Are BMI and other anthropometric measures appropriate as indices for obesity? A study in an Asian population

Celiac artery mesenteric fat measurement with endosonography (CAMEUS) reliably correlates with obesity and related comorbidities

Background

Visceral fat represents a metabolically active entity linked to adverse metabolic sequelae of obesity. We aimed to determine if celiac artery mesenteric fat thickness can be reliably measured during endoscopic ultrasound (EUS), and if these measurements correlate with metabolic disease burden.

Methods

This was a retrospective analysis of patients who underwent celiac artery mesenteric fat measurement with endosonography (CAMEUS) measurement at a tertiary referral center, and a validation prospective trial of patients with obesity and nonalcoholic steatohepatitis who received paired EUS exams with CAMEUS measurement before and after six months of treatment with an intragastric balloon.

Results

CAMEUS was measured in 154 patients [56.5% females, mean age 56.5 ± 18.0 years, body mass index (BMI) 29.8 ± 8.0 kg/m2] and was estimated at 14.7 ± 6.5 mm. CAMEUS better correlated with the presence of non-alcoholic fatty liver disease (NAFLD) (R2 = 0.248, P < 0.001) than BMI (R2 = 0.153, P < 0.001), and significantly correlated with metabolic parameters and diseases. After six months of intragastric balloon placement, the prospective cohort experienced 11.7% total body weight loss, 1.3 points improvement in hemoglobin A1c (P = 0.001), and a 29.4% average decrease in CAMEUS (-6.4 ± 5.2 mm, P < 0.001). CAMEUS correlated with improvements in weight (R2 = 0.368), aspartate aminotransferase to platelet ratio index (R2 = 0.138), and NAFLD activity score (R2 = 0.156) (all P < 0.05).

Conclusions

CAMEUS is a novel measure that is significantly correlated with critical metabolic indices and can be easily captured during routine EUS to risk-stratify susceptible patients. This station could allow for EUS access to sampling and therapeutics of this metabolic region.

Associations between body composition profile and hypertension in different fatty liver phenotypes

Background

It is currently unclear whether and how the association between body composition and hypertension varies based on the presence and severity of fatty liver disease (FLD).

Methods

FLD was diagnosed using ultrasonography among 6,358 participants. The association between body composition and hypertension was analyzed separately in the whole population, as well as in subgroups of non-FLD, mild FLD, and moderate/severe FLD populations, respectively. The mediation effect of FLD in their association was explored.

Results

Fat-related anthropometric measurements and lipid metabolism indicators were positively associated with hypertension in both the whole population and the non-FLD subgroup. The strength of this association was slightly reduced in the mild FLD subgroup. Notably, only waist-to-hip ratio and waist-to-height ratio showed significant associations with hypertension in the moderate/severe FLD subgroup. Furthermore, FLD accounted for 17.26% to 38.90% of the association between multiple body composition indicators and the risk of hypertension.

Conclusions

The association between body composition and hypertension becomes gradually weaker as FLD becomes more severe. FLD plays a significant mediating role in their association.

Abdominal obesity in Chinese patients undergoing hemodialysis and its association with all-cause mortality

Introduction

Obesity in patients undergoing hemodialysis is common. However, there is limited information on the relationship between obesity types defined by the combined body mass index (BMI) and waist circumference (WC) classification criteria and all-cause mortality in Chinese hemodialysis patients. Our objective was to determine the association between obesity types and all-cause mortality in hemodialysis patients.

Methods

We conducted a prospective cohort study including patients from 11 hemodialysis centers in Beijing. According to the World Health Organization's standards, patients were classified into 2 categories with WC and 4 categories with BMI and then followed up for 1 year. Kaplan-Meier survival analysis was used to compare the difference in the cumulative survival rate in different BMI and WC groups. A multivariate Cox regression analysis was used to determine the association between different types of obesity and all-cause mortality.

Results

A total of 613 patients were enrolled, the mean age was 63.8 ± 7.1 years old, and 42.1% were women. Based on the baseline BMI, there were 303 (49.4%) patients with normal weight, 227 (37.0%) with overweight, 37(6.0%) with obesity, and 46 (7.5%) with underweight. Based on the baseline WC, 346 (56.4%) patients had abdominal obesity. During a median follow-up of 52 weeks, 69 deaths occurred. Kaplan-Meier plots demonstrated a significant association of BMI categories (log-rank χ2 = 18.574, p<0.001) and WC categories (log-rank χ2 = 5.698, p=0.017) with all-cause death. With normal BMI and non-abdominal obesity as a reference, multivariate Cox regression analysis results showed that obesity (HR 5.36, 95% CI, 2.09-13.76, p<0.001), underweight (HR, 5.29, 95% CI, 2.32-12.07, p<0.001), normal weight combined with abdominal obesity (HR 2.61, 95% CI, 1.20-5.66, p=0.016), and overweight combined with abdominal obesity (HR 1.79, 95% CI, 1.03-3.73, p=0.031, respectively) were significantly associated with higher risks of all-cause mortality.

Conclusion

Our study indicated that abdominal obesity is common and associated with all-cause mortality among Chinese hemodialysis patients.

Blindspot in the evidence base: A systematic review of psychological interventions for children and adolescents with intellectual disabilities and co-occurring obesity

BACKGROUND

Children and adolescents with intellectual disabilities (C&A-ID) face many disadvantages in healthcare research and service delivery. Intellectual disabilities have been found to precipitate weight-related problems, and together, they may be indicators of rare genetic diseases (RGDs). C&A-ID may require support for health problems exacerbated by primary diagnoses. While it is generally agreed that C&A-ID have more complex needs than typically developing individuals, psychological services to address these needs are under-explored.

AIMS

This systematic review aimed to identify psychological interventions for weight management in C&A-ID.

METHOD

MEDLINE, PsycINFO, CINAHL, The Cochrane Library and SCOPUS were systematically searched. Data extraction and quality appraisal were performed for all eligible studies RESULTS: The search strategy yielded seven studies published in English between 2010 and 2022. All interventions addressed obesity through multi-disciplinary programmes and resulted in weight reductions, with most interventions theoretically influenced by principles of behaviourism. Quality appraisal revealed methodological weaknesses in six of seven studies, such as heterogeneity in samples, interventions, and outcome measures, disallowing meta-analyses and weakening the generalisability of interventions to diverse contexts and groups CONCLUSIONS AND IMPLICATIONS: A genuine disconnect between empirical evidence and services for C&A with complex needs was observed. This emphasises an urgency for increased inclusion in clinical and behavioural research and for robust enquiries to test/adapt psychological interventions for weight management for C&A-ID. The findings of this review hold clinical utility for clinicians working with C&A-ID, and with RGDs such as Bardet-Biedl, Prader-Willi and Down syndromes. Recommendations and a conceptual framework are provided herein for enhanced efficacy of interventions.

Anthropometric indices and their cut-off points in relation to type 2 diabetes among Ghanaian migrants and non-migrants: The RODAM study

AIMS

To compare body mass index (BMI), waist circumference (WC) and waist-to-hip ratio (WHR) as determinants of type 2 diabetes (T2DM) and determine optimal cut-offs in a sub-Saharan African population.

METHODS

Data from the RODAM study including Ghanaians aged 25-70 living in rural Ghana, urban Ghana and Europe were used. Logistic regression was used to assess associations between BMI, WC, WHR and T2DM status, by sex and site. Area under the curve (AUC) were constructed to discriminate between indices and establish performance and cut-off values.

RESULTS

WHR had the strongest association with T2DM in men and women across sites, except for rural men. The highest adjusted odds ratio (aOR) and AUC were in rural women for WHR (aOR = 2.09, 95%CI = 1.47-2.99; AUC = 0.71). Among migrants, WHR had higher AUCs compared with BMI (p < 0.01) and WC (p < 0.05). Cut-offs for BMI and WC in men were lower compared with the WHO reference across sites (WC: 85.4-93.7 vs 102 cm, BMI: 23.1-28.2 vs 30.0 kg/m²).

CONCLUSIONS

WHR outperformed BMI and WC as anthropometric indices in relation to T2DM among Ghanaian migrants. The lower BMI and WC cut-offs for T2DM than WHO established standards, highlights the need for African specific cut-offs to avoid missing high risk populations.

Cardiovascular Anthropometry: What Is Best Suited for Large-Scale Population Screening in Sub-Saharan Africa?

Background : Body mass index (BMI) measures overweight/obesity. It, however, especially in sub-Saharan Africa (SSA), misclassifies cardiometabolic risk. Central obesity measures are superior. We therefore sought to compare BMI, waist-to-hip ratio (WHR) and abdominal height (AH) in predicting cardiovascular disease risk in sub-Saharan Africa. Methods : Subjects had blood pressures, BMI, and WHR determined. Blood pressure was taken, weight and height measured to generate BMI, and AH measured with a new locally fabricated abdominometer. The ability of the anthropometric indices in identifying abnormal individuals needing intervention was assessed with sensitivity, specificity, and area under the receiver operator characteristic curve. Results : Adults totaling 1,508 (728 M/780 F) adults were studied. For BMI, 985 (65.3%) were normal, while 375 (24.9%), consisting of 233 males and 142 females, had normal WHR. Blood pressure was normal in 525 (34.8%) and 317 (21.0%) for systolic and diastolic blood pressures, respectively. Using BMI as gold standard, sensitivity, specificity, positive, and negative predictive values for WHR in males were 80.7, 37.5, 62.5, and 19.3%, respectively. For females and in the same order, they were 62.0, 34.3, 65.7, and 38.0%. For AH, it was equal in both genders at 82.6, 39.2, 60.8, and 17.4%. By receiver operating curves comparing AH, WHR, and BMI against blood pressure detection, the area under the curve was 0.745, 0.604, and 0.554 for AH, BMI, and WHR, respectively. Conclusion : Abdominometer-derived AH has a better sensitivity and greater area under the receiver operator curve compared with BMI and WHR in this sub-Sahara African population; implying superiority as a cardiovascular anthropometric index.

Beneficial impact of weight loss on respiratory function in interstitial lung disease patients with obesity

BACKGROUND

Interstitial lung disease (ILD) patients commonly become obese or overweight due to deteriorated daily living activities and the adverse effects of prednisolone. This study aimed to clarify the effect of weight loss on pulmonary function test (PFT) in ILD patients with obesity.

METHODS

Among all consecutive ILD patients with a body mass index (BMI) ≥ 27 kg/m² who received nutrition education for improving obesity between June 2014 and December 2018, we retrospectively included patients who successfully decreased their body weight by over 2 kg and underwent follow-up PFT within 6 months. The results of PFT at baseline and follow-up and the level of Krebs von den Lungen-6 (KL-6) were compared.

RESULTS

Eleven patients (5 men and 6 women; median BMI of 34.1 kg/m²), were enrolled. For PFT at baseline, the percentages of forced vital capacity (%FVC), functional residual capacity (%FRC), and diffusing capacity of the lung for carbon monoxide (%DLCO) were 69.3%, 59.9%, and 54%, respectively. The median KL-6 was 1035 U/mL. The median interval from baseline to the follow-up PFTs was 41 days. Compared to the baseline results of PFT, %FVC, %FRC, and %DLCO significantly increased (p = 0.018, 0.0006, and 0.024, respectively), and the changes in body weight and FVC were strongly correlated (p = 0.0004). In addition, the median serum level of KL-6 at follow-up tended to decrease by 206.5 U/mL (p = 0.083).

CONCLUSION

In ILD patients with obesity, weight loss is important and potentially improves their disease course.

Associations between Psycho-Hedonic Responses to Sweet and Savoury Tastes with Diet and Body Composition in a Sample of Asian Females

Taste preferences guide food choices and dietary behaviours, yet few studies have shown a relationship between sweet and savoury taste preference and differences in dietary intakes or energy consumed from different "taste clusters". We investigated differences in psycho-hedonic responses to sweet and savoury tastes and their association with energy intake, proportion of energy from macronutrients and energy intake from different "taste clusters". In addition, we evaluated correspondence between two methods to classify "sweet-liker" status and the overlap between sweet and savoury taste preferences. Psycho-hedonic responses to sweet and savoury tastes of female participants (n = 66) were captured via staircase paired preference and the "sweet-liker phenotype" classification method. Quantitative dietary energy and macronutrient intakes were measured using three-day food diary, and the relative contributions of specific taste clusters to energy intake were derived for each participant. All participants completed anthropometric assessments measuring body mass index (BMI) and adiposity. Results showed no association between sweet and savoury preferences with dietary energy or macronutrient intakes, though there was a trend towards higher sweet food consumption among "sweet-likers". A higher preference for savouriness was not associated with differences in daily energy intake, energy intake from protein, BMI or adiposity levels. There was little overlap in sweet and savoury preferences, suggesting a bi-modal split in taste preferences. "Sweet-likers" preferred a higher mean sucrose concentration than sweet "dislikers" (p < 0.001) indicating agreement between the two approaches. Future studies should consider comparing taste-liker differences using food choice tasks to address the current gap between taste preference measures and actual dietary behaviours.

Cost-effectiveness of a family-based multicomponent outpatient intervention program for children with obesity in Germany

OBJECTIVES

Facing an epidemic of childhood obesity and budget constraints, public health administrations are showing an urgent interest in interventions that are both health effective and cost-effective. Thus, this study intends to analyze the return on investment of these existing programs.

STUDY DESIGN

All analyses are based on a comprehensive data set from 249 children with obesity and overweight children who participated in the Children's Health InterventionaL Trial (CHILT), an 11-month outpatient multidisciplinary family-based program.

METHODS

Cost-effectiveness was assessed by comparing estimated savings associated with a reduction in weight and improvement of obesity-related health parameters with intervention costs. Projected future savings in health care expenditures were modeled on existing research, using estimates of health care costs associated with juvenile obesity and remission thresholds of obesity-related disease.

RESULTS

On average, participants achieved a 0.19-unit reduction in the body mass index standard deviation score, showed reduction in their blood pressure values (systolic = -1.76 mmHg, diastolic = -2.82 mmHg), and showed improvement in their high-density lipoprotein (HDL) and low-density lipoprotein (LDL) cholesterol values (HDL = +1.31 mg/dL, LDL = -4.82 mg/dL). The intervention costs were 1799€ per participant, and the benefits of avoided future health care costs varied by individual. On an aggregated level, future savings amounted to between 1859€ and 1926€ per person, translating into a return on investment of 3.3-7.0%.

CONCLUSIONS

This study shows that a multicomponent obesity intervention, such as the CHILT, not only results in weight loss and improves important health parameters but also is cost-effective.

Validation and utility of a body condition scoring system for chimpanzees (Pan troglodytes)

Obesity is a problem in captive chimpanzee colonies that can lead to increased risk for disease; therefore, implementation of effective weight management strategies is imperative. To properly implement a weight management program, captive managers should be able to noninvasively identify and assess overweight or obese individuals. Traditional means of categorizing obese individuals involve sedating the animals to obtain body weights or skin fold measurements. The current study aimed to validate a noninvasive, subjective body condition score (BCS) system for captive chimpanzees. The system utilizes a 10-point scale, with one rated as "emaciated," five as "normal," and 10 as "extremely obese." Between 2013 and 2014, 158 chimpanzees were weighed and scored using this system (a) while sedated and (b) while awake in their social group within 1-3 days of sedation ("In-group" ratings). We found high inter-rater reliability between In-group raters, as well as between sedated and In-group scores. BCSs, which require observation only, were significantly positively correlated with weight (an objective measure of obesity often requiring anesthetization), supporting the scale's validity. The BCS system identified 36 individuals as "overweight," while the use of weights alone identified only 26 individuals as "overweight." Furthermore, the BCS system was able to classify individuals of the same sex and weight as having different BCSs, ranging from normal to overweight. Lastly, using focal animal behavioral observations from 2016 to 2018 (N = 120), we found that In-group BCS predicted individual levels of inactive behavior more than 2 years later, demonstrating the predictive validity of the scale. These results illustrate the utility of the BCS system as a noninvasive, reliable, and valid technique that may be more sensitive than traditional methods in identifying and quantifying obesity in chimpanzees. This system can be a useful tool for captive managers to monitor and manage the weight of chimpanzees and other nonhuman primates.

Body mass index and waist-to-hip ratio misclassification of overweight and obesity in Chinese military personnel

BACKGROUND

The rising prevalence of obesity in military personnel has raised great concerns. Previous studies suggest that body mass index (BMI)- and waist-to-hip ratio (WHR)-based obesity classifications in US military personnel and firefighters have high false negative and subsequently cause obesity misclassification.

OBJECTIVE

To determine whether BMI and WHR could reflect the fat mass of Chinese military personnel.

METHODS

Three hundred fifty-three male Chinese military personnel and 380 age-matched male adults were recruited. Obesity classification was defined by BMI, WHR, and body fat percentage (BFP).

RESULTS

Chinese military personnel had extremely low obesity rate determined by either BFP (0.3%) or BMI (0.6%). By combining overweight and obese individuals, BMI- and WHR-determined prevalence of overweight/obesity was 22.4% and 17.0% compared to BFP-based standard (4.0%) (P < 0.05). In reference to BFP, BMI and WHR have high false-positive rate compared to the control group. Further analysis showed that Chinese military personnel consisted of high percentage of BFP^lowBMI^high and/or BFP^lowWHR^high subpopulations. Eighty-one percent of BMI^high and 78.3% of WHR^high of them were BFP low.

CONCLUSIONS

Chinese military personnel has extremely low obesity rate. BMI and WHR have high false-positive rates in reference to BFP, which cannot accurately reflect the mass of adipose tissue and leads to obesity misclassification.

The range of non-traditional anthropometric parameters to define obesity and obesity-related disease in children: a systematic review

Obesity is defined as an abnormal/excessive accumulation of body fat, associated with health consequences. Although overall obesity does confer a significant threat to the health of individuals, the distribution of body fat, especially abdominal/central obesity is of greater importance. For practical reasons, proxy anthropometric measurements have been developed to identify central obesity, however, major limitations are noted in these traditional measurements. The present study aims to evaluate the literature, to identify and describe non-traditional anthropometric measurements of overweight and obesity in children. The current systematic review was conducted in accordance with the PRISMA guidelines, and the search was undertaken in the PubMed^® database, using MeSH (Medical Subject Headings) terms. Data extracted from each study were: (a) details of the study, (b) anthropometric parameter(s) evaluated in the study and its details, (c) study methods, (d) objectives of the study and/or comparisons, and (e) main findings/conclusions of the study. The search yielded a total of 3697 articles, of which 31 studies were deemed eligible to be included. The literature search identified 13 non-traditional anthropometric parameters. Data on non-traditional anthropometric parameters were derived from 24 countries. Majority were descriptive cross-sectional studies (n = 29), while sample size varied from 65 to 23,043. Non-traditional anthropometric parameters showed variable correlation with obesity and/or related metabolic risk factors. Some parameters involved complex calculations, while others were based on a single anthropometric measurement or derived from traditional measures. Most studies lacked comparison with a 'gold standard' assessment of body fat, hence further research is required to determine their accuracy and precision.

The performance of anthropometric tools to determine obesity: a systematic review and meta-analysis

The aim of this systematic review was to assess the performance of anthropometric tools to determine obesity in the general population (CRD42018086888). Our review included 32 studies. To detect obesity with body mass index (BMI), the meta-analyses rendered a sensitivity of 51.4% (95% CI 38.5-64.2%) and a specificity of 95.4% (95% CI 90.7-97.8%) in women, and 49.6% (95% CI 34.8-64.5%) and 97.3% (95% CI 92.1-99.1%), respectively, in men. For waist circumference (WC), the summary estimates for the sensitivity were 62.4% (95% CI 49.2-73.9%) and 88.1% for the specificity (95% CI 77.0-94.2%) in men, and 57.0% (95% CI 32.2-79.0%) and 94.8% (95% CI 85.8-98.2%), respectively, in women. The data were insufficient to pool the results for waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR) but were similar to BMI and WC. In conclusion, BMI and WC have serious limitations for use as obesity screening tools in clinical practice despite their widespread use. No evidence supports that WHR and WHtR are more suitable than BMI or WC to assess body fat. However, due to the lack of more accurate and feasible alternatives, BMI and WC might still have a role as initial tools for assessing individuals for excess adiposity until new evidence emerges.

The Impact of Coconut Oil and Epigallocatechin Gallate on the Levels of IL-6, Anxiety and Disability in Multiple Sclerosis Patients

Background: Due to the inflammatory nature of multiple sclerosis (MS), interleukin 6 (IL-6) is high in blood levels, and it also increases the levels of anxiety related to functional disability. Epigallocatechin gallate (EGCG) decreases IL-6, which could be enhanced by the anti-inflammatory effect of high ketone bodies after administering coconut oil (both of which are an anxiolytic). Therefore, the aim of this study was to assess the impact of coconut oil and EGCG on the levels of IL-6, anxiety and functional disability in patients with MS. Methods: A pilot study was conducted for four months with 51 MS patients who were randomly divided into an intervention group and a control group. The intervention group received 800 mg of EGCG and 60 mL of coconut oil, and the control group was prescribed a placebo. Both groups followed the same isocaloric Mediterranean diet. State and trait anxiety were determined before and after the study by means of the State-Trait Anxiety Inventory (STAI). In addition, IL-6 in serum was measured using the ELISA technique and functional capacity was determined with the Expanded Disability Status Scale (EDSS) and the body mass index (BMI). Results: State anxiety and functional capacity decreased in the intervention group and IL-6 decreased in both groups. Conclusions: EGCG and coconut oil improve state anxiety and functional capacity. In addition, a decrease in IL-6 is observed in patients with MS, possibly due to the antioxidant capacity of the Mediterranean diet and its impact on improving BMI.

Novel anthropometric parameters to define obesity and obesity-related disease in adults: a systematic review

Context

Obesity is defined as an abnormal or excessive accumulation of body fat. Traditionally, it has been assessed using a wide range of anthropometric, biochemical, and radiological measurements, with each having its advantages and disadvantages.

Objective

A systematic review of the literature was conducted to identify novel anthropometric measurements of obesity in adults.

Data Sources

Using a combination of MeSH terms, the PubMed database was searched.

Data Extraction

The current systematic review was conducted in accordance with the PRISMA guidelines. The data extracted from each study were (1) details of the study, (2) anthropometric parameter(s) evaluated, (3) study methods, (4) objectives of the study and/or comparisons, and (5) main findings/conclusions of the study.

Data Analysis

The search yielded 2472 articles, of which 66 studies were deemed eligible to be included. The literature search identified 25 novel anthropometric parameters. Data on novel anthropometric parameters were derived from 26 countries. Majority were descriptive cross-sectional studies (n = 43), while 22 were cohort studies. Age range of the study populations was 17–103 years, while sample size varied from 45 to 384 612.

Conclusions

The novel anthropometric parameters identified in the present study showed variable correlation with obesity and/or related metabolic risk factors. Some parameters involved complex calculations, while others were derived from traditional anthropometric measurements. Further research is required in order to determine the accuracy and precision.

An anthropometry-based equation of fat mass percentage as a valid discriminator of obesity

OBJECTIVE

To develop a new predictive equation for fat mass percentage (%FM) based on anthropometric measurements and to assess its ability to discriminate between obese and non-obese individuals.

DESIGN

Cross-sectional study.

SETTING

Mexican adults.ParticipantsAdults (n 275; 181 women) aged 20-63 years with BMI between 17·4 and 42·4 kg/m2.

RESULTS

Thirty-seven per cent of our sample was obese using %FM measured by air-displacement plethysmography (BOD POD®; Life Measurement Instruments). The fat mass was computed from the difference between weight and fat-free mass (FFM). FFM was estimated using an equation obtained previously in the study from weight, height and sex of the individuals. The %FM estimated from the obtained FFM showed a sensitivity of 90·3 (95 % CI 86·8, 93·8) % and a specificity of 58·0 (95 % CI 52·1, 63·8) % in the diagnosis of obesity. Ninety-three per cent of participants with obesity and 65 % of participants without obesity were correctly classified.

CONCLUSIONS

The anthropometry-based equation obtained in the present study could be used as a screening tool in clinical and epidemiological studies not only to estimate the %FM, but also to discriminate the obese condition in populations with similar characteristics to the participant sample.

Utility of anthropometric traits and indices in predicting the risk of coronary artery disease in the adult men of southern Andhra Pradesh

BACKGROUND/AIM

Optimal cutoff values are influenced by ethnicity, geography, lifestyles, and physical activity, and hence, there is a need for establishing population- and disease-specific cutoff values to screen individuals/populations. Therefore, the present study was carried out to determine the optimal cutoff values of anthropometric variables for coronary artery disease (CAD) for the population of southern Andhra Pradesh.

METHODS

One hundred sixty five patients with CAD and 87 controls were recruited, and 52 anthropometric variables were measured for them.

RESULTS

Higher means in 22 anthropometric variables covering circumferences, skinfold thickness (sft), and indices were observed in patients than those in controls. Receiver operator curve analysis revealed that 18 variables including circumference, sft, and fat measures with an area under curve ranging from 0.61 to 0.72 were found to have the ability of predicting the risk of CAD. A stepwise discriminant analysis showed 9 variables to correctly classify 87.4% of subjects into CAD and controls. In logistic regression analysis, among these 9 variables, only circumferences of abdomen and foot; sft of supratellar, thigh and calf; and sum of subscapular/suprailiac, waist-hip ratio and lean body mass were associated with CAD and explained 73.4% of its variation.

CONCLUSIONS

Eighteen anthropometric variables were found to have the ability of predicting the risk of CAD. Longitudinal studies are needed to confirm the use of anthropometric variables in predicting the risk of CAD.

Diabetes prevalence in rural Indigenous Guatemala: A geographic-randomized cross-sectional analysis of risk

BACKGROUND

Developing countries and Indigenous populations are disproportionately affected by global trends in diabetes (T2DM), but inconsistent data are available to corroborate this pattern in Guatemala and indigenous communities in Central America. Historic estimates of T2DM, using a variety of sampling techniques and diagnostic methods, in Guatemala include a T2DM prevalence of: 4·2% (1970) and 8·4% (2003). Objectives of this geographically randomized, cross-sectional analysis of risk include: (1) use HbA1c to determine prevalence of T2DM and prediabetes in rural Indigenous community of Atitlán (2) identify risk factors for T2DM including age, BMI and gender.

METHODS

A spatially random sampling method was used to identify 400 subjects. Prevalence was compared using the confidence interval method, and logistic regression and linear regression were used to assess association between diabetes and risk factors.

FINDINGS

The overall prevalence of T2DM using HbA1c was 13·81% and prediabetes was also 13·81% in Atitlán, representing a tripling in diabetes from historic estimates and a large population with pre-diabetes. The probability of diabetes increased dramatically with increasing age, however no significant overall relationship existed with gender or BMI.

CONCLUSIONS

Diabetes is a larger epidemic than previously expected and appears to be related to ageing rather than BMI. Our proposed explanations for these findings include: possible Indigenous unique genetic susceptibility to T2DM, shortcomings in BMI as a metric for adiposity in assessing risk, changes in lifestyle and diet, and an overall aging population. The conclusion of this study suggest that (1) T2DM in rural regions of Guatemala may be of epidemic proportion. With pre-diabetes, more than 25% of the population will be diabetic in the very near future; (2) Age is a significant risk factor in the Indigenous population but BMI is not. This suggests that in some populations diabetes may be a disease of ageing.

Analysis of association of gene variants with obesity traits in New Zealand European children at 6 years of age

Childhood obesity is a public health problem, which is associated with a long-term increased risk of cardiovascular disease and premature mortality. Several gene variants have previously been identified that have provided novel insights into biological factors that contribute to the development of obesity. As obesity tracks through childhood into adulthood, identification of the genetic factors for obesity in early life is important. The objective of this study was to identify putative associations between genetic variants and obesity traits in children at 6 years of age. We recruited 1208 children of mothers from the New Zealand centre of the international Screening for Pregnancy Endpoints (SCOPE) study. Eighty common genetic variants associated with obesity traits were evaluated by the Sequenom assay. Body mass index standardised scores (BMI z-scores) and percentage body fat (PBF; measured by bio-impedance assay (BIA)) were used as anthropometric measures of obesity. A positive correlation was found between BMI z-scores and PBF (p < 0.001, r = 0.756). Two subsets of gene variants were associated with BMI z-scores (HOXB5-rs9299, SH2B1-rs7498665, NPC1-rs1805081 and MSRA-rs545854) and PBF (TMEM18-rs6548238, NPY-rs17149106, ETV-rs7647305, NPY-rs16139, TIMELESS-rs4630333, FTO-rs9939609, UCP2-rs659366, MAP2K5-rs2241423 and FAIM2-rs7138803) in the genotype models. However, there was an absence of overlapping association between any of the gene variants with BMI z-scores and PBF. A further five variants were associated with BMI z-scores (TMEM18-rs6548238, FTO-rs9939609 and MC4R-rs17782313) and PBF (SH2B1-rs7498665 and FTO-rs1421085) once separated by genetic models (additive, recessive and dominant) of inheritance. This study has identified significant associations between numerous gene variants selected on the basis of prior association with obesity and obesity traits in New Zealand European children.

Development of Growth Charts of Pakistani Children Aged 4-15 Years Using Quantile Regression: A Cross-sectional Study

Background

Growth charts are essential tools used by pediatricians as well as public health researchers in assessing and monitoring the well-being of pediatric populations. Development of these growth charts, especially for children above five years of age, is challenging and requires current anthropometric data and advanced statistical analysis. These growth charts are generally presented as a series of smooth centile curves. A number of modeling approaches are available for generating growth charts and applying these on national datasets is important for generating country-specific reference growth charts.

Objective

To demonstrate that quantile regression (QR) as a viable statistical approach to construct growth reference charts and to assess the applicability of the World Health Organization (WHO) 2007 growth standards to a large Pakistani population of school-going children.

Methodology

This is a secondary data analysis using anthropometric data of 9,515 students from a Pakistani survey conducted between 2007 and 2014 in four cities of Pakistan. Growth reference charts were created using QR as well as the LMS (Box-Cox transformation (L), the median (M), and the generalized coefficient of variation (S)) method and then compared with WHO 2007 growth standards.

Results

Centile values estimated by the LMS method and QR procedure had few differences. The centile values attained from QR procedure of BMI-for-age, weight-for-age, and height-for-age of Pakistani children were lower than the standard WHO 2007 centile.

Conclusion

QR should be considered as an alternative method to develop growth charts for its simplicity and lack of necessity to transform data. WHO 2007 standards are not suitable for Pakistani children.

Female urinary incontinence and obesity assessed by anthropometry and dual-energy X-ray absorptiometry: Analysis from the 2008-09 Korean National Health and Nutrition Examination Survey

OBJECTIVE

In the present study we evaluated the association between obesity, assessed by dual energy X-ray absorptiometry (DEXA), and urinary incontinence (UI).

METHODS

The study was performed on 5792 women who had taken part in the Korean National Health and Nutrition Examination Survey. UI was deemed to be present if a woman answered "yes" to the question "Do you have current UI?". Obesity was assessed using anthropometry and DEXA. Data were analyzed using Chi-squared tests, t-tests, receiver operating characteristic curves, and logistic regression analysis.

RESULTS

The UI group had significantly higher mean (±SD) waist circumference (78.5 ± 10.0 vs, 82.4±9.1 kg) and body mass index (23.3 ± 3.4 vs. 24.2 ± 3.1 kg/m² ) than the non-UI group. In addition, total fat mass (18.5 ± 5.3 vs. 19.4 ± 4.9 kg), trunk fat mass (9.3 ± 3.4 vs. 10.1 ± 3.2 kg), the trunk fat/leg fat (mass) ratio (1.58 ± 0.54 vs. 1.73 ± 0.50), total body fat percentage (32.3 ± 5.4% vs. 33.0 ± 5.0%), and trunk fat percentage (32.4 ± 7.3% vs. 33.9 ± 6.6%) were significantly higher in the UI group. Of these parameters, the trunk fat/leg fat ratio showed highest sensitivity (83.6%), with a cut-off value of 1.272. Before and after adjustment, trunk fat/leg fat ratio >1.272 was significantly related to UI and had the highest odds ratio (OR) among all DEXA parameters (adjusted OR 1.807; 95% confidence interval 1.343-2.431).

CONCLUSION

Obesity parameters obtained using DEXA are closely related to UI. Of these parameters, the trunk fat/leg fat ratio is the strongest in predicting the presence of UI. In addition, the present study has found a novel trunk fat/leg fat ratio cut-off value for defining obesity related to the UI.

Metabolic and Inflammatory Changes with Orlistat and Sibutramine Treatment in Obese Malaysian Subjects

INTRODUCTION

Obesity is associated with numerous health problems, particularly metabolic and cardiovascular complications. This study aimed to assess the effects that, nine months of pharmacological intervention with orlistat or sibutramine, on obese Malaysians' body weight and compositions, metabolic profiles and inflammatory marker.

METHODS

Seventy-six obese subjects were randomly placed into two groups. The first group received three daily 120 mg dosages of orlistat for nine months (n=39), and the second group received a once daily 10 or 15 mg dosage of sibutramine for nine months (n=37). Baseline measurements for weight, body mass index (BMI), waist circumference (WC), body fat percentage (BF), visceral fat (VF), adiponectin, fasting plasma glucose (FPG), fasting insulin, pancreatic B cell secretory capacity (HOMA%B), insulin sensitivity (HOMA%S), insulin resistance (HOMA-IR) and serum high sensitivity C-reactive protein (hs-CRP) were performed and repeated during the sixth and ninth months of treatment.

RESULTS

Twenty-four subjects completed the trial in both groups. For both groups, weight, BMI, WC, BF, VF, HOMA-IR and hs-CRP were significantly lower at the end of the nine month intervention. However, there were no significant differences between the two groups for these parameters with nine months treatment. There was a significant decrease in FPG in orlistat group; while fasting insulin and HOMA%B reduced in sibutramine group. For both groups, there were also significant increases in adiponectin levels and HOMA%S at the end of the nine month intervention.

CONCLUSION

Nine months of treatment with orlistat and sibutramine not only reduced weight but also significantly improved BMI, WC, BF, VF, FPG, adiponectin, fasting insulin, HOMA%B, HOMA%S, HOMA-IR and hs-CRP. These improvements could prove useful in the reduction of metabolic and cardiovascular risks in obese subjects.

Estimation of body fat in Pakistani adult: A comparison of equations based upon skinfold thickness measurements

Objective:

To compare three different body fats estimation equations using skin fold measurements with bioelectrical impedance analysis.

Methods:

A total of 130 subjects were included from Department of Endocrinology and Metabolism, Services Hospital, Lahore from 1^st April 2016 to 30^th Sep. 2016. The triceps, biceps, subscapular, chest, thigh, abdominal, suprailiac skinfold thickness of the subjects was measured with skin-fold calipers (Harpenden) on non-dominant side. The percentage fat mass (%FM) predicted by using each skin-fold-thickness equations namely Durnin & Womersley, Jackson & Pollock and Sloan was compared with %FM measured using a bioelectrical impedance analyzer (BIA).

Results:

The mean age of subjects was 48.75±10.7 years, mean BMI was 29.08±6.09 kg/m². The mean %FM calculated by Durnin & Womersley (32.408±0.584), Jackson & Pollock (24.658±0.527), Sloan (20.40±0.545). The %FM by BIA was 38.182±0.529. All three equations showed positive correlation but underestimated %FM as compared to BIA.

Conclusion:

All three BF estimation equations underestimate body fat percentage compared to BIA. Among the three, Durnin & Womersley equation shows best positive correlation and hence it can be used for estimation of percentage fat mass as an alternate to BIA.

Whole-Body Computed Tomography-Based Body Mass and Body Fat Quantification: A Comparison to Hydrostatic Weighing and Air Displacement Plethysmography

OBJECTIVE

We correlate and evaluate the accuracy of accepted anthropometric methods of percent body fat (%BF) quantification, namely, hydrostatic weighing (HW) and air displacement plethysmography (ADP), to 2 automatic adipose tissue quantification methods using computed tomography (CT).

METHODS

Twenty volunteer subjects (14 men, 6 women) received head-to-toe CT scans. Hydrostatic weighing and ADP were obtained from 17 and 12 subjects, respectively. The CT data underwent conversion using 2 separate algorithms, namely, the Schneider method and the Beam method, to convert Hounsfield units to their respective tissue densities. The overall mass and %BF of both methods were compared with HW and ADP.

RESULTS

When comparing ADP to CT data using the Schneider method and Beam method, correlations were r = 0.9806 and 0.9804, respectively. Paired t tests indicated there were no statistically significant biases. Additionally, observed average differences in %BF between ADP and the Schneider method and the Beam method were 0.38% and 0.77%, respectively. The %BF measured from ADP, the Schneider method, and the Beam method all had significantly higher mean differences when compared with HW (3.05%, 2.32%, and 1.94%, respectively).

CONCLUSIONS

We have shown that total body mass correlates remarkably well with both the Schneider method and Beam method of mass quantification. Furthermore, %BF calculated with the Schneider method and Beam method CT algorithms correlates remarkably well with ADP. The application of these CT algorithms have utility in further research to accurately stratify risk factors with periorgan, visceral, and subcutaneous types of adipose tissue, and has the potential for significant clinical application.

Body Mass Index and Mortality according to Gender in a Community-Dwelling Elderly Population: The 3-Year Follow-up Findings from the Living Profiles of Older People Surveys in Korea

Background

Body mass index is widely regarded as an important predictor of mortality. The purpose of this study was to investigate the relationship between body mass index and mortality and to compare community-dwelling elderly people in South Korea according to sex.

Methods

Data were collected from the 2008 and 2011 Living Profiles of Older People Surveys, which comprised 10,613 community-living South Korean men and women aged 65 years or older. The participants were stratified into five groups according to body mass index as defined by the World Health Organization guidelines. The sociodemographic characteristics of participants and mortality rates were compared across the body mass index groups.

Results

The highest survival rates were observed in men with a body mass index of 25.0–29.9 kg/m². A similar trend was observed in women, but it was not statistically significant. After adjusting for covariates, this association was also found in men across all BMI index groups, but not in women.

Conclusion

This study supports previous findings that overweight or mild obesity is associated with the lowest mortality and suggests that the current categories of obesity require revision. Furthermore, the absence of statistically significant findings in the female cohort suggests that body mass index is not a suitable predictor of mortality in women and that an alternative is required.

Childhood cognitive ability and body composition in adulthood

Background:

Childhood cognitive ability has been identified as a novel risk factor for adulthood overweight and obesity as assessed by adult body mass index (BMI). BMI does not, however, distinguish fat-free and metabolically harmful fat tissue. Hence, we examined the associations between childhood cognitive abilities and body fat percentage (BF%) in young adulthood.

Methods:

Participants of the Arvo Ylppö Longitudinal Study (n=816) underwent tests of general reasoning, visuomotor integration, verbal competence and language comprehension (M=100; s.d.=15) at the age of 56 months. At the age of 25 years, they underwent a clinical examination, including measurements of BF% by the InBody 3.0 eight-polar tactile electrode system, weight and height from which BMI (kg m⁻²) was calculated and waist circumference (cm).

Results:

After adjustments for sex, age and BMI-for-age s.d. score at 56 months, lower general reasoning and visuomotor integration in childhood predicted higher BMI (kg m⁻²) increase per s.d. unit decrease in cognitive ability (−0.32, 95% confidence interval −0.60,−0.05; −0.45, −0.75,−0.14, respectively) and waist circumference (cm) increase per s.d. unit decrease in cognitive ability (−0.84, −1.56,−0.11; −1.07,−1.88,−0.26, respectively) in adulthood. In addition, lower visuomotor integration predicted higher BF% per s.d. unit decrease in cognitive ability (−0.62,−1.14,−0.09). Associations between general reasoning and BMI/waist were attenuated when adjusted for smoking, alcohol consumption, intake of fruits and vegetables and physical activity in adulthood, and all associations, except for visuomotor integration and BMI, were attenuated when adjusted for parental and/or own attained education and/or birth weight.

Conclusions:

Of the measured childhood cognitive abilities, only lower visuomotor integration was associated with BF% in adulthood. This challenges the view that cognitive ability, at least when measured in early childhood, poses a risk for adiposity in adulthood, as characterized by higher BF%.

The Accuracy of Body Mass Index and Gallagher's Classification in Detecting Obesity among Iranians

BACKGROUND

The study was conducted to examine the comparability of the BMI and Gallagher's classification in diagnosing obesity based on the cutoff points of the gold standards and to estimate suitable cutoff points for detecting obesity among Iranians.

METHODS

The cross-sectional study was comparative in nature. The sample consisted of 20,163 adults. The bioelectrical impedance analysis (BIA) was used to measure the variables of interest. Sensitivity, specificity, positive predictive power (PPV), and negative predictive power (NPV) were used to evaluate the comparability of the two classification methods in detecting obesity.

RESULTS

The BMI wrongly classified 29% of the obese persons as overweight. In both classifications, as age increased, the accuracy of detecting obesity decreased. The Gallagher's classification is better than MBI in detecting obesity in men with the exception of those older than 59 years. In females, the BMI was better in determining sensitivity. In both classifications, either female or male, an increase in age was associated with a decrease in sensitivity and NPV with the exception of the BMI for the 18 year olds. Gallagher can correctly classify males and females who are less than 40 and 19 years old, respectively.

CONCLUSION

Gallagher's classification is recommended for non-obese in both sexes and in obese males younger than 40 years old. The BMI is recommended for obese females. The suitable cutoff points for the BMI to detect obesity are 27.70 kg/m(2) for females and males, 27.70 kg/m(2) for females, and 27.30 kg/m(2) for males.

Serum Adiponectin Level May be an Independent Predictor of Clear Cell Renal Cell Carcinoma

Objectives: To examine whether serum adiponectin or leptin level has the ability to differentiate clear cell renal cell carcinoma (ccRCC) from other subtypes of renal cell carcinoma (RCC) in a Chinese population.

Patients and methods: We recruited 198 consecutive patients who were treated with radical or partial nephrectomy in our department from September 2011 to June 2013. Their histological types were all malignant, including clear cell, papillary, chromophobe and unclassified RCC. We also enrolled 86 people with no cancer or cancer-related diseases as normal controls. We measured patients' preoperative blood samples for plasma adiponectin and leptin concentrations using an enzyme-linked immunosorbent assay method. Statistical methods were used to analyze ccRCC and other subtypes as they relate to serum adiponectin/leptin level and other factors such as body mass index or visceral fat area.

Results: In our database, normal controls had significantly higher circulating adiponectin (p < 0.001) and leptin levels (p < 0.001) than patients with RCC. Among the 198 RCC patients, 156 patients had ccRCC while 42 patients had other histological types. Serum adiponectin levels were lower in ccRCC patients than in non-clear-cell RCC patients (p = 0.004). However, the plasma leptin level was not differently distributed between ccRCC and non-ccRCC patients (p = 0.940). In multivariate analysis, we found that serum adiponectin level may be an independent predictor for discriminating ccRCC patients from others (p = 0.004). Furthermore, in the ccRCC subgroup, we observed that men with ccRCC had lower leptin (p < 0.001) and adiponectin (p = 0.002) levels, and diabetic patients had lower plasma adiponectin levels (p = 0.001).

Conclusions: Lower plasma adiponectin concentration was related to an increased incidence of ccRCC and may act as an independent predictor for ccRCC. Our study may help define the process from obesity to adipose tissue, to cytokines and finally to ccRCC.

Da Vinci Xi and Si platforms have equivalent perioperative outcomes during robot-assisted partial nephrectomy: preliminary experience

The aims of this study were to compare the perioperative outcomes of da Vinci Xi to Si during robotic-assisted partial nephrectomy (RAPN) and to discuss the feasibility of our novel port placement scheme for the da Vinci Xi platform, to overcome the existing kinetic and technical difficulties we faced with the linear port placement in patients with a small body habitus. A retrospective data analysis of patients who underwent RPN using da Vinci Xi (n = 18) was carried out. The outcomes of the Xi group were compared with the Si group (n = 18) selected using a case-matched methodology. For da Vinci Xi, we applied the universal linear port placement in 12 patients and our modified port placement in the remaining 6 patients. The Xi group had a shorter mean docking time of 17.8 ± 2.6 min compared to the Si group of 20.5 ± 2.1 min (p = 0.002); otherwise, no significant difference was present with regard to the remaining perioperative variables (p > 0.05). The modified Xi port placement had a shorter mean console time of 70.8 ± 9.7 min compared to the universal linear port placement of 89.3 ± 17.2 min (p = 0.03). Moreover, it provided a broader field of vision with excellent robotic arms movement, minimizing collisions and allowing an easier and comfortable surgical assist. Da Vinci Xi appears to be feasible and safe during RPN with similar outcomes to Si. The novel Xi port placement makes surgery easier in patients with low BMI.

The effects of anti-obesity intervention with orlistat and sibutramine on microvascular endothelial function

INTRODUCTION

Obesity is associated with impaired microvascular endothelial function. We aimed to determine the effects of orlistat and sibutramine treatment on microvascular endothelial function, anthropometric and lipid profile, blood pressure (BP), and heart rate (HR).

METHODS

76 subjects were recruited and randomized to receive orlistat 120 mg three times daily or sibutramine 10 mg daily for 9 months. Baseline weight, BMI, BP, HR and lipid profile were taken. Microvascular endothelial function was assessed using laser Doppler fluximetry and iontophoresis process. Maximum change (max), percent change (% change) and peak flux (peak) in perfusion to acetylcholine (ACh) and sodium nitroprusside (SNP) iontophoresis were used to quantify endothelium dependent and independent vasodilatations.

RESULTS

24 subjects in both groups completed the trial. After treatment, weight and BMI were decreased for both groups. AChmax, ACh % change and ACh peak were increased in orlistat-treated group but no difference was observed for sibutramine-treated group. BP and total cholesterol (TC) were reduced for orlistat-treated group. HR was reduced for orlistat-treated group but was increased in sibutramine-treated group.

CONCLUSION

9 months treatment with orlistat significantly improved microvascular endothelial function. This was associated with reductions in weight, BMI, BP, HR, TC and low density lipoprotein cholesterol. No effect was seen in microvascular endothelial function with sibutramine.

Aging and bone health in Singaporean Chinese pre-menopausal and postmenopausal women

OBJECTIVE

The study evaluated relationships between menopausal statuses, hormone replacement therapy (HRT), body mass index (BMI), percent body fat (PBF), and exercise with osteoporosis and bone mineral density (BMD) in Singaporean women.

STUDY DESIGN

This is a cross-sectional study.

MAIN OUTCOME MEASURES

The spine BMD, and femoral neck BMD as well as the prevalence of osteoporosis are the main outcome measures studied.

RESULTS

Age, BMI, PBF and exercise intensity were independently associated with spine and femoral neck BMD. Women with higher BMI and lower PBF had higher BMD and lower prevalence of osteoporosis. Postmenopausal women without HRT had lower BMD and higher prevalence of osteoporosis while those on HRT had similar BMD and prevalence of osteoporosis as premenopausal women.

CONCLUSION

This study shows that BMI and PBF are powerful predictors of BMD. Osteoporosis is site-specific in the Singapore population, being higher in the femoral neck than in the lumbar spine. The bone status after menopause may not be worse than that dictated by age alone and both ERT and E/PRT could sustain the BMD to levels corresponding to those of women a decade younger. A strategy to improve bone health should include dieting and physical exercise program that focuses on selectively reducing fat mass and increasing lean mass.

Obesity Is Associated With the Development of Interstitial Pneumonia Under Long-Term Administration of Amiodarone in Refractory Atrial Fibrillation Patients

Although oral amiodarone (AMD) has been used for the management of atrial fibrillation (AF), serious complications such as interstitial pneumonia (IP) occur very occasionally. We evaluated which factors were associated with the development of IP under the long-term administration of AMD in patients with refractory AF.This study included 122 consecutive patients (65.8 ± 11.4 years, mean body mass index [BMI] of 23.2 ± 4.3 kg/m(2)) who orally received AMD to inhibit AF between January 2004 and December 2013. Administration of AMD was begun at 400 mg daily as a loading dose, and was continued at a dosage of 50-400 mg daily after the initial loading phase, determined by the control of the arrhythmias and occurrence of side-effects. The clinical factors were compared between the patients with and without adverse effects, especially IP.During an average follow-up period of 49.2 ± 28.2 months, 53 patients (43.4%) were determined to have converted and maintained sinus rhythm. In contrast, adverse effects were detected in 46 patients (37.7%) with AMD. IP occurred in 8 patients (6.6%), thyrotoxicosis in 35 (28.7%), and others in 5 (4.1%). Four (50.0%) out of 8 patients complicated with IP had obesity (BMI > 27 kg/m(2)). Among the clinical factors, only obesity was significantly associated with the development of IP (P = 0.026).In patients with refractory AF, AMD had an antiarrhythmic effect with long-term administration, but greater adverse effects were also observed. Obesity was the most significant factor associated with the development of IP.

Association of general and abdominal obesity with age, endocrine and metabolic factors in Asian men

OBJECTIVE

This study made use of the percent abdominal fat to define abdominal obesity (AbO) and examined the differential associations of general obesity (GOb) and AbO with age, metabolic and endocrine factors.

METHODS

Metabolic, endocrine and anthropometric factors and body composition were measured in 481 Asian men.

RESULTS

A DEXA-derived ≥25% abdominal fat (PAbdF) was used to define men with AbO. Age was directly associated with PAbdF and percent total body fat (PBF). Exercise intensity was negatively associated with PBF. Both PBF and PAbdF were associated with HDL and LDL, but have opposite correlation with triglyceride. Furthermore, both PBF and PAbdF were associated with the number of metabolic syndrome (MetS) risk factors. Men with GOb had lower levels of percent lean mass (PLM), testosterone and bioavailable testosterone, and higher insulin and glucose levels. Men with AbO had lower arm and leg fat, higher insulin levels and triglycerides.

CONCLUSIONS

Men with GOb and AbO had different pattern of body composition. Age may be a contributory factor in AbO and a sedentary lifestyle may contribute to GOb. Both GOb and AbO are associated with an increased risk of MetS, with GOb more predispose to risk of diabetes, while AbO more at risk for cardiovascular diseases.

Aging, lifestyle factors, hormones and bone health in Singaporean men

Purpose

The present study examined how age, bodyweight, body fat, regular exercise and some endocrine factors are associated with osteoporosis, spine bone mineral density (Sbmd) and femoral neck bone mineral density (Fnbmd) in Singaporean men.

Methods

Body composition and bone scans of lumbar spine at L2-L4 and hip were carried out with duel-energy X-ray absorptiometry (DXA). Anthropometric parameters were measured and demographic data, medical history and exercise schedule were collected via a questionnaire.

Results

Osteoporosis prevalence was higher and Sbmd and Fnbmd were lower in men with high percent body fat (PBF) and conversely osteoporosis prevalence was lower and Sbmd and Fnbmd were higher in men with higher body mass index (BMI). Age was negatively associated with Fnbmd but not Sbmd. On the other hand, PBF and insulin levels were negatively associated with both Sbmd and Fnbmd. Body mass index and exercise intensity were positively associated with both Sbmd and Fnbmd. Sex hormones were significantly associated with only Sbmd but not Fnbmd. Both estradiol and DHEAS were positively, while testosterone was negatively associated with Sbmd.

Conclusion

The study shows that the prevalence of osteoporosis and some of the determinants of bone mineral density (BMD) in Singaporean men was site-specific. Further, BMI and PBF are opposing predictors of BMD. Therefore, any strategy for improving bone health should include modalities that increase lean and bone mass and decrease fat mass. The bone health of Singaporean men is comparable to non-Hispanic whites and better than some other Asian men.

•

Determinants of the prevalence of osteoporosis and BMD in Singaporean men are site-specific.

•

Further, BMI and PBF are opposing predictors of BMD.

•

Strategy for improving bone health should include modalities that increase lean and bone mass and decrease fat mass.

High prevalence of underweight and undernutrition in Japanese inpatients with schizophrenia: a nationwide survey

OBJECTIVES

To clarify the prevalence of underweight and overweight/obesity, and laboratory data for nutritional status in Japanese outpatients and inpatients with schizophrenia.

DESIGN

Cross-sectional study.

SETTING

A questionnaire conducted in inpatient and outpatient facilities in Japan.

PARTICIPANTS

The population of adult patients with schizophrenia in Japan (N=23,116).

MAIN OUTCOME MEASURES

The prevalence of underweight and undernutrition in Japanese inpatients and outpatients with schizophrenia.

RESULTS

We conducted a large-scale investigation of the prevalence of underweight and undernutrition in 520 outpatient facilities and 247 inpatient facilities belonging to the Japan Psychiatric Hospitals Association between January 2012 and July 2013. There were 7655 outpatients and 15,461 inpatients with schizophrenia. There was a significant difference in the distribution of three body mass index levels between outpatients and inpatients (p<0.001). The proportion of underweight inpatients with schizophrenia was significantly higher than that among outpatients (p<0.001). Age-specific analysis revealed that the proportion of underweight individuals aged ≥ 40 years was higher in inpatients than in outpatients and in the general Japanese population. The proportion of individuals with hypocholesterolaemia was significantly higher in inpatients with schizophrenia than in outpatients (p<0.001). There was a significant difference in the severity of underweight between outpatients and inpatients with schizophrenia; the proportion of severe underweight in inpatients was twofold higher than in outpatients.

CONCLUSIONS

The prevalence of underweight and undernutrition in Japanese inpatients with schizophrenia was higher than in outpatients and the general population. Therefore, the physical risk of inpatients should be carefully considered in clinical practice.

Optimal cutoffs for low skeletal muscle mass related to cardiovascular risk in adults: The Korea National Health and Nutrition Examination Survey 2009-2010

The possible association between low skeletal muscle mass and cardiovascular disease (CVD) risk factors necessitates estimation of muscle mass even in subjects with normal body mass index (BMI). This study was aimed to investigate optimal cutoffs for skeletal muscle mass reflecting CVD risk factors and to evaluate the relationship between skeletal muscle mass and CVD risk factors in the general population and in subjects with normal BMI using these cutoffs. This cross-sectional study analyzed data from the Korea National Health and Nutrition Examination Survey 2009-2010. We enrolled 5120 men and 6559 women aged ≥20 years. Skeletal muscle index (SMI) was defined as the weight-adjusted appendicular skeletal muscle mass measured by dual-energy X-ray absorptiometry. Using receiver operating characteristic curve analyses, SMI cutoffs associated with CVD risk factors were determined. Lower SMI was significantly associated with an increased prevalence of CVD risk factors. The first cutoffs in men and women were 32 and 25%, respectively, and the second cutoffs were 30 and 23.5%. Subjects in stage I and stage II SMI categories showed increased prevalence and risk for several CVD risk factors. These tendencies persisted in the association between cardiometabolic characteristics and SMI even in subjects with normal BMI. Using cutoffs of low skeletal muscle mass reflecting CVD risk factors, lower skeletal muscle mass was associated with increased prevalence and risk of several CVD risk factors. A higher prevalence of cardiometabolic abnormalities was observed among subjects with normal BMI but low skeletal muscle mass.

Body mass index and mortality among Korean elderly in rural communities: Kangwha Cohort Study

Background

The relationship between body mass index (BMI) and mortality may differ by ethnicity, but its exact nature remains unclear among Koreans. The study aim was to prospectively examine the association between BMI and mortality in Korean.

Methods

6166 residents (2636 men; 3530 women) of rural communities (Kangwha County, Republic of Korea) aged 55 and above were followed up for deaths from 1985–2008. The multivariable-adjusted hazard ratios were calculated using the Cox proportional hazards model.

Results

During the 23.8 years of follow-up (an average of 12.5 years in men and 15.7 years in women), 2174 men and 2372 women died. Men with BMI of 21.0–27.4 and women with BMI of 20.0–27.4 had a minimal risk for all-cause mortality. A lower BMI as well as a higher BMI increased the hazard ratio of death. For example, multivariable-adjusted hazard ratios associated with BMI below 16, and with BMI of 27.5 and above, were 2.4 (95% CI = 1.6–3.5) and 1.5 (95% CI = 1.1–1.9) respectively, in men, compared to those with BMI of 23.0–24.9. This reverse J-curve association was maintained among never smokers, and among people with no known chronic diseases. Higher BMI increased vascular mortality, while lower BMI increased deaths from vascular diseases, cancers, and, especially, respiratory diseases. Except for cancers, these associations were generally weaker in women than in men.

Conclusions

A reverse J-curve association between BMI and all-cause mortality may exist. BMI of 21–27.4 (rather than the range suggested by WHO of 18.5–23 for Asians) may be considered a normal range with acceptable risk in Koreans aged 55 and above, and may be used as cut points for interventions. More concern should be given to people with BMI above and below a BMI range with acceptable risk. Further studies are needed to determine ethnicity-specific associations.

Visceral fat accumulation is associated with different pathological subtypes of renal cell carcinoma (RCC): a multicentre study in China

OBJECTIVE

To investigate whether visceral obesity is associated with certain histological subtypes of renal cell carcinoma (RCC) ina multicentre Chinese cohort.

PATIENTS AND METHODS

A kidney tumour database was created using three tertiary centres in China; 487 patients were enrolled presenting with localised RCC and complete computer tomography(CT)/magnetic resonance imaging (MRI) information. A single-slice CT image was used to measure the area of visceral and subcutaneous adipose tissues in each patient. Statistical methods were used to analyse clear-cell RCC (ccRCC) and non-clear-cell RCC (non-ccRCC) as they relate to visceral fat area (VFA) and other risk factors, such as age, gender, tumour size, diabetes, hypertension, total fat area (TFA) and body mass index (BMI).

RESULTS

In all, 418 patients had a ccRCC subtype and 69 had a non-ccRCC subtype. For all the patients with RCC, the mean VFA was 102 cm2, while mean BMI was 24 kg/m2. The mean VFA was greater in ccRCC than non-ccRCC patients by 25 cm2. There were significant differences in the mean VFA and TFA between patients with ccRCC and those with non-ccRCC.Multivariate analysis showed that the presence ofVFA was more important than the effects of BMI and Type 2 diabetes on pathology prediction. In patients with a normal BMI, those with a higher quartile of VFA were more likely to develop ccRCC than those with a low VFA.

CONCLUSIONS

Increased visceral fat was found to be associated with ccRCC and the significance of VFA outweighed the effects of BMI and Type 2 diabetes for the prediction of RCC pathology in multivariate analyses. As a result, VFA could constitute a primary explanation for the link between obesity and ccRCC.

The association of metabolic syndrome and aging with cognition in Asian men

BACKGROUND

The present cross-sectional study examined the associations of individual metabolic factors and age with the short-term memory and perceptual capacity in 472 healthy Asian men.

METHODS

The symbol digit and digit span tests from the Swedish Performance Evaluation System were used to assess the perceptual capacity and memory cognitive domains. Linear regression with the stepwise method, and multivariate analyses of the General Linear Model with the Bonferroni correction for multiple comparisons were carried out with the SPSS 21.0 package.

RESULTS

High blood pressure and HDL were not significantly associated with either short-term memory or perceptual capacity. Age and glucose level were negatively associated but regular physical exercise was positively associated with perceptual capacity. On the other hand, high triglyceride level (TG) was positively associated but high waist/height ratio was negatively associated with short-term memory. When men without any component of the metabolic syndrome (MetS) were compared with men with one, two or three or more components of MetS, no significant differences in cognitive performance were noted.

CONCLUSION

Not all the metabolic factors were significantly associated with short-term memory or the perceptual capacity domains. Those that were did not show a sufficiently consistent pattern of association to support a role for MetS as a whole in cognitive decline with aging. It may not be meaningful to evaluate the association of MetS as a whole with cognition.

Metabolomic biomarkers for obesity in humans: a short review

BACKGROUND

The prevalence and incidence of obesity have become a major public health problem during the last decades, but the underlying biochemical and metabolic processes are not fully understood. Metabolomics, the science of small molecules of the metabolism, is helping to unravel these mechanisms via the identification of markers related to obesity. These biomarkers are used to prevent diseases in later life or for the early diagnosis of diseases. This review focuses on articles dealing with biomarkers for obesity.

KEY MESSAGES

Branched-chain amino acids (BCAA), nonesterified fatty acids, organic acids, acylcarnitines, and phospholipids were identified as potential biomarkers for obesity. This indicates a relation between elevated BCAA, and other amino acids, and the obese state. Furthermore, deregulation of β-oxidation is associated with the development of obesity. The results have several limitations, including the differing ages of the subjects in the studies, the fact that all of the studies had a case-control design and therefore no causal explanatory power, and that most looked for similar metabolites and reported almost equal results.

CONCLUSION

The strength of this review is that it gives a comprehensive overview of the current status of the knowledge on metabolomics biomarkers for obesity, but further research is needed because the methods used in the studies to date are very homogenous, e.g. most used a targeted approach and therefore analyzed almost the same group of metabolites. Moreover, prospective studies are lacking since all of the studies are either case-control or cross-sectional studies.

Plasma adipocytokines and antioxidants-status in Korean overweight and obese females with dyslipidemia

BACKGROUD/OBEJECTIVES

It is hypothesized that obese people with dyslipidemia is more likely to have increased oxidative stress and decreased antioxidant status, in comparison with the controls who were obese without dyslipidemia. Thus, the aims of the present study were to determine the dietary intakes, plasma adipokines, and antioxidative systems between obese with dyslipidemia and obese without dyslipidemia were investigated.

SUBJECTS/METHODS

Female subjects who were between 20 and 55 years old, and whose BMI was 23 or greater were recruited. Subjects who met the criteria of BMI ≥ 23, total cholesterol ≥ 200 mg/dL, LDL cholesterol ≥ 130 mg/dL, and TG ≥ 110 mg/dL were categorized Obese with dyslipidemia. Anthropometric measurements and blood biochemical tests were conducted. The diet survey was conducted by a trained dietitian using two days of 24 hour dietary recall. The lipid peroxidation, the plasma total antioxidant capacity (TAC), the activities of antioxidantive enzymes, and various antioxidantive vitamins levels were determined.

RESULTS

Plasma adiponectin and leptin levels were also determined. There were no significant differences for age, Body Mass index (BMI), and body fat (%), waist-size between two groups. Obese with dyslipidemia had significantly high levels of total cholesterol, triglyceride, LDL-cholesterol, the ratio of total cholesterol/HDL-C, and the ratio of HDL-C/LDL-C, respectively. Blood alkaline phosphatase level was statistically different between the two groups (P < 0.05). No statistical significance in dietary intake between two groups was shown. In case of obese with dyslipidemia group, the levels of GSH-Px (P < 0.05) and catalase (P < 0.05) as well as adjusted blood retinol (P < 0.05) and tocopherol level (P < 0.05) were significantly low. However, the plasma concentration of leptin was significantly high (P < 0.05).

CONCLUSIONS

Obesity with dyslipidemia was shown to have high arthtrogenic index, depleted antioxidant status, and higher blood leptin levels which suggest higher risks of oxidative stress and cardiovascular diseases.

The relation between body mass index and self-rated mental health among older adults: do racial/ethnic differences exist?

OBJECTIVES

To examine racial and ethnic differences in the relation between body mass index (BMI) and self-rated mental health (SRMH) among community-dwelling older adults.

DESIGN

Cross-sectional analyses of nationally representative data from the Collaborative Psychiatric Epidemiology Surveys.

SETTING

In-person household interviews.

PARTICIPANTS

Older adults aged 60 and older (N = 2,017), including non-Hispanic white (N = 547), black (N = 814), Hispanic (N = 401), and Asian (N = 255) patients.

MEASUREMENTS

SRMH was measured with a single item, "How would you rate your own mental health?" BMI categories were underweight (<18.5 kg/m(2)), healthy weight (18.5-24.9 kg/m(2)), overweight (25.0-29.9 kg/m(2)), and obese (≥30.0 kg/m(2)).

RESULTS

A two-way analysis of covariance showed that after controlling for covariates, there was a significant main effect of race/ethnicity on SRMH, but the main effect of BMI was not significant. A significant interaction between BMI and race/ethnicity on SRMH was also found. The linear contrasts showed that white adults had a significant trend showing that SRMH decreased with increases in BMI, whereas black adults had a significant trend showing that SRMH increased with increases in BMI. The linear trends for Hispanic and Asian adults were not significant.

CONCLUSIONS

There were significant racial/ethnic differences in the relation between BMI and SRMH. Understanding the role of race/ethnicity as a moderator of the relation between BMI and mental health may help improve treatment for older adults with unhealthy weights. Clinical implications are also discussed.

Subclinical vascular inflammation in subjects with normal weight obesity and its association with body fat: an 18 F-FDG-PET/CT study

Background

Although body mass index (BMI) is the most widely accepted parameter for defining obesity, recent studies have indicated a unique set of patients who exhibit normal BMI and excess body fat (BF), which is termed as normal weight obesity (NWO). Increased BF is an established risk factor for atherosclerosis. However, it is unclear whether NWO subjects already have a higher degree of vascular inflammation compared to normal weight lean (NWL) subjects; moreover, the association of BF with vascular inflammation in normal weight subjects is largely unknown.

Methods

NWO and NWL subjects (n = 82 in each group) without any history of significant vascular disease were identified from a 3-year database of consecutively recruited patients undergoing ¹⁸ F-fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸ F-FDG-PET/CT) at a self-referred Healthcare Promotion Program. The degree of subclinical vascular inflammation was evaluated using the mean and maximum target-to-background ratios (TBRmean and TBRmax) of the carotid artery, which were measured by ¹⁸ F-FDG-PET/CT (a noninvasive tool for assessing vascular inflammation).

Results

We found that metabolically dysregulation was greater in NWO subjects than in NWL subjects, with a significantly higher blood pressure, higher fasting glucose level, and worse lipid profile. Moreover, NWO subjects exhibited higher TBR than NWL subjects (TBRmean: 1.33 ± 0.16 versus 1.45 ± 0.19, p < 0.001; TBRmax: 1.52 ± 0.23 versus 1.67 ± 0.25, p < 0.001). TBR was significantly associated with total BF (TBRmean: r = 0.267, p = 0.001; TBRmax: r = 0.289, p < 0.001), age (TBRmean: r = 0.170, p = 0.029; TBRmax: r = 0.165, p = 0.035), BMI (TBRmean: r = 0.184, p = 0.018; TBRmax: r = 0.206, p = 0.008), and fasting glucose level (TBRmean: r = 0.157, p = 0.044; TBRmax: r = 0.182, p = 0.020). In multiple linear regression analysis, BF was an independent determinant of TBRmean and TBRmax, after adjusting for age, BMI, and fasting glucose level (TBRmean: regression coefficient = 0.020, p = 0.008; TBRmax: regression coefficient = 0.028, p = 0.005). Compared to NWL, NWO was also independently associated with elevated TBRmax values, after adjusting for confounding factors (odds ratio = 2.887, 95% confidence interval 1.206–6.914, p = 0.017).

Conclusions

NWO is associated with a higher degree of subclinical vascular inflammation, of which BF is a major contributing factor. These results warrant investigations for subclinical atherosclerosis in NWO patients.