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Lee TL, Lin FJ, Yeh CF, Hsiao YC, Yang KC, Hsuan CF, Wu CC. Evaluating the potential of waist-to-BMI ratio, a body shape index, and other anthropometric parameters in predicting cardiovascular disease mortality: evidence from NHANES III. BMC Public Health 2025; 25:1828. [PMID: 40382539 PMCID: PMC12085018 DOI: 10.1186/s12889-025-22944-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2025] [Accepted: 04/25/2025] [Indexed: 05/20/2025] Open
Abstract
BACKGROUND Anthropometric measures can be obtained easily and quickly and have the potential for prognostic stratification in the context of cardiovascular disease (CVD). This study evaluates the prognostic value of the waist-to-BMI ratio, a body shape index (ABSI), body roundness index (BRI), waist circumference (WC), and body mass index (BMI) for CVD mortality prediction in the general population, compared with the Framingham risk score (FRS). METHODS Data of participants from the United States Third National Health and Nutrition Examination Survey (NHANES III) (1988 to 1994), aged 40-79 years with complete data were extracted and analyzed. Cox regression, receiver operating characteristic (ROC) curve analysis, and the C-index were used to determine the predictive value of the anthropometric parameters for CVD mortality, with follow-up through the end of 2019 via the National Center for Health Statistics (NCHS) Linked Mortality File. RESULTS After applying inclusion and exclusion criteria, 6,746 individuals (mean age 57.6 years) were analyzed. Cox regression indicated significant associations between BMI, WC, waist-to-BMI ratio, BRI, ABSI, and increased CVD mortality risk (adjusted hazard ratios [aHR] = 1.11, 1.19, 1.07, 1.12, and 1.13, respectively). ROC analysis revealed that FRS had the best performance for predicting 10-year CVD mortality (AUC = 0.7252), followed by ABSI (0.6407) and waist-to-BMI ratio (0.6120). Time-dependent AUC analyses confirmed FRS had the highest C-index (0.7004), followed by ABSI (0.6358) and waist-to-BMI ratio (0.5807). CONCLUSIONS Our study suggests that, among the anthropometric measures studied, ABSI and waist-to-BMI ratio may offer predictive capability for CVD mortality in the general US population. The simplicity of measuring and calculating the waist-to-BMI ratio enhances its practicality, making it a potentially useful tool, particularly when other clinical factors are not available. CLINICAL TRIAL NUMBER Not applicable.
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Affiliation(s)
- Thung-Lip Lee
- Division of Cardiology, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, 824005, Taiwan
- School of medicine for International Students, College of Medicine, I-Shou University, Kaohsiung, 824005, Taiwan
| | - Fang-Ju Lin
- Graduate Institute of Clinical Pharmacy & School of Pharmacy, College of Medicine, National Taiwan University, Taipei, 100233, Taiwan
- Department of Pharmacy, National Taiwan University Hospital, Taipei, 100225, Taiwan
| | - Chih-Fan Yeh
- Division of Cardiology and Cardiovascular Center, Department of Internal Medicine, National Taiwan University Hospital, Taipei, 100225, Taiwan
| | - Yu-Chung Hsiao
- Division of Cardiology and Cardiovascular Center, Department of Internal Medicine, National Taiwan University Hospital, Taipei, 100225, Taiwan
| | - Kai-Chien Yang
- Division of Cardiology and Cardiovascular Center, Department of Internal Medicine, National Taiwan University Hospital, Taipei, 100225, Taiwan
- Department and Graduate Institute of Pharmacology, National Taiwan University College of Medicine, Taipei, 100233, Taiwan
| | - Chin-Feng Hsuan
- Division of Cardiology, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, 824005, Taiwan.
- Division of Cardiology, Department of Internal Medicine, E-Da Dachang Hospital, I-Shou University, Kaohsiung, 807066, Taiwan.
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, 824005, Taiwan.
- Division of Cardiology, Department of Internal Medicine, E-Da Dachang Hospital, No. 305, Dachang 1st Road, Sanmin District, Kaohsiung City, 807066, Taiwan.
| | - Chau-Chung Wu
- Division of Cardiology and Cardiovascular Center, Department of Internal Medicine, National Taiwan University Hospital, Taipei, 100225, Taiwan
- Graduate Institute of Medical Education & Bioethics, College of Medicine, National Taiwan University, Taipei, 100233, Taiwan
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Zhang Y, Gu X, Lv H, Wan D, Wu Y, Wu J. Diabetes is the missing link between cardiometabolic index and gallstones: a large cross-sectional study. Sci Rep 2025; 15:9947. [PMID: 40121318 PMCID: PMC11929793 DOI: 10.1038/s41598-025-93908-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2024] [Accepted: 03/10/2025] [Indexed: 03/25/2025] Open
Abstract
The cardiometabolic index (CMI), which integrates individual lipid and visceral fat parameters, represents a superior new predictive tool for cardiovascular and metabolic disorders, but its predictive value for gallstones (GS) is unclear. Therefore, the present study used this vacancy to explore the relationship between CMI levels and GS in US adults, assess the mediating role of diabetes mellitus in the pathogenesis of both, and provide new clinical ideas for early prevention and screening of GS in patients with diabetes mellitus. This survey extracted information from the National Health and Nutrition Examination Survey (NHANES) 2017-2020 vintage cycle. Cross-sectional analyses and a variety of statistical techniques were used to analyze the correlation between CMI and GS, including logistic regression, propensity score matching, subject work curves, and restricted cubic spline (RCS). Furthermore, mediation analysis was used to investigate whether and to what extent diabetes mediated the effect of CMI on GS. After analysis of 3,395 participants, a significant positive correlation was observed between elevated CMI levels and increased prevalence of GS In the fully corrected model (Model 4), the prevalence of GS exhibited a 23% increase for every incremental unit rise in logarithmically transformed CM. Mediation analysis showed that diabetes largely mediated the association between CMI and GS, with a mediation ratio of 15.1%. Higher CMI levels are closely linked to a greater occurrence of GS, and diabetes plays a key mediating role in the pathogenesis of both. Addressing dyslipidemia while not neglecting blood glucose levels, and co-management of the two may be a proven way to reduce GS risk.
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Affiliation(s)
- Yu Zhang
- Department of Gastrointestinal Surgery, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi Medical Center, Wuxi, Jiangsu, China
| | - Xiangqian Gu
- Department of Hepatobiliary Surgery, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi Medical Center, Wuxi, Jiangsu, China
| | - Hua Lv
- Department of Neurosurgery, Yixing People's Hospital Affiliated to Jiangsu University, Yixing, Jiangsu, China
| | - Daiwei Wan
- Department of Gastrointestinal Surgery, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi Medical Center, Wuxi, Jiangsu, China.
| | - Yilin Wu
- Department of Emergency Medicine, Run Run Shaw Hospital affiliated to Zhejiang University School of Medicine, Hangzhou, China.
| | - Ji Wu
- Department of Hand and Foot Surgery, Affiliated Huishan Hospital of Xinglin College, Nantong University, Wuxi Huishan District People's Hospital, Wuxi, China.
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Sorlí JV, de la Cámara E, González JI, Portolés O, Giménez-Alba IM, Fernández-Carrión R, Coltell O, González-Monje I, Saiz C, Pascual EC, Villamil LV, Corella D, Asensio EM, Ortega-Azorín C. From Liking to Following: The Role of Food Preferences, Taste Perception, and Lifestyle Factors in Adherence to the Mediterranean Diet Among Young Individuals. Nutrients 2025; 17:600. [PMID: 39940456 PMCID: PMC11820210 DOI: 10.3390/nu17030600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2025] [Revised: 01/27/2025] [Accepted: 02/04/2025] [Indexed: 02/16/2025] Open
Abstract
BACKGROUND AND AIMS The Mediterranean diet (MedDiet) is a healthy dietary pattern associated with reduced risk of chronic diseases. However, adherence is declining, particularly among younger populations. Therefore, it is crucial to identify the main aspects that affect its adherence, particularly food preferences and sensory function, which have received insufficient attention. Our aims were to investigate the impact of socio-demographic and lifestyle factors on adherence to the MedDiet among young individuals; to assess the association of taste preferences and food liking with MedDiet adherence; and to evaluate the associations between taste perception modalities, taste and food preferences, and adherence. METHODS A cross-sectional study on young adults (aged 20.5 ± 4.7 years) in a Mediterranean country (n = 879) was carried out. Demographic characteristics, clinical characteristics, anthropometric characteristics, lifestyle characteristics, MedDiet adherence, taste preferences, and food preferences were assessed. Taste perception for bitter, salty, sweet, sour, and umami was determined by rating different concentrations of prototypical tastants. We computed a total taste perception score and three scores to combine food preferences. RESULTS We identified several socio-demographic and lifestyle factors associated with adherence to the MedDiet, as well as food preferences, taste preferences, and taste perception determinants. Food preferences were significantly associated with total adherence to the MedDiet. Higher preference for olive oil, oranges, broccoli, fish, and legumes was associated with higher MedDiet adherence (p < 0.05 for all). Conversely, higher preference for sweet foods, red meat, and butter was associated with lower adherence (p < 0.05 for all). The combined positive score for food preference was strongly associated with higher MedDiet adherence (p = 1.4 × 10-23) in the multivariate adjusted model. The combined negative food preference score was inversely associated (p = 1.9 × 10-8). Likewise, taste preferences were significantly associated with adherence to the MedDiet (strong inverse association for sweet taste preference and direct association for bitter taste preference; both p < 0.001). Moreover, bitter taste perception was inversely associated with adherence to the MedDiet and with bitter foods (p < 0.05). In conclusion, future precision nutrition studies should measure food liking and taste preferences, which are crucial determinants of MedDiet adherence, especially in young people.
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Affiliation(s)
- José V. Sorlí
- Department of Preventive Medicine and Public Health, School of Medicine, University of Valencia, 46010 Valencia, Spain; (E.d.l.C.); (J.I.G.); (O.P.); (I.M.G.-A.); (R.F.-C.); (I.G.-M.); (C.S.); (E.C.P.); (L.V.V.); (E.M.A.); (C.O.-A.)
- CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, 28029 Madrid, Spain;
| | - Edurne de la Cámara
- Department of Preventive Medicine and Public Health, School of Medicine, University of Valencia, 46010 Valencia, Spain; (E.d.l.C.); (J.I.G.); (O.P.); (I.M.G.-A.); (R.F.-C.); (I.G.-M.); (C.S.); (E.C.P.); (L.V.V.); (E.M.A.); (C.O.-A.)
- Servicio de Oftalmología, Hospital Clínico Universitario Lozano Blesa, 50009 Zaragoza, Spain
| | - José I. González
- Department of Preventive Medicine and Public Health, School of Medicine, University of Valencia, 46010 Valencia, Spain; (E.d.l.C.); (J.I.G.); (O.P.); (I.M.G.-A.); (R.F.-C.); (I.G.-M.); (C.S.); (E.C.P.); (L.V.V.); (E.M.A.); (C.O.-A.)
- CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, 28029 Madrid, Spain;
| | - Olga Portolés
- Department of Preventive Medicine and Public Health, School of Medicine, University of Valencia, 46010 Valencia, Spain; (E.d.l.C.); (J.I.G.); (O.P.); (I.M.G.-A.); (R.F.-C.); (I.G.-M.); (C.S.); (E.C.P.); (L.V.V.); (E.M.A.); (C.O.-A.)
- CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, 28029 Madrid, Spain;
| | - Ignacio M. Giménez-Alba
- Department of Preventive Medicine and Public Health, School of Medicine, University of Valencia, 46010 Valencia, Spain; (E.d.l.C.); (J.I.G.); (O.P.); (I.M.G.-A.); (R.F.-C.); (I.G.-M.); (C.S.); (E.C.P.); (L.V.V.); (E.M.A.); (C.O.-A.)
- CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, 28029 Madrid, Spain;
| | - Rebeca Fernández-Carrión
- Department of Preventive Medicine and Public Health, School of Medicine, University of Valencia, 46010 Valencia, Spain; (E.d.l.C.); (J.I.G.); (O.P.); (I.M.G.-A.); (R.F.-C.); (I.G.-M.); (C.S.); (E.C.P.); (L.V.V.); (E.M.A.); (C.O.-A.)
- CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, 28029 Madrid, Spain;
| | - Oscar Coltell
- CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, 28029 Madrid, Spain;
- Department of Computer Languages and Systems, Universitat Jaume I, 12071 Castellón, Spain
| | - Inmaculada González-Monje
- Department of Preventive Medicine and Public Health, School of Medicine, University of Valencia, 46010 Valencia, Spain; (E.d.l.C.); (J.I.G.); (O.P.); (I.M.G.-A.); (R.F.-C.); (I.G.-M.); (C.S.); (E.C.P.); (L.V.V.); (E.M.A.); (C.O.-A.)
| | - Carmen Saiz
- Department of Preventive Medicine and Public Health, School of Medicine, University of Valencia, 46010 Valencia, Spain; (E.d.l.C.); (J.I.G.); (O.P.); (I.M.G.-A.); (R.F.-C.); (I.G.-M.); (C.S.); (E.C.P.); (L.V.V.); (E.M.A.); (C.O.-A.)
- CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, 28029 Madrid, Spain;
| | - Eva C. Pascual
- Department of Preventive Medicine and Public Health, School of Medicine, University of Valencia, 46010 Valencia, Spain; (E.d.l.C.); (J.I.G.); (O.P.); (I.M.G.-A.); (R.F.-C.); (I.G.-M.); (C.S.); (E.C.P.); (L.V.V.); (E.M.A.); (C.O.-A.)
| | - Laura V. Villamil
- Department of Preventive Medicine and Public Health, School of Medicine, University of Valencia, 46010 Valencia, Spain; (E.d.l.C.); (J.I.G.); (O.P.); (I.M.G.-A.); (R.F.-C.); (I.G.-M.); (C.S.); (E.C.P.); (L.V.V.); (E.M.A.); (C.O.-A.)
- Department of Physiology, School of Medicine, University Antonio Nariño, Bogotá 111511, Colombia
| | - Dolores Corella
- Department of Preventive Medicine and Public Health, School of Medicine, University of Valencia, 46010 Valencia, Spain; (E.d.l.C.); (J.I.G.); (O.P.); (I.M.G.-A.); (R.F.-C.); (I.G.-M.); (C.S.); (E.C.P.); (L.V.V.); (E.M.A.); (C.O.-A.)
- CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, 28029 Madrid, Spain;
| | - Eva M. Asensio
- Department of Preventive Medicine and Public Health, School of Medicine, University of Valencia, 46010 Valencia, Spain; (E.d.l.C.); (J.I.G.); (O.P.); (I.M.G.-A.); (R.F.-C.); (I.G.-M.); (C.S.); (E.C.P.); (L.V.V.); (E.M.A.); (C.O.-A.)
- CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, 28029 Madrid, Spain;
| | - Carolina Ortega-Azorín
- Department of Preventive Medicine and Public Health, School of Medicine, University of Valencia, 46010 Valencia, Spain; (E.d.l.C.); (J.I.G.); (O.P.); (I.M.G.-A.); (R.F.-C.); (I.G.-M.); (C.S.); (E.C.P.); (L.V.V.); (E.M.A.); (C.O.-A.)
- CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, 28029 Madrid, Spain;
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Arizpe A, Chapman TM, Rodriguez C, Carvajal A, Queen KJ, Navarro S, Ochoa-Dominguez CY, Kim. SE, Toledo-Corral CM, Farias AJ. Alcohol and Cannabis Use Associated with Cardiometabolic Biomarkers among "All of Us" Cancer Survivors. Cancer Epidemiol Biomarkers Prev 2025; 34:51-58. [PMID: 39526879 PMCID: PMC11737210 DOI: 10.1158/1055-9965.epi-24-1241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2024] [Revised: 10/17/2024] [Accepted: 11/07/2024] [Indexed: 11/16/2024] Open
Abstract
BACKGROUND Cancer survivors are at increased risk for cardiometabolic comorbidities following cancer treatment, which may be further exacerbated by cannabis and alcohol use. We aimed to examine the direct relationships of cannabis, alcohol, and the co-use of both substances with cardiometabolic risk factors and to explore disparities by race/ethnicity and sex. METHODS Cross-sectional data were extracted from adult cancer survivors in the "All of Us" from 2018 to 2022. Cannabis use was defined as occasional or frequent/regular cannabis use (vs. never) in the past 3 months and hazardous alcohol intake (AUDIT-C >3 for females; AUDIT-C >4 for males) versus nonhazardous in the past year, respectively. Co-use was defined as participants who engaged in regular cannabis and hazardous alcohol intake. We identified binary cardiovascular, immune, and metabolic system biomarkers, with high values defined by clinically established cutoffs or >75th percentile. We used multivariable logistic regression adjusting for sociodemographic and clinical factors. RESULTS In our sample (N = 7,054), 7.6% were Hispanic, 6.2% were Black, and 86.2% were White cancer survivors. Less than 5% of Hispanic and White survivors reported substance co-use compared with 7% of Black survivors. Compared with never-users, co-users were 1.58 (95% confidence interval, 1.14-2.19) more likely to have high blood pressure. No significant associations were found between co-use and immune biomarkers or sex differences. CONCLUSIONS Co-use of cannabis and hazardous alcohol may worsen high blood pressure in survivors, who are at higher risk for cardiometabolic comorbidities. IMPACT The study investigates substance use and cardiometabolic biomarkers, urging much research on their effects on cancer survivors.
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Affiliation(s)
- Angel Arizpe
- Department of Population and Public Health Sciences, Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - Tiffany M Chapman
- Department of Population and Public Health Sciences, Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - Claudia Rodriguez
- Department of Population and Public Health Sciences, Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - Alberto Carvajal
- Department of Population and Public Health Sciences, Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - Katelyn J Queen
- Department of Medicine, Division of Hematology-Oncology, University of California, Los Angeles, Los Angeles, CA
| | - Stephanie Navarro
- Department of Population and Public Health Sciences, Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - Carol Y. Ochoa-Dominguez
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, San Diego, CA
| | - Sue E Kim.
- Department of Population and Public Health Sciences, Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | | | - Albert J. Farias
- Department of Population and Public Health Sciences, Keck School of Medicine of the University of Southern California, Los Angeles, CA
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Rezaianzadeh A, Johari MG, Baeradeh N, Seif M, Hosseini SV. Sex differences in hypertension incidence and risk factors: a population-based cohort study in Southern Iran. BMC Public Health 2024; 24:3575. [PMID: 39716231 DOI: 10.1186/s12889-024-21082-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2024] [Accepted: 12/12/2024] [Indexed: 12/25/2024] Open
Abstract
BACKGROUND Hypertension (HTN) is a major global public health concern. This study aims to identify gender differences to inform more effective prevention strategies and targeted management approaches. METHODS This prospective cohort study included 7,710 participants aged 40 to 70 years, with a mean follow-up duration of 5.2 years. HTN was defined using European hypertension management guidelines. A Cox regression model was employed to determine factors associated with HTN, adjusting for confounding variables effects. RESULTS During the mean follow-up period of 5.2 years, the incidence rate of hypertension was 21.54 per 1,000 person-years, with females exhibiting a higher incidence than males. Several significant predictors of HTN were identified. In men, key risk factors included age (60-70 years, 2.83-fold increase, 95% CI 2.05-3.92), high waist-to-height ratio (5.63-fold increase, 95% CI 2.42-13.07), smoking (2.68-fold increase, 95% CI 1.04-6.91), and opium use (1.93-fold increase, 95% CI 1.06-3.49). In women, significant predictors included age (60-70 years, 3.65-fold increase, 95% CI 2.59-5.15), contraceptive drug use (1.24-fold increase, 95% CI 1.01-1.52), high waist-to-height ratio (1.87-fold increase, 95% CI 1.19-2.92), pre-HTN (3.64-fold increase, 95% CI 3.01-4.40), and kidney stones (1.32-fold increase, 95% CI 1.06-1.65). CONCLUSION This study identified key predictors of hypertension (HTN) with notable gender differences. For men, significant risk factors included age, high waist-to-height ratio, smoking, and opium use; for women, the prominent predictors were age, contraceptive use, pre-HTN, and kidney stones. These findings highlight the need for gender-specific strategies in HTN prevention and management, focusing on modifiable risk factors by gender.
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Affiliation(s)
- Abbas Rezaianzadeh
- Department of Community Medicine School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Masoumeh Ghoddusi Johari
- Assistant Professor of Community Medicine, Breast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Najibullah Baeradeh
- Department of Public Health, Ferdows Faculty of Medical Sciences, Birjand University of Medical Sciences, Birjand, Iran.
| | - Mozhgan Seif
- Department of Epidemiology, School of Health, Non-Communicable Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyed Vahid Hosseini
- Department of Community Medicine School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Wu Z, Huang Z, Sun L, Fu Y, Chen S, Wu S, Gao X. Neck circumference, waist-to-height ratio, Chinese visceral adiposity index and incident heart failure. Nutr J 2024; 23:149. [PMID: 39609796 PMCID: PMC11604003 DOI: 10.1186/s12937-024-01048-7] [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: 06/18/2024] [Accepted: 11/13/2024] [Indexed: 11/30/2024] Open
Abstract
BACKGROUND The indicators of abdominal obesity have shown to be associated with a high risk of cardiovascular diseases (CVDs), even adjusted for body mass index (BMI). We aimed to investigate the association between neck circumference, waist-to-height ratio (WHtR), Chinese visceral adiposity index (CVAI) and incident heart failure (HF) in Chinese adults. METHODS The current study included 86,546 participants from two independent cohorts: the Kailuan I study established in 2006 and the Kailuan study II established in 2008. Participants aged 18-80 years who were free of CVDs or cancer were recruited at baseline. The values of neck circumference, WHtR and CVAI were available in 2014. The trajectory analysis was conducted using repeated measures of WHtR and CVAI in the 2008, 2010, 2012 and 2014 surveys. The incident HF cases were identified via reviewing medical records by cardiologists. RESULTS During a mean follow-up of 5.62 years, 724 incident HF cases were documented. The highest quartiles of neck circumference, WHtR and CVAI respectively, were significantly associated with a high risk of HF compared to the lowest quartiles of adiposity measures (neck circumference: HR:1.30, 95%CI: 1.03-1.65; WHtR: HR:1.49, 95%CI: 1.16-1.92; and CVAI: HR:1.98, 95%CI: 1.48-2.65). The combination of adiposity measures with BMI or metabolic abnormalities jointly predicted incident HF. Presence of hypertension and diabetes appeared to be the major mediators, accounting for ∼ 8.11-24.7% of the associations between three indicators of abdominal obesity and HF risk. CONCLUSION The new indices of abdominal adiposity could help to identify those who were at a high risk of HF, especially in the presence of high BMI or metabolic abnormalities.
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Affiliation(s)
- Zhijun Wu
- Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Zhe Huang
- Department of Cardiology, Kailuan General Hospital, 57 Xinhua East Rd, Tangshan, 063000, People's Republic of China
| | - Liang Sun
- Department of Nutrition and Food Hygiene, School of Public Health, Institute of Nutrition, Fudan University, 130 Dongan Rd, Shanghai, 200032, People's Republic of China
| | - Yuang Fu
- Department of Nutrition and Food Hygiene, School of Public Health, Institute of Nutrition, Fudan University, 130 Dongan Rd, Shanghai, 200032, People's Republic of China
| | - Shuohua Chen
- Department of Cardiology, Kailuan General Hospital, 57 Xinhua East Rd, Tangshan, 063000, People's Republic of China
| | - Shouling Wu
- Department of Cardiology, Kailuan General Hospital, 57 Xinhua East Rd, Tangshan, 063000, People's Republic of China.
| | - Xiang Gao
- Department of Nutrition and Food Hygiene, School of Public Health, Institute of Nutrition, Fudan University, 130 Dongan Rd, Shanghai, 200032, People's Republic of China.
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Tian Y, Tang X, Liu Y, Liu SY. Mendelian randomization studies of lifestyle-related risk factors for stroke: a systematic review and meta-analysis. Front Endocrinol (Lausanne) 2024; 15:1379516. [PMID: 39558973 PMCID: PMC11570884 DOI: 10.3389/fendo.2024.1379516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 10/14/2024] [Indexed: 11/20/2024] Open
Abstract
Objective Stroke risk factors often exert long-term effects, and Mendelian randomization (MR) offers significant advantages over traditional observational studies in evaluating the causal impact of these factors on stroke. This study aims to consolidate and evaluate the relationships between potential causal factors and stroke risk, drawing upon existing MR research. Methods A comprehensive search for MR studies related to stroke was conducted up to August 2023 using databases such as PubMed, Web of Science, Embase, and Scopus. This meta-analysis examines the relationships between potential causative factors and stroke risk. Both random-effects and fixed-effects models were utilized to compile the dominance ratios of various causative elements linked to stroke. The reliability of the included studies was assessed according to the Strengthening the Reporting of Observational Studies in Epidemiology incorporating Mendelian Randomization (STROBE-MR) guidelines. Results The analysis identified several risk factors for stroke, including obesity, hypertension, low-density lipoprotein cholesterol (LDL-C), chronic kidney disease (CKD), and smoking. Protective factors included high-density lipoprotein cholesterol (HDL-C), estimated glomerular filtration rate (eGFR), and educational attainment. Subgroup analysis revealed that type 2 diabetes mellitus (T2DM), diastolic blood pressure (DBP) are risk factors for ischemic stroke (IS). Conclusion This study confirms that variables such as obesity, hypertension, elevated LDL-C levels, CKD, and smoking are significantly linked to the development of stroke. Our findings provide new insights into genetic susceptibility and potential biological pathways involved in stroke development. Systematic review registration https://www.crd.york.ac.uk/PROSPERO, identifier CRD42024503049.
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Affiliation(s)
- Yi Tian
- School of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Xin Tang
- School of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Yi Liu
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA, United States
| | - Shu Yi Liu
- General Practice, Chengdu Integrated Traditional Chinese Medicine (TCM) & Western Medicine Hospital, Chengdu, China
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Feng Q, Bešević J, Conroy M, Omiyale W, Woodward M, Lacey B, Allen N. Waist-to-height ratio and body fat percentage as risk factors for ischemic cardiovascular disease: a prospective cohort study from UK Biobank. Am J Clin Nutr 2024; 119:1386-1396. [PMID: 38839194 PMCID: PMC11196863 DOI: 10.1016/j.ajcnut.2024.03.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 03/06/2024] [Accepted: 03/22/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND The independent effect of waist-to-height ratio (WHtR) and body fat percentage (BF%) on ischemic cardiovascular disease (CVD) remains uncertain. OBJECTIVES This study aimed to investigate the independent associations of WHtR and BF% with ischemic CVD. METHODS This prospective cohort study used data from the UK Biobank. BF% was calculated as fat mass divided by body weight, measured by bioimpedance. Cox models estimated hazard ratios (HRs) with 95% confidence intervals (CIs) for overall and sex-specific associations of BF% and WHtR with risks of ischemic CVD and its main subtypes [myocardial infarction (MI) and ischemic stroke (IS)], adjusted for a range of potential confounders, including mutual adjustment for BF% and WHtR. RESULTS In total, 468,333 participants without existing CVD were included in the analysis. During 12 y of follow-up, 20,151 ischemic CVD events, 13,604 MIs, and 6681 ISs were recorded. WHtR was linearly associated with ischemic CVD, MI, and IS, with an HR per 5% increase of 1.23 (95% CI: 1.20, 1.25), 1.24 (95% CI: 1.21, 1.27), and 1.22 (95% CI: 1.18, 1.26), respectively, independent of BF%. A stronger association between WHtR and MI was seen in females than in males. The association of BF% with these outcomes was substantially attenuated in both sexes after adjustment for WHtR. For example, in females, the HR (highest compared with lowest fifth) was reduced from 1.94 (95% CI: 1.76, 2.15) to 1.04 (95% CI: 0.90, 1.01) for ischemic CVD, from 2.04 (95% CI: 1.79, 2.32) to 0.97 (95% CI: 0.81, 1.16) for MI, and from 1.81 (95% CI: 1.54, 2.13) to 1.07 (95% CI: 0.85, 1.33) for IS. CONCLUSIONS WHtR, when used as a proxy measure for central obesity, is linearly associated with ischemic CVD in both sexes, which is independent of BF%. In contrast, the relationship of BF% with these health outcomes is predominantly driven by its correlation with WHtR.
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Affiliation(s)
- Qi Feng
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom; JC School of Public Health and Primary Care, the Chinese University of Hong Kong, Hong Kong.
| | - Jelena Bešević
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom; UK Biobank, Stockport, United Kingdom
| | - Megan Conroy
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom; UK Biobank, Stockport, United Kingdom
| | - Wemimo Omiyale
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom; UK Biobank, Stockport, United Kingdom
| | - Mark Woodward
- The George Institute for Global Health, University of New South Wales, Newtown, NSW, Australia; The George Institute for Global Health, Imperial College London, London, United Kingdom
| | - Ben Lacey
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom; UK Biobank, Stockport, United Kingdom.
| | - Naomi Allen
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom; UK Biobank, Stockport, United Kingdom
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Feng Q, Kim JH, Xie J, Bešević J, Conroy M, Omiyale W, Wu Y, Woodward M, Lacey B, Allen N. Use of Sex-Specific Body Mass Index to Optimize Low Correlation With Height and High Correlation With Fatness: A UK Biobank Study. Am J Epidemiol 2024; 193:296-307. [PMID: 37814392 PMCID: PMC10840076 DOI: 10.1093/aje/kwad195] [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: 03/27/2023] [Revised: 07/21/2023] [Accepted: 10/05/2023] [Indexed: 10/11/2023] Open
Abstract
Body mass index (BMI; weight (kg)/height (m)2) is commonly used to measure general adiposity. However, evidence of its appropriateness for males and females remains inconsistent. We aimed to identify the most appropriate sex-specific power value that height should be raised to in the formula and the value that would make it achieve height independency and body fatness dependency. We randomly assigned UK Biobank participants recruited in the United Kingdom between 2006 and 2010 (n = 489,873; mean age = 56.5 years; 94.2% White) to training and testing sets (80%:20%). Using height raised to the power of -50.00 to 50.00, we identified the optimal power value that either minimized correlation with height or maximized correlation with body fat percentage, using age-adjusted correlations. The optimal power values for height were 1.77 for males and 1.39 for females. The new formulas resulted in 4.5% of females and 2.4% of males being reclassified into a different BMI category. The formulas did not show significant improvement (in terms of area under the receiver operating characteristic curve, sensitivity, and specificity) in identifying individuals with excessive body fat percentage or in predicting risk of all-cause mortality. Therefore, the conventional BMI formula is still valuable in research and disease screening for both sexes.
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Affiliation(s)
- Qi Feng
- Correspondence to Dr. Qi Feng, Nuffield Department of Population Health, Medical Sciences Division, University of Oxford, Old Road Campus, Headington, Oxford OX3 7LF, United Kingdom (e-mail: )
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Lee JH, Heo S, Kwon Y. Sex-Specific Comparison Between Triglyceride Glucose Index and Modified Triglyceride Glucose Indices to Predict New-Onset Hypertension in Middle-Aged and Older Adults. J Am Heart Assoc 2023; 12:e030022. [PMID: 37721166 PMCID: PMC10547265 DOI: 10.1161/jaha.123.030022] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 08/18/2023] [Indexed: 09/19/2023]
Abstract
Background Triglyceride and glucose (TyG) index and TyG-related indices combined with obesity-related markers are considered important markers of insulin resistance. We aimed to examine the association between the TyG index and modified TyG indices with new-onset hypertension and their predictive ability stratified by sex. Methods and Results We analyzed data from 5414 Korean Genome and Epidemiology Study participants aged 40 to 69 years. Multiple Cox proportional hazard regression analyses were conducted to estimate the hazard ratio (HR) and 95% CI for new-onset hypertension according to sex-specific tertile groups after confounder adjustments. To evaluate the predictive performance of these indices for new-onset hypertension, we calculated Harrell's C-index (95% CI). Over a 9.5-year follow-up period, 1014 men and 1012 women developed new-onset hypertension. Compared with the lowest tertile (T) group, the adjusted HR and 95% CI for new-onset hypertension in T3 for TyG, TyG-body mass index, TyG-waist circumference, and TyG-waist-to-height ratio were 1.16 (0.95-1.40), 1.11 (0.84-1.48), 1.77 (1.38-2.27), and 1.68 (1.33-2.13) in men and 1.37 (1.13-1.66), 1.55 (1.16-2.06), 1.43 (1.15-1.79), and 1.64 (1.30-2.07) in women, respectively. The C-indices of TyG-waist-to-height ratio for new-onset hypertension were significantly higher than those of TyG and TyG-body mass index in both men and women. Conclusions TyG and TyG-body mass index were significantly associated with new-onset hypertension only in women. TyG-waist circumference and TyG-waist-to-height ratio were significantly associated with new-onset hypertension in both men and women. A sex-specific approach is required when using TyG and modified TyG indices to identify individuals at risk of incident hypertension.
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Affiliation(s)
- Joo Hyung Lee
- Department of Family Medicine, Yongin Severance HospitalYonsei University College of MedicineYonginRepublic of Korea
| | - Seok‐Jae Heo
- Division of Biostatistics, Department of Biomedical Systems InformaticsYonsei University College of MedicineSeoulRepublic of Korea
| | - Yu‐Jin Kwon
- Department of Family Medicine, Yongin Severance HospitalYonsei University College of MedicineYonginRepublic of Korea
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Duangjai A, Phanthurat N, Sajjapong W, Ontawong A, Pengnet S, Yosboonruang A, Jongsomchai K, Thatsanasuwan N. Association of abdominal obesity and systolic blood pressure indices with cardiovascular disease risk prediction among community-dwelling older adults. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2023. [DOI: 10.29333/ejgm/12855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
<b>Background:</b> Excess adiposity is an established risk factor for cardiovascular disease (CVD), therefore the early screening indies with predicted CVD risk is more useful for older adults. The current study evaluated the associations between anthropometric, body composition and dietary indices and elevated 10-year CVD risk in older people.<br />
<b>Methods:</b> This research, which involved 55 to 94-year-olds living in the community. Standard techniques were used to determine anthropometric factors and body composition indicators. The risk prediction chart created by World Health Organization and International Society of Hypertension was used to calculate the CVD risk score. Odds ratio (OR) and 95% confidence interval (CI) were determined.<br />
<b>Results:</b> CVD risk prediction was positively correlated with the anthropometric and body composition parameters. After controlling for confounding variables, the logistic regression analysis revealed that waist circumference (OR=16.34; 95% CI: 7.22, 36.98; <i>p</i><0.001), systolic blood pressure (BP) (OR=9.53; 95% CI: 4.52, 20.07; <i>p</i><0.001), and visceral adipose tissue percentage (OR=5.47; 95% CI: 2.98, 10.01; <i>p</i><0.001) were correlated with cardiovascular risk prediction.<br />
<b>Conclusions:</b> Abdominal obesity and increase of systolic BP were associated to increased risk for CVD. Additionally, a positive association between the risk factors for CVD (%visceral adipose tissue) and diet (cholesterol consumption) was established.
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Affiliation(s)
- Acharaporn Duangjai
- Division of Physiology, School of Medical Sciences, University of Phayao, Phayao, THAILAND
| | - Naritsara Phanthurat
- Division of Nutrition and Dietetics, School of Medical Sciences, University of Phayao, Phayao, THAILAND
| | - Wittawas Sajjapong
- Division of Nutrition and Dietetics, School of Medical Sciences, University of Phayao, Phayao, THAILAND
| | - Atcharaporn Ontawong
- Division of Physiology, School of Medical Sciences, University of Phayao, Phayao, THAILAND
| | - Sirinat Pengnet
- Division of Physiology, School of Medical Sciences, University of Phayao, Phayao, THAILAND
| | - Atchariya Yosboonruang
- Division of Microbiology, School of Medical Sciences, University of Phayao, Phayao, THAILAND
| | - Kamonwan Jongsomchai
- Division of Anatomy, School of Medical Sciences, University of Phayao, Phayao, THAILAND
| | - Natthaphon Thatsanasuwan
- Division of Nutrition and Dietetics, School of Medical Sciences, University of Phayao, Phayao, THAILAND
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Serum Folate Related to Five Measurements of Obesity and High-Sensitivity C-Reactive Protein in Korean Adults. Nutrients 2022; 14:nu14173461. [PMID: 36079719 PMCID: PMC9459859 DOI: 10.3390/nu14173461] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/14/2022] [Accepted: 08/18/2022] [Indexed: 11/16/2022] Open
Abstract
This study investigated the effects of folic acid on obesity and high-sensitivity C-reactive protein (CRP) levels. Using data from the Korea National Health and Nutrition Examination Survey (KNHANES VII 2016–2018), 6394 adults (aged 19–80 years) who met the study criteria were identified and divided into young, middle-aged, and older adult groups. The analysis assessed associations using logistic regression for complex samples. Obesity was measured using body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR), a body shape index (ABSI), and body roundness index (BRI). The odds ratio (OR) of obesity based on BMI were statistically significant for young adults and older participants with low levels of folic acid compared to those with high levels (OR: 1.33 and 1.58, respectively). The OR of obesity based on BMI, WC, WHtR, ABSI, and BRI was significant with low levels of folic acid in middle-aged individuals (OR: 1.36, 1.32, 1.41, 1.29, and 1.47, respectively). Low folate levels were related to higher high-sensitivity CRP levels in middle-aged patients. In conclusion, folate level showed a significant inverse association with obesity and inflammatory biomarkers, especially in the middle-aged group. Further longitudinal or randomized controlled trials are needed to confirm and expand our results.
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