosed T2DM and determined their appropriate cut point for each obesity measure. Individuals were recruited from the large-scale population-based Kerala Diabetes Prevention Program. Oral glucose tolerance tests was performed to diagnose T2DM. Receiver operating characteristic (ROC) curve analyses were used to compare the association of different obesity indicators with T2DM and to determine the optimal cut points for identifying T2DM. A total of 357 new cases of T2DM and 1352 individuals without diabetes were identified. The mean age of the study participants was 46⋅4 (sd 7⋅4) years and 62 % were men. Waist circumference (WC), waist:hip ratio (WHR), waist:height ratio (WHtR), BMI, body fat percentage and fat per square of height were found to be significantly higher (P < 0⋅001) among those with diabetes compared with individuals without diabetes. In addition, ROC for WHR (0⋅67; 95 % 0⋅59, 0⋅75), WHtR (0⋅66; 95 % 0⋅57, 0⋅75) and WC (0⋅64; 95 % 0⋅55, 0⋅73) were shown to better identify patients with T2DM. The proposed cut points with an optimal sensitivity and specificity for WHR, WHtR and WC were 0⋅96, 0⋅56 and 86 cm for men and 0⋅88, 0⋅54 and 83 cm for women, respectively. The present study has shown that WHR, WHtR and WC are better than other anthropometric measures for detecting T2DM in the Indian population. Their utility in clinical practice may better stratify at-risk patients in this population than BMI, which is widely used at present.
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Nichols AE, Oh I, Loiselle AE. Effects of Type II Diabetes Mellitus on Tendon Homeostasis and Healing. J Orthop Res 2020; 38:13-22. [PMID: 31166037 PMCID: PMC6893090 DOI: 10.1002/jor.24388] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 05/28/2019] [Indexed: 02/06/2023]
Abstract
Over 300,000 tendon repairs are performed annually in the United States to repair damage to tendons as a result of either acute trauma or chronic tendinopathy. Individuals with type II diabetes mellitus (T2DM) are four times more likely to experience tendinopathy, and up to five times more likely to experience a tendon tear or rupture than non-diabetics. As nearly 10% of the US population is diabetic, with an additional 33% pre-diabetic, this is a particularly problematic health care challenge. Tendon healing in general is challenging and often unsatisfactory due to the formation of mechanically inferior scar-tissue rather than regeneration of native tendon structure. In T2DM tendons, there is evidence of an amplified scar tissue response, which may be associated with the increased the risk of rupture or impaired restoration of range of motion. Despite the dramatic effect of T2DM on tendon function and outcomes following injury, there are few therapies available to promote improved healing in these patients. Several recent studies have enhanced our understanding of the pro-inflammatory environment of T2DM healing and have assessed potential treatment approaches to mitigate pathological progression in pre-clinical models of diabetic tendinopathy. This review discusses the current state of knowledge of diabetic tendon healing from molecular to mechanical disruptions and identifies promising approaches and critical knowledge gaps as the field moves toward identification of novel therapeutic strategies to maintain or restore tendon function in diabetic patients. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:13-22, 2020.
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Affiliation(s)
- Anne E.C. Nichols
- Center for Musculoskeletal Research, Department of Orthopaedics & Rehabilitation, University of Rochester Medical Center, Rochester, NY 14642
| | - Irvin Oh
- Center for Musculoskeletal Research, Department of Orthopaedics & Rehabilitation, University of Rochester Medical Center, Rochester, NY 14642
| | - Alayna E. Loiselle
- Center for Musculoskeletal Research, Department of Orthopaedics & Rehabilitation, University of Rochester Medical Center, Rochester, NY 14642,Corresponding Author Alayna E. Loiselle, PhD, Center for Musculoskeletal Research, University of Rochester Medical Center, 601 Elmwood Ave, Box 665, Rochester, NY, 14642, Phone: (585) 275-7239, Fax: (585) 276-2177,
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Fan Y, Li W, Liu H, Wang L, Zhang S, Li W, Liu H, Leng J, Shen Y, Tuomilehto J, Yu Z, Yang X, Liu M, Hu G. Effects of obesity and a history of gestational diabetes on the risk of postpartum diabetes and hyperglycemia in Chinese women: Obesity, GDM and diabetes risk. Diabetes Res Clin Pract 2019; 156:107828. [PMID: 31472162 PMCID: PMC6858564 DOI: 10.1016/j.diabres.2019.107828] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 08/19/2019] [Accepted: 08/23/2019] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To evaluate the independent or combined effects of gestational diabetes (GDM) and pre-pregnancy and postpartum BMI on the odds of postpartum diabetes and hyperglycemia. METHODS The study samples included 1263 women with prior GDM and 705 women without GDM. Postpartum 1-7 years diabetes was diagnosed by the standard oral glucose tolerance test. RESULTS The multivariable-adjusted odds ratios among women with prior GDM, compared with those without it, were 7.52 for diabetes and 2.27 for hyperglycemia. The multivariable-adjusted odds ratios at different postpartum BMI levels (<24, 24-27.9, and ≥ 28 kg/m2) were 1.00, 2.80, and 8.08 for diabetes (Ptrend < 0.001), and 1.00, 2.10, and 4.42 for hyperglycemia (Ptrend < 0.001), respectively. Women with high body fat (≥31.9%) or abdominal obesity (≥85 cm) had a 2.7-6.9-fold higher odds ratio for diabetes or hyperglycemia. Women with both obesity and prior GDM had the highest risk of diabetes or hyperglycemia compared with non-obese women without GDM. Non-obese women with prior GDM had the same risk of diabetes and hyperglycemia as non-GDM women with obesity. When using Cox regression models, the results were very close to those using logistic regression models. CONCLUSIONS Maternal prior GDM and pre-pregnancy or postpartum obesity contribute equally to postpartum diabetes and hyperglycemia risk.
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Affiliation(s)
- Yuxin Fan
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, China; Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Weiqin Li
- Tianjin Women's and Children's Health Center, Tianjin, China
| | - Huikun Liu
- Tianjin Women's and Children's Health Center, Tianjin, China
| | - Leishen Wang
- Tianjin Women's and Children's Health Center, Tianjin, China
| | - Shuang Zhang
- Tianjin Women's and Children's Health Center, Tianjin, China
| | - Wei Li
- Tianjin Women's and Children's Health Center, Tianjin, China
| | - Hongyan Liu
- Tianjin Women's and Children's Health Center, Tianjin, China
| | - Junhong Leng
- Tianjin Women's and Children's Health Center, Tianjin, China
| | - Yun Shen
- Pennington Biomedical Research Center, Baton Rouge, LA, USA; Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Six People's Hospital, Shanghai, China
| | - Jaakko Tuomilehto
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Zhijie Yu
- Population Cancer Research Program, Dalhousie University, Halifax, NS, Canada
| | - Xilin Yang
- Department of Epidemiology, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Ming Liu
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, China
| | - Gang Hu
- Pennington Biomedical Research Center, Baton Rouge, LA, USA.
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10
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Stojek MM, Maples-Keller JL, Dixon HD, Umpierrez GE, Gillespie CF, Michopoulos V. Associations of childhood trauma with food addiction and insulin resistance in African-American women with diabetes mellitus. Appetite 2019; 141:104317. [PMID: 31185252 DOI: 10.1016/j.appet.2019.104317] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 06/05/2019] [Accepted: 06/07/2019] [Indexed: 02/07/2023]
Abstract
Food addiction (FA) describes a group of disordered eating behaviors. Childhood trauma has been associated with adult FA and trauma has known effects on the endocrine system, but it is unclear whether FA is associated with insulin resistance. We hypothesized that severity of childhood trauma will be associated with FA and higher insulin resistance (HOMA-IR) in a sample of obese women with type 2 diabetes mellitus (T2DM), and that FA will mediate the association between childhood trauma and HOMA-IR. Women with a diagnosis of T2DM (N = 73; MBMI = 35.86, SDBMI = 7.72; Mage = 50.59, SDage = 9.72) were recruited from a diabetes clinic at a county hospital. Participants completed the Childhood Trauma Questionnaire and the Yale Food Addiction Scale. Fasting blood samples were obtained from 64 participants to assess plasma hemoglobin A1c (HbA1c), insulin and glucose (used to calculate HOMA-IR); Oral Glucose Tolerance Test (OGTT) was performed to measure change in glucose and insulin secretion. 48% of the sample met diagnostic criteria for FA. Women with FA reported significantly higher HOMA-IR (F = 25.692, p < 0.001, df = 1,62), HbA1c (F = 4.358, p = 0.041, df = 1,62), and OGGT glucose (F = 5.539, p = 0.022, df = 1,62) as well as severity of childhood trauma (F = 10.453, p = 0.002, df = 1,71). In a hierarchical linear regression controlling for BMI, income level, and T2DM treatment, the severity of childhood trauma did not contribute to the prediction of HOMA-IR (β = -0.011, p = 0.942) whereas FA did (β = 0.422, p = 0.007). In a bootstrapped mediation analysis, the association between childhood trauma and HOMA-IR was mediated by FA severity (b = 0.596, p = 0.020). Understanding the psychological factors that contribute to HOMA-IR in an underserved population of African American women may lead to more effective diabetes management and prevention strategies.
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Affiliation(s)
- Monika M Stojek
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA; Emory Healthcare Veterans Program, USA
| | - Jessica L Maples-Keller
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA; Emory Healthcare Veterans Program, USA
| | - Hayley Drew Dixon
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Guillermo E Umpierrez
- Department of Medicine, Division of Endocrinology, Emory University School of Medicine, USA
| | - Charles F Gillespie
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Vasiliki Michopoulos
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA; Yerkes National Primate Research Center, Atlanta, GA, USA.
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11
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Luo J, Hendryx M, Laddu D, Phillips LS, Chlebowski R, LeBlanc ES, Allison DB, Nelson DA, Li Y, Rosal MC, Stefanick ML, Manson JE. Racial and Ethnic Differences in Anthropometric Measures as Risk Factors for Diabetes. Diabetes Care 2019; 42:126-133. [PMID: 30352893 PMCID: PMC6463546 DOI: 10.2337/dc18-1413] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 09/25/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The study objective was to examine the impact of race/ethnicity on associations between anthropometric measures and diabetes risk. RESEARCH DESIGN AND METHODS A total of 136,112 postmenopausal women aged 50-79 years participating in the Women's Health Initiative without baseline cancer or diabetes were followed for 14.6 years. BMI, waist circumference (WC), and waist-to-hip ratio (WHR) were measured in all participants, and a subset of 9,695 had assessment of whole-body fat mass, whole-body percent fat, trunk fat mass, and leg fat mass by DXA. Incident diabetes was assessed via self-report. Multivariate Cox proportional hazards regression models were used to assess associations between anthropometrics and diabetes incidence. RESULTS During follow-up, 18,706 cases of incident diabetes were identified. BMI, WC, and WHR were all positively associated with diabetes risk in each racial and ethnic group. WC had the strongest association with risk of diabetes across all racial and ethnic groups. Compared with non-Hispanic whites, associations with WC were weaker in black women (P < 0.0001) and stronger in Asian women (P < 0.0001). Among women with DXA determinations, black women had a weaker association with whole-body fat (P = 0.02) but a stronger association with trunk-to-leg fat ratio (P = 0.03) compared with white women. CONCLUSIONS In postmenopausal women across all racial/ethnic groups, WC was a better predictor of diabetes risk, especially for Asian women. Better anthropometric measures that reflect trunk-to-leg fat ratio may improve diabetes risk assessment for black women.
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Affiliation(s)
- Juhua Luo
- Department of Epidemiology and Biostatistics, School of Public Health, Indiana University, Bloomington, IN
| | - Michael Hendryx
- Department of Environmental and Occupational Health, School of Public Health, Indiana University, Bloomington, IN
| | - Deepika Laddu
- Department of Physical Therapy, College of Applied Health Science, University of Illinois at Chicago, Chicago, IL
| | - Lawrence S Phillips
- Atlanta VA Health Care System, Decatur, GA.,Division of Endocrinology and Metabolism, Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | | | - Erin S LeBlanc
- Kaiser Permanente Center for Health Research NW, Portland, OR
| | - David B Allison
- Department of Epidemiology and Biostatistics, School of Public Health, Indiana University, Bloomington, IN
| | - Dorothy A Nelson
- Department of Sociology, Anthropology, Social Work, and Criminal Justice, Oakland University, Rochester, MI
| | - Yueyao Li
- Department of Epidemiology and Biostatistics, School of Public Health, Indiana University, Bloomington, IN
| | - Milagros C Rosal
- Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester, MA
| | - Marcia L Stefanick
- Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA
| | - JoAnn E Manson
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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12
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Han Q, Shao P, Leng J, Zhang C, Li W, Liu G, Zhang Y, Li Y, Li Z, Ren Y, Chan JCN, Yang X. Interactions between general and central obesity in predicting gestational diabetes mellitus in Chinese pregnant women: A prospective population-based study in Tianjin, China. J Diabetes 2018; 10:59-67. [PMID: 28383185 DOI: 10.1111/1753-0407.12558] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 03/14/2017] [Accepted: 04/02/2017] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The aim of the present study was to define cut-off points of body mass index (BMI) and waist circumference (WC) for gestational diabetes mellitus (GDM) and to investigate any interactions between high BMI and high WC on the risk of GDM in pregnant Chinese women. METHODS From 2010 to 2012, 17 803 women in Tianjin, China, who were at 4-12 weeks gestation were recruited to the study. Gestational diabetes mellitus was diagnosed according to the criteria of the International Association of Diabetes and Pregnancy Study Group at 24-28 weeks gestation. Binary logistic regression was used to obtain odds ratios (ORs) and 95% confidence intervals (CIs) while controlling for the confounding effects of traditional risk factors. Restricted cubic spline was used to identify cut-off points of WC and BMI, if any, for GDM. RESULTS Gestational diabetes mellitus developed in 1383 (7.8%) women. The risk of GDM increased steeply with increasing WC from ≥78.5 cm and BMI ≥22.5 kg/m2 . If BMI <22.5 kg/m2 and WC <78.5 cm were used as the reference, BMI between ≥22.5 and <24.0 kg/m2 (multivariable OR 1.76; 95%CI 1.47-2.10) and WC between ≥78.5 and <85.0 cm (multivariable OR 1.53; 95%CI 1.31-1.78) were independently associated with increased risks of GDM. In addition, the presence of both BMI ≥22.5 kg/m2 and WC ≥78.5 cm further increased the OR to 2.83 (95% CI 2.44-3.28), with significant additive interaction. CONCLUSIONS Body mass index ≥22.5 kg/m2 and WC ≥78.5 cm measured up to 12 weeks of gestation were independently and synergistically associated with increased risks of GDM in Chinese pregnant women.
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Affiliation(s)
- Qian Han
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Ping Shao
- Department of Women Health, Tianjin Women and Children's Health Center, Tianjin, China
| | - Junhong Leng
- Department of Women Health, Tianjin Women and Children's Health Center, Tianjin, China
| | - Cuiping Zhang
- Department of Women Health, Tianjin Women and Children's Health Center, Tianjin, China
| | - Wei Li
- Department of Women Health, Tianjin Women and Children's Health Center, Tianjin, China
| | - Guifeng Liu
- Nankai District Women and Children's Health Center, Tianjin, China
| | - Yuanyuan Zhang
- Heping District Women and Children's Health Center, Tianjin, China
| | - Yi Li
- Department of Women Health, Tianjin Women and Children's Health Center, Tianjin, China
| | - Zhe Li
- Department of Women Health, Tianjin Women and Children's Health Center, Tianjin, China
| | - Yanfeng Ren
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Juliana C N Chan
- Department of Medicine and Therapeutics, Hong Kong Institute of Diabetes and Obesity, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
| | - Xilin Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
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13
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Pujos-Guillot E, Brandolini M, Pétéra M, Grissa D, Joly C, Lyan B, Herquelot É, Czernichow S, Zins M, Goldberg M, Comte B. Systems Metabolomics for Prediction of Metabolic Syndrome. J Proteome Res 2017; 16:2262-2272. [PMID: 28440083 DOI: 10.1021/acs.jproteome.7b00116] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The evolution of human health is a continuum of transitions, involving multifaceted processes at multiple levels, and there is an urgent need for integrative biomarkers that can characterize and predict progression toward disease development. The objective of this work was to perform a systems metabolomics approach to predict metabolic syndrome (MetS) development. A case-control design was used within the French occupational GAZEL cohort (n = 112 males: discovery study; n = 94: replication/validation study). Our integrative strategy was to combine untargeted metabolomics with clinical, sociodemographic, and food habit parameters to describe early phenotypes and build multidimensional predictive models. Different models were built from the discriminant variables, and prediction performances were optimized either when reducing the number of metabolites used or when keeping the associated signature. We illustrated that a selected reduced metabolic profile was able to reveal subtle phenotypic differences 5 years before MetS occurrence. Moreover, resulting metabolomic markers, when combined with clinical characteristics, allowed improving the disease development prediction. The validation study showed that this predictive performance was specific to the MetS component. This work also demonstrates the interest of such an approach to discover subphenotypes that will need further characterization to be able to shift to molecular reclassification and targeting of MetS.
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Affiliation(s)
- Estelle Pujos-Guillot
- Université Clermont Auvergne, INRA, UNH, CRNH Auvergne, F-63000 Clermont-Ferrand, France.,Université Clermont Auvergne, INRA, UNH, Plateforme d'Exploration du Métabolisme, MetaboHUB Clermont, CRNH Auvergne, F-63000 Clermont-Ferrand, France
| | - Marion Brandolini
- Université Clermont Auvergne, INRA, UNH, Plateforme d'Exploration du Métabolisme, MetaboHUB Clermont, CRNH Auvergne, F-63000 Clermont-Ferrand, France
| | - Mélanie Pétéra
- Université Clermont Auvergne, INRA, UNH, Plateforme d'Exploration du Métabolisme, MetaboHUB Clermont, CRNH Auvergne, F-63000 Clermont-Ferrand, France
| | - Dhouha Grissa
- Université Clermont Auvergne, INRA, UNH, CRNH Auvergne, F-63000 Clermont-Ferrand, France
| | - Charlotte Joly
- Université Clermont Auvergne, INRA, UNH, Plateforme d'Exploration du Métabolisme, MetaboHUB Clermont, CRNH Auvergne, F-63000 Clermont-Ferrand, France
| | - Bernard Lyan
- Université Clermont Auvergne, INRA, UNH, Plateforme d'Exploration du Métabolisme, MetaboHUB Clermont, CRNH Auvergne, F-63000 Clermont-Ferrand, France
| | | | - Sébastien Czernichow
- INSERM, UMS 011, F-94807 Villejuif, France.,Department of Nutrition, Hôpital Européen Georges-Pompidou , 20, rue Leblanc, F-75015 Paris, France.,Université Paris Descartes , 12, rue de l'école de médecine, F-75006 Paris, France.,INSERM, UMR-S 1168, F-94807 Villejuif, France
| | - Marie Zins
- INSERM, UMS 011, F-94807 Villejuif, France.,Université Paris Descartes , 12, rue de l'école de médecine, F-75006 Paris, France.,INSERM, UMR-S 1168, F-94807 Villejuif, France
| | - Marcel Goldberg
- INSERM, UMS 011, F-94807 Villejuif, France.,Université Paris Descartes , 12, rue de l'école de médecine, F-75006 Paris, France
| | - Blandine Comte
- Université Clermont Auvergne, INRA, UNH, CRNH Auvergne, F-63000 Clermont-Ferrand, France
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14
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Hardy DS, Stallings DT, Garvin JT, Gachupin FC, Xu H, Racette SB. Anthropometric discriminators of type 2 diabetes among White and Black American adults. J Diabetes 2017; 9:296-307. [PMID: 27106521 PMCID: PMC5079832 DOI: 10.1111/1753-0407.12416] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 03/30/2016] [Accepted: 04/15/2016] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The aim of the present study was to determine the best anthropometric discriminators of type 2 diabetes mellitus (T2DM) among White and Black males and females in a large US sample. METHODS We used Atherosclerosis Risk in Communities study baseline data (1987-89) from 15 242 participants (1827 with T2DM) aged 45-65 years. Anthropometric measures included a body shape index (ABSI), body adiposity index (BAI), body mass index, waist circumference (WC), waist: height ratio (WHtR), and waist: hip ratio (WHR). All anthropometric measures were standardized to Z-scores. Using logistic regression, odds ratios for T2DM were adjusted for age, physical activity, and family history of T2DM. The Akaike information criterion and receiver operating characteristic C-statistic were used to select the best-fit models. RESULTS Body mass index, WC, WHtR, and WHR were comparable discriminators of T2DM among White and Black males, and were superior to ABSI and BAI in predicting T2DM (P < 0.0001). Waist circumference, WHtR, and WHR were the best discriminators among White females, whereas WHR was the best discriminator among Black females. The ABSI was the poorest discriminator of T2DM for all race-gender groups except Black females. Anthropometric values distinguishing T2DM cases from non-cases were lower for Black than White adults. CONCLUSIONS Anthropometric measures that included WC, either alone or relative to height (WHtR) or hip circumference (WHR), were the strongest discriminators of T2DM across race-gender groups. Body mass index was a comparable discriminator to WC, WHtR, and WHR among males, but not females.
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Affiliation(s)
- Dale S. Hardy
- Institute of Public and Preventive Health, Augusta University, Augusta, Georgia
- Correspondence, Dale S. Hardy, Institute of Public and Preventive Health, CJ-2325, Augusta University, 1120 15th Street, Augusta, GA 30912-0850, Phone: (706) 721-8794,
| | | | - Jane T. Garvin
- College of Nursing, Augusta University, Augusta, Georgia
| | - Francine C. Gachupin
- Department of Family and Community Medicine, College of Medicine, University of Arizona, Tucson, Arizona, USA
| | - Hongyan Xu
- Department of Biostatistics and Epidemiology, Augusta University, Augusta, Georgia
| | - Susan B. Racette
- Program in Physical Therapy and Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
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15
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Hardy DS, Stallings DT, Garvin JT, Xu H, Racette SB. Best anthropometric discriminators of incident type 2 diabetes among white and black adults: A longitudinal ARIC study. PLoS One 2017; 12:e0168282. [PMID: 28141847 PMCID: PMC5283673 DOI: 10.1371/journal.pone.0168282] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 11/28/2016] [Indexed: 01/05/2023] Open
Abstract
Objective To determine which anthropometric measures are the strongest discriminators of incident type 2 diabetes (T2DM) among White and Black males and females in a large U.S. cohort. Methods We used Atherosclerosis Risk in Communities study data from 12,121 participants aged 45–64 years without diabetes at baseline who were followed for over 11 years. Anthropometric measures included a body shape index (ABSI), body adiposity index (BAI), body mass index (BMI), waist circumference (WC), waist to hip ratio (WHR), waist to height ratio (WHtR), and waist to hip to height ratio (WHHR). All anthropometric measures were repeated at each visit and converted to Z-scores. Hazard ratios and 95% confidence intervals adjusted for age were calculated using repeated measures Cox proportional hazard regression analysis. Akaike Information Criteria was used to select best-fit models. The magnitude of the hazard ratio effect sizes and the Harrell’s C-indexes were used to rank the highest associations and discriminators, respectively. Results There were 1,359 incident diabetes cases. Higher values of all anthropometric measures increased the risk for development of T2DM (p < 0.0001) except ABSI, which was not significant in White and Black males. Statistically significant hazard ratios ranged from 1.26–1.63 for males and 1.15–1.88 for females. In general, the largest hazard ratios were those that corresponded to the highest Harrell’s C-Index and lowest Akaike Information Criteria values. Among White and Black males and females, BMI, WC, WHR, and WHtR were comparable in discriminating cases from non-cases of T2DM. ABSI, BAI, and WHHR were inferior discriminators of incident T2DM across all race-gender groups. Conclusions BMI, the most commonly used anthropometric measure, and three anthropometric measures that included waist circumference (i.e., WC, WHR, WHtR) were the best anthropometric discriminators of incident T2DM across all race-gender groups in the ARIC cohort.
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Affiliation(s)
- Dale S. Hardy
- Institute of Public and Preventive Health, Augusta University, Augusta, Georgia, United States of America
- * E-mail:
| | - Devita T. Stallings
- School of Nursing, Saint Louis University, St. Louis, Missouri, United States of America
| | - Jane T. Garvin
- College of Nursing, Augusta University, Augusta, Georgia, United States of America
| | - Hongyan Xu
- Department of Biostatistics and Epidemiology, Augusta University, Augusta, Georgia, United States of America
| | - Susan B. Racette
- Program in Physical Therapy and Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, United States of America
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16
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Prediction of cold and heat patterns using anthropometric measures based on machine learning. Chin J Integr Med 2016; 24:16-23. [PMID: 28035540 DOI: 10.1007/s11655-016-2641-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To examine the association of body shape with cold and heat patterns, to determine which anthropometric measure is the best indicator for discriminating between the two patterns, and to investigate whether using a combination of measures can improve the predictive power to diagnose these patterns. METHODS Based on a total of 4,859 subjects (3,000 women and 1,859 men), statistical analyses using binary logistic regression were performed to assess the significance of the difference and the predictive power of each anthropometric measure, and binary logistic regression and Naive Bayes with the variable selection technique were used to assess the improvement in the predictive power of the patterns using the combined measures. RESULTS In women, the strongest indicators for determining the cold and heat patterns among anthropometric measures were body mass index (BMI) and rib circumference; in men, the best indicator was BMI. In experiments using a combination of measures, the values of the area under the receiver operating characteristic curve in women were 0.776 by Naive Bayes and 0.772 by logistic regression, and the values in men were 0.788 by Naive Bayes and 0.779 by logistic regression. CONCLUSIONS Individuals with a higher BMI have a tendency toward a heat pattern in both women and men. The use of a combination of anthropometric measures can slightly improve the diagnostic accuracy. Our findings can provide fundamental information for the diagnosis of cold and heat patterns based on body shape for personalized medicine.
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17
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Yu JH, Kim JS, Lee MR, Yoon SY, Cho SY, Yoo SH, Kim BI. Risks of borderline liver enzyme abnormalities to the incidence of impaired fasting glucose and diabetes mellitus: a 7 year follow up study of workers. Ann Occup Environ Med 2016; 28:18. [PMID: 27057316 PMCID: PMC4823863 DOI: 10.1186/s40557-016-0105-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 03/28/2016] [Indexed: 01/14/2023] Open
Abstract
Background The aim of this study was to identify the relationships between borderline serum liver enzyme abnormalities and the incidence of impaired fasting glucose (IFG) and diabetes mellitus (DM) during a 7-year follow-up of workers, and to evaluate the quantitative level of risks. Methods A total of 749 workers in an electronics manufacturing company were divided into the normal fasting blood glucose (n = 633), IFG (n = 98), and DM (n = 18) groups, according to the results of their health checkup in 2006. Among 633 workers in the normal group, excluding 55 workers who were impossible to follow, incidence rate and relative risks of 578 workers to the IFG or DM in 2013 according to the levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), and gamma-glutamyltransferase (γ-GTP) were investigated. The liver enzyme levels were categorized as A (normal), B (borderline elevation), and R (definite elevation) following the standard of the National Health Insurance Service of Korea. Results The incidence rate of IFG or DM based on ALT level was 9.7 % for the A, 30.0 % for B, and 15.4 % for R. According to γ-GTP, the incidence rate was 9.8 % for A, 34.5 % for B, and 25.0 % for R. The relative risk(RR) to the incidence of IFG or DM depending on the level of ALT were 3.09 in B and 1.59 in R compared to A. According to γ-GTP, RR was 3.52 in B and 2.55 in R compared to A. AST level was not related to the incidence of IFG or DM. A multiple logistic regression analysis with the incidence of IFG or DM as a dependent variable resulted in an odds ratio of 2.664(1.214–5.849) for B level ALT, 3.685(1.405–9.667) for B level of γ-GTP even after adjustment for other variables such as age, sex, body mass index, AUDIT score, systolic blood pressure, and triglyceride. Conclusions Even borderline elevations of ALT and γ-GTP, but not AST, increased the incidence and risk of IFG or DM after 7 years. Borderline elevation of ALT and γ-GTP was identified as an independent risk factor of IFG or DM.
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Affiliation(s)
- Jin-Hyun Yu
- Department of Occupational and Environmental Medicine, Soonchunhyang University Gumi Hospital, 179, Gongdan 1-dong, Gumi-si, Gyeongbuk, 730-706 South Korea
| | - Jin-Seok Kim
- Department of Occupational and Environmental Medicine, Soonchunhyang University Gumi Hospital, 179, Gongdan 1-dong, Gumi-si, Gyeongbuk, 730-706 South Korea
| | - Mee-Ra Lee
- LIGnex1 Gumi company, 133, Gongdan 1-dong, Gumi-si, Gyeongbuk, 730-703 South Korea
| | - Seong-Yong Yoon
- Department of Occupational and Environmental Medicine, Soonchunhyang University Gumi Hospital, 179, Gongdan 1-dong, Gumi-si, Gyeongbuk, 730-706 South Korea
| | - Seong-Yong Cho
- Department of Occupational and Environmental Medicine, Soonchunhyang University Gumi Hospital, 179, Gongdan 1-dong, Gumi-si, Gyeongbuk, 730-706 South Korea
| | - Seung-Hyun Yoo
- Department of Occupational and Environmental Medicine, Soonchunhyang University Gumi Hospital, 179, Gongdan 1-dong, Gumi-si, Gyeongbuk, 730-706 South Korea
| | - Boo-Il Kim
- Department of Occupational and Environmental Medicine, Soonchunhyang University Gumi Hospital, 179, Gongdan 1-dong, Gumi-si, Gyeongbuk, 730-706 South Korea
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18
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Ashwell M, Gibson S. Waist-to-height ratio as an indicator of 'early health risk': simpler and more predictive than using a 'matrix' based on BMI and waist circumference. BMJ Open 2016; 6:e010159. [PMID: 26975935 PMCID: PMC4800150 DOI: 10.1136/bmjopen-2015-010159] [Citation(s) in RCA: 255] [Impact Index Per Article: 31.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES There is now good evidence that central obesity carries more health risks compared with total obesity assessed by body mass index (BMI). It has therefore been suggested that waist circumference (WC), a proxy for central obesity, should be included with BMI in a 'matrix' to categorise health risk. We wanted to compare how the adult UK population is classified using such a 'matrix' with that using another proxy for central obesity, waist-to-height ratio (WHtR), using a boundary value of 0.5. Further, we wished to compare cardiometabolic risk factors in adults with 'healthy' BMI divided according to whether they have WHtR below or above 0.5. SETTING, PARTICIPANTS AND OUTCOME MEASURES Recent data from 4 years (2008-2012) of the UK National Diet and Nutrition Survey (NDNS) (n=1453 adults) were used to cross-classify respondents on anthropometric indices. Regression was used to examine differences in levels of risk factors (triglycerides (TG), total cholesterol (TC), low-density lipoprotein (LDL), high-density lipoprotein (HDL), TC: HDL, glycated haemoglobin (HbA1c), fasting glucose, systolic (SBP) and diastolic blood pressure (DBP)) according to WHtR below and above 0.5, with adjustment for confounders (age, sex and BMI). RESULTS 35% of the group who were judged to be at 'no increased risk' using the 'matrix' had WHtR ≥ 0.5. The 'matrix' did not assign 'increased risk' to those with a 'healthy' BMI and 'high' waist circumference. However, our analysis showed that the group with 'healthy' BMI, and WHtR ≥ 0.5, had some significantly higher cardiometabolic risk factors compared to the group with 'healthy' BMI but WHtR below 0.5. CONCLUSIONS Use of a simple boundary value for WHtR (0.5) identifies more people at 'early health risk' than does a more complex 'matrix' using traditional boundary values for BMI and WC. WHtR may be a simpler and more predictive indicator of the 'early heath risks' associated with central obesity.
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Affiliation(s)
- Margaret Ashwell
- Ashwell Associates, Ashwell, Herts, UK
- Honorary Senior Visiting Fellow, City University London, UK
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Little M, Humphries S, Patel K, Dodd W, Dewey C. Factors associated with glucose tolerance, pre-diabetes, and type 2 diabetes in a rural community of south India: a cross-sectional study. Diabetol Metab Syndr 2016; 8:21. [PMID: 26958082 PMCID: PMC4782344 DOI: 10.1186/s13098-016-0135-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 02/17/2016] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND India's national rural prevalence of type 2 diabetes has quadrupled in the past 25 years. Despite the growing rural burden, few studies have examined putative risk factors and their relationship with glucose intolerance and diabetes in rural areas. We undertook a cross-sectional study to determine the prevalence of impaired fasting glucose (IFG), impaired glucose tolerance (IGT), and type 2 diabetes in a rural area of south India. In addition, we determined which factors were associated with type 2 diabetes. METHODS We sampled 2 % of the adult population from 17 villages using a randomized household-level sampling technique. Each participant undertook a questionnaire that included basic descriptive information and an assessment of socioeconomic status, physical activity, and dietary intake. Height, weight, waist and hip circumference, and blood pressure measurements were taken. An oral glucose tolerance test was used to determine diabetes status. We used stepwise logistic model building techniques to determine associations between several putative factors and type 2 diabetes. RESULTS 753 participants were included in the study. The age- and sex-standardized prevalence of IFG was 3.9 %, IGT was 5.6 %, and type 2 diabetes was 10.8 %. Factors associated with type 2 diabetes after adjusting for confounders included physical activity [OR 0.81], rurality [OR 0.76], polyunsaturated fat intake [OR 0.94], body mass index [OR 1.85], waist to hip ratio [OR 1.62], and tobacco consumption [OR 2.82]. CONCLUSION Our study contributes to the growing body of research suggesting that diabetes is a significant concern in rural south India. Associated risk factors should be considered as potential targets for reducing health burdens in India.
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Affiliation(s)
- Matthew Little
- />Department of Population Medicine, University of Guelph, Guelph, ON Canada
| | - Sally Humphries
- />Department of Sociology and Anthropology, University of Guelph, Guelph, ON Canada
| | - Kirit Patel
- />Department of International Development Studies, Menno Simons College, University of Winnipeg, Winnipeg, MB Canada
| | - Warren Dodd
- />Department of Population Medicine, University of Guelph, Guelph, ON Canada
| | - Cate Dewey
- />Department of Population Medicine, University of Guelph, Guelph, ON Canada
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Cha S, Park AY, Kang C. A Genome-Wide Association Study Uncovers a Genetic Locus Associated with Thoracic-to-Hip Ratio in Koreans. PLoS One 2015; 10:e0145220. [PMID: 26675016 PMCID: PMC4686062 DOI: 10.1371/journal.pone.0145220] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Accepted: 11/30/2015] [Indexed: 02/02/2023] Open
Abstract
The thoracic-to-hip circumference ratio (THR) is an anthropometric marker recently described as a predictor of type 2 diabetes. In this study, we performed a genome-wide association study (GWAS) followed by confirmatory analyses to identify genetic markers associated with THR. A total of 7,240 Korean subjects (4,988 for the discovery stage and 2,252 for the confirmatory analyses) were recruited for this study, and genome-wide single nucleotide polymorphism (SNP) genotyping of the initial 4,988 individuals was performed using Affymetrix Human SNP array 5.0. Linear regression analysis was then performed to adjust for the effects of age, sex, and current diabetes medication status on the THR of the study subjects. In the initial discovery stage, there was a statistically nominal association between minor alleles of SNP markers on chromosomes 4, 8, 10, and 12, and THR changes (p < 5.0 × 10−6). The subsequent confirmatory analyses of these markers, however, only detected a significant association between two SNPs in the HECTD4 gene and decreased THRs. Notably, this association was detected in male (rs11066280: p = 1.14 × 10−2; rs2074356: p = 1.10 × 10−2), but not in female subjects. Meanwhile, the combined results from the two analyses (initial and confirmatory) indicated that minor alleles of these two intronic variants exhibited a significant genome-wide association with decreased THR in the male subjects (n = 3,155; rs11066280: effect size = −0.008624, p = 6.19 × 10−9; rs2074356: effect size = −0.008762, p = 1.89 × 10−8). Furthermore, minor alleles of these two SNPs exhibited protective effects on patients’ risks for developing type 2 diabetes. In conclusion, we have identified two genetic variations in HECTD4 that are associated with THR, particularly in men.
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Affiliation(s)
- Seongwon Cha
- Mibyeong Research Center, Korea Institute of Oriental Medicine, 1672 Yuseongdae-ro, Yuseong-gu, Daejeon 34054, Republic of Korea
| | - Ah Yeon Park
- Mibyeong Research Center, Korea Institute of Oriental Medicine, 1672 Yuseongdae-ro, Yuseong-gu, Daejeon 34054, Republic of Korea
| | - Changsoo Kang
- Department of Biology and Research Institute of Basic Sciences, College of Natural Sciences, Sungshin Women’s University, Seoul, 01133, Republic of Korea
- * E-mail:
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21
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Crandall CJ, Yildiz VO, Wactawski-Wende J, Johnson KC, Chen Z, Going SB, Wright NC, Cauley JA. Postmenopausal weight change and incidence of fracture: post hoc findings from Women's Health Initiative Observational Study and Clinical Trials. BMJ 2015; 350:h25. [PMID: 25627698 PMCID: PMC6168976 DOI: 10.1136/bmj.h25] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To determine associations between postmenopausal change in body weight and incidence of fracture and associations between voluntary and involuntary weight loss and risk of fracture. DESIGN Post hoc analysis of data from the Women's Health Initiative Observational Study and Clinical Trials. SETTING 40 clinical centers in the United States. PARTICIPANTS 120,566 postmenopausal women, aged 50-79 at baseline (1993-98), followed through 2013 (mean fracture follow-up duration 11 years from baseline). EXPOSURES Annualized percentage change in measured body weight from baseline to year 3, classified as stable (<5% change), weight loss (≥ 5%), or weight gain (≥ 5%). Self assessment of whether weight loss was intentional or unintentional. Cox proportional hazards regression models were adjusted for age, race/ethnicity, baseline body mass index (BMI), smoking, alcohol intake, level of physical activity, energy expenditure, calcium and vitamin D intake, physical function score, oophorectomy, hysterectomy, previous fracture, comorbidity score, and drug use. MAIN OUTCOMES Incident self reported fractures of the upper limbs, lower limbs, and central body; hip fractures confirmed by medical records. RESULTS Mean participant age was 63.3. Mean annualized percent weight change was 0.30% (95% confidence interval 0.28 to 0.32). Overall, 79,279 (65.6%) had stable weight; 18,266 (15.2%) lost weight; and 23,021 (19.0%) gained weight. Compared with stable weight, weight loss was associated with a 65% higher incidence rates of fracture in hip (adjusted hazard ratio 1.65, 95% confidence interval 1.49 to 1.82), upper limb (1.09, 1.03 to 1.16), and central body (1.30, 1.20 to 1.39); weight gain was associated with higher incidence rates of fracture in upper limb (1.10, 1.05 to 1.18) and lower limb (1.18, 1.12 to 1.25). Compared with stable weight, unintentional weight loss was associated with a 33% higher incidence rates of hip fracture (1.33, 1.19 to 1.47) and increased incidence rates of vertebral fracture (1.16, 1.06 to 1.26); intentional weight loss was associated with increased incidence rates of lower limb fracture (1.11, 1.05 to 1.17) and decreased incidence of hip fracture (0.85, 0.76 to 0.95). CONCLUSIONS Weight gain, weight loss, and intentional weight loss are associated with increased incidence of fracture, but associations differ by fracture location. Clinicians should be aware of fracture patterns after weight gain and weight loss.
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Affiliation(s)
- Carolyn J Crandall
- David Geffen School of Medicine at University of California, Los Angeles, Division of General Internal Medicine and Health Services Research, UCLA Medicine/GIM, 911 Broxton Avenue, 1st floor, Los Angeles, CA, 90024, USA
| | - Vedat O Yildiz
- Center for Biostatistics, Ohio State University, 2012 Kenny Road, Columbus, Ohio, USA
| | - Jean Wactawski-Wende
- Department of Social and Preventive Medicine, University at Buffalo, State University of New York, 65 Farber Hall, 3435 Main Street, Buffalo, NY 14214-3000 State University of NY at Buffalo, Buffalo, NY, USA
| | - Karen C Johnson
- Department of Preventive Medicine, University of Tennessee Health Science Center, 66 N. Pauline, Suite 633, Memphis, TN 38163, USA
| | - Zhao Chen
- Division of Epidemiology and Biostatistics, University of Arizona, Tucson, Arizona, USA
| | - Scott B Going
- Department of Nutritional Sciences, University of Arizona, Tucson, Arizona, USA
| | - Nicole C Wright
- Department of Epidemiology, University of Alabama at Birmingham, RPHB 523C, Birmingham, AL, 35294, USA
| | - Jane A Cauley
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
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Lee BJ, Ku B, Nam J, Pham DD, Kim JY. Prediction of fasting plasma glucose status using anthropometric measures for diagnosing type 2 diabetes. IEEE J Biomed Health Inform 2014; 18:555-61. [PMID: 24608055 DOI: 10.1109/jbhi.2013.2264509] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
It is well known that body fat distribution and obesity are important risk factors for type 2 diabetes. Prediction of type 2 diabetes using a combination of anthropometric measures remains a controversial issue. This study aims to predict the fasting plasma glucose (FPG) status that is used in the diagnosis of type 2 diabetes by a combination of various measures among Korean adults. A total of 4870 subjects (2955 females and 1915 males) participated in this study. Based on 37 anthropometric measures, we compared predictions of FPG status using individual versus combined measures using two machine-learning algorithms. The values of the area under the receiver operating characteristic curve in the predictions by logistic regression and naive Bayes classifier based on the combination of measures were 0.741 and 0.739 in females, respectively, and were 0.687 and 0.686 in males, respectively. Our results indicate that prediction of FPG status using a combination of anthropometric measures was superior to individual measures alone in both females and males. We show that using balanced data of normal and high FPG groups can improve the prediction and reduce the intrinsic bias of the model toward the majority class.
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Luo W, Guo Z, Hu X, Zhou Z, Wu M, Zhang L, Liu J. 2 years change of waist circumference and body mass index and associations with type 2 diabetes mellitus in cohort populations. Obes Res Clin Pract 2014; 7:e290-6. [PMID: 24306157 DOI: 10.1016/j.orcp.2012.02.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2011] [Revised: 02/05/2012] [Accepted: 02/08/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Compare the association between 2 years change of waist circumference (WC) or body mass index (BMI) and incident type 2 diabetes mellitus (T2DM) in cohort populations. METHODS Prospective cohort study, based on a baseline investigation from 1999, we conducted the first follow-up for subjects whose follow time met 2 years, and the second follow-up for subjects whose follow time met 5 years. Two years change of WC or BMI was measured by the D-value between baseline and the first follow up values. The association between 2 years change of WC or BMI and incident T2DM were analyzed by using Poisson regression model. RESULTS Among 3461 participants without T2DM at baseline, 160 subjects developed T2DM during follow up period. Across quartiles of WC D-value, hazards ratio (HR) of incident T2DM increased, but there was no significant dose response relationship was found between BMI D-value and incident T2DM. Compared with subjects whose both WC and BMI were modified, there was no significant increase for T2DM risk in subjects whose WC was modified but BMI was not modified [HR(95%CI) = 1.66(0.70-3.97)], but the T2DM risk was significantly higher in subjects whose WC was not modified but BMI was modified [HR(95%CI) = 1.73(1.17-2.54)]. CONCLUSIONS WC change was a better predictor for incident T2DM than BMI change. Intervention programs designed to reduce WC through lifestyle modification, including physical activity and diet, may have significant public health significance in preventing incident T2DM.
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Affiliation(s)
- Wenshu Luo
- Department of Radiology & Public Health, Soochow University, SuZhou, JiangSu 215123, China
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24
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Alvim RDO, Mourao-Junior CA, de Oliveira CM, Krieger JE, Mill JG, Pereira AC. Body mass index, waist circumference, body adiposity index, and risk for type 2 diabetes in two populations in Brazil: general and Amerindian. PLoS One 2014; 9:e100223. [PMID: 24937307 PMCID: PMC4061074 DOI: 10.1371/journal.pone.0100223] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Accepted: 05/25/2014] [Indexed: 11/30/2022] Open
Abstract
Objective The use of the anthropometric indices of adiposity, especially body mass index and waist circumference in the prediction of diabetes mellitus has been widely explored. Recently, a new body composition index, the body adiposity index was proposed. The aim of this study was to compare the effectiveness of body mass index, waist circumference, and body adiposity index in the risk assessment for type 2 diabetes mellitus. Design and methods A total of 1,572 individuals from the general population of Vitoria City, Brazil and 620 Amerindians from the Aracruz Indian Reserve, Brazil were randomly selected. BMI, waist circumference, and BAI were determined according to a standard protocol. Type 2 diabetes mellitus was diagnosed by the presence of fasting glucose ≥126 mg/dL or by the use of antidiabetic drugs. Results The area under the curve was similar for all anthropometric indices tested in the Amerindian population, but with very different sensitivities or specificities. In women from the general population, the area under the curve of waist circumference was significantly higher than that of the body adiposity index. Regarding risk assessment for type 2 diabetes mellitus, the body adiposity index was a better risk predictor than body mass index and waist circumference in the Amerindian population and was the index with highest odds ratio for type 2 diabetes mellitus in men from the general population, while in women from the general population waist circumference was the best risk predictor. Conclusion Body adiposity index was the best risk predictor for type 2 diabetes mellitus in the Amerindian population and men from the general population. Our data suggest that the body adiposity index is a useful tool for the risk assessment of type 2 diabetes mellitus in admixture populations.
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Affiliation(s)
- Rafael de Oliveira Alvim
- Laboratory of Genetics and Molecular Cardiology, Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, Brazil
| | | | | | - José E. Krieger
- Laboratory of Genetics and Molecular Cardiology, Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - José G. Mill
- Department of Physiology, Federal University of Espírito Santo, Espírito Santo, Brazil
| | - Alexandre C. Pereira
- Laboratory of Genetics and Molecular Cardiology, Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, Brazil
- * E-mail:
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25
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Boardman HF, Avery AJ. Effectiveness of a community pharmacy weight management programme. Int J Clin Pharm 2014; 36:800-6. [DOI: 10.1007/s11096-014-9964-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Accepted: 05/27/2014] [Indexed: 11/29/2022]
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26
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Kunutsor SK, Seddoh D. Alanine aminotransferase and risk of the metabolic syndrome: a linear dose-response relationship. PLoS One 2014; 9:e96068. [PMID: 24781277 PMCID: PMC4004562 DOI: 10.1371/journal.pone.0096068] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Accepted: 04/03/2014] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Elevated baseline circulating alanine aminotransferase (ALT) level has been demonstrated to be associated with an increased risk of the metabolic syndrome (MetS), but the nature of the dose-response relationship is uncertain. METHODS We performed a systematic review and meta-analysis of published prospective cohort studies to characterize in detail the nature of the dose-response relationship between baseline ALT level and risk of incident MetS in the general population. Relevant studies were identified in a literature search of MEDLINE, EMBASE, and Web of Science up to December 2013. Prospective studies in which investigators reported relative risks (RRs) of MetS for 3 or more categories of ALT levels were eligible. A potential nonlinear relationship between ALT levels and MetS was examined using restricted cubic splines. RESULTS Of the 489 studies reviewed, relevant data were available on 29,815 non-overlapping participants comprising 2,125 incident MetS events from five prospective cohort studies. There was evidence of a linear association (P for nonlinearity=0.38) between ALT level and risk of MetS, characterised by a graded increase in MetS risk at ALT levels 6-40 U/L. The risk of MetS increased by 14% for every 5 U/L increment in circulating ALT level (95% CI: 12-17%). Evidence was lacking of heterogeneity and publication bias among the contributing studies. CONCLUSIONS Baseline ALT level is associated with risk of the MetS in a linear dose-response manner. Studies are needed to determine whether the association represents a causal relationship.
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Affiliation(s)
- Setor K. Kunutsor
- Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Cambridge, United Kingdom
- * E-mail:
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27
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Rood JC, Schwarz JM, Gettys T, Mynatt RL, Mendoza T, Johnson WD, Cefalu WT. Effects of Artemisia species on de novo lipogenesis in vivo. Nutrition 2014; 30:S17-20. [PMID: 24985100 DOI: 10.1016/j.nut.2014.03.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 03/28/2014] [Accepted: 03/29/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Botanical compounds and extracts are widely used as nutritional supplements for the promotion of health or the prevention of disease. An extract of Artemisia dracunculus (PMI 5011) has been shown to improve insulin action, yet the precise mechanism is not known. The aim of this study is to demonstrate that the mechanism by which PMI 5011 and two related Artemisia extracts improve insulin action is associated with a down-regulation of de novo lipogenesis (DNL) in the liver and an increase in DNL in the adipose tissue. METHODS Diet-induced obese 16-wk-old male mice (C57 BL/6 J) were divided into four groups: (control, 5011, Santa, and Scopa) and fed for 30 d with respective extracts incorporated into the diet at 1% (w/w). Deuterium was administered on day 30 for the measurement of DNL in blood, liver, and white adipose tissue. Individual fatty acids and glycerol levels were also measured. RESULTS No statistically significant differences were seen in DNL between the control group and the three botanical treatments. Plasma levels of all four long-chain fatty acids were significantly lower in the three treatment groups. Glycerol in the plasma was lower in the treatment groups compared with the control group; however, this did not reach statistical significance in all cases. Tissue levels of the fatty acids and glycerol did not differ between any of the treatment groups. CONCLUSIONS These results suggest that botanicals may not affect fractional DNL in animals on a high-fat diet. However, there were decreases in long-chain fatty acids and in glycerol coming from the newly synthesized triglycerides in plasma.
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Affiliation(s)
- Jennifer C Rood
- Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, Louisiana, USA.
| | - Jean-Marc Schwarz
- University of California-San Francisco, San Francisco, California, USA
| | - Thomas Gettys
- Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, Louisiana, USA
| | - Randall Ll Mynatt
- Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, Louisiana, USA
| | - Tamara Mendoza
- Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, Louisiana, USA
| | - William D Johnson
- Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, Louisiana, USA
| | - William T Cefalu
- Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, Louisiana, USA
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Mamtani M, Meikle PJ, Kulkarni H, Weir JM, Barlow CK, Jowett JB, Bellis C, Dyer TD, Almasy L, Mahaney MC, Duggirala R, Comuzzie AG, Blangero J, Curran JE. Plasma dihydroceramide species associate with waist circumference in Mexican American families. Obesity (Silver Spring) 2014; 22:950-6. [PMID: 23929697 PMCID: PMC3918249 DOI: 10.1002/oby.20598] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Accepted: 08/03/2013] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Waist circumference (WC), the clinical marker of central obesity, is gaining popularity as a screening tool for type 2 diabetes (T2D). While there is epidemiologic evidence favoring the WC-T2D association, its biological substantiation is generally weak. Our objective was to determine the independent association of plasma lipid repertoire with WC. METHODS Samples and data from the San Antonio Family Heart Study of 1208 Mexican Americans from 42 extended families were used. Association of plasma lipidomic profiles with the cross-sectionally assessed WC was determined. Plasma lipidomic profiling entailed liquid chromatography with mass spectrometry. Statistical analyses included multivariable polygenic regression models and bivariate trait analyses using the SOLAR software. RESULTS After adjusting for age and sex interactions, body mass index, homeostasis model of assessment-insulin resistance, total cholesterol, triglycerides, high density lipoproteins and use of lipid lowering drugs, dihydroceramides as a class were associated with WC. Dihydroceramide species 18:0, 20:0, 22:0, and 24:1 were significantly associated and genetically correlated with WC. Two sphingomyelin species (31:1 and 41:1) were also associated with WC. CONCLUSIONS Plasma dihydroceramide levels independently associate with WC. Thus, high resolution plasma lipidomic studies can provide further credence to the biological underpinnings of the association of WC with T2D.
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Affiliation(s)
- Manju Mamtani
- Department of Genetics, Texas Biomedical Research Institute, San Antonio, TX 78227, USA
| | - Peter J. Meikle
- Baker IDI Heart and Diabetes Institute, Melbourne, VIC 3004, Australia
| | - Hemant Kulkarni
- Department of Genetics, Texas Biomedical Research Institute, San Antonio, TX 78227, USA
| | - Jacquelyn M. Weir
- Baker IDI Heart and Diabetes Institute, Melbourne, VIC 3004, Australia
| | | | - Jeremy B. Jowett
- Baker IDI Heart and Diabetes Institute, Melbourne, VIC 3004, Australia
| | - Claire Bellis
- Department of Genetics, Texas Biomedical Research Institute, San Antonio, TX 78227, USA
| | - Thomas D. Dyer
- Department of Genetics, Texas Biomedical Research Institute, San Antonio, TX 78227, USA
| | - Laura Almasy
- Department of Genetics, Texas Biomedical Research Institute, San Antonio, TX 78227, USA
| | - Michael C. Mahaney
- Department of Genetics, Texas Biomedical Research Institute, San Antonio, TX 78227, USA
| | | | - Anthony G. Comuzzie
- Department of Genetics, Texas Biomedical Research Institute, San Antonio, TX 78227, USA
| | - John Blangero
- Department of Genetics, Texas Biomedical Research Institute, San Antonio, TX 78227, USA
| | - Joanne E. Curran
- Department of Genetics, Texas Biomedical Research Institute, San Antonio, TX 78227, USA
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Sagun G, Oguz A, Karagoz E, Filizer AT, Tamer G, Mesci B. Application of alternative anthropometric measurements to predict metabolic syndrome. Clinics (Sao Paulo) 2014; 69:347-53. [PMID: 24838901 PMCID: PMC4012236 DOI: 10.6061/clinics/2014(05)09] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2013] [Accepted: 11/06/2013] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE The association between rarely used anthropometric measurements (e.g., mid-upper arm, forearm, and calf circumference) and metabolic syndrome has not been proven. The aim of this study was to assess whether mid-upper arm, forearm, calf, and waist circumferences, as well as waist/height ratio and waist-to-hip ratio, were associated with metabolic syndrome. METHODS We enrolled 387 subjects (340 women, 47 men) who were admitted to the obesity outpatient department of Istanbul Medeniyet University Goztepe Training and Research Hospital between September 2010 and December 2010. The following measurements were recorded: waist circumference, hip circumference, waist/height ratio, waist-to-hip ratio, mid-upper arm circumference, forearm circumference, calf circumference, and body composition. Fasting blood samples were collected to measure plasma glucose, lipids, uric acid, insulin, and HbA1c. RESULTS The odds ratios for visceral fat (measured via bioelectric impedance), hip circumference, forearm circumference, and waist circumference/hip circumference were 2.19 (95% CI, 1.30-3.71), 1.89 (95% CI, 1.07-3.35), 2.47 (95% CI, 1.24-4.95), and 2.11(95% CI, 1.26-3.53), respectively. The bioelectric impedance-measured body fat percentage correlated with waist circumference only in subjects without metabolic syndrome; the body fat percentage was negatively correlated with waist circumference/hip circumference in the metabolic syndrome group. All measurements except for forearm circumference were equally well correlated with the bioelectric impedance-measured body fat percentages in both groups. Hip circumference was moderately correlated with bioelectric impedance-measured visceral fat in subjects without metabolic syndrome. Muscle mass (measured via bioelectric impedance) was weakly correlated with waist and forearm circumference in subjects with metabolic syndrome and with calf circumference in subjects without metabolic syndrome. CONCLUSION Waist circumference was not linked to metabolic syndrome in obese and overweight subjects; however, forearm circumference, an unconventional but simple and appropriate anthropometric index, was associated with metabolic syndrome and bioelectric impedance-measured visceral fat, hip circumference, and waist-to-hip ratio.
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Affiliation(s)
- Gul Sagun
- Department of Internal Medicine, Istanbul Medeniyet University Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Aytekin Oguz
- Department of Internal Medicine, Istanbul Medeniyet University Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Engin Karagoz
- Department of Internal Medicine, Istanbul Medeniyet University Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Arzu Tiğli Filizer
- Department of Family Medicine, Istanbul Medeniyet University Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Gonca Tamer
- Department of Endocrinology, Istanbul Medeniyet University Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Banu Mesci
- Department of Internal Medicine, Istanbul Medeniyet University Goztepe Training and Research Hospital, Istanbul, Turkey
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Akbas EM, Hamur H, Demirtas L, Bakirci EM, Ozcicek A, Ozcicek F, Kuyrukluyildiz U, Turkmen K. Predictors of epicardial adipose tissue in patients with type 2 diabetes mellitus. Diabetol Metab Syndr 2014; 6:55. [PMID: 24822086 PMCID: PMC4018267 DOI: 10.1186/1758-5996-6-55] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Accepted: 05/02/2014] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Epicardial adipose tissue (EAT), visceral fat depot of the heart, was found to be associated with coronary artery disease in cardiac and non-cardiac patients. Platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR) were introduced as potential markers to determine inflammation in various disorders. Recently, atherogenic index of plasma (AIP) was found to be closely associated with atherosclerosis in general population. Waist circumference is commonly used to assess the risk factors in various metabolic disorders. There has been a well known relation between inflammation and peripheral adipose tissue in diabetes mellitus. However, the data regarding EAT and inflammation is scant in this population. Hence, we aimed to determine the relationship between PLR, NLR, AIP, waist circumference and EAT in diabetic patients. METHODS This was a cross-sectional study involving 156 patients with type 2 diabetes mellitus (87 females, 69 males; mean age, 53.62 ± 9.33 years) and 50 control subjects (35 females, 15 males; mean age, 51.06 ± 8.74 years). EAT was measured by using a trans-thoracic echocardiogram. Atherogenic index of plasma was calculated as the logarithmically transformed ratio of the serum triglyceride to high density lipoprotein (HDL)cholesterol. NLR and PLR were calculated as the ratio of the neutrophils and platelets to lymphocytes, respectively. RESULTS Waist circumference, PLR, NLR, AIP and EAT measurements were significantly higher in diabetic patients when compared to control subjects. When diabetic patients were separated into two groups according to their median value of EAT (Group 1, EAT < 4.53 (n = 78) and group 2, EAT ≥4.53 (n = 78)), group 2 patients had significantly higher Body mass index (BMI), waist circumference, AIP, NLR and PLR levels. In the bivariate correlation analysis, EAT was positively correlated with PLR, NLR, AIP, BMI and waist circumference (r = 0.197, p = 0.014; r = 0.229, p = 0.004; r = 0.161, p = 0.044; r = 0.248, p = 0.002; r = 0.306, p < 0.001, respectively). Waist circumference was found to be independent variables of EAT. CONCLUSIONS Simple calculation of PLR and measurement of waist circumference were found to be associated with increased EAT in diabetic patients.
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Affiliation(s)
- Emin M Akbas
- Department of Endocrinology, Erzincan University Mengucek Gazi Training and Research Hospital, Erzincan, Turkey
| | - Hikmet Hamur
- Department of Cardiology, Erzincan University Mengucek Gazi Training and Research Hospital, Erzincan, Turkey
| | - Levent Demirtas
- Department of Internal Medicine, Erzincan University Mengucek Gazi Training and Research Hospital, Erzincan, Turkey
| | - Eftal M Bakirci
- Department of Cardiology, Erzincan University Mengucek Gazi Training and Research Hospital, Erzincan, Turkey
| | - Adalet Ozcicek
- Department of Internal Medicine, Erzincan University Mengucek Gazi Training and Research Hospital, Erzincan, Turkey
| | - Fatih Ozcicek
- Department of Internal Medicine, Erzincan University Mengucek Gazi Training and Research Hospital, Erzincan, Turkey
| | - Ufuk Kuyrukluyildiz
- Department of Anesthesiology and Reanimation, Erzincan University Mengucek Gazi Training and Research Hospital, Erzincan, Turkey
| | - Kultigin Turkmen
- Department of Nephrology, Erzincan University Mengucek Gazi Training and Research Hospital, Erzincan, Turkey
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Janghorbani M, Amini M. Comparison of body mass index with abdominal obesity indicators and waist-to-stature ratio for prediction of type 2 diabetes: The Isfahan diabetes prevention study. Obes Res Clin Pract 2013; 4:e1-e82. [PMID: 24345623 DOI: 10.1016/j.orcp.2009.07.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2009] [Revised: 07/08/2009] [Accepted: 07/18/2009] [Indexed: 10/20/2022]
Abstract
SUMMARY OBJECTIVES The aim of this study was to compare the ability of the body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR) and waist-to-stature ratio (WSR) to predict progression to diabetes in non-diabetic first-degree relatives (FDRs) of patients with type 2 diabetes. METHODS A total of 704 non-diabetics FDRs 20-70 years old in 2003-2005 were followed through 2008 for the occurrence of type 2 diabetes mellitus. At baseline and through follow-ups, participants were underwent a standard 75 g 2-h oral glucose tolerance test. Prediction of progression to type 2 diabetes was assessed with area under the receiver operating characteristic (ROC) curves based upon measurement of BMI, WC, WHR and WSR. RESULTS The incidence of type 2 diabetes was 3.3% per year in men and 4.8% in women. BMI, WC and WSR were related to diabetes. These three obesity indicators have similar associations with incident diabetes. Areas under the ROC curves were 0.625 for BMI, 0.620 for WC, 0.611 for WSR and 0.538 for WHR. CONCLUSIONS These data indicate that BMI was as strong as WC or WSR in predicting progression to diabetes.
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Affiliation(s)
- Mohsen Janghorbani
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Masoud Amini
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Himabindu Y, Sriharibabu M, Alekhya K, Saisumanth K, Lakshmanrao N, Komali K. Correlations between anthropometry and lipid profile in type 2 diabetics. Indian J Endocrinol Metab 2013; 17:727-729. [PMID: 23961494 PMCID: PMC3743378 DOI: 10.4103/2230-8210.113769] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Over a period of time, anthropometric parameters have evolved into reliable indicators for predicting the incidence of diabetes mellitus. A number of studies have shown correlations between anthropometry and lipid profiles in healthy volunteers. This study examined correlations between anthropometry and lipid profile in type 2 diabetics. The limited observations made in this study reveal that anthropometric parameters are not ideal for predicting lipid profile abnormalities in type 2 diabetics.
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Affiliation(s)
- Yalamanchali Himabindu
- Department of Obstetrics and Gynecology, GSL Medical College and General Hospital, Rajahmundry, Andhra Pradesh, India
| | - Manne Sriharibabu
- Department of Medicine, GSL Medical College and General Hospital, Rajahmundry, Andhra Pradesh, India
| | - Katamreddy Alekhya
- GSL Medical College and General Hospital, GSL Medical College and General Hospital, Rajahmundry, Andhra Pradesh, India
| | - Kandula Saisumanth
- Department of Medicine, GSL Medical College and General Hospital, Rajahmundry, Andhra Pradesh, India
| | - Nambaru Lakshmanrao
- Department of Community Medicine, GSL Medical College and General Hospital, Rajahmundry, Andhra Pradesh, India
| | - Kanagala Komali
- Department of Medicine, GSL Medical College and General Hospital, Rajahmundry, Andhra Pradesh, India
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Waist circumference independently associates with the risk of insulin resistance and type 2 diabetes in mexican american families. PLoS One 2013; 8:e59153. [PMID: 23536864 PMCID: PMC3594157 DOI: 10.1371/journal.pone.0059153] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Accepted: 02/12/2013] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE In spite of the growing recognition of the specific association of waist circumference (WC) with type 2 diabetes (T2D) and insulin resistance (IR), current guidelines still use body mass index (BMI) as a tool of choice. Our objective was to determine whether WC is a better T2D predictor than BMI in family-based settings. RESEARCH DESIGN AND METHODS Using prospectively collected data on 808 individuals from 42 extended Mexican American families representing 7617.92 person-years follow-up, we examined the performance of WC and BMI as predictors of cumulative and incident risk of T2D. We used robust statistical methods that accounted for the kinships and included polygenic models, discrete trait modeling, Akaike information criterion, odds ratio (OR), relative risk (RR) and Kullback-Leibler R(2). SOLAR software was used to conduct all the data analyses. RESULTS We found that in multivariate polygenic models, WC was an independent predictor of cumulative (OR = 2.76, p = 0.0002) and future risk of T2D (RR = 2.15, p = 3.56×10(-9)) and outperformed BMI when compared in a head-to-head fashion. High WC (≥94.65 cm after adjusting for age and sex) was also associated with high fasting glucose, insulin and triglyceride levels and low high-density lipoprotein levels indicating a potential association with IR. Moreover, WC was specifically and significantly associated with insulin resistant T2D (OR = 4.83, p = 1.01×10(-13)). CONCLUSIONS Our results demonstrate the value of using WC as a screening tool of choice for future risk of T2D in Mexican American families. Also, WC is specifically associated with insulin resistant T2D.
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Liu K, He S, Hong B, Yang R, Zhou X, Feng J, Wang S, Chen X. Over time, do anthropometric measures still predict diabetes incidence in chinese han nationality population from chengdu community? Int J Endocrinol 2013; 2013:239376. [PMID: 24222764 PMCID: PMC3810432 DOI: 10.1155/2013/239376] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Revised: 09/03/2013] [Accepted: 09/11/2013] [Indexed: 02/05/2023] Open
Abstract
Objective. To examine whether anthropometric measures could predict diabetes incidence in a Chinese population during a 15-year follow-up. Design and Methods. The data were collected in 1992 and then again in 2007 from the same group of 687 individuals. Waist circumference, body mass index, waist to hip ratio, and waist to height ratio were collected based on a standard protocol. To assess the effects of baseline anthropometric measures on the new onset of diabetes, Cox's proportional hazards regression models were used to estimate the hazard ratios of them, and the discriminatory power of anthropometric measures for diabetes was assessed by the area under the receiver operating curve (AROC). Results. Seventy-four individuals were diagnosed with diabetes during a 15-year follow-up period (incidence: 10.8%). These anthropometric measures also predicted future diabetes during a long follow-up (P < 0.001). At 7-8 years, the AROC of central obesity measures (WC, WHpR, WHtR) were higher than that of general obesity measures (BMI) (P < 0.05). But, there were no significant differences among the four anthropometric measurements at 15 years. Conclusions. These anthropometric measures could still predict diabetes with a long time follow-up. However, the validity of anthropometric measures to predict incident diabetes may change with time.
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Affiliation(s)
- Kai Liu
- Department of Cardiovascular Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Sen He
- Department of Cardiovascular Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Biying Hong
- Department of Cardiovascular Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Rui Yang
- Department of Cardiovascular Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Xiaoyan Zhou
- Department of Cardiovascular Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jiayue Feng
- Department of Cardiovascular Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Si Wang
- Department of Cardiovascular Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Xiaoping Chen
- Department of Cardiovascular Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
- *Xiaoping Chen:
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Ryoo JH, Park SK. Association of apolipoprotein B and incidence of metabolic syndrome in Korean men: a 5-years' follow-up study. Atherosclerosis 2012; 226:496-501. [PMID: 23273962 DOI: 10.1016/j.atherosclerosis.2012.11.024] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Revised: 11/14/2012] [Accepted: 11/25/2012] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND OBJECTIVE There have been reports for the association between elevated serum apolipoprotein B (ApoB) and several cardiometabolic disorders. However, it remains unclear whether serum ApoB level predicts the development of metabolic syndrome (MetS). Accordingly, we carried out a prospective study to evaluate the longitudinal effects of baseline serum ApoB levels on the development of MetS. PATIENTS AND METHODS A cohort of 25,193 healthy Korean men without MetS had been followed up prospectively. Baseline serum ApoB levels were categorized to following quintiles (quintile 1-5: <76.4, 76.4-88.4, 88.4-99.5, 99.5-113.0, ≥113.0). We evaluated the differences in the incidence of MetS according to quintiles of serum ApoB levels. Cox proportional hazards models were used to calculate the adjusted hazard ratios (HRs) for MetS. RESULTS During follow-up, 5407 (21.5%) cases developed MetS between 2006 and 2010. Incidence of MetS increased according to quintiles of serum ApoB levels [quintile 1-5: 9.1%, 16.4%, 22.1%, 27.3%, 36.4%, respectively (P for trend <0.001)]. Even after adjusting for various covariates including non-HDL-cholesterol, the hazard ratios (95% CI) for MetS increased in proportion to the quintiles of serum ApoB levels, compared to quintile 1 [quintile 2-5: 1.64 (1.43-1.89), 1.98 (1.71-2.31), 2.32 (1.96-2.75) and 2.92 (2.37-3.60), respectively (P for trend <0.001)]. These associations were apparent still in the clinically relevant subgroup analyses. CONCLUSIONS Serum ApoB levels predict MetS, independent of baseline confounding variables including non-HDL-cholesterol.
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Affiliation(s)
- Jae-Hong Ryoo
- Department of Preventive Medicine, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
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Freedman DS, Thornton JC, Pi-Sunyer FX, Heymsfield SB, Wang J, Pierson RN, Blanck HM, Gallagher D. The body adiposity index (hip circumference ÷ height(1.5)) is not a more accurate measure of adiposity than is BMI, waist circumference, or hip circumference. Obesity (Silver Spring) 2012; 20:2438-44. [PMID: 22484365 PMCID: PMC3477292 DOI: 10.1038/oby.2012.81] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Based on cross-sectional analyses, it was suggested that hip circumference divided by height(1.5) -18 (the body adiposity index (BAI)), could directly estimate percent body fat without the need for further correction for sex or age. We compared the prediction of percent body fat, as assessed by dual-energy X-ray absorptiometry (PBF(DXA)), by BAI, BMI, and circumference (waist and hip) measurements among 1,151 adults who had a total body scan by DXA and circumference measurements from 1993 through 2005. After accounting for sex, we found that PBF(DXA) was related similarly to BAI, BMI, waist circumference, and hip circumference. In general, BAI underestimated PBF(DXA) among men (2.5%) and overestimated PBF(DXA) among women (4%), but the magnitudes of these biases varied with the level of body fatness. The addition of covariates and quadratic terms for the body size measures in regression models substantially improved the prediction of PBF(DXA), but none of the models based on BAI could more accurately predict PBF(DXA) than could those based on BMI or circumferences. We conclude that the use of BAI as an indicator of adiposity is likely to produce biased estimates of percent body fat, with the errors varying by sex and level of body fatness. Although regression models that account for the nonlinear association, as well as the influence of sex, age, and race, can yield more accurate estimates of PBF(DXA), estimates based on BAI are not more accurate than those based on BMI, waist circumference, or hip circumference.
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Affiliation(s)
- David S Freedman
- Division of Nutrition, Physical Activity, and Obesity Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
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Frank LK, Heraclides A, Danquah I, Bedu-Addo G, Mockenhaupt FP, Schulze MB. Measures of general and central obesity and risk of type 2 diabetes in a Ghanaian population. Trop Med Int Health 2012. [PMID: 23190041 DOI: 10.1111/tmi.12024] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The epidemic of obesity and type 2 diabetes is evident in sub-Saharan Africa (SSA). However, their associations have hardly been examined in this region. METHODS A hospital-based case-control study in urban Ghana consisting of 1221 adults (542 cases and 679 controls) investigated the role of anthropometric parameters for diabetes. Logistic regression was used for analysis. The discriminative power and population-specific cut-off points for diabetes were identified by receiver operating characteristic curves. RESULTS The strongest association with diabetes was observed for waist-to-hip ratio: age-adjusted odds ratios per 1 standard deviation difference were 1.95 (95% confidence interval [CI]: 1.64-2.31) in women and 1.40 [1.01-1.94] in men. Also, among women, the odds of diabetes increased with higher waist circumference (1.35 [1.17-1.57]) and waist-to-height ratio (1.29 [1.12-1.50]). Among men, this was not discernible. Rather, hip circumference was inversely related (0.69 [0.50-0.95]). Body mass index was neither associated with diabetes in women (1.01 [0.88-1.15]) nor in men (0.74 [0.52-1.04]). Among both genders, waist-to-hip ratio showed the best discriminative ability for diabetes in this population and the optimal cut-off points were ≥ 0.88 in women and ≥ 0.90 in men. Recommended cut-off points for body mass index and waist circumference had a poor predictive ability. CONCLUSION Our findings suggest that measures of central rather than general obesity relate to type 2 diabetes in SSA. It remains to be verified from larger population-based epidemiological studies whether anthropometric targets of obesity prevention in SSA differ from those in developed countries.
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Affiliation(s)
- Laura K Frank
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany.
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Saligram S, Williams EJ, Masding MG. Raised liver enzymes in newly diagnosed Type 2 diabetes are associated with weight and lipids, but not glycaemic control. Indian J Endocrinol Metab 2012; 16:1012-1014. [PMID: 23226654 PMCID: PMC3510928 DOI: 10.4103/2230-8210.103027] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Non-alcoholic fatty liver disease (NAFLD) is associated with Type 2 diabetes (T2DM) and the metabolic syndrome, and can progress to chronic liver disease. We examined the incidence of elevated (>35 iu/l) alanine transaminase (ALT), as a surrogate marker for NAFLD, in patients with newly diagnosed T2DM. MATERIALS AND METHODS Retrospective analysis of ALT with metabolic parameters, in 606 consecutive patients presenting to district wide education sessions for newly diagnosed T2DM. RESULTS ALT was elevated in 155 patients (25.6% (95% CI 22.1, 29.2)), who tended to be older (mean difference 7.3 years (5.2, 9.5), P < 0.001), heavier (body mass index (BMI) mean difference 2.0 kg/m(2) (1.0, 3.0), P < 0.001), and more likely to be male (M:F raised ALT 104:51, normal ALT 219:232, P < 0.001), with higher triglycerides (median difference 0.2 mmol/l, P = 0.001) and lower HDL cholesterol (mean difference 0.09 mmol/l (0.02, 0.15), P = 0.001). There were no statistically significant differences in HBA1C or total cholesterol. CONCLUSIONS In a well-defined population of newly diagnosed people with T2DM, there is a high incidence of abnormal ALT levels, which is associated with features of the metabolic syndrome (obesity and lipid abnormalities), but not glycemic control.
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Affiliation(s)
- Shreyas Saligram
- University of Pittsburgh Medical Centre, USA
- Department of Gastroenterology, Poole Hospital NHS Foundation Trust, UK
| | | | - Michael G. Masding
- Department of Diabetes, Poole Hospital NHS Foundation Trust, Bournemouth University, UK
- School of Health and Social Care, Bournemouth University, UK
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Haslam D. Management of diabesity in primary care: individualisation of care. PRACTICAL DIABETES 2012. [DOI: 10.1002/pdi.1717] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Hu G, Lakka TA, Lakka HM, Tuomilehto J. Lifestyle management in the metabolic syndrome. Metab Syndr Relat Disord 2012; 4:270-86. [PMID: 18370746 DOI: 10.1089/met.2006.4.270] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Type 2 diabetes and metabolic syndrome are two of the fastest growing public health problems in both developed and developing countries. Cardiovascular disease is the most prevalent complication of type 2 diabetes and the metabolic syndrome. Overweight, obesity, or weight gain has been shown to be an important risk factor for the development of type 2 diabetes and an important component of the metabolic syndrome. Physical inactivity is another important risk factor for the development of type 2 diabetes. Data from prospective studies have shown that at least 30 min/day of moderate to vigorous physical activity can prevent type 2 diabetes. Moderate or high levels of physical fitness are effective in preventing type 2 diabetes. Results from clinical trials have indicated that lifestyle changes, including dietary modification and increase in physical activity, can prevent type 2 diabetes. Analyses from prospective studies have confirmed that healthy diets are effective and safe ways to prevent type 2 diabetes and the metabolic syndrome. Public health messages, health care professionals, and the health care system should aggressively promote physical activity and responsible nutritional habits during occupation, leisure time, and daily life and prevent overweight and obesity.
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Affiliation(s)
- Gang Hu
- Department of Epidemiology and Health Promotion, National Public Health Institute, Helsinki, Finland., Department of Public Health, University of Helsinki, Helsinki, Finland
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Janghorbani M, Amini M. Metabolic syndrome in type 2 diabetes mellitus in isfahan, iran: prevalence and risk factors. Metab Syndr Relat Disord 2012; 5:243-54. [PMID: 18370778 DOI: 10.1089/met.2005.0010] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Our goal was to estimate the prevalence and risk factors of metabolic syndrome (MetSyn) in people with type 2 diabetes mellitus (T2DM) using routinely collected data from a clinical information system at Isfahan Endocrinology and Metabolism Research Centre, Iran. METHODS Consecutive diabetic patients (9889 total, 4164 male and 5725 female) from Isfahan Endocrinology and Metabolism Research Centre outpatient clinics, Iran, have been examined. The mean (SD) age of participants was 52.0 (10.9) years with a mean (standard deviation) duration of diabetes of 6.4 (6.4) years at initial registration. A modified National Cholesterol Education Program-Adult Treatment Panel III definition with body mass index instead of waist circumference was used for the MetSyn. RESULTS The prevalence of MetSyn was 65.0% [95% confidence interval (CI) 64.0, 65.9], with higher rate in females than males (71.7 [95% CI: 70.5, 72.8] female and 55.8 [95% CI: 54.3, 57.3] male) and it was greater with older age. The age-adjusted prevalence rate of MetSyn was associated with female gender, duration of diabetes, fasting blood glucose, systolic and diastolic blood pressure, body mass index (BMI), smoking, proteinuria, insulin-treatment, triglyceride, cholesterol, HDL cholesterol, hypertension, and dyslipidemia. Using a stepwise binary logistic regression model, age, gender, fasting blood glucose, systolic and diastolic blood pressure, BMI, triglyceride, and cholesterol were significant predictors of MetSyn for T2DM patients. CONCLUSIONS These data suggest MetSyn in this population of Iranian type 2 diabetic patients is common, and with an estimated prevalence of 65%, MetSyn clearly poses a formidable health threat to Iranian diabetic patients. Lifestyle interventions in T2DM subjects are needed in Iran to halt the burden of macro- and micro-vascular complications in T2DM.
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Affiliation(s)
- Mohsen Janghorbani
- Department Of Epidemiology and Isfahan Endocrinology and Metabolism Research Centre, Isfahan University of Medical Sciences and Health Services, Iran
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Eliasen R, Daly NL, Wulff BS, Andresen TL, Conde-Frieboes KW, Craik DJ. Design, synthesis, structural and functional characterization of novel melanocortin agonists based on the cyclotide kalata B1. J Biol Chem 2012; 287:40493-501. [PMID: 23012369 DOI: 10.1074/jbc.m112.395442] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Cyclotides are useful scaffolds to stabilize bioactive peptides. RESULTS Four melanocortin analogues of kalata B1 were synthesized. One is a selective MC4R agonist. CONCLUSION The analogues retain the native kalata B1 scaffold and introduce a designed pharmacological activity, validating cyclotides as protein engineering scaffolds. SIGNIFICANCE A novel type of melanocortin agonist has been developed, with potential as a drug lead for treating obesity. Obesity is an increasingly important global health problem that lacks current treatment options. The melanocortin receptor 4 (MC4R) is a target for obesity therapies because its activation triggers appetite suppression and increases energy expenditure. Cyclotides have been suggested as scaffolds for the insertion and stabilization of pharmaceutically active peptides. In this study, we explored the development of appetite-reducing peptides by synthesizing MC4R agonists based on the insertion of the His-Phe-Arg-Trp sequence into the cyclotide kalata B1. The ability of the analogues to fold similarly to kalata B1 but display MC4R activity were investigated. Four peptides were synthesized using t-butoxycarbonyl peptide chemistry with a C-terminal thioester to facilitate backbone cyclization. The structures of the peptides were found to be similar to kalata B1, evaluated by Hα NMR chemical shifts. KB1(GHFRWG;23-28) had a K(i) of 29 nm at the MC4R and was 107 or 314 times more selective over this receptor than MC1R or MC5R, respectively, and had no detectable binding to MC3R. The peptide had higher affinity for the MC4R than the endogenous agonist, α-melanocyte stimulation hormone, but it was less potent at the MC4R, with an EC(50) of 580 nm for activation of the MC4R. In conclusion, we synthesized melanocortin analogues of kalata B1 that preserve the structural scaffold and display receptor binding and functional activity. KB1(GHFRWG;23-28) is potent and selective for the MC4R. This compound validates the use of cyclotides as scaffolds and has the potential to be a new lead for the treatment of obesity.
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Xin Z, Liu C, Niu WY, Feng JP, Zhao L, Ma YH, Hua L, Yang JK. Identifying obesity indicators which best correlate with type 2 diabetes in a Chinese population. BMC Public Health 2012; 12:732. [PMID: 22937748 PMCID: PMC3490952 DOI: 10.1186/1471-2458-12-732] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2012] [Accepted: 08/24/2012] [Indexed: 11/15/2022] Open
Abstract
Background Obesity has been shown to be a prognostic indicator of type 2 diabetes (T2D); however, the power of different obesity indicators in the detection of T2D remains controversial. This study evaluates the detecting power of body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR) and waist-to-height ratio (WHTR) for the presence of T2D in undiagnosed diabetics among the Chinese population. Methods Individuals were selected from an ongoing large-scale population-based Beijing Community Pre-Diabetes (BCPD) study cohort. The oral glucose tolerance tests (OGTT) were performed to diagnose diabetes. A total of 220 new cases of T2D and 1,868 normal blood glucose subjects were analyzed. ROC curve analyses were used to compare the association of different obesity indicators with T2D and determine the optimal cut-off points of the best predictor for identifying T2D in men and women. Results All indicators positively correlated with presence of T2D in both men and women. In women, WC, WHR and WHTR were similar, but were better in identifying T2D when compared to BMI (P < 0.0001, P=0.0016 and P=0.0001, respectively). In men, WC, WHTR and BMI were similar, but WC and WHTR were better than WHR (P=0.0234, P=0.0101, respectively). For women, 86 cm was the optimal WC cut-off point, and its sensitivity and specificity were 0.714 and 0.616; for men, the optimal cut-off point was 90 cm, and its sensitivity and specificity were 0.722 and 0.571. Conclusion Compared with BMI, WHR and WHTR, WC is a simple and accurate measure for predicting T2D in the Chinese population.
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Affiliation(s)
- Zhong Xin
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, 1 Dong Jiao Min Xiang, Beijing 100730, China
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Park SE, Rhee EJ, Lee WY, Kim WJ, Yoo SH, Bae JC, Choi ES, Park CY, Oh KW, Park SW, Kim SW. The role of serum adipocyte fatty acid-binding protein on the development of metabolic syndrome is independent of pro-inflammatory cytokines. Nutr Metab Cardiovasc Dis 2012; 22:525-532. [PMID: 21186114 DOI: 10.1016/j.numecd.2010.09.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2010] [Revised: 09/13/2010] [Accepted: 09/17/2010] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND AIM Adipocyte fatty acid-binding protein (FABP4) is abundantly expressed in adipocytes and plays a role in glucose homeostasis. We analysed the relationship between serum FABP4 levels and the progression of metabolic syndrome in healthy adults. METHODS AND RESULTS A total of 465 subjects were selected from participants in a medical check-up programme at a Health Promotion Center. Baseline serum FABP4 levels were measured, and the subjects were evaluated for the presence of metabolic syndrome (MetS) according to the recommendations of the American Heart Association/National Heart, Lung, and Blood Institute. The subjects were re-evaluated 4 years later. Baseline FABP4 concentrations were significantly higher in subjects with MetS than in those without MetS (P<0.001). At the 4-year follow-up, subjects in the highest FABP4 tertile at baseline exhibited higher values for body mass index, fat mass and percent body fat, as well as blood pressure, fasting glucose, total cholesterol, triglycerides, low-density lipoprotein (LDL)-cholesterol, insulin, homeostasis model assessment of insulin resistance, monocyte chemoattractant protein-1 and tumor necrosis factor-α levels (all P<0.05). The subjects with higher FABP4 levels had lower HDL-cholesterol concentrations (P<0.05). After adjustment for age, sex, change in percent body fat and baseline values for other metabolic and inflammatory parameters, FABP4 levels at baseline were shown to be strongly associated with the development of MetS by year 4 (odds ratio (OR), 5.75; 95% confidence interval (CI), 2.71-12.23 for highest tertile vs. lowest tertile, P<0.001) CONCLUSION Baseline serum FABP4 levels appear to be a significant predictor for the future development of MetS, independent of pro-inflammatory cytokines.
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Affiliation(s)
- S E Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, No. 108 Pyung-Dong, Jongro-Ku, Seoul 110-746, Republic of Korea
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Katzmarzyk PT, Staiano AE. New race and ethnicity standards: elucidating health disparities in diabetes. BMC Med 2012; 10:42. [PMID: 22546706 PMCID: PMC3378451 DOI: 10.1186/1741-7015-10-42] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2011] [Accepted: 04/30/2012] [Indexed: 12/01/2022] Open
Abstract
The concepts of race and ethnicity are useful for understanding the distribution of disease in the population and for identifying at-risk groups for prevention and treatment efforts. The U.S. Department of Health and Human Services recently updated the race and ethnicity classifications in order to more effectively monitor health disparities. Differences in chronic disease mortality rates are contributing to race and ethnic health disparities in life expectancy in the United States. The prevalence of diabetes is higher in African Americans and Hispanics compared to white Americans, and parallel trends are seen in diabetes risk factors, including physical inactivity, dietary patterns, and obesity. Further research is required to determine the extent to which the observed differences in diabetes prevalence are attributable to differences in lifestyle versus other characteristics across race and ethnic groups.
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Affiliation(s)
- Peter T Katzmarzyk
- Population Science, Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA 70808, USA
| | - Amanda E Staiano
- Population Science, Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA 70808, USA
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Is the body adiposity index (hip circumference/height(1.5)) more strongly related to skinfold thicknesses and risk factor levels than is BMI? The Bogalusa Heart Study. Br J Nutr 2012; 109:338-45. [PMID: 22716994 DOI: 10.1017/s0007114512000979] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Because of its strong association (r 0.85) with percentage of body fat determined by dual-energy X-ray absorptiometry, hip circumference divided by height(1.5) (the body adiposity index) has recently been proposed as an index of body fatness among adults. We examined whether this proposed index was more strongly associated with skinfold thicknesses and levels of CVD risk factors (lipids, fasting insulin and glucose, and blood pressure) than was BMI among 2369 18- to 49-year-olds in the Bogalusa Heart Study. All analyses indicated that the body adiposity index was less strongly associated with skinfold thicknesses and CVD risk factors than was either waist circumference or BMI. Correlations with the skinfold sum, for example, were r 0.81 (BMI) v. r 0.75 (body adiposity index) among men, and r 0.87 (BMI) v. r 0.80 among women; P< 0.001 for both differences. An overall index of seven CVD risk factors was also more strongly associated with BMI (r 0.58) and waist circumference (r 0.61) than with the body adiposity index (r 0.49). The weaker associations with the body adiposity index were observed in analyses stratified by sex, race, age and year of examination. Multivariable analyses indicated that if either BMI or waist circumference were known, the body adiposity index provided no additional information on skinfold thicknesses or risk factor levels. These findings indicate that the body adiposity index is likely to be an inferior index of adiposity than is either BMI or waist circumference.
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Obesity and downregulated hypothalamic leptin receptors in male metallothionein-3-null mice. Neurobiol Dis 2011; 44:125-32. [DOI: 10.1016/j.nbd.2011.06.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2011] [Revised: 05/24/2011] [Accepted: 06/16/2011] [Indexed: 11/21/2022] Open
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Jung HS, Chang IH, Kim KD, Moon YT, Kim TH, Myung SC, Kim YS, Lee JY. Possible Relationship between Metabolic Syndrome Traits and Nephrolithiasis: Incidence for 15 Years According to Gender. Korean J Urol 2011; 52:548-53. [PMID: 21927702 PMCID: PMC3162221 DOI: 10.4111/kju.2011.52.8.548] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2011] [Accepted: 07/18/2011] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To analyze the independent effect of metabolic syndrome (MS) on nephrolithiasis (NL) despite differences in gender compared with the known lithogenic factors. MATERIALS AND METHODS From 1995 to 2009, 40,687 Koreans were enrolled in the study and observed for the development of NL at a health promotion center. The examination included anthropometric and biochemical measurements as well as kidney ultrasonography. A student's t-test or chi-square test was used to characterize the participants and a standard Cox proportional hazards model was used to calculate the adjusted odds ratio of lithogenic risk factors in the NL model. RESULTS The mean age of the study cohort was 44.9 years (range, 13-100 years), and 22,540 (55.4%) of the cohort was male. The incidence of NL was 1.5% (609 participants), with males exhibiting a higher incidence than females (1.9% vs 1.0%, p<0.01). Among the total cohort, MS as well as each trait of MS were risk factors for NL. In males, high body mass index (BMI), high blood pressure, and abnormal glucose metabolism were significant lithogenic factors, whereas in females, lithogenic factors included only high BMI and abnormal glucose metabolism. CONCLUSIONS MS is a significant lithogenic factor compared with other lithogenic factors. There was a correlated change in the prevalence of MS and NL and MS traits in Korea.
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Affiliation(s)
- Hui Seok Jung
- Department of Urology, Chung-Ang University College of Medicine, Seoul, Korea
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Ingram KH, Lara-Castro C, Gower BA, Makowsky R, Allison DB, Newcomer BR, Munoz AJ, Beasley TM, Lawrence JC, Lopez-Ben R, Rigsby DY, Garvey WT. Intramyocellular lipid and insulin resistance: differential relationships in European and African Americans. Obesity (Silver Spring) 2011; 19:1469-75. [PMID: 21436797 PMCID: PMC3171736 DOI: 10.1038/oby.2011.45] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Insulin resistance has been associated with the accumulation of fat within skeletal muscle fibers as intramyocellular lipid (IMCL). Here, we have examined in a cross-sectional study the interrelationships among IMCL, insulin sensitivity, and adiposity in European Americans (EAs) and African Americans (AAs). In 43 EA and 43 AA subjects, we measured soleus IMCL content with proton-magnetic resonance spectroscopy, insulin sensitivity with hyperinsulinemic-euglycemic clamp, and body composition with dual-energy X-ray absorptiometry. The AA and EA subgroups had similar IMCL content, insulin sensitivity, and percent fat, but only in EA was IMCL correlated with insulin sensitivity (r = -0.47, P < 0.01), BMI (r = 0.56, P < 0.01), percent fat (r = 0.35, P < 0.05), trunk fat (r = 0.47, P < 0.01), leg fat (r = 0.40, P < 0.05), and waist and hip circumferences (r = 0.54 and 0.55, respectively, P < 0.01). In a multiple regression model including IMCL, race, and a race by IMCL interaction, the interaction was found to be a significant predictor (t = 1.69, DF = 1, P = 0.0422). IMCL is related to insulin sensitivity and adiposity in EA but not in AA, suggesting that IMCL may not function as a pathophysiological factor in individuals of African descent. These results highlight ethnic differences in the determinants of insulin sensitivity and in the pathogenesis of the metabolic syndrome trait cluster.
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Affiliation(s)
- Katherine H Ingram
- Department of Biostatistics, University of Alabama, Birmingham, Alabama, USA.
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Ryu S, Chang Y, Kim SG, Cho J, Guallar E. Serum uric acid levels predict incident nonalcoholic fatty liver disease in healthy Korean men. Metabolism 2011; 60:860-6. [PMID: 20863537 DOI: 10.1016/j.metabol.2010.08.005] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2010] [Revised: 08/18/2010] [Accepted: 08/18/2010] [Indexed: 02/07/2023]
Abstract
The objective of the study was to assess the prospective association between serum uric acid levels and incident nonalcoholic fatty liver disease in a cohort of healthy Korean men. A cohort study was performed on 5741 Korean men, 30 to 59 years of age, with no evidence of fatty liver disease on liver ultrasound and with no major risk factors for liver disease at baseline. Study participants were followed in annual or biennial health examinations between 2002 and 2008. The presence of fatty liver was determined at each examination by ultrasound. Cox proportional hazards models were used to evaluate the association of baseline and time-dependent levels of serum uric acid with incident fatty liver, adjusted for potential confounders. During 23,995 person-years of follow-up, 1717 participants developed fatty liver on ultrasound examination. After adjustment for age, body mass index, smoking, and alcohol intake, the hazard ratios (95% confidence intervals) for incident fatty liver comparing quartiles 2 to 4 of serum uric acid to quartile 1 were 1.17 (1.01-1.37), 1.28 (1.11-1.48), and 1.51 (1.31-1.73), respectively (P for trend = .001). The adjusted hazard ratio comparing participants with hyperuricemia (serum uric acid ≥7.0 mg/dL) to those with normouricemia (<7.0 mg/dL) was 1.29 (1.14-1.46). A graded and statistically significant association persisted after adjusting for other cardiometabolic factors and also in time-dependent models. Serum uric acid was an independent risk factor of incident fatty liver detected by ultrasonography. Additional research should clarify the mechanisms underlying this association and the role of hyperuricemia in the development of fatty liver.
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Affiliation(s)
- Seungho Ryu
- Department of Occupational Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul 110-746, South Korea
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