Anthropometric and central obesity indices as predictors of long-term cardiometabolic risk among Saudi young and middle-aged men and women

Sex differences in prevalence of metabolic syndrome components and contributing factors among psychiatric patients in Saudi Arabia

Background/objectives

The purpose of this study was to detect sex differences in metabolic syndrome (MS) features and risk variables among Saudi participants.

Methods

For this study, 144 patients (52.08% males, 47.92% females) aged 19 to 59 signed a written consent form based on the Declaration of Helsinki, either as a patient or a family member. A cross-sectional survey was used to collect data on family disease history, health, and eating habits. MS components included waist circumstance (WC), high-density lipoprotein cholesterol (HDL-C), triglycerides (TGs), fasting glucose (FG), and blood pressure. A chi-square test was used to compare categorical data within and across sexes.

Results

The associations between variables were found using Spearman correlation coefficients and simple regression analysis. Anthropometric indices were significantly (p ≤ 0.01) varied between sexes as well as family history, health behaviors, and eating behaviors. Sex variations in MS components that contributed to an MS diagnosis were discovered and were significantly varied between sexes. The most common components in males were low HDL-C (90.67%), high WC (85.33), and elevated TG levels (76.0%). In females, the most typically recognized components were high WC (86.96%), followed by high FG (69.57%) and high blood pressure and TG (63.77%). Sex differences in other risk variables for MS, such as family history, health, dietary habits, sedentary lifestyle, and smoking, were found to be associated with high anthropometric indices.

Conclusion

Sex-specific public health policies and management techniques for preventing MS in the older adult population should be created for Saudis who are aging physiologically.

Predicting cardiometabolic disease in medical students using FibroScan and 30-year Framingham risk scores

Introduction

Metabolic dysfunction-associated steatotic liver disease (MASLD) has become a major cause of end-stage hepatic disease worldwide requiring liver transplantation, whereas cardiovascular disease (CVD) remains the leading cause of morbidity and mortality globally. Development of MASLD and CVD among young adults is understudied. This study aimed to assess CVD risk in healthy young medical university students using lipid-based and body mass index (BMI)-based 30-year Framingham risk scores (FS30) and to evaluate disease burden for asymptomatic patients with MASLD by performing FibroScan.

Methods

We included medical university students aged 18-30 years without any known medical conditions. All participants underwent physical and anthropometric measurements, and completed a questionnaire. Blood samples were collected for the analysis of glycosylated haemoglobin levels, renal and liver function, biomarker analysis to calculate liver fibrosis risk, and subclinical atherosclerosis biomarkers. Liver stiffness measurements (LSM) and controlled attenuation parameter (CAP) values were measured using FibroScan 430 mini to calculate liver fibrosis and steatosis, respectively. FS30 based on body mass index (FS30-BMI) and lipid levels (FS30-Lipid) were also calculated.

Results

Overall, 138 medical students participated in this study after providing informed consent. Using FS30-Lipid and FS30-BMI, CVD risk was identified in two (1.5%; n = 138) and 23 (17.6%; n = 132) individuals, respectively. MASLD fibrosis was identified based on FibroScan LSMs >7.0 kPa in 12 medical students (9.4%, n = 128; 95% CI, 4.7-14.8%). Consumption of coffee and sugary soft drinks were predictive of liver fibrosis. In total, 36 students (28.6%; n = 128) were found to have hepatic steatosis based on FibroScan CAP values >236 dB, and the predictive factors included increased body fat percentage, male sex, and lack of physical activity. Levels of inflammatory biomarkers, such as C-reactive protein and lipids were not elevated in participants with MASLD.

Discussion

CVD risk was identified in >17% of young medical students. The frequency of liver fibrosis and steatosis was also high among the participants, indicating that liver damage starts at a relatively early age. Early intervention is needed among young adults via health promotion and lifestyle changes.

Assessment of the appropriate cutoff points for anthropometric indices and their relationship with cardio-metabolic indices to predict the risk of metabolic associated fatty liver disease

BACKGROUND

Research on Metabolic Associated Fatty Liver Disease (MAFLD) is still in its early stages, with few studies available to identify and predict effective indicators of this disease. On the other hand, early diagnosis and intervention are crucial to reduce the burden of MAFLD. Therefore, the aim of this research was to investigate the effectiveness of eleven anthropometric indices and their appropriate cut-off values as a non-invasive method to predict and diagnose MAFLD in the Iranian population.

METHODS

In this cross-sectional study, we analyzed baseline data from the Hoveyzeh Cohort Study, a prospective population-based study conducted in Iran that enrolled a total of 7836 subjects aged 35 to 70 years from May 2016 through August 2018.

RESULTS

The optimal cut-off values of anthropometric indices for predicting MAFLD risk were determined for waist circumference(WC) (102.25 cm for males and 101.45 cm for females), body mass index (BMI) (27.80 kg/m2 for males and 28.75 kg/m2 for females), waist-to-hip ratio (WHR) (0.96 for both males and females), waist-to-height ratio (WHtR) (0.56 for males and 0.63 for females), body adiposity index (BAI) (23.24 for males and 32.97 for females), visceral adiposity index (VAI) (1.64 for males and 1.88 for females), weight-adjusted waist index (WWI) (10.63 for males and 11.71 for females), conicity index (CI) (1.29 for males and 1.36 for females), body roundness index (BRI) (4.52 for males and 6.45 for females), relative fat mass (RFM) (28.18 for males and 44.91 for females) and abdominal volume index (AVI) (18.85 for males and for 21.37 females). VAI in males (sensitivity: 77%, specificity: 60%, Youden's Index: 0.37) and RFM in females (sensitivity: 76%, specificity: 59%, Youden's Index: 0.35) were found to have higher sensitivity and specificity compared to other anthropometric indices. Furthermore, anthropometric indices demonstrated statistically significant correlations with various hepatic and cardiometabolic indices. Among these, the strongest positive correlations were observed between WC, BMI, BAI, BRI, and AVI with the Hepatic Steatosis Index (HSI), TyG-BMI, and TyG-WC, as well as between VAI and the Atherogenic Index of Plasma (AIP), Lipid Accumulation Product (LAP), Cardiometabolic Index (CMI), and the Triglyceride and Glucose (TyG) Index.

CONCLUSION

Anthropometric indices are effective in predicting MAFLD risk among Iranian adults, with WWI, VAI, and RFM identified as the strongest predictors. The proposed cutoff values could serve as a straightforward and non-invasive methods for the early diagnosis of MAFLD.

Development and validation of novel equation for prediction of resting energy expenditure in active Saudi athletes

Being the most stable component of energy expenditure, resting metabolic rate (RMR) is usually used in the calculation of energy requirements for athletes. An adequate energy prescription is essential in supporting athlete development. This work aims to develop and validate an equation for calculating energy requirements for Arabic Saudi athletes. This cross-sectional study included 171 active athletes aged 18 to 45 years. The sample was divided into a development group (n = 127) and a validation group (n = 44). Anthropometry, indirect calorimetry, and body composition analysis via bioelectric impedance analysis were performed on all participants. The novel predictive equations were created by using stepwise linear regression analyses. The accuracy of the novel equations was compared with 10 equations, and Bland and Altman plots were used to estimate the limits of agreement between measured RMR and novel equations. The first novel equation used a set of basic measures, including weight, gender, and age, was [RMR = 1137.094 + (Wt × 14.560)-(Age × 18.162) + (G × 174.917)] (R = 0.753, and R2 = 0.567, wt = weight, G = gender; for male use 1 and female 0). The second equation used fat-free mass, age, and weight [RMR = 952.828 + (fat-free mass × 10.970)-(Age × 18.648) + (Wt × 10.297)] (R = 0.760 and R2 = 0.577). Validation of the second novel equation increased the prediction of measured RMR to 72.7% and reduced the amount of bias to 138.82 ± 133.18 Kcal. Finally, the new set of equations was designed to fit available resources in clubs and showed up to 72.73% accurate prediction and good agreement with measured RMR by Bland and Altman plots.

Relationship between Body Mass Index and Diagnosis of Overweight or Obesity in Veterans Administration Population

Background: This paper examined the gap between obesity and its diagnosis for cohorts of patients with overweight, obesity, and morbid obesity in the Veterans Administration (VA) population. Using the risk adjustment models, it also identified factors associated with the underdiagnosis of obesity. Methods: Analysis was performed on a VA data set. We identified diagnosed patients and undiagnosed patients (identified through BMI but not diagnosed using ICD-10 codes). The groups' demographics were compared using nonparametric chi-square tests. We used logistic regression analysis to predict the likelihood of the omission of diagnosis. Results: Of the 2,900,067 veterans with excess weight, 46% were overweight, 46% had obesity, and 8% of them had morbid obesity. The overweight patients were the most underdiagnosed (96%), followed by the obese (75%) and morbidly obese cohorts (69%). Older, male, and White patients were more likely to be undiagnosed as overweight and obese; younger males were more likely to be undiagnosed as morbidly obese. (p < 0.05) Comorbidities significantly contributed to diagnosis. Conclusions: The underdiagnosis of obesity continues to be a significant problem despite its prevalence. Diagnosing obesity accurately is necessary to provide effective management and treatment.

Gastric Myoelectric Activity and Body Composition Changes during Weight Loss via Sleeve Gastrectomy and Lifestyle Modification: Prospective Cohort Study

The capability of bariatric surgery (BS) and lifestyle intervention (LSI) in ameliorating obesity-associated altered gastric myoelectric activity (GMA) in relation to body composition is underinvestigated. This work studied GMA during weight loss via sleeve gastrectomy and multimodal lifestyle intervention. Seventy-nine participants with morbid obesity were assigned into three groups: bariatric surgery (BS group, n = 27), in which laparoscopic sleeve gastrectomy was performed; lifestyle intervention (LS group, n = 22), in which a calorie-deficit balanced diet with gradual physical activity and personalized behavioral modification were carried out; and waitlist control (C group, n = 30). For all participants, multichannel electrogastrography (EGG) with water-load testing and bioelectric impedance body composition analysis were done at baseline, after three months, and at six months. In the BS group, the water-load volume was decreased but without improvement in the bradygastria. In the LS group, preprandial bradygastria were reduced and some postprandial normogastria were increased throughout the study period. Except for fat-free mass and total body water, the parameters of body composition changes were superior in the BS group. In the LS group, the amount of fat-mass loss was negatively correlated with bradygastria times and positively correlated with preprandial and the early postprandial average dominant frequency (ADF). In addition, in the BS group, fat-mass loss was positively correlated with the ADF at late postprandial times. In conclusion, compared to BS, LS produced moderate normalization of GMA with the preservation of fat-free mass. The GMA changes were significantly associated with the amount of fat loss, regardless of the method of obesity management.

Inflammatory Cytokines, Redox Status, and Cardiovascular Diseases Risk after Weight Loss via Bariatric Surgery and Lifestyle Intervention

Background and Objectives: Obesity is a chronic inflammatory condition and is considered a major risk factor for cardiovascular disease (CVD). The effects of obesity management via sleeve gastrectomy (SG) and lifestyle intervention (LS) on inflammatory cytokines, redox status, and CVD risk were studied in this work. Materials and Methods: A total of 92 participants (18 to 60 years old) with obesity (BMI ≥ 35 kg/m2 were divided into two groups: the bariatric surgery (BS) group (n = 30), and the LS group (n = 62). According to the achievement of 7% weight loss after 6 months, the participants were allocated to either the BS group, the weight loss (WL) group, or the weight resistance (WR) group. Assessments were performed for body composition (by bioelectric impedance), inflammatory markers (by ELISA kits), oxidative stress (OS), antioxidants (by spectrophotometry), and CVD risk (by the Framingham risk score (FRS) and lifetime atherosclerotic cardiovascular disease risk (ASCVD)). Measurements were taken before and after six months of either SG or LS (500 kcal deficit balanced diet, physical activity, and behavioral modification). Results: At the final assessment, only 18 participants in the BS group, 14 participants in the WL group, and 24 participants in the WR group remained. The loss in fat mass (FM) and weight loss were greatest in the BS group (p < 0.0001). Levels of IL-6, TNF-a, MCP-1, CRP, and OS indicators were significantly reduced in the BS and WL groups. The WR group had significant change only in MCP-1 and CRP. Significant reductions in the CVD risk in the WL and BS groups were detected only when using FRS rather than ASCVD. The FM loss correlated inversely with FRS-BMI and ASCVD in the BS group, whereas in the WL group, FM loss correlated only with ASCVD. Conclusions: BS produced superior weight and fat mass loss. However, both BS and LS produced a similar reduction in the inflammatory cytokines, relief of OS indicators, and enhancement of antioxidant capacity, and consequently reduced the CVD risk.

Cut points of the conicity index as an indicator of abdominal obesity in individuals undergoing hemodialysis: An analysis of latent classes

OBJECTIVES

Abdominal obesity favors the involvement of cardiometabolic complications in renal patients on hemodialysis. Thus, the aim of the study was to identify the cut-points of the conicity index in individuals undergoing hemodialysis.

METHODS

This was a cross-sectional study carried out with 953 individuals undergoing hemodialysis in clinics in a metropolitan region of southeastern Brazil. The conicity index was calculated using the following mathematical equation: waist circumference/0.109 × √weight/height. The receiver operating characteristic (ROC) curve was calculated from the analysis of latent classes by cross-validation through a latent variable of abdominal obesity. This latent variable was defined using the response pattern of the observed anthropometric variables considering the presence and absence of abdominal obesity: waist circumference, waist-to-height ratio, and body shape index. The cut-points identified were elucidated by the area under the curve (AUC), Youden index, sensitivity, and specificity.

RESULTS

The cut-points for the conicity index found for both sexes were similar, resulting in a cut-point for men of 1.275 (AUC, 0.921; Youden index, 0.666), with a sensitivity and specificity of 83% and 83.6%, and a cut-point for women of 1.285 (AUC, 0.921; Youden index, 0.679), with a sensitivity and specificity of 78.6% and 89.3%, respectively.

CONCLUSIONS

The conicity index showed high discriminatory power for the identification of abdominal obesity in hemodialysis patients, therefore it can be a simple and easily accessible tool to be incorporated into clinical practice in this population.

Association of lipid accumulation product with type 2 diabetes mellitus, hypertension, and mortality: a systematic review and meta-analysis

Purpose

Novel anthropometric measures are simple, applicable, and inexpensive tools for cardiovascular risk assessment. This study evaluates the association of lipid accumulation product (LAP) with hypertension, type 2 diabetes mellitus (T2DM), and all-cause mortality, and compares it with other anthropometric measures.

Methods

PubMed, Web of Science, EMBASE, and Scopus were systematically searched for articles published until May 15, 2021. We included all the studies that had measured LAP predictability for T2DM, all-cause mortality, and hypertension with no limitation in comorbidities and follow-up duration. We assessed the predictability measures of LAP for the aforementioned outcomes. We also performed a meta-analysis on four articles on mortality using an inverse variance method by the "meta" package in R software.

Results

Twenty-nine studies were included in the review after applying the eligibility criteria. The hazard ratio for all-cause mortality per one standard deviation increment of LAP was 1.24 (95% confidence interval [CI]: 1.00-1.53; P = 0.0463) in females, and 1.07 (95% CI: 0.74-1.57; P = 0.709) in males. All included studies found a direct association between LAP with T2DM and hypertension. However, studies used different cut-off points for LAP. Most studies found that LAP was superior in predicting T2DM and hypertension compared to conventional indices, e.g., body mass index and waist circumference. We found that LAP may have higher prognostic significance in females compared to males.

Conclusion

LAP is an inexpensive method to evaluate the risk of all-cause mortality, T2DM, and hypertension, and could outperform conventional anthropometric indices in this regard.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-022-01114-z.

The Association between Vitamin D Hypovitaminosis and Cardiovascular Disease Risk in Saudi Diabetic Patients Type II

We evaluated the prevalence and association of Vitamin D deficiency with glycemic control and CVD risk in T2DM patients. Serum 25 (OH)D3, lipid profile, glucose panel, HbA1c, serum insulin, and HOMA-IR were assessed in 93 T2DM patients and 69 controls. 10 years and lifetime ASCVD risk scores were calculated. The levels of 25(OH)D3 were significantly low in T2DM patients compared to the control. T2DM patients with hypovitaminosis D displayed significantly increased FBG, insulin, and HOMA-IR compared to normovitaminosis. Their lifetime and 10-year ASCVD risk scores were significantly higher regardless of vitamin D deficiency levels (P=0.006; P=0.023) in comparison to patients with sufficient levels of vitamin D. Among patients, the lifetime and 10 years of ASCVD risk showed a significant negative correlation with serum 25(OH)D3 and HDLc (P=0.037; 0.018) (P=0.0001), respectively, and significant positive correlation with T2DM duration, serum insulin, and HOMA-IR (P=0.018; 0.0001) (P=0.002; 0.001) (P=0.005; 0.001), respectively. The 10-year ASCVD risk exhibited a significant positive correlation with FBG (P=0.003) and HbA1c (P=0.009). T2DM duration was a predictor of vitamin D deficiency among T2DM patients (β = 0.22; CI = 0.002-0.04). There is a considerable association between lifetime and 10 years of ASCVD risk with hypovitaminosis D in T2DM, regardless of the deficiency levels which could be predicted by the diabetes duration.

Exploring the relationships between anthropometric indices of adiposity and physical performance in middle-aged and older Brazilian women: a canonical correlation analysis

OBJECTIVES

This study analyzed the influence of anthropometric indices of adiposity on the physical performance of middle-aged and older women.

METHODS

A cross-sectional study was conducted among 368 women from 50 years to 80 years old. Anthropometric and biochemical characteristics were analyzed, and physical performance was evaluated. The statistical analysis used measures of central tendency and dispersion for descriptive data, Pearson correlations to demonstrate the initial associations between the variables, and canonical correlation (CC) to evaluate the relationship between the set of anthropometric adiposity indices and performance-related variables.

RESULTS

The participants had a mean age of 58.57±8.21 years, a visceral adiposity index of 7.09±4.23, a body mass index of 29.20±4.94 kg/m2, and a conicity index of 1.33±0.07. The average handgrip strength was 25.06±4.89 kgf, gait speed was 1.07±0.23 m/s, and the mean Short Physical Performance Battery (SPPB) score was 10.83±1.36. The first canonical function presented the highest shared variance, CC, and redundancy index (cumulative percentage of variance, 82.52; Wilks' lambda, 0.66; CC, 0.532; p<0.001). From the analysis of this canonical function, the conicity index (-0.59) displayed inverse correlations with handgrip strength (0.84) and the SPPB (0.68), as well as a direct correlation with gait speed (-0.43).

CONCLUSIONS

In middle-aged and older women, there was an inverse relationship between the conicity index and muscle strength and power, while a direct relationship was found between the same index and gait speed.

Association of Gastric Myoelectrical Activity With Ghrelin, Gastrin, and Irisin in Adults With Metabolically Healthy and Unhealthy Obesity

Background and Objective: Functional disturbances of gastric myoelectrical activity (GMA) might exist in obesity. However, studies on its association with the gastric hormones in obesity phenotypes are lacking. The objective was to study the association of GMA with the serum levels of key gastric hormones in different obesity phenotypes.

Methods: A total of 139 adults (31.00 ± 11.12 years) were classified into different metabolic phenotypes of obesity: 1) normal weight-lean (NWL group): BMI <25 kg/m² and the fat-mass index (FMI) ≤9.7 kg/m² in females and ≤6.3 kg/m² in males; 2) metabolically obese normal weight (MONW group): BMI <25 kg/m² and FMI >9.7 kg/m² in females and >6.3 kg/m² in males; 3) metabolically healthy obese (MHO group): BMI ≥25 and FMI ≤9.7 kg/m² in females and ≤6.3 kg/m² in males; and 4) metabolically unhealthy obese (MUO group): BMI ≥25 and FMI >9.7 kg/m² in females and >6.3 kg/m² in males. The GMA was measured at the baseline and post-prandial state using a multichannel electrogastrography with a water load satiety test. The average power distribution by the frequency region and the average dominant frequency were used for analysis. Anthropometric measurements and bioelectric impedance analysis were performed to calculate the FMI and fat-free mass index (FFMI). Serum levels of ghrelin, gastrin, and irisin were measured by ELISA kits according to the manufacturer’s protocol.

Results: Compared to the NWL group, gastrin and ghrelin levels were significantly low in the MUO participants, while irisin was significantly high. The EGG showed significantly lower baseline and 20-min normogastria frequencies in the MHO and MUO groups. In the MHO group, baseline duodenal frequency was positively correlated with the gastrin level, while normogastria times were positively associated with the irisin level and negatively associated with the ghrelin level. In the MUO group, percentages of bradygastria frequencies at 10, 20, and 30 min were positively correlated with the BMI and FFMI. This bradygastria was correlated positively with the irisin level and negatively with the ghrelin level.

Conclusion: The EGG patterns might be associated with obesity-related gastric hormones in different obesity phenotypes. EGG may be a promising clinical tool in obesity assessment. The association of the EGG patterns with hormonal levels needs further investigation for potential practical uses.

Cutoff points of adiposity anthropometric indices for low muscle mass screening in middle-aged and older healthy women

Background

The reduction of female sex hormones causes changes in the contractile properties of muscles as well as infiltration of fat in the muscle tissue. This results in a consequent decline in muscle strength. These changes are related to higher levels of functional impairment and physical disability. In this sense, several anthropometric indices have been used to quantify body and visceral fat. Thus, the objective of this paper is to propose cutoff points for adiposity anthropometric indices in order to identify low muscle mass, as well as to analyze the relationship between these indices and low muscle mass in middle-aged and older women.

Methods

Cross-sectional analytical study carried out in the Northeast of Brazil. The sample was formed by 593 women between 40—80 years old. Data collection included anthropometric assessment (BMI: Body Mass Index – WC: Waist Circumference – WHR: Waist-to-hip Ratio – WHtR: Waist-to-height Ratio – CI: Conicity Index – BAI: Body Adiposity Index – VAI: Visceral Adiposity Index – LAP: Lipid Accumulation Product), bioimpedance test and biochemical dosage. Moreover, sociodemographic data and practice of physical activity were collected. Descriptive statistics, Student's t-test, ROC curves, chi-squared and logistic regression were performed.

Results

The participants had a mean age of 53.11 (8.89) years, BMI of 28.49 (5.17) kg/m² and WC of 95.35 (10.39). The prevalence of low muscle mass was 19.4%. Based on sensitivity and specificity of adiposity anthropometric indices, cutoff points were developed to identify the presence of low muscle mass (p < 0.05), except for VAI. After logistic regression, WC (OR = 6.2; CI 95%: 1.4—28.1), WHR (OR = 1.8; CI: 1.0—3.4), WHtR (OR = 5.0; CI 95%: 1.0—23.7) and BAI (OR = 14.5; CI 95%: 6.6—31.7) were associated with low muscle mass.

Conclusions

All anthropometric indices, except VAI, showed adequate accuracy in identifying low muscle mass in women, especially those that took into account WC. This suggests that they can become accessible and also be cost-effective strategies for assessing and managing health outcomes related to muscle mass analysis.

Lean non-alcoholic fatty liver disease and associated metabolic disturbance: A Saudi Arabian cross-sectional study

Non-alcoholic liver disease (NAFLD) is a metabolic liver disease associated with visceral adiposity and insulin resistance. Recently, NAFLD has been described in lean individuals who additionally have impaired metabolic parameters similar to their non-lean counterparts. We aimed to explore this further in Saudi Arabia. From 2016 to 2019, we prospectively studied a group of newly diagnosed NAFLD patients at a tertiary hospital in Saudi Arabia. Patients were classified into three groups: lean (body mass index [BMI] <25), overweight (BMI ≥25 and <30), and obese (BMI ≥30). We made comparisons between these groups on basic clinical, demographic, and laboratory parameters. In total, 1753 patients were recruited and 1262 patients met the inclusion criteria. Altogether, 159 (12.6%), 365 (29%), and 737 (58.4%) patients were in the lean, overweight, and obese categories, respectively. Lean NAFLD patients were, on average, younger than those in the overweight group (mean 49.95 ± 15.3) and had a significantly higher high-density lipoprotein value (HDL) (mean 52.56 ± 16.27). Sex, hyperlipidemia, type 2 diabetes, and hypertension were significantly associated with BMI. Lean NAFLD patients displayed the features of metabolic syndrome including elevated glycosylated hemoglobin and abnormal lipid profile but had higher serum HDL. This is in contrast to the widely held belief that lean individuals have no dysmetabolic changes compared to overweight individuals. Recognition of this problem is essential so that lean NAFLD patients can be screened for metabolic changes and managed appropriately to prevent complications.

Obesity-Related Indices Are Associated with Peripheral Artery Occlusive Disease in Patients with Type 2 Diabetes Mellitus

Type 2 diabetes mellitus (DM) is an increasing global health issue. Peripheral artery occlusive disease (PAOD) is a common complication of diabetes, and it is a complex and costly disease. The association between type 2 DM and obesity is well known, however, the relationship between obesity and PAOD in patients with type 2 DM has yet to be elucidated. Therefore, the aim of this study was to examine associations between obesity-related indices and PAOD in patients with type 2 DM. A total of 1872 outpatients with type 2 DM were recruited from two hospitals in southern Taiwan. An ankle–brachial index (ABI) < 0.9 in either leg was considered to indicate the presence of PAOD. The following obesity-related indices were investigated: conicity index (CI), waist–hip ratio (WHR), body roundness index (BRI), waist-to-height ratio (WHtR), abdominal volume index, a body shape index (ABSI), visceral adiposity index (VAI), lipid accumulation product (LAP), body adiposity index, body mass index and triglyceride–glucose index. Overall, 4.1% of the enrolled patients had an ABI < 0.9. High values of the following obesity-related indices were significantly associated with a low ABI: WHtR (p = 0.045), VAI (p = 0.003), CI (p = 0.042), BRI (p = 0.021) and ABSI (p = 0.043). Furthermore, WHR (area under the curve (AUC) = 0.661), CI (AUC = 0.660) and LAP (AUC = 0.642) had the best performance (all p < 0.001) to predict PAOD. In conclusion, high WHtR, BRI, CI, VAI and BAI values were associated with a low ABI in the enrolled patients, and WHR, CI and LAP were the most powerful predictors of PAOD.

The Efficacy of Antioxidant Oral Supplements on the Progression of COVID-19 in Non-Critically Ill Patients: A Randomized Controlled Trial

Modulation of cytokine production using immunonutrition is a relatively novel concept to improve outcomes among patients with SARS-CoV-2 infection and is now hypothesized to help manage COVID-19, however, clinical evidence is lacking. This prospective, double-blinded, randomized parallel-controlled interventional clinical trial investigated the effect of antioxidant supplements on inflammatory cytokines and disease progression in non-critically ill patients. A total of 87 hospitalized COVID-19 patients were randomized using computer-generated-randomization into the supplement group (n = 18) and the placebo group (n = 16) for 10 days. Baseline and final nutritional screening via nutrition risk screening (NRS-2002) and subjective global assessment (SGA), as well as the recording of anthropometric, clinical, biochemical, and functional parameters, were done. Serum ferritin level, cytokine storm parameters such as interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), monocyte chemoattractant protein 1(MCP-1), C-reactive protein, total leukocyte count, lymphocytic count, and neutrophil-to-lymphocyte ratio were measured. Anthropometric and clinical parameters showed nonsignificant differences between groups. The hematology profile showed improvement in lymphocyte count in the supplement group. However, levels of alkaline phosphatase, IL-6, TNF-α, and MCP-1 were significantly lower in the supplement group. In conclusion, antioxidant oral supplementation significantly reduced the cytokine storm and led to partial improvements in clinical parameters among patients with non-critical COVID-19.

Comparison of anthropometric indices for predicting the risk of metabolic syndrome in older adults

Background. The prevalence of obesity and metabolic syndrome (MetS) is increasing, worldwide. Using a simple, efficient and reliable tool for predicting MetS is an essential approach in preventive health programs. The aim of this study was to compare the different anthropometric indices in predicting metabolic syndrome in older adults.Methods. This cross-sectional study is a part of the Amirkola Health and Ageing cohort Project (2011-2016). Of total, 1,488 older people aged 60-92 years were entered to the study. Medical and personal information of participants were collected by a questionnaire. After measuring the height, weight, waist circumference, hip circumference and neck circumference, body mass index, waist to hip ratio, waist to height ratio, abdominal volume index and conicity index were calculated. Independent t-test, chi-square and ROC curve were used to analyze the data.Results. Based on ATPIII-2005 diagnostic criteria, the prevalence of metabolic syndrome was 71.57%.The prevalence in female was higher than male. All of examined anthropometric indices, except neck circumference (p = 0.10), showed a significant difference in people with MetS compared to the individuals without metabolic syndrome (p<0.001). Waist to height ratio showed the largest area under the curve for predicting MetS (0.786; 95% CI: 0.76-0.81) followed by BMI (0.746; 95% CI: 0.71-0.77), AVI (0.745; 95% CI: 0.71-0.77), and waist circumference (0.743; 95% CI: 0.71-0.77).Conclusion. Waist to height ratio was the best predictor of MetS in older adults.

Adiposity and Cardiometabolic Risk assessment Among University Students in Saudi Arabia

Overweight and obesity have become a significant health hazard among adolescents on account of quick growth in its occurrence rate and its common comorbidities like cardiometabolic disease (CMD). The aim of this study was to evaluate the prevalence of adiposity and assess the risk of CMD among university students in Eastern Province, Saudi Arabia. A cross-sectional study was conducted during the academic year 2017-2018, in a sample of 310 subjects (127 males; 183 females). The measurements were taken using standardized instruments including Body Mass Index (BMI), Fat Mass Index (FMI), Body Fat Percentage BFP), Mass of Body Fat (MBF), Visceral Fat Area (VFA), Waist Circumference (WC), and Waist to Hip Ratio (WHR). Moreover, CMD risk indicators were calculated by Conicity index (C index), WC, and WHR. The findings showed that the majority was overweight and obese (16.8% and 21.6%, respectively). While evaluating obesity indicators, males were found to have higher adiposity (obese students 34.6%) compared to female students (12.6%; p < 0.001). Additionally, FMI showed that the mean was significantly higher among males (8.65 ± 6.06) compared to females (7.26 ± 3.30; p < 0.019). Analysis of the predictors' indices for cardiometabolic risk score highlighted a significantly higher percentage of WC, WHR, and C index among male students (50, 38.5, 59) compared to females (16.9, 14.2, 34; p < 0.001). Significant positive correlations were observed between C index quartiles and BMI with the other cardiometabolic indices (p < 0.001). This study highlighted a high prevalence of adiposity and CMD risk among university students. The prediction of CMD in early age is quite helpful in preventing adiposity related health issues. Decision makers need to spread awareness about healthy consumption as well as the relationship between physical inactivity and chronic diseases.

Correlation between Thyroid Homeostasis and Obesity in Subclinical Hypothyroidism: Community-Based Cross-Sectional Research

OBJECTIVE

It remains unknown whether obesity has an effect on the pituitary-thyroid feedback control axis in subclinical hypothyroidism (SCH). We aimed to investigate the association of thyroid homeostasis with obesity in a SCH population.

METHODS

Our study consisted of a community-based and cross-sectional study from the Epidemiological Survey of Thyroid Diseases in Fujian Province, China. A total of 193 subjects with SCH (90 males and 103 females) without a history of treatment of thyroid disease, such as surgery, radiation, and thyroid hormone or antithyroid medication, were included in the present study. Indices of obesity, including body mass index (BMI), waist circumference (WC), and waist-height ratio (WHtR) were measured.

RESULTS

Our results showed that the secretory capacity of the thyroid gland (SPINA-GT) and Jostel's thyrotropin index (TSHI) were negatively correlated with BMI, WC, and WHtR, whereas the reciprocal of the thyrotroph thyroid hormone resistance index (TTSI-1) was positively correlated with BMI (all p < 0.05). After adjustment for age, sex, smoking, iodine status, and glucolipid metabolism, the associations between TSHI, TTSI (reciprocal transformation), and BMI still persisted (all p < 0.05).

CONCLUSIONS

These results suggest that low levels of thyroid homeostasis indexes may be associated with overall obesity in SCH, rather than central adiposity.

Measured resting metabolic rate, respiratory quotient, and body composition in patients with narcolepsy: a preliminary report of a case-control study

This case–control study compared the body composition, resting metabolic rate (RMR), and respiratory quotient (RQ) of narcolepsy patients with those of body mass index (BMI)- gender and age-matched controls. This study included 14 male patients with narcolepsy and 14 matched controls. The narcolepsy patients were subdivided into two subgroups (n = 7/each): those with cataplexy (NT1) and those without cataplexy (NT2). Anthropometric measurements, bioelectric impedance analysis, and indirect calorimetry were used in addition to the calculation of common body-composition indices (conicity index, abdominal volume index, and body adiposity index). Our results showed no significant difference in fat percentage, fat mass, fat-free mass, and TBW among NT1, NT2, and controls (p > 0.05). Compared to matched controls, there was a reduction of muscle mass in both NT1 and NT2 subgroups. The RMR was similar in all groups, while patients in the NT1/NT2 subgroups had a lower RQ, used more fat and fewer carbohydrates during the fasting period. These findings give an insight into the distinctive state of altered metabolism in patients with narcolepsy, especially the resting metabolic rate, which was not altered in NT1 vs. NT2 compared to the controls when matched for BMI, age, and gender.

Impact of the Glycemic Control and Duration of Type 2 Diabetes on Vitamin D Level and Cardiovascular Disease Risk

BACKGROUND AND AIMS

To investigate the impact of glycemic control and T2D duration on vitamin D status and cardiovascular disease (CVD) risk among Saudi patients.

METHODS

This case-control study was conducted in King Faisal Specialist Hospital, Saudi Arabia. A total of 25 nondiabetic controls and 92 patients with confirmed T2D, aged 20-60 years, were included. Patients with T2D were divided into the following groups based on disease duration (newly diagnosed: ≈6 months and long duration: ≥5 years) and glycemic control based on their glycated hemoglobin (HbA_1C) level with a threshold of ≤0.053 mol/mol: newly diagnosed controlled (NC, n = 25), newly diagnosed uncontrolled (NU, n = 25), newly diagnosed uncontrolled (NU, n = 25), newly diagnosed uncontrolled (NU, n = 25), newly diagnosed uncontrolled (NU.

RESULTS

Our study showed that T2D duration was an independent predictor of vitamin D deficiency. The longer disease duration, the lower odds of being vitamin D deficient (odds ratio (OR) = 0.05, 95% CI: 0.01-0.29, p < 0.05). No significant association was observed between vitamin D and HbA_1C levels. In the NU group, CVD risk scores were directly correlated with serum 25(OH)D (r = 0.53, p < 0.05). No significant association was observed between vitamin D and HbA_1C levels. In the NU group, CVD risk scores were directly correlated with serum 25(OH)D (r = 0.53, p < 0.05). No significant association was observed between vitamin D and HbA_1C levels. In the NU group, CVD risk scores were directly correlated with serum 25(OH)D (.

CONCLUSION

Duration of diabetes rather than glycemic control is associated with vitamin D deficiency. Glycemic uncontrol may augment vitamin D deficiency-associated CVD risk in both newly diagnosed and old patients with type 2 diabetes.

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.

Body Mass Index versus Other Adiposity Traits: Best Predictor of Cardiometabolic Risk

BACKGROUND

A number of anthropometric indices have been used in different world populations as markers to estimate obesity and its related health risks. The present study is large population based study dealing with five anthropometric obesity scales; Body mass index (BMI), waist circumference (WC), waist to hip ratio (WHR), basal adiposity index (BAI), and Visceral adiposity index (VAI) to identify common adiposity trait(s) that best predict obesity and associated health complication(s).

METHODS

A total of 4000 subjects including 1000 in each category of BMI from four provinces (Punjab, Sindh, Kahyber pakhtoonkha and Balochistan) of Pakistan from 2012-2017 were collected. Complete anthropometric measurementswere obtained and blood samples were collected and Biochemical profiling was performed. Descriptive statistics, linear regression, binary and multiple regression analysis was done.

RESULTS

Our data analysis explored the relationships of obesity five indices; BMI, WC, WHR, BAI, and VAI with common metabolic health complications. Effect size analysis clearly indicates that a unit increase in BMI significant raised all anthropometric and clinical parameters. General and sex specific association analysis of adiposity traits with risk phenotypes (hypertension, hyperglycemia and dyslipidemia) indicated significant associations of WC with all three metabolic risks. Varying degrees of correlations of other adiposity traits with metabolic risks were observed. Frequency of different obesity classes among obese population group were as follows; 55.7% class I, 28.50% Class II and 15.80% Class III.

CONCLUSION

WC is the strong predictor of obesity associated metabolic health issues in Pakistani populations. While BMI has significant increasing effect on other obesity indices like WHR, VAI and BAI.

Design and validation of a novel estimator of visceral adipose tissue area and comparison to existing adiposity surrogates

AIMS

Visceral adiposity measured by computed tomography (CT) as intra-abdominal fat area (IAFA) predicts metabolic diseases. Existing adiposity surrogates have not been systematically compared to a regression-based model derived in individuals of Japanese ancestry. We developed and validated a method to estimate IAFA in individuals of Japanese ancestry and compared it to existing adiposity surrogates.

METHODS

We assessed age, BMI, waist circumference (WC), fasting lipids, glucose, smoking status, grip strength, mid-thigh circumference (MTC), humeral length, leg length, and IAFA by single-slice CT at the umbilicus for 622 Japanese Americans. We used stepwise linear regression to predict IAFA and termed the predicted value the Estimate of Visceral Adipose Tissue Area (EVA). For men, the final model included age, BMI, WC, high-density lipoprotein cholesterol (HDLc), glucose, and MTC; for women, age, BMI, WC, HDLc, low-density lipoprotein cholesterol, glucose, and MTC. We compared goodness-of-fit (R2) from linear regression models and mean-squared errors (MSE) from k-fold cross-validation to compare the ability of EVA to estimate IAFA compared to an estimate by Després et al., waist-to-height ratio, WC, deep abdominal adipose tissue index, BMI, lipid accumulation product, and visceral adiposity index (VAI). We classified low/high IAFA using area under receiver-operating characteristic curves (AUROC) for IAFA dichotomized at the 75th percentile.

RESULTS

EVA gave the least MSE and greatest R2 (men: 1244, 0.61; women: 581, 0.72). VAI gave the greatest MSE and smallest R2 (mean 2888, 0.08; women 1734, 0.14).

CONCLUSIONS

EVA better predicts IAFA in Japanese-American men and women compared to existing surrogates for adiposity.