Comparison of overall obesity and body fat distribution in predicting risk of mortality

Body Shapes of Multiple Anthropometric Traits and All-cause and Cause-specific Mortality in the UK Biobank

BACKGROUND

Individual traditional anthropometric measures such as body mass index and waist circumference may not fully capture the relation of adiposity to mortality. Investigating multitrait body shapes could overcome this limitation, deepening insights into adiposity and mortality.

METHODS

Using UK Biobank data from 462,301 adults (40-69 years at baseline: 2006-2010), we derived four body shapes from principal component analysis on body mass index, height, weight, waist and hip circumference, and waist-to-hip ratio. We then used multivariable-adjusted Cox proportional hazard models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for associations between body shapes and mortality for principal component scores of +1 and -1.

RESULTS

During 6,114,399 person-years of follow-up, 28,807 deaths occurred. A generally obese body shape exhibited a U-shaped mortality association. A tall and centrally obese body shape showed increased mortality risk in a dose-response manner (comparing a score of +1 and 0: HR = 1.16, 95% CI = 1.14, 1.18). Conversely, tall and lean or athletic body shapes displayed no increased mortality risks when comparing a score of +1 and 0, with positive relations for the comparison between a score of -1 and 0 in these shapes (short and stout shape: HR = 1.12, 95% CI = 1.10, 1.14; nonathletic shape: HR = 1.15, 95% CI = 1.13, 1.17).

CONCLUSION

Four distinct body shapes, reflecting heterogeneous expressions of obesity, were differentially associated with all-cause and cause-specific mortality. Multitrait body shapes may refine our insights into the associations between different adiposity subtypes and mortality.

Based on CT scans at the 12th thoracic spine level, assessing the impact of skeletal muscle and adipose tissue index on one-year postoperative mortality in elderly hip fracture patients: a propensity score-matched multicenter retrospective study

BACKGROUND

Research has demonstrated that individuals with sarcopenia or sarcopenic obesity who experience fractures or undergo major surgical interventions exhibit a poorer prognosis compared to the general population. However, few studies have investigated the relationship between the skeletal muscle and adipose tissue indices, as measured at the 12th thoracic spine level, and adverse outcomes following orthopedic surgery. Therefore, this study aimed to prove whether skeletal muscle and adipose tissue index measured by computed tomography (CT) images based on a single layer are associated with one-year postoperative mortality in elderly hip fracture patients.

METHODS

A total of 334 participants from two institutions were enrolled in this study to obtain skeletal muscle index (SMI), subcutaneous fat index (SFI), visceral fat index (VFI), and the visceral-to-subcutaneous ratio of the fat area (VSR) at T12 levels and divide them into death and survival groups based on the results of follow-up after 1 year. Propensity score matching (PSM) was employed to evaluate one-year postoperative mortality.

RESULTS

Institution 1's results identified that a lower SMI significantly heightened the risk of one-year postoperative mortality (OR = 0.799,95%CI 0.677-0.943, P = 0.008), making SMI an independent predictor. Institution 2's results identified that age (OR = 1.081, 95%CI 1.005-1.163, P = 0.036), SMI (OR = 0.881, 95%CI 0.784-0.991, P = 0.035) as independent predictors of one-year postoperative mortality in elderly hip fracture. Receiver operator characteristics analysis revealed area under the curve (AUC) values for institution 1: SMI (0.738 (95%CI 0.626-0.851), significant), VFI (0.605 (95%CI 0.476-0.734)), VSR (0.583 (95%CI 0.451-0.715)); and for institution 2: SMI (0.742 (95%CI 0.612-0.872), significant) and Age (0.775 (95%CI 0.677-0.874), significant). Collectively, these results underscore that SMI serves as an independent predictor of one-year postoperative mortality in elderly hip fracture patients.

CONCLUSION

This study demonstrated that the T12-based SMI was independently associated with one-year mortality following hip fracture in geriatric patients, with lower preoperative SMI correlating with higher mortality rates post-surgery.

Body roundness index as a predictor of all-cause and cardiovascular mortality in patients with diabetes and prediabetes

BACKGROUND

There are limited population-based studies examining the correlation between body roundness index (BRI) and mortality in diabetes and prediabetes patients.

METHOD

Our final analysis encompassed 15,848 patients with diabetes and prediabetes sourced from the National Health and Nutrition Examination Survey(NHANES) spanning from 2003 to 2018. Cox proportional hazards model and restricted cubic splines (RCS) were utilized to assess the correlation between BRI and both all-cause mortality and cardiovascular mortality.

RESULTS

During an average follow-up period of 92.9 months, 2655 participants (12.73 %) died, including 730 (3.44 %) from cardiovascular diseases. RCS demonstrated a U-shaped nonlinear association between BRI with all-cause mortality and cardiovascular mortality, with threshold values of 5.54 and 5.21, respectively. When BRI was below the threshold, a negative correlation was observed between BRI and all-cause mortality (HR 0.87, 95 % CI 0.81-0.93).The correlation with cardiovascular mortality is not significant. Conversely, when BRI was above the threshold, a positive correlation was observed between BRI with all-cause mortality (HR 1.10, 95 % CI 1.06-1.14) and cardiovascular mortality (HR 1.13, 95 % CI 1.07-1.20).

CONCLUSION

Our research indicates that among US adults with diabetes or prediabetes, BRI exhibits a U-shaped relationship with all-cause and cardiovascular mortality, with threshold values of 5.54 and 5.21, respectively.

Evaluating the evening carbohydrate dilemma: the effect of within-the-day carbohydrate periodization on body composition and physical fitness

PURPOSE

To assess the effects of carbohydrate timing and type on body composition and physical fitness.

METHODS

Forty-two healthy, trained male volunteers underwent a four-week intervention, randomly divided into three groups: (i) Sleep Low-No Carbohydrates (SL-NCHO): consuming all carbohydrate intake at regular intervals prior to evening training, (ii) Sleep High-Low Glycemic Index (SH-LGI), and (iii) Sleep High-High Glycemic Index (SH-HGI). In both SH-LGI and SH-HGI, carbohydrates were distributed throughout the day, both pre-(60% of total intake) and post-evening training (40% of total intake). The SH-LGI and SH-HGI groups diverged in evening carbohydrate quality, featuring LGI and HGI foods, respectively. All participants performed a standardized exercise program combining resistance exercise and high-intensity interval training. Body composition was assessed using skinfold measurements and bioelectrical impendence analysis. Physical fitness was assessed by measuring VO2max, Visual Reaction Time (VRT), Countermovement Jump (CMJ), and 1-repetition maximum (1RM) in hack squat, chest press, shoulder press, and lat-pulldown exercises.

RESULTS

There was a significant time-effect on both body composition and physical fitness indices. Bodyfat percentage decreased by an average of 1.5% (p < 0.001), fat-mass by 1.4 kg (p < 0.001) and fat-free mass increased by 0.9 kg (p = 0.006). A time-effect was also observed in VO2max, CMJ, 1RM testing, and VRT (all p < 0.05). There were no significant differences among interventions.

CONCLUSIONS

A balanced dietary plan with sufficient nutrient and energy intake promotes body composition optimization and physical fitness, independently of carbohydrate type or timing. This study points towards implementing flexible nutrition interventions, emphasizing the potential of tailored dietary strategies to optimize health and physical fitness.

TRIAL REGISTRATION NUMBER

The trial was registered at clinicaltrials.gov as NCT05464342.

Association of waist circumference and BMI with premature death in young and middle-aged population

Introduction

Premature death is a global health indicator, significantly impacted by obesity, especially in young and middle-aged population. Both body mass index (BMI) and waist circumference (WC) assess obesity, with WC specifically indicating central obesity and showing a stronger relationship with mortality. However, despite known associations between BMI and premature death, as well as the well-recognized correlation between WC and adverse health outcomes, the specific relationship between WC and premature death remains unclear. Therefore, focusing on young and middle-aged individuals, this study aimed to reliably estimate independent and combined associations between WC, BMI and premature death, thereby providing causal evidence to support strategies for obesity management.

Methods

This study involved 49,217 subjects aged 18-50 years in the United States from 1999 to 2018 National Health and Nutrition Examination Survey (NHANES). Independent and combined associations between WC and BMI with premature death across sex and age stratum were examined by Cox regression. Survey weighting and inverse probability weighting (IPW) were further considered to control selection and confounding bias. Robustness assessment has been conducted on both NHANES and China Health and Retirement Longitudinal Study (CHARLS) data.

Results

A linear and positive relationship between WC and all-cause premature death was found in both males and females, with adjusted HRs of 1.019 (95%CI = 1.004-1.034) and 1.065 (95%CI = 1.039-1.091), respectively. Nonlinear relationships were found with respect to BMI and all-cause premature death. For females aged 36-50 with a BMI below 28.6 kg/m2, the risk of premature death decreased as BMI increased, indicated by adjusted HRs of 0.856 (95%CI = 0.790-0.927). Joint analysis showed among people living with obesity, a larger WC increased premature death risk (HR = 1.924, 95%CI = 1.444-2.564).

Discussion

WC and BMI exhibited prominent associations with premature death in young and middle-aged population. Maintaining an appropriate WC and BMI bears significant implications for preventing premature death.

The association between body mass index and metabolite response to a liquid mixed meal challenge: a Mendelian randomization study

BACKGROUND

Metabolite abundance is a dynamic trait that varies in response to environmental stimuli and phenotypic traits, such as food consumption and body mass index (BMI, kg/m2).

OBJECTIVES

In this study, we used the Netherlands Epidemiology of Obesity (NEO) study data to identify observational and causal associations between BMI and metabolite response to a liquid meal.

METHODS

A liquid meal challenge was performed, and Nightingale Health metabolite profiles were collected in 5744 NEO participants. Observational and one-sample Mendelian randomization (MR) analysis were conducted to estimate the effect of BMI on metabolites (n = 229) in the fasting, postprandial, and response (or change in abundance) states.

RESULTS

We observed 473 associations with BMI (175 fasting, 188 postprandial, and 110 response) in observational analyses. In MR analyses, we observed 20 metabolite traits (5 fasting, 12 postprandial, and 3 response) to be associated with BMI. MR associations included the glucogenic amino acid alanine, which was inversely associated with BMI in the response state (β: -0.081; SE: 0.023; P = 5.91 × 10-4), suggesting that as alanine increased in postprandial abundance, that increase was attenuated with increasing BMI.

CONCLUSIONS

Overall, this study showed that MR estimates were strongly correlated with observational effect estimates, suggesting that the broad associations seen between BMI and metabolite variation has a causal underpinning. Specific effects in previously unassessed postprandial and response states are detected, and these may likely mark novel life course risk exposures driven by regular nutrition.

Relationship of Obesity and Severe Penetrating Thoracic and Abdominal Injuries in Adolescent Patients

BACKGROUND

Over 20% of United States adolescents are obese. A thicker layer of subcutaneous adiposity might provide a protective "armor" layer against penetrating wounds. We hypothesized that adolescents with obesity presenting after isolated thoracic and abdominal penetrating trauma have lower rates of severe injury and mortality than adolescents without obesity.

METHODS

The 2017-2019 Trauma Quality Improvement Program database was queried for patients between 12 and 17 years old presenting with knife or gunshot wounds. Patients with body mass index (BMI) ≥30 (obese) were compared to patients with BMI <30. Sub-analyses were performed for adolescents with isolated abdominal trauma and isolated thoracic trauma. Severe injury was defined as an abbreviated injury scale grade >3. Bivariate analyses were performed.

RESULTS

12,181 patients were identified; 1603 (13.2%) had obesity. In isolated abdominal gunshot or knife wounds, rates of severe intra-abdominal injuries and mortality were similar (all P > .05) between groups. In isolated thoracic gunshot wounds, adolescents with obesity had a lower rate of severe thoracic injury (5.1% vs 13.4%, P = .005) but statistically similar mortality (2.2% vs 6.3%, P = .053) compared to adolescents without obesity. In isolated thoracic knife wounds, rates of severe thoracic injuries and mortality were similar (all P > .05) between groups.

DISCUSSION

Adolescent trauma patients with and without obesity presenting after isolated abdominal or thoracic knife wounds had similar rates of severe injury, operative intervention, and mortality. However, adolescents with obesity presenting after an isolated thoracic gunshot wound had a lower rate of severe injury. This may impact the future work-up and management of adolescents sustaining isolated thoracic gunshot wounds.

Different associations of anthropometric indices with diabetic retinopathy and diabetic kidney disease in chinese patients with type 2 diabetes mellitus

AIMS

To investigate the associations of anthropometric indices, including body mass index (BMI), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), waist circumference (WC) and hip circumference (HC), with diabetic retinopathy (DR) and diabetic kidney disease (DKD) in Chinese patients with type 2 diabetes mellitus (T2DM).

MATERIALS AND METHODS

This cross-sectional study evaluated 5226 Chinese participants with T2DM at three hospitals between 2005 and 2016. Logistic regression models and restricted cubic spline analysis were used to assess the associations of anthropometric indices with DR and DKD.

RESULTS

A BMI of around 25 kg/m2 was related to a low risk of DR (OR based on the third fifth: 0.752, 95%CI: 0.615-0.920). Besides, HC had an inverse association with DR in men independently of BMI (OR based on the highest fifth: 0.495, 95%CI: 0.350-0.697). In the restricted cubic spline models, BMI, WHtR, WC, and HC showed J-shaped associations with DKD, while WHR showed an S-shaped association with DKD. Compared to the lowest fifth, the odds ratios (OR) based on the highest fifth of BMI, WHR, WHtR, WC and HC for DKD were 1.927 (1.572-2.366), 1.566 (1.277-1.923), 1.910 (1.554-2.351), 1.624 (1.312-2.012) and 1.585 (1.300-1.937) respectively in multivariable models.

CONCLUSIONS

A median BMI and a large hip might be related to a low risk of DR, while lower levels of all the anthropometric indices were associated with a lower risk of DKD. Our findings suggested maintain a median BMI, a low WHR, a low WHtR and a large hip for prevention of DR and DKD.

Associations between eating speed and food temperature and type 2 diabetes mellitus: a cross-sectional study

OBJECTIVE

This study aimed to evaluate the relationship between eating speed and food temperature and type 2 diabetes mellitus (T2DM) in the Chinese population.

METHODS

A cross-sectional survey was conducted between December 2020 to March 2022 from the department of Endocrinology at the Shandong Provincial Hospital. All recruited participants were asked to complete structured questionnaires on their eating behaviors at the time of recruitment. Clinical demographic data such as gender, age, height, weight, familial history of T2DM, prevalence of T2DM and various eating behaviors were collected. Univariate and multivariate logistic regression analyses were used to analyze the associations between eating behaviors and T2DM.

RESULTS

A total of 1,040 Chinese adults were included in the study, including 344 people with T2DM and 696 people without T2DM. Multivariate logistic regression analysis of the general population showed that gender (OR = 2.255, 95% CI: 1.559-3.260, p < 0.001), age (OR = 1.091, 95% CI: 1.075-1.107, p < 0.001), BMI (OR = 1.238, 95% CI: 1.034-1.483, p = 0.020), familial history of T2DM (OR = 5.709, 95% CI: 3.963-8.224, p < 0.001), consumption of hot food (OR = 4.132, 95% CI: 2.899-5.888, p < 0.001), consumption of snacks (OR = 1.745, 95% CI: 1.222-2.492, p = 0.002), and eating speed (OR = 1.292, 95% CI:1.048-1.591, p = 0.016) were risk factors for T2DM.

CONCLUSION

In addition to traditional risk factors such as gender, age, BMI, familial history of T2DM, eating behaviors associated with Chinese culture, including consumption of hot food, consumption of snacks, and fast eating have shown to be probable risk factors for T2DM.

Obesity and the risk of cardiometabolic diseases

The prevalence of obesity has reached pandemic proportions, and now approximately 25% of adults in Westernized countries have obesity. Recognized as a major health concern, obesity is associated with multiple comorbidities, particularly cardiometabolic disorders. In this Review, we present obesity as an evolutionarily novel condition, summarize the epidemiological evidence on its detrimental cardiometabolic consequences and discuss the major mechanisms involved in the association between obesity and the risk of cardiometabolic diseases. We also examine the role of potential moderators of this association, with evidence for and against the so-called 'metabolically healthy obesity phenotype', the 'fatness but fitness' paradox or the 'obesity paradox'. Although maintenance of optimal cardiometabolic status should be a primary goal in individuals with obesity, losing body weight and, particularly, excess visceral adiposity seems to be necessary to minimize the risk of cardiometabolic diseases.

Sources and severity of bias in estimates of the BMI-mortality association

Estimates of mortality differences by body mass index (BMI) are likely biased by: (1) confounding bias from heterogeneity in body shape; (2) positive survival bias in high-BMI samples due to recent weight gain; and (3) negative survival bias in low-BMI samples due to recent weight loss. I investigate these sources of bias in the National Health and Nutrition Examination Survey (NHANES) 1988-94 and 1999-2006 linked to mortality up to 2015 (17,784 cases; 4,468 deaths). I use Cox survival models to estimate BMI differences in all-cause mortality risks among adults aged [45-85) in the United States. I test for age-based differences in BMI-mortality associations and estimate functional forms of the association using nine BMI levels. Estimates of the BMI-mortality association in NHANES data are significantly affected by all three biases, and obesity-mortality associations adjusted for bias are substantively strong at all ages. The mortality consequences of overweight and obesity have likely been underestimated, especially at older ages.

Efficacy and safety of Obex® in overweight and obese subjects: a randomised, double-blind, placebo-controlled clinical trial

BACKGROUND

Obex® may be helpful in reducing body weight and fat. The current study was carried out to evaluate the efficacy and safety of Obex® in the treatment of overweight and obese subjects.

METHODS

A double-blind, randomised, controlled phase III clinical trial was conducted involving 160 overweight and obese subjects (BMI ≥ 25.0 and < 40 kg/m²) aged 20 to 60 years, who received Obex® (n = 80) and placebo (n = 80) plus non-pharmacological treatment (physical activity and nutritional counseling). One sachet of Obex® or placebo were administered before the two main meals each day for 6 months. In addition to anthropometric measurements and blood pressure, fasting plasma and 2 h glucose levels during the oral glucose tolerance test, lipid profile, insulin, liver enzymes, creatinine, and uric acid (UA) were determined, insulin resistance (HOMA-IR) beta-cell function (HOMA-β) were assessed and insulin sensitivity (IS) was calculated with three indirect indexes.

RESULTS

After 3 months of Obex®, 48.3% of the participants (28/58) achieved complete success in reducing both weight and waist circumference by greater than or equal to 5% from baseline, as opposed to 26.0% (13/50) of individuals receiving placebo (p = 0.022). Compared to baseline, at 6 months no differences were found between the groups concerning anthropometric and biochemical measurements, except for high-density lipoprotein cholesterol (HDL-c) levels, which were higher in subjects receiving Obex® compared to those receiving placebo (p = 0.030). After 6 months of treatment, both groups showed reduced cholesterol and triglyceride levels (p < 0.012) compared to baseline value. However, only those intake Obex® showed reduced insulin concentrations and HOMA-IR, improved IS (p < 0.05), and decreased creatinine and UA levels (p < 0.005).

CONCLUSIONS

The consumption of Obex® together with lifestyle changes increased HDL-c, contributed to a rapid reduction of weight and waist circumference, as well as improved insulin homeostasis, which did not occur in the placebo group, and appears to be safe as an adjunct at conventional obesity treatment.

TRIAL REGISTRATION

Clinical trial protocol was registered in the Cuban public registry of clinical trials under code RPCEC00000267 on 17/04/2018 and also registered in the international registry of clinical trials, ClinicalTrials.gov, under code: NCT03541005 on 30/05/2018.

Age-specific and sex-specific associations of visceral adipose tissue mass and fat-to-muscle mass ratio with risk of mortality

BACKGROUND

Limited studies have explored the association between visceral adipose tissue (VAT) mass and fat-to-muscle mass ratio (FMR) and mortality. We aimed to evaluate the sex-specific association of VAT and FMR with all-cause and cause-specific mortality by age.

METHODS

A total of 438 896 participants (49.8% men, mean age ± standard deviation: 57 ± 8 years for men; 56 ± 8 years for women) were included from the UK Biobank cohort. The nature of VAT was predictive, as obtained by sex-stratified, non-linear prediction models. Fat and muscle mass were estimated using a bioelectrical impedance assessment device. FMR was calculated as the fat mass divided by the muscle mass in the whole body. VAT and FMRs were divided into quintiles in ascending order, and the 3rd quintile was used as the reference. Cox regression analyses were used to estimate the associations between VAT, FMR and mortality.

RESULTS

During a median of 12.4 years of follow-up, we documented 29 903 deaths. After adjusting for various covariates, the individuals in the highest quintiles of VAT and FMR had the highest hazard ratios (HRs) of all-cause mortality [1.24 (95% confidence interval: 1.17-1.33) for VAT and 1.24 (1.17-1.31) for FMR in men; and 1.11 (1.03-1.21) for VAT in women], except that the 1st quintile of FMR in women had the greatest HR [1.18 (1.09-1.27)]. Significant interactions were observed in both sexes according to age category (P for interaction < 0.05). Among men <50 years, participants in the 1st and 5th quintiles of VAT and FMR had significantly higher risks of mortality [1.30 (1.02-1.66) and 1.67 (1.27-2.19) in VAT; 1.25 (0.99-1.56) and 1.41 (1.11-1.79) in FMR, respectively]; in women, this phenomenon was observed in the ≥60 age group [1.16 (1.06-1.27) and 1.19 (1.08-1.31) in VAT; 1.18 (1.08-1.29) and 1.11 (1.01-1.22) in FMR, respectively]. VAT showed a linear positive association with mortality in women <60 years and a J-shaped association from respiratory disease in both sexes ≥60 years. FMR showed a linear positive association with mortality from cancer in men <60 years and a J-shaped association with mortality from cause-specific mortality in both sexes ≥60 years, except for mortality from cardiovascular disease in men.

CONCLUSIONS

Most associations of VAT and FMR with all-cause mortality were J-shaped and were significantly modified by age status (<50, 50-59 and ≥60 years). The clinical implication is that regarding body composition and VAT mass, different health strategies may be adopted for people of different sexes and ages.

Inflammatory potential of diet and risk of mortality in normal-weight adults with central obesity

BACKGROUND & AIMS

Inflammatory potential of diet may contribute to poor health outcomes in individuals with metabolic disorders. In a representative sample of the U.S. population, we investigated the association between consuming a pro-inflammatory diet and mortality risk in adults with normal range of body mass index (BMI) but with central obesity.

METHODS

This prospective cohort study included 3521 adults 20-90 years of age with normal BMI who participated in the National Health and Nutrition Examination Survey III, 1988-1994 and did not have a history of cardiovascular disease (CVD) or cancer and did not change their dietary intake in the year preceding baseline measurements. Mortality from all causes, CVD, and cancer was ascertained from the National Death Index. Normal-weight central obesity (NWCO, n = 1777) was defined as those with BMI 18.5 to <25 kg/m2 and waist-to-hip ratio (WHR) ≥0.85 in women and ≥0.90 in men. Severe central obesity was defined as WHR ≥0.92 in women and ≥1.00 in men. The dietary inflammatory index (DII®) was computed based on baseline dietary intake using 24-h dietary recalls, and associations with mortality were estimated using multivariable Cox proportional hazards regression.

RESULTS

In individuals with NWCO, DII score (i.e., more pro-inflammatory diet) was associated with increased risk of CVD mortality (HRT3 vs T1, 1.89 [95% CI, 1.01-3.53], P trend = 0.04; HR 1 SD increase 1.29 [95% CI, 1.06-1.57]). This association was stronger with more severe central obesity (HRT3 vs T1, 2.79 [95% CI, 1.10-7.03], P trend = 0.03; HR 1 SD increase 1.52 [95% CI, 1.05-2.21]). DII score was not associated with increased risk of mortality in normal-weight individuals without central obesity or with risk of cancer mortality in either group.

CONCLUSION

Among individuals in the normal-weight range of BMI, a pro-inflammatory diet assessed by high DII scores was associated with increased risk of CVD mortality in those with central obesity.

Association of genetic variants related to combined exposure to higher BMI and waist-to-hip ratio on lifelong cardiovascular risk in UK Biobank

OBJECTIVE

This study examines the individual and combined association of BMI and waist-to-hip ratio (WHR) with CVD risk using genetic scores of the obesity measurements as proxies.

DESIGN

A 2 × 2 factorial analysis approach was applied, with participants divided into four groups of lifetime exposure to low BMI and WHR, high BMI, high WHR, and high BMI and WHR based on weighted genetic risk scores. The difference in CVD risk across groups was evaluated using multivariable logistic regression.

SETTING

Cohort study.

PARTICIPANTS

A total of 408 003 participants were included from the prospective observational UK Biobank study.

RESULTS

A total of 58 429 CVD events were recorded. Compared to the low BMI and WHR genetic scores group, higher BMI or higher WHR genetic scores were associated with an increase in CVD risk (high WHR: OR, 1·07; 95 % CI (1·04, 1·10)); high BMI: OR, 1·12; 95 % CI (1·09, 1·16). A weak additive effect on CVD risk was found between BMI and WHR (high BMI and WHR: OR, 1·16; 95 % CI (1·12, 1·19)). Subgroup analysis showed similar patterns between different sex, age (<65, ≥65 years old), smoking status, Townsend deprivation index, fasting glucose level and medication uses, but lower systolic blood pressure was associated with higher CVD risk in obese participants.

CONCLUSIONS

High BMI and WHR were associated with increased CVD risk, and their effects are weakly additive. Even though there were overlapping of effect, both BMI and WHR are important in assessing the CVD risk in the general population.

Mendelian randomization investigation identified the causal relationship between body fat indexes and the risk of bladder cancer

Background

Observational studies have suggested that obesity is associated with the risk of bladder cancer (BCa). However, their causal relationship remains unclear. This study aimed to prove the causal relationship between obesity and the risk of BCa by using Mendelian randomization.

Methods

Single-nucleotide polymorphisms (SNPs) correlated with body fat indexes were screened from several genome-wide association studies (GWAS) with more than 300,000 individuals. Summary-level genetic data of BCa-related GWAS were obtained from a European cohort with a sample size of 218,792. An inverse-variance-weighted (IVW) method was used as the major MR analysis. The MR-Egger regression, IVW regression, leave-one-out test, and MR-Pleiotropy Residual Sum and Outlier methods were used to test the reliability and stability of MR results.

Results

Genetically predicted per 1-SD increase in body fat indexes (whole body fat mass, and the right leg, left leg, right arm, left arm, and trunk fat mass) were associated with increased BCa risk with values of 51.8%, 77.9%, 75.1%, 67.2%, 59.7%, and 36.6%, respectively. Sensitivity analyses suggested that the genetically determined risk effect of obesity on BCa was stable and reliable.

Conclusions

Our study provided powerful evidence to support the causal hypothesis that the genetically predicted high body fat mass was associated with a risk increase for BCa. The finding is a new idea for drawing up prevention strategies for BCa.

The interaction between Alternative Healthy Eating Index and MC4R rs17782313 gene variants on central and general obesity indices in women: a cross-sectional study

BACKGROUND

Previous studies have shown that the C allele of melanocortin 4 receptor (MC4R) rs17782313 and Alternative Healthy Eating Index (AHEI) are separately associated with obesity. However, no study has assessed the aim of this study which is to investigate the interaction between MC4R rs17782313 variants and AHEI and their association with central and general obesity indices.

METHODS

A total of 291 women with BMI ≥25 and aged 18-48 years enrolled in this cross-sectional study. All participants were assessed for body composition, anthropometric measures, dietary intake, and blood parameters. After obtaining data of dietary intake from the 147-item food frequency questionnaire (FFQ) the AHEI was calculated. MC4R rs17782313 SNPs were assessed using the restriction fragment length polymorphism (PCR-RFLP) method.

RESULTS

After adjustment for age, energy intake, physical activity, marital and economic status, the interaction between MC4R rs17782313 and AHEI was associated with hip circumference (HC) (β=-0.41, 95%CI: -0.77 to -0.05, P=0.02), body mass index (BMI) (β=-0.15, 95%CI: -0.29 to -0.02, P=0.02), fat mass (kg) (β=-0.28, 95%CI: -0.56 to -0.01, P=0.03), Visceral fat area (VFA) (β=-5.68, 95%CI: -9.55 to -1.80, P=0.004). The other measures that seem to be suggestively related to this interaction (0.05< P <0.07) are waist circumference (WC), waist-to-height ratio (WHtR), trunk fat (TF) (%), TF (kg), fat mass (%), and fat mass index (FMI).

CONCLUSION

Interaction between MC4R rs17782313 and AHEI can be related to some central and general obesity indices in overweight/obese women. This article is protected by copyright. All rights reserved.

Abdominal Obesity: An Independent Influencing Factor of Visuospatial and Executive/Language Ability and the Serum Levels of Aβ40/Aβ42/Tau Protein

BACKGROUND

Although obesity affects human health and cognitive function, the influence of abdominal obesity on cognitive function is still unclear.

METHODS

The MoCA scale was used to evaluate the overall cognitive function and the function of each subitem of 196 subjects, as well as the SDMT and TMT-A scales for evaluating the attention and information processing speed. In addition, radioimmunoassay was used to detect the serum levels of Aβ40, Aβ42, and tau protein in 45 subjects. Subjects were divided into abdominal and nonabdominal obesity groups. Before and after correcting confounding factors, the differences in cognitive scale evaluation indexes and three protein levels between the two groups were compared. We also explore further the correlation between various cognitive abilities and the waist circumference/levels of the three proteins. Linear regression was used to identify the independent influencing factors of various cognitive functions and three protein levels.

RESULTS

After correcting for multiple factors, we observed the lower scores of visuospatial function, execution, and language in the MoCA scale, as well as higher levels of Aβ40 and tau protein in the abdominal obesity group, supported by the results of correlation analysis. Abdominal obesity was identified as an independent negative influencing factor of MoCA visual space, executive power, and language scores and an independent positive influencing factor of Aβ40, Aβ42, and tau protein levels.

CONCLUSION

Abdominal obesity may play a negative role in visuospatial, executive ability, and language function and a positive role in the Aβ40, Aβ42, and tau protein serum levels.

β-cell function and body mass index are predictors of exercise response in elderly patients with pre-diabetes

Aims/Introduction

To explore the predicting factors of exercise response (whether the participants converted to diabetes) in elderly patients with prediabetes.

Materials and Methods

This is a retrospective subgroup analysis of the registered clinical trial with previous publication of the same cohort. A total of 248 participants with prediabetes were randomized to the aerobic training (n = 83) group, resistance training (n = 82) group and control group (n = 83). The patients who finished the 2‐year exercise intervention were included in this analysis to explore the factors impacting exercise response.

Results

A total of 113 patients with prediabetes completed 2 years of exercise, with 56 participants in the aerobic exercise group and 57 in the resistance exercise group. Patients who reversed to normal glucose tolerance, remained in prediabetes and developed diabetes were 18 (15.90%), 70 (62.00%) and 25 (22.10%), respectively. Logistic regression showed that baseline, homeostatic model 2 assessment of β‐cell function (β = −0.143, P = 0.039), hemoglobin A1c (β = 3.301, P = 0.007) and body mass index (β = 0.402, P = 0.012) were related to exercise response, whereas the waist‐to‐hip ratio (β = −3.277, P = 0.693) and types of exercise (β = 1.192, P = 0.093) were not significantly related to exercise response.

Conclusions

Baseline homeostatic model 2 assessment of β‐cell function, hemoglobin A1c and body mass index were the predictors for the response to exercise in elderly patients with prediabetes.

Inflammation and Cardiovascular Diseases in the Elderly: The Role of Epicardial Adipose Tissue

Human aging is a complex phenomenon characterized by a wide spectrum of biological changes which impact on behavioral and social aspects. Age-related changes are accompanied by a decline in biological function and increased vulnerability leading to frailty, thereby advanced age is identified among the major risk factors of the main chronic human diseases. Aging is characterized by a state of chronic low-grade inflammation, also referred as inflammaging. It recognizes a multifactorial pathogenesis with a prominent role of the innate immune system activation, resulting in tissue degeneration and contributing to adverse outcomes. It is widely recognized that inflammation plays a central role in the development and progression of numerous chronic and cardiovascular diseases. In particular, low-grade inflammation, through an increased risk of atherosclerosis and insulin resistance, promote cardiovascular diseases in the elderly. Low-grade inflammation is also promoted by visceral adiposity, whose accumulation is paralleled by an increased inflammatory status. Aging is associated to increase in epicardial adipose tissue (EAT), the visceral fat depot of the heart. Structural and functional changes in EAT have been shown to be associated with several heart diseases, including coronary artery disease, aortic stenosis, atrial fibrillation, and heart failure. EAT increase is associated with a greater production and secretion of pro-inflammatory mediators and neuro-hormones, so that thickened EAT can pathologically influence, in a paracrine and vasocrine manner, the structure and function of the heart and is associated to a worse cardiovascular outcome. In this review, we will discuss the evidence underlying the interplay between inflammaging, EAT accumulation and cardiovascular diseases. We will examine and discuss the importance of EAT quantification, its characteristics and changes with age and its clinical implication.

Prevalence of central obesity and associated factors in Ethiopia: A systematic review and meta-analysis

INTRODUCTION

Obesity is a global public health concern that is now on the rise, especially in low- and middle-income nations. Despite the fact that there are several studies reporting the prevalence of central obesity among adults in Ethiopia, there is a lack of a systematic review and meta-analysis synthesizing the existing observational studies. Therefore, this systematic review and meta-analysis aimed to determine the prevalence of central obesity and its associated factors in Ethiopia.

METHODS

Online libraries such as PubMed, Google Scholar, Scopus, Science Direct, and Addis Ababa University were searched. Data were extracted using Microsoft Excel and analyzed using STATA statistical software (v. 16). Forest plots, Begg's rank test, and Egger's regression test were all used to check for publication bias. To look for heterogeneity, I² was computed, and an overall estimated analysis was carried out. Subgroup analysis was done by region and study setting. In addition, the pooled odds ratio for related covariates was calculated.

RESULTS

Out of 685 studies assessed, 20 met our criteria and were included in the study. A total of 12,603 people were included in the study. The prevalence of central obesity was estimated to be 37.31% [95% confidence interval (CI): 29.55-45.07]. According to subgroup analysis by study region and setting, the highest prevalence was observed in the Dire Dawa region (61.27%) and community-based studies (41.83%), respectively. Being a woman (AOR = 6.93; 95% CI: 3.02-10.85), having better socioeconomic class (AOR = 5.45; 95% CI: 0.56-10.34), being of age 55 and above (AOR = 5.23; 95% CI: 2.37-8.09), being physically inactive (AOR = 1.80; 95% CI: 1.37-2.24), being overweight (AOR = 4.00; 95% CI: 2.58-5.41), being obese (AOR = 6.82; 95% CI: 2.21-11.43), and having hypertension (AOR = 3.84; 95% CI: 1.29-6.40) were the factors associated with central obesity.

CONCLUSION

The prevalence of central obesity was high in Ethiopia. Being a woman, having a higher socioeconomic class, being older, being physically inactive, being overweight or obese, and having hypertension were all associated. Therefore, it is vital for the government and health organizations to design and implement preventive measures like early detection, close monitoring, and positive reversal of central obesity in all patients and the general population. High-quality investigations on the prevalence of central obesity in the Ethiopian people are required to better understand the status of central obesity in Ethiopia.

SYSTEMATIC REVIEW REGISTRATION

https://www.crd.york.ac.uk/PROSPERO, identifier: CRD42022329234.

Obesity, Body Composition, and Sex Hormones: Implications for Cardiovascular Risk

Cardiovascular disease (CVD) continues to be the leading cause of death in adults, highlighting the need to develop novel strategies to mitigate cardiovascular risk. The advancing obesity epidemic is now threatening the gains in CVD risk reduction brought about by contemporary pharmaceutical and surgical interventions. There are sex differences in the development and outcomes of CVD; premenopausal women have significantly lower CVD risk than men of the same age, but women lose this advantage as they transition to menopause, an observation suggesting potential role of sex hormones in determining CVD risk. Clear differences in obesity and regional fat distribution among men and women also exist. While men have relatively high fat in the abdominal area, women tend to distribute a larger proportion of their fat in the lower body. Considering that regional body fat distribution is an important CVD risk factor, differences in how men and women store their body fat may partly contribute to sex-based alterations in CVD risk as well. This article presents findings related to the role of obesity and sex hormones in determining CVD risk. Evidence for the role of sex hormones in determining body composition in men and women is also presented. Lastly, the clinical potential for using sex hormones to alter body composition and reduce CVD risk is outlined. © 2022 American Physiological Society. Compr Physiol 12:1-45, 2022.

Associations of Skeletal Muscle Mass and Fat Mass With Incident Cardiovascular Disease and All-Cause Mortality: A Prospective Cohort Study of UK Biobank Participants

Background There is debate whether body mass index is a good predictor of health outcomes because different tissues, namely skeletal muscle mass (SMM) and fat mass (FM), may be differentially associated with risk. We investigated the association of appendicular SMM (aSMM) and FM with fatal and nonfatal cardiovascular disease (CVD) and all-cause mortality. We compared their prognostic value to that of body mass index. Methods and Results We studied 356 590 UK Biobank participants aged 40 to 69 years with bioimpedance analysis data for whole-body FM and predicted limb muscle mass (to calculate aSMM). Associations between aSMM and FM with CVD and all-cause mortality were examined using multivariable Cox proportional hazards models. Over 3 749 501 person-years of follow-up, there were 27 784 CVD events and 15 844 all-cause deaths. In men, aSMM was positively associated with CVD incidence (hazard ratio [HR] per 1 SD 1.07; 95% CI, 1.06-1.09) and there was a curvilinear association in women. There were stronger positive associations between FM and CVD with HRs per SD of 1.20 (95% CI, 1.19-1.22) and 1.25 (95% CI, 1.23-1.27) in men and women respectively. Within FM tertiles, the associations between aSMM and CVD risk largely persisted. There were J-shaped associations between aSMM and FM with all-cause mortality in both sexes. Body mass index was modestly better at discriminating CVD risk. Conclusions FM showed a strong positive association with CVD risk. The relationship of aSMM with CVD risk differed between sexes, and potential mechanisms need further investigation. Body fat and SMM bioimpedance measurements were not superior to body mass index in predicting population-level CVD incidence or all-cause mortality.

Association between "a body shape index" and mortality: Bambuí Cohort Study of Aging, Brazil

This article aims to evaluate the joint and separate association between abdominal and general adiposity indicators and mortality. Data was collected from 1,366 older adults in the Bambuí Cohort Study of Aging with complete information for all variables of interest. The outcome variable was all-cause time until death; exposure variables were a body shape index (ABSI), waist circumference (WC), waist-to-height ratio (WHtR) and body mass index (BMI), assessed at the beginning of the study, and at the 3rd, 5th and 11th year of follow-up. Association between the quartiles of anthropometric indicators and mortality was calculated using an extended Cox proportional hazards model and adjusted for socioeconomic and behavioral confounding factors. Older adults in the 4th ABSI quartile had a higher risk of mortality regardless of BMI (1.27; 95%CI: 1.01-1.58), but this association was not observed in sensitivity analyses. Older adults in the 2nd, 3rd and 4th BMI quartiles had a lower risk of mortality, even when adjusted for WC or ABSI. WC and WHtR showed no association consistent with all-cause mortality after adjustment for confounding factors. Considering the loss of significance in the sensitivity analyses, ABSI's predictive capacity for mortality is still weak. Thus, adopting ABSI in clinical practice or in epidemiological surveys, in conjunction or replacing BMI and WC, requires more in-depth studies.

Gender Differences in the Relationship of Waist Circumference to Coronary Artery Lesions and One-Year Re-Admission Among Coronary Artery Disease Patients with Normal Body Mass Index

PURPOSE

The study explored the association of waist circumference (WC) with the severity of cardiovascular diseases and hospital readmission of coronary artery disease (CAD) patients with normal body mass index (BMI).

PATIENTS AND METHODS

213 female and 431 male normal-BMI CAD patients were enrolled and assigned in three groups based on their gender-specific WC tertiles. Their cardiovascular risk factors and coronary angiography characteristics were analyzed in a cross-sectional study, and the gender-specific relationship between WC and one-year re-admission rate was prospectively explored.

RESULTS

The cross-sectional analysis showed that for male normal-BMI CAD patients, diabetes and dyslipidemia prevalence, Apo B/A1, hs-CRP, and uric acid levels triglycerides-glucose index, the incidence of left main disease, three vessel disease, calcification lesion, total occlusive lesion, and complex lesion, as well as Gensini score was in the order of WC tertile 3 > WC tertile 2 > WC tertile 1. In addition, male normal-BMI CAD patients in the highest WC tertile were at an increased risk of severe CAD (OR=2.21), and the correlation was still statistically significant even after adjusting for potential cardiovascular risk factors (OR=1.87). For female normal-BMI CAD patients, as the WC tertiles increased, uric acid level, the prevalence of three vessel disease, diffuse lesion, and complex lesion gradually increased (P <0.05), but no significant difference was found in the risk of severe CAD among different WC groups (all P >0.05). Prospective analyses showed that the higher the WC tertile was, the higher the one-year re-admission rate in men, but not in women, and after adjusting for other risk factors, men with the highest WC tertile showed more than twice the risk of patients with the lowest WC tertile.

CONCLUSION

Male but not female, normal-BMI CAD patients with increased WC had more severe CAD and a higher risk of one-year re-admission rate.

Central fatness and risk of all cause mortality: systematic review and dose-response meta-analysis of 72 prospective cohort studies

OBJECTIVE

To quantify the association of indices of central obesity, including waist circumference, hip circumference, thigh circumference, waist-to-hip ratio, waist-to-height ratio, waist-to-thigh ratio, body adiposity index, and A body shape index, with the risk of all cause mortality in the general population, and to clarify the shape of the dose-response relations.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

PubMed and Scopus from inception to July 2019, and the reference lists of all related articles and reviews.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Prospective cohort studies reporting the risk estimates of all cause mortality across at least three categories of indices of central fatness. Studies that reported continuous estimation of the associations were also included.

DATA SYNTHESIS

A random effects dose-response meta-analysis was conducted to assess linear trend estimations. A one stage linear mixed effects meta-analysis was used for estimating dose-response curves.

RESULTS

Of 98 745 studies screened, 1950 full texts were fully reviewed for eligibility. The final analyses consisted of 72 prospective cohort studies with 2 528 297 participants. The summary hazard ratios were as follows: waist circumference (10 cm, 3.94 inch increase): 1.11 (95% confidence interval 1.08 to 1.13, I2=88%, n=50); hip circumference (10 cm, 3.94 inch increase): 0.90 (0.81 to 0.99, I2=95%, n=9); thigh circumference (5 cm, 1.97 inch increase): 0.82 (0.75 to 0.89, I2=54%, n=3); waist-to-hip ratio (0.1 unit increase): 1.20 (1.15 to 1.25, I2=90%, n=31); waist-to-height ratio (0.1 unit increase): 1.24 (1.12 to 1.36, I2=94%, n=11); waist-to-thigh ratio (0.1 unit increase): 1.21 (1.03 to 1.39, I2=97%, n=2); body adiposity index (10% increase): 1.17 (1.00 to 1.33, I2=75%, n=4); and A body shape index (0.005 unit increase): 1.15 (1.10 to 1.20, I2=87%, n=9). Positive associations persisted after accounting for body mass index. A nearly J shaped association was found between waist circumference and waist-to-height ratio and the risk of all cause mortality in men and women. A positive monotonic association was observed for waist-to-hip ratio and A body shape index. The association was U shaped for body adiposity index.

CONCLUSIONS

Indices of central fatness including waist circumference, waist-to-hip ratio, waist-to-height ratio, waist-to-thigh ratio, body adiposity index, and A body shape index, independent of overall adiposity, were positively and significantly associated with a higher all cause mortality risk. Larger hip circumference and thigh circumference were associated with a lower risk. The results suggest that measures of central adiposity could be used with body mass index as a supplementary approach to determine the risk of premature death.

Central Obesity is Associated With Neuropathy in the Severely Obese

OBJECTIVE

To determine the prevalence of neuropathy stratified by glycemic status and the association between extensive anthropometric measurements and neuropathy.

PATIENTS AND METHODS

We performed a cross-sectional, observational study in obese individuals, before surgery, with body mass index (BMI) greater than 35 kg/m². Lean controls were recruited from a research website. Neuropathy was defined by the Toronto consensus definition of probable neuropathy. We compared nine anthropometric measurements between obese participants with and without neuropathy. We used multivariable logistic regression to explore associations between these measures, and other metabolic risk factors, and neuropathy.

RESULTS

We recruited 138 obese individuals and 46 lean controls. The mean age (SD) was 45.1 (11.3) years in the obese population (76.1% female, n=105) and 43.8 (12.1) years in the lean controls (82.2% female, n=37). The prevalence of neuropathy was 2.2% (n=1) in lean controls, 12.1% (n=4) in obese participants with normoglycemia, 7.1% (n=4) in obese participants with pre-diabetes, and 40.8% (n=20) in obese participants with diabetes (p≤.01). Waist circumference was the only anthropometric measure that was larger in those with neuropathy (139.3 cm vs 129.1 cm, p=.01). Hip-thigh (71.1 cm vs 76.6 cm, p<.01) and mid-thigh (62.2 cm vs 66.3 cm, p=.03) circumferences were smaller in those with neuropathy. The body mass index was comparable between patients who were obese with and without neuropathy (p=.86). Waist circumference (odds ratio [OR], 1.39; 95% CI, 1.10 to 1.75), systolic blood pressure (OR, 2.89; 95% CI, 1.49 to 5.61), and triglycerides (OR, 1.31; 95% CI, 1.00 to 1.70) were significantly associated with neuropathy.

CONCLUSION

Normoglycemic obese patients have a high prevalence of neuropathy indicating that obesity alone may be sufficient to cause neuropathy. Waist circumference, but not general obesity, is significantly associated with neuropathy.

Evaluation on the Effects of Tamarindus Indica L. Fruit on Body Weight and Several Cardiometabolic Risk Factors in Obese and Overweight Adult Patients: A Randomized Controlled Clinical Trial

Background:

Animal studies have shown the anti-obesity effects of Tamarindus indica L. (tamarind) fruit pulp. This study aimed to evaluate the weight-reducing effects of T. indica L. fruit as well as its blood pressure- and lipid-lowering effects in a clinical trial.

Methods:

In a randomized controlled clinical trial, obese and overweight patients were randomly and equally assigned to tamarind and control groups. Both groups were instructed proper diet and maintaining physical activity for 6 weeks. Furthermore, the participants of tamarind group were instructed to consume 10 grams of tamarind fruit pulp twice daily with meals for the same period. Body mass index (BMI), waist circumference, systolic blood pressure (SBP) and diastolic blood pressure (DBP), fasting serum levels of glucose (fasting plasma glucose, FPG), total cholesterol, triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) were determined and recorded for all patients pre- and post-intervention.

Results:

Twenty patients in each group completed the study. Tamarind significantly reduced BMI, WC, LDL-C, SBP, and DBP compared to baseline. However, none of these effects were statistically significant compared to control group.

Conclusions:

Consumption of tamarind fruit pulp with daily dose of 20 g has no significant effects on body weight, waist circumference, serum lipid profile, blood glucose, and blood pressure.

Visceral adiposity index and longitudinal risk of incident metabolic syndrome: Korean genome and epidemiology study (KoGES)

Available data is insufficient to identify the influence of visceral adiposity assessed by visceral adiposity index (VAI) on incident MetS. This study was to evaluate the association of VAI with incident MetS. In a cohort of Korean genome epidemiology study, 5,807 free of MetS were followed-up for 10 years. They were subdivided into 3 tertile groups according to VAI score. Cox proportional hazard model was used to evaluate the hazard ratios (HRs) and 95% confidential interval (CI) [adjusted HRs (95% CI)] for MetS according to VAI tertiles. Subgroup analyses were conducted for VAI and waist circumference (WC). Receiver operating characteristic (ROC) and area under curve (AUC) analyses were conducted to compare the discriminative ability for Mets among indices. The risk for MetS increased proportionally to VAI tertiles in all participants, which was similarly observed in both men and women. Subgroup analysis indicated that group with high VAI and low WC had the increased risk for MetS (all participants: 2.76 [2.48-3.07], men: 2.77 [2.40-3.19] and women: 2.55 [2.16-3.00]), compared with groups with low VAI and low WC. Group with low VAI and high WC generally had the higher adjusted HRs for MetS than group with the high VAI and low WC. In AUC analyses, WC had the highest discriminative ability for Mets. In conclusion, elevated VAI was significantly associated with the increased long-term risk of MetS. VAI is a useful supplementary to classic anthropometric indices in screening high risk group of MetS.

Body image perception and body composition: assessment of perception inconsistency by a new index

Background

A correct perception of the body image, as defined by comparison with actual anthropometric analyses, is crucial to ensure the best possible nutritional status of each individual. Bioimpedance analysis (BIA) represents a leading technique to assess body composition parameters and, in particular, the fat mass. This study examined the self-perception of body image at various levels of adiposity proposing a new index.

Methods

We investigated 487 young Italian adults (mean age of males: 21.9 ± 2.4 years; mean age of females: 21.0 ± 2.2 years). Each subject could choose, on the Contour Drawing Rating Scale, the silhouette that he/she considered most resembling his/her perceived body image as well as his/her ideal body image. On each subject, we performed anthropometric measurements and determined the values of Fat mass and  %Fat with BIA. A new index, FAI^FAT (Feel fat status minus Actual fat status Inconsistency), was developed to evaluate possible fat status perception inconsistencies by BIA.

Results

Based on ideal and feel body image comparison, women showed higher dissatisfaction than men and preferred slimmer silhouettes. FAI^FAT values indicated that the fat status perception was correct in the majority of the examined individuals and only three subjects showed a serious misperception.

Conclusions

Our findings suggest that FAI^FAT is an appropriate index for assessing the perceived fat status from the body image when compared with data obtained by BIA. In a population, the use of this index will allow the correct identification of groups at risk for eating disorders.

Chromosomal stability in buccal cells was linked to age but not affected by exercise and nutrients - Vienna Active Ageing Study (VAAS), a randomized controlled trial

The purpose of this study was to investigate the effect of six months strength training with or without supplementing protein and vitamins, on chromosomal integrity of buccal cells in institutionalized elderly.

One hundred seventeen women and men (65–98 years) performed either resistance training (RT), RT combined with a nutritional supplement (RTS) or cognitive training (CT) twice per week for six months. Participants’ fitness was measured using the 6 min walking, the chair rise, and the handgrip strength test. Genotoxicity and cytotoxicity parameters were investigated with the Buccal Micronucleus Cytome (BMcyt) assay.

Six minutes walking and chair rise performance improved significantly, however, no changes of the parameters of the BMcyt were detected. Age and micronuclei (MN) frequency correlated significantly, for both women (r = 0.597, p = 0.000) and men (r = 0.508, p = 0.000). Squared regressions revealed a significant increase in the MN frequency of buccal cells with age (R² = 0.466, p = 0.000).

Interestingly and contrary to what was shown in blood lymphocytes, chromosomal damage in buccal cells increases until very old age, which might qualify them as a valid biomarker for aging. Unexpectedly, in this group of institutionalized elderly, resistance training using elastic bands had no effect on chromosomal damage in buccal cells.

•

Mutation in buccal cells increased until very old age – a new aging biomarker?

•

Chromosomal damage in buccal cells was age-dependent and equal for women and men.

•

Strength training improved fitness but not mutagenicity in buccal cells of elderly.

Prevalence of abdominal obesity and its correlates among adults in a peri-urban population of West Africa

Introduction

Prevalence of abdominal obesity dramatically increases both in developed countries and in developing countries. In several regions in Africa, obesity (especially abdominal) is seen as a sign of affluence, dignity and respect. The objective of this study was to determine prevalence of abdominal obesity and seek some factors associated in a peri-urban population of West Africa.

Methods

During April-May 2014, a cross-sectional study was conducted in Anonkoi 3, a neighborhood of Abidjan (Ivory Coast). Adults of 18 years old and over, not bedridden were included. Sampling was done in two stages. First, we selected the households. Then in each household we randomly chose one adult. Abdominal obesity was measured using a measuring tape and defined by waist circumference ratio (TT) to hip circumference (TH) greater or equal to 0.80 in women and greater or equal to 0.95 in men. Data from sociodemographic, corpulence, socioeconomic level, food habit, level of physical activity and blood pressure were analyzed. Univariate analysis using the Pearson KHI-square test at a significance level of 0.05 and a logistic regression was performed.

Results

We visited 486 households in which 486 people aged 36.1 ± 12.83 years agreed to participate in the study. Prevalence of abdominal obesity was 50.8%. Those aged 30–45 years, women, couples, those with a primary level of education, the poor, people with high blood pressure, subjects less active and obese (general obesity) had more abdominal obesity. After logistic regression, individuals aged 30–45 years (adjusted OR = 2.35; p = 0.004) and 45 years and older (adjusted OR = 3.18; p = 0.001); females (adjusted OR = 49.05; p = 0.000); hypertension (adjusted OR = 2.26; p = 0.014) and obesity (OR = 2.94; p = 0.009).

Conclusion

This work allowed us to estimate a relatively high prevalence of abdominal obesity in a peri-urban African population.

Increased waist-to-hip ratio is associated with decreased urine glucose excretion in adults with no history of diabetes

PURPOSE

Promoting urine glucose excretion (UGE) is an attractive approach for the treatment of diabetes. Obesity is associated with increased risk for type 2 diabetes. This study was aimed to investigate the association of waist-to-hip ratio (WHR), a simple measure of abdominal obesity, with UGE determined in subjects without previous history of diabetes.

METHODS

We studied the correlation of WHR with UGE in 7485 participants without previous history of diabetes. All participants were given a standard 75 g glucose solution. Clinical parameters and demographic characteristics were assessed. Multiple linear regression analysis and multivariate logistic regression analysis were performed to determine the association of WHR with UGE.

RESULTS

Individuals with high WHR (H-WHR) exhibited significantly lower UGE compared to those with low WHR (L-WHR), in either normal glucose tolerance group or pre-diabetes group. In newly diagnosed diabetes group, individuals with H-WHR also showed lower UGE than those with L-WHR; however, no statistical significance was observed. After adjustment for potential confounding factors, including age, genders, and blood glucose level, WHR was negatively associated with UGE (β = -250.901, 95% CI: -471.891 to -29.911, p = 0.026). However, no significant association was observed between BMI and UGE. Furthermore, multivariable logistic regression model showed that individuals with H-WHR were more likely to have low UGE (OR = 0.83, 95% CI: 0.71-0.97, p = 0.018).

CONCLUSIONS

Individuals with H-WHR were at risk for decreased UGE. This study suggests that WHR, but not BMI, might be an important determinant of UGE.

Waist Circumference and All-Cause Mortality among Older Adults in Rural Indonesia

Waist circumference, a measure of abdominal obesity, is associated with all-cause mortality in general adult population. However, the link between abdominal obesity with all-cause mortality in the studies of older adults is unclear. This study aims to determine the association between waist circumference and all-cause mortality in older adults in Indonesia. The association between waist circumference and all-cause mortality was examined in 10,997 men and women aged 50 years and older, in the World Health Organization (WHO) and International Network of field sites for continuous Demographic Evaluation of Populations and their Health in developing countries (INDEPTH) collaboration Study on global AGEing and adult health (SAGE) in Purworejo District Central Java, Indonesia during 2007⁻2010. Multivariate Cox regression analysis with restricted cubic splines was used to assess the non-linear association between waist circumference and all-cause mortality. During the 3-year follow-up, a total of 511 men and 470 women died. The hazard ratio plot shows a pattern of U-shape relationship between waist circumference and all-cause mortality among rich women, though the result was significant only for women in the lower end of waist circumference distribution (p < 0.05). Poor men with a low waist circumference (5th percentile) have a two times higher mortality risk (HR = 2.1; 95% CI = 1.3, 3.3) relative to those with a waist circumference of 90 cm. Poor women with a low waist circumference (25th percentile) have a 1.4 times higher mortality risk (HR = 1.4; 95% CI = 1.1, 1.8) relative to those with a waist circumference of 80 cm. This study shows a significant association between low waist circumference measure and mortality, particularly among poor men and women. Though the association between large waist circumference and mortality was not significant, we observed a trend of higher mortality risk particularly among rich women with large waist circumference measure. Public health intervention should include efforts to improve nutritional status among older people and promoting healthy lifestyle behaviours including healthy food and active lifestyle.

Aging and Imaging Assessment of Body Composition: From Fat to Facts

The aging process is characterized by the chronic inflammatory status called "inflammaging", which shares major molecular and cellular features with the metabolism-induced inflammation called "metaflammation." Metaflammation is mainly driven by overnutrition and nutrient excess, but other contributing factors are metabolic modifications related to the specific body composition (BC) changes occurring with age. The aging process is indeed characterized by an increase in body total fat mass and a concomitant decrease in lean mass and bone density, that are independent from general and physiological fluctuations in weight and body mass index (BMI). Body adiposity is also re-distributed with age, resulting in a general increase in trunk fat (mainly abdominal fat) and a reduction in appendicular fat (mainly subcutaneous fat). Moreover, the accumulation of fat infiltration in organs such as liver and muscles also increases in elderly, while subcutaneous fat mass tends to decrease. These specific variations in BC are considered risk factors for the major age-related diseases, such as cardiovascular diseases, type 2 diabetes, sarcopenia and osteoporosis, and can predispose to disabilities. Thus, the maintenance of a balance rate of fat, muscle and bone is crucial to preserve metabolic homeostasis and a health status, positively contributing to a successful aging. For this reason, a detailed assessment of BC in elderly is critical and could be an additional preventive personalized strategy for age-related diseases. Despite BMI and other clinical measures, such as waist circumference measurement, waist-hip ratio, underwater weighing and bioelectrical impedance, are widely used as a surrogate measure for body adiposity, they barely reflect the distribution of body fat. Because of the great advantages offered by imaging tools in research and clinics, the attention of clinicians is now moving to powerful imaging techniques such as computed tomography, magnetic resonance imaging, dual-energy X-ray absorptiometry and ultrasound to obtain a more accurate estimation of BC. The aim of this review is to present the state of the art of the imaging techniques that are currently available to measure BC and that can be applied to the study of BC changes in the elderly, outlining advantages and disadvantages of each technique.

Development and Validation of a Tool to Screen for Cognitive Frailty among Community-Dwelling Elders

OBJECTIVES

Reciprocal age-related impairments in physical and cognitive functioning have been termed 'cognitive frailty', which is associated with adverse health outcomes and is a potential target for preventing or delaying the onset of disability in older people. However, cognitive frailty as currently defined is challenging to diagnose. To facilitate earlier diagnosis and intervention, we conducted this study to develop and validate a simple evidence-based instrument to identify community-dwelling elders at risk of cognitive frailty.

DESIGN

Retrospective analyses of data from the I-Lan Longitudinal Aging Study (ILAS) to develop a prediction model, and from the Longitudinal Aging Study of Taipei (LAST) for external validation.

SETTING

Community-dwelling adults from Taipei City, New Taipei City and Yilan (I-Lan) County, Taiwan.

PARTICIPANTS

1271 community residents ≥65 years old, without impaired global cognition or dependency for activities of daily living/instrumental activities of daily living.

MEASUREMENTS

Demographic characteristics, anthropometric measurements, medical history, Mini-Mental State Examination, Montreal Cognitive Assessment, Functional Autonomy Measuring System, Functional Assessment Staging Test, Center for Epidemiologic Studies Depression Scale, handgrip strength, 6-metre walk speed.

METHODS

Baseline characteristics of groups with/without cognitive frailty were analyzed and factors differing significantly in univariate analysis input to binary logistic regression to develop a cognitive frailty risk (CFR) score.

RESULTS

The prevalence of cognitive frailty was 15.8% overall; ILAS 21.4%, LAST 8.4%. Predictors of CFR comprised: age ≥75 years; female sex; waist circumference ≥90 cm (male), ≥80 cm (female); calf circumference <33 cm (male), <32 cm (female); memory deficits; and diabetes mellitus. CFR ≥5/14 had sensitivity of 70%, specificity of 60%, and predictive accuracy of 72%.

CONCLUSIONS

A CFR score based on simple history-taking and anthropometric measurements integrates age, sex, cardiometabolic risk, memory deficits, sarcopenia, and nutrition, with validated predictive accuracy, and could be performed easily in community settings to identify seniors with cognitive frailty for appropriate interventions.

Identification of chronic kidney disease risk in relatively lean Southern Chinese: the hypertriglyceridemic waist phenotype vs. anthropometric indexes

PURPOSE

Assessing and comparing the ability of the hypertriglyceridemic waist (HW) phenotype and anthropometric obesity indexes to identify subjects at high risk of chronic kidney disease (CKD) in a relatively lean population in South China.

METHODS

Using data from a community-based, cross-sectional study conducted in Zhuhai City, Southern China, we examined associations between the HW phenotype, anthropometric obesity indexes, and incident CKD risk in a relatively lean population. Multiple logistic regression analyses were used to evaluate the associations.

RESULTS

The HW phenotype associated with CKD significantly in the unadjusted analysis (OR 3.53, 95% CI 1.65-7.52, P = 0.001). Further adjustment for gender, age, and other potential confounding variables had an impact on the odd ratios (OR); the OR decreased but still existed (OR 2.91, 95% 1.23-6.87, P = 0.016). The association of the HW phenotype with CKD remained significant after further adjustment for hypertension and diabetes. No significant association between the anthropometric indexes and incident CKD was found.

CONCLUSION

The HW phenotype, but not the anthropometric indexes, is associated with an elevated risk of CKD in relatively lean subjects. The HW phenotype appears to be a better predictor of CKD than the anthropometric indexes.

LEVEL OF EVIDENCE

Level V, descriptive study.

Pickle Consumption is Associated with Body Mass Index and Blood Pressure among Iranian Female College Students: a Cross-Sectional Study

Pickle is consumed in high amount among Iranians. Pickle consumption may be related to body mass index (BMI) and blood pressure (BP) but limited evidence exist in this regard. The aim of current study was to determine the association between pickle consumption and risk of overweight, central obesity and BP among Isfahanian female youths. A cross-sectional study was conducted on 289 female students aged 18–27 years randomly selected from students of Isfahan University of Medical Sciences, Isfahan, Iran. Diet was assessed by a validated and reliable food-frequency questionnaire. Mean pickle consumption was 15.1 ± 2.2 g/day. Individuals in the highest tertile of pickle consumption had a significantly higher BMI, systolic and diastolic BP (p = 0.001, 0.03, and 0.03, respectively), whereas we did not observe significant association for waist circumference (p = 0.21). Total energy intake (p = 0.02) and consumption of carbohydrate (p = 0.01), protein (p = 0.03), and fat (p = 0.05) in the upper tertile was higher than lower tertiles. There was a significant association between pickle consumption and obesity and BP among Iranian female youths. Further prospective studies are needed to confirm this association.

Examining the association between anthropometric parameters and telomere length and mortality risk

A shorter telomere length is associated with several systemic disorders. Telomere length may be an informative biomarker for the maintenance of the overall health status and mortality. There are a limited number of empirical studies concerning the effect of anthropometric parameters on telomere length. The data are derived from the National Health and Nutrition Examination Survey from 1999 to 2002. The primary outcomes of this study were to examine the potential relationships between the anthropometric indices and the telomere length, while secondary outcomes of this study was to investigate the association between different anthropometric indices and mortality risk. A significant positive correlation was noted between the mean telomere length and the thigh circumference (TC) and calf circumference (CC) in all designed models. Participants in the highest TC and CC quartiles tended to have a longer telomere length and lowered the hazards for all-cause mortality to 43% and 57%, respectively. Notably, the anthropometric indices involving the CC with higher values seemed to be surrogate markers for the reduction of the risk of all-cause, cardiovascular and malignancy-related mortality (all P < 0.05). The CCmay be a valuable tool to guide public health policy and a clinical prognostic indicator for the risk of mortality.

Falls among older adults in the South of Brazil: prevalence and determinants

OBJECTIVE

Evaluate the prevalence and the factors associated with the occurrence of falls among older adults.

METHODS

A cross-sectional study with a representative sample of 1,451 elderly residents in the urban area of Pelotas, RS, in 2014. A descriptive analysis of the data was performed and the prevalence of falls in the last year was presented. The analysis of demographic, socioeconomic, behavioral and health factors associated with the outcome was performed using Poisson regression with adjustment for robust variance according to the hierarchical model. The variables were adjusted to each other within each level and for the higher level. Those with p ≤ 0.20 were maintained in the model for confounding control and those with p < 0.05 were considered to be associated with the outcome.

RESULTS

The prevalence of falls among older adults in the last year was 28.1% (95%CI 25.9–30.5), and most occurred in the person’s own residence. Among the older adults who fell, 51.5% (95%CI 46.6–56.4) had a single fall and 12.1% (95%CI 8.9–15.3) had a fracture as a consequence, usually in the lower limbs. The prevalence of falls was higher in women, adults of advanced age, with lower income and schooling level, with functional incapacity for instrumental activities, and patients with diseases such as diabetes, heart disease, and arthritis.

CONCLUSIONS

The occurrence of falls reached almost a third of the older adults, and the prevalence was higher in specific segments of the population in question. About 12% of the older adults who fell fractured some bone. The factors associated with the occurrence of falls identified in this study may guide measures aimed at prevention in the older adult population.

Joint association between body fat and its distribution with all-cause mortality: A data linkage cohort study based on NHANES (1988-2011)

Objective

Although obesity is recognized as an important risk of mortality, how the amount and distribution of body fat affect mortality risk is unclear. Furthermore, whether fat distribution confers any additional risk of mortality in addition to fat amount is not understood.

Methods

This data linkage cohort study included 16415 participants (8554 females) aged 18 to 89 years from National Health and Nutrition Examination Survey III (1988–1994) and its linked mortality data (31 December 2011). Cox proportional hazard models and parametric survival models were used to estimate the association between body fat percentage (BF%), based on bioelectrical impedance analysis, and waist-hip ratio (WHR) with mortality.

Results

A total of 4999 deaths occurred during 19-year follow-up. A U-shaped association between BF% and mortality was found in both sexes, with the adjusted hazard ratios for other groups between 1.02 (95% confidence interval: 0.89, 1.18) and 2.10 (1.47, 3.01) when BF% groups of 25–30% in males and 30–35% in females were used as references. A non-linear relationship between WHR and mortality was detected in males, with the adjusted hazard ratios among other groups ranging from 1.05 (0.94, 1.18) to 1.52 (1.15, 2.00) compared with the WHR category of 0.95–1.0. However in females, the death risk constantly increased across the WHR spectrum. Joint impact of BF% and WHR suggested males with BF% of 25–30% and WHR of 0.95–1.0 and females with BF% of 30–35% and WHR <0.9 were associated with the lowest mortality risk and longest survival age compared with their counterparts in other categories.

Conclusions

This study supported the use of body fat distribution in addition to fat amount in assessing the risk of all-cause mortality.

Bias in Hazard Ratios Arising From Misclassification According to Self-Reported Weight and Height in Observational Studies of Body Mass Index and Mortality

Misclassification of body mass index (BMI) categories arising from self-reported weight and height can bias hazard ratios in studies of BMI and mortality. We examined the effects on hazard ratios of such misclassification using national US survey data for 1976 through 2010 that had both measured and self-reported weight and height along with mortality follow-up for 48,763 adults and a subset of 17,405 healthy never-smokers. BMI was categorized as <22.5 (low), 22.5-24.9 (referent), 25.0-29.9 (overweight), 30.0-34.9 (class I obesity), and ≥35.0 (class II-III obesity). Misreporting at higher BMI categories tended to bias hazard ratios upwards for those categories, but that effect was augmented, counterbalanced, or even reversed by misreporting in other BMI categories, in particular those that affected the reference category. For example, among healthy male never-smokers, misclassifications affecting the overweight and the reference categories changed the hazard ratio for overweight from 0.85 with measured data to 1.24 with self-reported data. Both the magnitude and direction of bias varied according to the underlying hazard ratios in measured data, showing that findings on bias from one study should not be extrapolated to a study with different underlying hazard ratios. Because of misclassification effects, self-reported weight and height cannot reliably indicate the lowest-risk BMI category.

Body mass index as a biomarker for the evaluation of the "Obesity Paradox" among inpatients

BACKGROUND

Overweight and obesity are, on the one hand, recognized as risk factors for many health-related disorders, and, on the other, as favorable prognostic factors in various patients treated for several different conditions; what is called the "obesity paradox". Until now, the existence of this phenomenon among a general population of consecutive inpatients has not been evaluated. We decided, therefore, to perform an evaluation.

PATIENTS AND METHODS

Historical prospective analysis of the medical documentation of 23 603 hospitalizations during two consecutive years in one center was performed. The outcomes measured were as follows: length of stay, in-hospital all-cause mortality, and non-scheduled readmission in the 14-day, 30-day and one-year periods following discharge.

RESULTS

Overweight and obese patients had a lower or similar prevalence of the measured outcomes than malnourished patients and those of normal weight. Adjustment of the standard WHO BMI ranges for patients aged ≥65 y (normal weight BMI range 23-33 kg/m²) made these differences more apparent. In logistic regression, the ratio of fat to fat-free body mass was a stronger and unfavorable risk factor compared with BMI for the measured outcomes.

CONCLUSIONS

The greatest risk of all-cause in-hospital death and readmission concerned malnourished inpatients. Compared to patients with a normal BMI range, overweight and obesity had a lower or similar (but not greater) risk of the outcomes measured. However, due to several BMI limitations, our observations should be interpreted as suggesting a "BMI paradox", rather than an "obesity paradox".

Association of metabolic syndrome and its components with all-cause and cardiovascular mortality in the elderly: A meta-analysis of prospective cohort studies

There is increasing evidence regarding the relationship between metabolic syndrome and mortality. However, previous research examining metabolic syndrome and mortality in older populations has produced mixed results. In addition, there is a clear need to identify and manage individual components of metabolic syndrome to decrease cardiovascular disease (CVD) mortality. In this meta-analysis, we searched the MEDLINE databases using PubMed, Cochrane Library, and EMBASE databases. Based on 20 prospective cohort studies, metabolic syndrome was associated with a higher risk of all-cause mortality [relative risk (RR), 1.23; 95% confidence interval (CI), 1.15-1.32; I = 55.9%] and CVD mortality (RR, 1.24; 95% CI, 1.11-1.39; I = 58.1%). The risk estimates of all-cause mortality for single components of metabolic syndrome were significant for higher values of waist circumference or body mass index (RR, 0.94; 95% CI, 0.88-1.00), higher values of blood glucose (RR, 1.19; 95% CI, 1.05-1.34), and lower values of high-density lipoprotein (HDL) cholesterol (RR, 1.11; 95% CI, 1.02-1.21). In the elderly population, metabolic syndrome was associated with an increased risk of all-cause and CVD mortality. Among the individual components of metabolic syndrome, increased blood glucose and HDL cholesterol levels were significantly associated with increased mortality. However, older obese or overweight individuals may have a decreased mortality risk. Thus, the findings of the current meta-analysis raise questions about the utility of the definition of metabolic syndrome in predicting all-cause mortality and CVD mortality in the elderly population.

Mango Supplementation Has No Effects on Inflammatory Mediators in Obese Adults

This pilot study examined the effects of freeze-dried mango (Mangifera indica L.) supplementation on anthropometric measurements, lipid parameters, and inflammatory mediators in obese individuals. A total of 20 obese (body mass index [BMI]: 30-35 kg/m2) adults (11 men and 9 women), aged 20 to 50 years, received 10 g/d of ground freeze-dried mango pulp for 12 weeks. Anthropometrics, lipids, and inflammatory mediators were assessed at baseline and after 12 weeks of mango supplementation. There were no differences between baseline and final visits in inflammatory mediators, lipids, diet, physical activity, and anthropometrics. Relationships were present at baseline and final visits between adiponectin and high-density lipoprotein cholesterol and between leptin and fat mass. Correlations were found after 12 weeks of mango supplementation between leptin and the following variables: waist-to-height ratio, BMI, percent fat, and fat mass. Our findings demonstrate that 12-week consumption of freeze-dried mango by obese individuals has no impact on obesity-related inflammation.

Body Mass Index, Waist Circumference, and Mortality in a Large Multiethnic Postmenopausal Cohort-Results from the Women's Health Initiative

OBJECTIVES

To determine whether the relationship between anthropometric measurements of obesity and mortality varies according to age, race, and ethnicity in older women.

DESIGN

Prospective cohort study of multiethnic postmenopausal women.

SETTING

Women's Health Initiative (WHI) observational study and clinical trials in 40 clinics.

PARTICIPANTS

Postmenopausal women aged 50-79 participating in WHI (N = 161,808).

MEASUREMENTS

Baseline height, weight, and waist circumference (WC) were measured, and body mass index (BMI) was calculated based on height and weight. Demographic, health, and lifestyle data from a baseline questionnaire were used as covariates. The outcome was adjudicated death (n = 18,320) during a mean follow-up of 11.4 ± 3.2 years.

RESULTS

Hazard ratios (HRs) and 95% confidence intervals (95% CIs) indicated that ethnicity and age modified (P < .01) the relationship between obesity and mortality. Underweight was associated with higher mortality, but overweight or slight obesity was not a risk factor for mortality in most ethnic groups except for Hispanic women in the obesity I category (HR = 1.42, 95% CI = 1.04-1.95). BMI was not or was only weakly associated with mortality in individuals aged 70-79 (HR = 0.90, 95% CI = 0.85-0.95 for overweight; HR = 0.98, 95 CI = 0.92-1.06 for obese I; HR = 1.11, 95% CI = 1.00-1.23 for obese II; HR = 1.08, 95% CI = 0.92-1.26 for obese III). In contrast, higher central obesity measured using WC was consistently associated with higher mortality in all groups.

CONCLUSION

Underweight is a significant risk factor for mortality in older women, and healthy BMI ranges may need to be specific for age, race, and ethnicity. The findings support a consistent relationship between central obesity and mortality.

Association between body shape index and small dense LDL particles in a cohort of mediterranean women: findings from Progetto ATENA

Small dense LDL particles (sd-LDL) and body shape index (ABSI), were evaluated in 228 women, living in Naples, Italy (Progetto ATENA). Serum cholesterol, HDL-cholesterol, LDL-cholesterol, triglycerides, insulin, HOMA, Apo B, hs-CPR and sd-LDL were measured. LDL particle separation was performed by Lipoprint System: seven LDL subfractions were obtained and LDL score (% of sd-LDL particles) calculated. ABSI was calculated according to Krakauer’s formula: ABSI (m^11/6 kg^−2/3). The association between sd-LDL and ABSI was evaluated taking into account different adjustment models. Women with elevated levels of ABSI show the following OR of having high LDL score: 2.39, p = 0.002; unadjusted; 2.47, p = 0.002; adjusted for age; 2.13, p = 0.011; adjusted for age and Apo B; 1.93, p = 0.026; adjusted for age and Apo B and triglycerides. ABSI was associated with elevated LDL score independently of age, Systolic pressure, Apo B and triglycerides. Median of LDL diameter decreased among ABSI quartiles: quartile I: 271.5 nm, quartile II: 270.7 nm, quartile III 270.5 nm, quartile IV 269.4 nm; Kruskall Wallis Test: p = 0.016. These results are in line with the hypothesis that ABSI could be a marker of visceral abdominal associated to adverse metabolic changes including presence of elevated sd-LDL, a risk factor for premature cardiovascular disease.

The association between A Body Shape Index and mortality: Results from an Australian cohort

It is well recognised that obesity increases the risk of premature death. A Body Shape Index (ABSI) is a formula that uses waist circumference (WC), body mass index (BMI) and height to predict risk of premature mortality, where a high score (Quartile 4) indicates that a person's WC is more than expected given their height and weight. Our study examines the association between ABSI quartiles and all-cause-, cardiovascular- and cancer-related mortality, and primary cause of death. Self-reported demographic and biomedically measured health-related risk factor and weight data was from the baseline stage of the North West Adelaide Health Study (1999-2003, n = 4056), a longitudinal cohort of Australian adults. Death-related information was obtained from the National Death Index. Primary cause of death across ABSI quartiles was examined. The association between mortality and ABSI (quartile and continuous scores) was investigated using a Cox proportional hazards survival model and adjusting for socioeconomic, and self-reported and biomedical risk factors. The proportion of all three types of mortality steadily increased from ABSI Quartile 1 through to Quartile 4. After adjusting for demographic and health-related risk factors, the risk of all-cause mortality was higher for people in ABSI Quartile 4 (HR 2.64, 95% CI 01.56-4.47), and ABSI Quartile 3 (HR 1.95, 95% CI 1.15-3.33), with a moderate association for the continuous ABSI score (HR 1.32, 95% CI 1.18-1.48). ABSI is therefore positively associated with mortality in Australian adults. Different combined measures of obesity such as the ABSI are useful in examining mortality risk.