Do upper-body and centralized adiposity measure different aspects of regional body-fat distribution? Relationship to non-insulin-dependent diabetes mellitus, lipids, and lipoproteins

Central Body Fat Distribution and Kidney Function after Living Kidney Donation

BACKGROUND

In most screening guidelines, high body mass index (BMI) is considered a contraindication for kidney donation. New insights suggest that central body fat distribution might provide greater power in assessing kidney risk. This study aimed to determine whether BMI and central body fat distribution measures are associated with long-term kidney function after donor nephrectomy. We hypothesized that higher BMI, waist circumference (WC), and waist-to-height ratio (WHtR) were associated with lower kidney function long term after donation.

METHODS

The study population consisted of living kidney donors. BMI, WC, and WHtR were measured during donor screening. The outcome postdonation kidney function was assessed using measured GFR (mGFR) (mGFR, 125 I-iothalamate infusion) at 3 months ( n =1042), 5 years ( n =556), and 10 years ( n =210) of follow-up. Primary multivariable linear regression analyses were performed with BMI and WC and secondary analyses with WHtR. Linear mixed models were performed to investigate change in postdonation eGFR.

RESULTS

The donor age was 52±11 years, and 48% were male. The mean BMI was 26.1±3.6 kg/m 2 , and WC was 91±11 cm. Higher predonation BMI was associated with lower mGFR throughout follow-up: -1.35 (95% confidence interval [CI], -1.95 to -0.80), -1.55 (95% CI, -2.50 to -0.65), and -2.35 (95% CI, -4.10 to -0.60) ml/min per m 2 per 5 kg/m 2 higher BMI at 3 months, 5, and 10 years after donation, respectively, adjusted for sex, age, and predonation GFR. For WC, differences in mGFR were -1.30 (95% CI, -1.70 to -0.90), -1.50 (95% CI, -2.20 to -0.80), and -1.70 (95% CI, -3.00 to -0.50) ml/min per m 2 per 10 cm higher WC at 3 months, 5, and 10 years after donation, respectively. In male donors, BMI and WC were significantly associated with a negative postdonation change in eGFR.

CONCLUSIONS

Higher BMI and WC were independently associated with lower GFR (long term) after living kidney donation.

The role of Wnt pathway in obesity induced inflammation and diabetes: a review

Diabetes has become a major killer worldwide and at present, millions are affected by it. Being a chronic disease it increases the risk of other diseases ranging from pulmonary disorders to soft tissue infections. The loss of insulin-producing capacity of the pancreatic β-cells is the main reason for the development of the disease. Obesity is a major complication that can give rise to several other diseases such as cancer, diabetes, etc. Visceral adiposity is one of the major factors that play a role in the development of insulin resistance. Obesity causes a chronic low-grade inflammation in the tissues that further increases the chances of developing diabetes. Several pathways have been associated with the development of diabetes due to inflammation caused by obesity. The Wnt pathway is one such candidate pathway that is found to have a controlling effect on the development of insulin resistance. Moreover, the pathway has also been linked to obesity and inflammation. This review aims to find a connection between obesity, inflammation, and diabetes by taking the wnt pathway as the connecting link.

The accuracy of anthropometric measurements of general and central obesity for the prediction of impaired glucose tolerance among the adult population of South India

BACKGROUND

The distribution of body fat and its variation is of great importance in determining the pathogenesis of insulin resistance. Central obesity has been recognized as an independent risk factor for diabetes. The objective of the study was to evaluate the predictive accuracy of various anthropometric measures of body fat in determining impaired glucose tolerance (IGT) or prediabetes among South Indian population.

METHODOLOGY

This was a community-based comparative cross-sectional study where the anthropometric measures of a representative sample of 171 individuals with glycosylated hemoglobin (HbA1c) in the range for IGT were compared with age- and gender-matched controls with HbA1c in the normal range. The predictive accuracy of the various anthropometric measures of obesity to identify individuals with IGT was estimated using the area under the receiver operating characteristic (ROC) curve.

RESULTS

Patients with IGT in both genders had significantly higher BMI, waist circumference (WC), neck circumference (NC), and waist-to-height ratio (WHtR). ROC analysis revealed WHtR in females and NC among males to have the largest area under the curve for predicting IGT. In both genders, WC, WHtR, and NC had better predictive accuracy for prediabetes as compared to BMI and waist-to-hip ratio (WHR).

CONCLUSION

It is suggested that the WHtR and WC are better screening tools for prediabetes in comparison to BMI and WHR among the South Indian population.

Skinfold thickness and the incidence of type 2 diabetes mellitus and hypertension: an analysis of the PERU MIGRANT study

OBJECTIVE

To determine the association between excess body fat, assessed by skinfold thickness, and the incidence of type 2 diabetes mellitus (T2DM) and hypertension (HT).

DESIGN

Data from the ongoing PERU MIGRANT Study were analysed. The outcomes were T2DM and HT, and the exposure was skinfold thickness measured in bicipital, tricipital, subscapular and suprailiac areas. The Durnin-Womersley formula and SIRI equation were used for body fat percentage estimation. Risk ratios and population attributable fractions (PAF) were calculated using Poisson regression.

SETTING

Rural (Ayacucho) and urban shantytown district (San Juan de Miraflores, Lima) in Peru.

PARTICIPANTS

Adults (n 988) aged ≥30 years (rural, rural-to-urban migrants, urban) completed the baseline study. A total of 785 and 690 were included in T2DM and HT incidence analysis, respectively.

RESULTS

At baseline, age mean was 48·0 (sd 12·0) years and 47 % were males. For T2DM, in 7·6 (sd 1·3) years, sixty-one new cases were identified, overall incidence of 1·0 (95 % CI 0·8, 1·3) per 100 person-years. Bicipital and subscapular skinfolds were associated with 2·8-fold and 6·4-fold risk of developing T2DM. On the other hand, in 6·5 (sd 2·5) years, overall incidence of HT was 2·6 (95 % CI 2·2, 3·1) per 100 person-years. Subscapular and overall fat obesity were associated with 2·4- and 2·9-fold risk for developing HT. The PAF for subscapular skinfold was 73·6 and 39·2 % for T2DM and HT, respectively.

CONCLUSIONS

We found a strong association between subscapular skinfold thickness and developing T2DM and HT. Skinfold assessment can be a laboratory-free strategy to identify high-risk HT and T2DM cases.

Gender Stratified Analyses of the Association of Skinfold Thickness with Hypertension: A Cross-Sectional Study in General Northeastern Chinese Residents

The association of hypertension with skinfold thickness (ST) in adults is not clear. Our study was aimed at finding out the association of hypertension with ST in different gender and obesity categories. This is a cross-sectional study based on 2336 Chinese residents (767 men). Both subscapular skinfold thickness (SST) and tricep skinfold thickness (TST) were examined. We estimated the association of hypertension with per SD increase of SST and TST using multivariable logistic regression analyses in men and women. Six subgroups were stratified using cutoff points of body mass index (BMI) and ST: larger and smaller ST in normal weight (BMI < 24 kg/m²), overweight (24 kg/m² ≤ BMI < 28 kg/m²) and obesity (BMI ≥ 28 kg/m²), respectively. The association of hypertension with ST was only shown in women after adjustment for other risk factors. Among women of the normal weight subgroup, higher prevalence of hypertension was shown in those with larger ST. No difference of the prevalence of hypertension was found between women with larger ST in the normal weight subgroup and those with smaller ST in overweight or obesity subgroups. Our study suggested that even for people with normal weight, it was necessary to monitor the subcutaneous fat using ST for preventing hypertension at least in general Chinese women.

Randomized Control Trial for Reduction of Body Weight, Body Fat Patterning, and Cardiometabolic Risk Factors in Overweight Worksite Employees in Delhi, India

BACKGROUND

We studied the impact of the multicomponent interventions on body weight and cardiometabolic risk factors in overweight individuals working in corporate worksites.

METHODS

Overweight (BMI ≥ 23 kg/m²) subjects were recruited from four randomised worksites [two active intervention (n, recruited, 180, completed 156) and two control (n, recruited 130, completed 111)]. Intensive intervention was given at intervention worksite.

RESULTS

High prevalence (%) of obesity (90.9, 80.2), abdominal obesity (93.5, 84.3), excess skinfold thickness (70.3, 75.9), and low high-density lipoprotein cholesterol (HDL-c) levels (56.8, 63.7) were seen in the intervention and the control group, respectively. At the end of intervention, the following significant changes were observed in the intervention group: decrease in weight, BMI, waist circumference, serum triglycerides, and increase in HDL-c. Weight loss of more than 5% was seen in 12% and 4% individuals in the intervention and control groups, respectively. Most importantly, the sum of all the skinfold measurements (mm) in the intervention group decreased significantly more than the control group (12.51 ± 10.38 versus 3.50 ± 8.18, resp.).

CONCLUSION

This multicomponent worksite trial showed a reduction in weight, excess subcutaneous fat, and cardiometabolic risk factors after 6 months of active intervention in overweight Asian Indians.

TRIAL REGISTRATION

This trial is registered with NCT03249610.

The correlation between anthropometric indices and hemodynamic changes after laryngoscopy and endotracheal intubation

BACKGROUND

Cardiovascular hemodynamic changes after laryngoscopy and endotracheal intubations can cause serious complications. This study was carried out to evaluate the correlation between the anthropometric indices and hemodynamic changes after laryngoscopy and endotracheal intubation (EI).

MATERIALS AND METHODS

This descriptive-analytical pilot study was carried out in 2012, in the Kashani Hospital, Isfahan, Iran. After obtaining written informed consent from 130 patients who fulfilled the inclusion criteria, they were enrolled in the study. The recorded data included were, age, weight, height, neck circumference (NC), waist-to-hip ratio (W/H ratio) and body mass index (BMI). The heart rate (HR), systolic blood pressure (SAP), diastolic blood pressure (DBP), and mean arterial blood pressure (MAP) were recorded at baseline (before injection of the anesthetic drugs), just before laryngoscopy, and one, three, five, and ten minutes after EI.

RESULTS

The best cut-off points for BMI, NC, and W/H ratio, for prediction of significant cardiovascular changes after EI were, 26.56 kg/m(2), 38 cm, and 0.82, respectively. There was a significant correlation between BMI and HR changes in the first and fifth minutes and also in MAP in the third and fifth minutes after EI (P < 0.05). Moreover, there was a significant correlation between NC and MAP in the fifth minute (P < 0.05). The W/H ratio was significantly related to the DBP in the tenth minute and MAP in the fifth and tenth minutes (P < 0.05).

CONCLUSIONS

Based on the results of this study, among the anthropometric indices, the BMI, NC, and W/H ratio were significantly correlated with cardiovascular changes after laryngoscopy and tracheal intubation.

Sonographic assessment of abdominal fat distribution during the first year of infancy

BACKGROUND

Longitudinal data regarding the fat distribution in the early postnatal period is sparse.

METHODS

We performed ultrasonography (US) as a noninvasive approach to investigate the development of abdominal subcutaneous (SC) and preperitoneal (PP) fat depots in infants ≤1 y and compared longitudinal US data with skinfold thickness (SFT) measurements and anthropometry in 162 healthy children at 6 wk, 4 mo, and 1 y postpartum.

RESULTS

US was found to be a reproducible method for the quantification of abdominal SC and PP adipose tissue (AT) in this age group. Thickness of SC fat layers significantly increased from 6 wk to 4 mo and decreased at 1 y postpartum, whereas PP fat layers continuously increased. Girls had a significantly higher SC fat mass compared to boys, while there was no sex-specific difference in PP fat thickness. SC fat layer was strongly correlated with SFT measurements, while PP fat tissue was only weakly correlated with anthropometric measures.

CONCLUSION

US is a feasible and reproducible method for the quantification of abdominal fat mass in infants ≤1 y of age. PP and SC fat depots develop differentially during the first year of life.

Beyond waist circumference in an adult male population of Southern Italy: Is there any role for subscapular skinfold thickness in the relationship between insulin-like growth factor-I system and metabolic parameters?

BACKGROUND

Apart from waist circumference, other adiposity measures, such as subscapular skin fold (SST), arouse growing interest due to their relationship to metabolic complications and cardiovascular risk. The IGF-I system is deregulated in obese subjects in proportion to their degree of visceral adiposity.

AIM

To examine the association among IGF-I, IGF-binding protein (BP)-1 and -3 levels and different measures of adiposity in a sample of adult male population in Southern Italy.

MATERIALS AND METHODS

A complete database for this analysis was available for 229 (age range 50-82 yr) participating at 2002-2004 Olivetti Heart Study follow-up.

RESULTS

After adjustment for age, IGF-I was inversely associated with body mass index (BMI) and waist circumference (p<0.05). IGFBP-1 was inversely associated with BMI, waist circumference, SST, homeostasis model assessment (HOMA) index, fat mass. HOMA index, age, and SST significantly predicted the IGFBP-1 plasma levels, with 24% of IGFBP-1 variability explained at a linear regression analysis.

CONCLUSIONS

IGFBP-1 inversely correlated to adiposity and HOMA index. Among adiposity indexes, SST was the best predictor of IGFBP-1 levels. The evaluation of some components of the IGF system, and simple measures of body adiposity, such as SST, may represent a further tool to better evidence phenotype profiles associated to the pathogenetic mechanism of cardiovascular risk factor clustering in male adults.

Dysregulation of the Autonomic Nervous System Can Be a Link between Visceral Adiposity and Insulin Resistance

OBJECTIVE

To evaluate the interplay among abdominal adipose tissue distribution, the cortisol axis, the autonomic nervous system, and insulin resistance.

RESEARCH METHODS AND PROCEDURES

Two age-, sex-, and BMI-matched groups were studied. Fifteen subjects were first-degree relatives of patients with type 2 diabetes (R), and 15 had no family history of diabetes (controls, C). A hyperinsulinemic euglycemic clamp, cortisol measurements, and analysis of heart rate variability (HRV) were performed. Computed tomography was performed in a subgroup (n = 9 + 9) to determine abdominal adipose tissue distribution.

RESULTS

R tended to be less insulin-sensitive than C (M value 9.2 +/- 1.0 vs 10.3 +/- 0.7 mg/kg per minute, not significant). Stimulation with tetracosactin or corticotropin releasing hormone yielded lower peak serum cortisol levels in R (p = 0.03 and p = 0.06, respectively). The amount of visceral abdominal fat (VAT) tended to be greater in R. In all subjects, VAT was negatively correlated to insulin sensitivity (r = -0.93, p < 0.001). There was a positive association between VAT and resting heart rate (r = 0.70, p = 0.003) and sympathetic/parasympathetic ratio in HRV assessment after tilt (r = 0.53, p = 0.03). Subcutaneous abdominal tissue was not associated with insulin sensitivity or any of the hormonal or HRV assessments.

DISCUSSION

Subjects genetically predisposed for type 2 diabetes had a tendency toward a larger amount of VAT and to lower insulin sensitivity compared with control subjects. The amount of visceral fat was strongly associated with insulin resistance and signs of a high ratio of sympathetic vs. parasympathetic reactivity. A large amount of visceral fat may act in concert with sympathetic/parasympathetic imbalance to promote the development of insulin resistance, and this may be partly independent of genetic background.

Cigarette Smoking and Fat Distribution in 21, 828 British Men and Women: A Population-based Study

OBJECTIVE

To examine the relationship between cigarette smoking habits and fat distribution in a population-based cohort of men and women.

RESEARCH METHODS AND PROCEDURES

We analyzed cross-sectional data from 21,828 men and women who were 45 to 79 years of age, residents in Norfolk, United Kingdom, and were recruited between 1993 and 1997. Cigarette smoking habits and other lifestyle factors were assessed using self-reported questionnaires. Anthropometric measures were obtained during a health examination.

RESULTS

Waist-hip ratio was highest among current smokers and least among never smokers after adjusting for age, BMI, alcohol intake, total energy intake, physical activity, and education. Higher waist-hip ratio was directly associated with higher smoking pack-years in current and former smokers and inversely with duration since quitting smoking in former smokers. Adjusting for age, BMI, and other covariates, current smokers had higher waist circumference but lower hip circumference compared with former or never smokers.

DISCUSSION

Cigarette smoking habits seem to influence fat distribution patterns. Although smokers have lower mean BMI compared with nonsmokers, they have a more metabolically adverse fat distribution profile, with higher central adiposity. The explanation for this association may help elucidate the mechanisms underlying the adverse health consequences of cigarette smoking and abdominal obesity.

Effect of reducing the n-6:n-3 long-chain PUFA ratio during pregnancy and lactation on infant adipose tissue growth within the first year of life: an open-label randomized controlled trial

BACKGROUND

The composition of long-chain PUFAs (LCPUFAs) in the maternal diet may affect obesity risk in the mother's offspring.

OBJECTIVE

We hypothesized that a reduction in the n-6 (omega-6):n-3 (omega-3) LCPUFA ratio in the diet of pregnant women and breastfeeding mothers may prevent expansive adipose tissue growth in their infants during the first year of life.

DESIGN

In a randomized controlled trial, 208 healthy pregnant women were randomly assigned to an intervention (1200 mg n-3 LCPUFAs as a supplement per day and a concomitant reduction in arachidonic acid intake) or a control diet from the 15th wk of pregnancy to 4 mo of lactation. The primary outcome was infant fat mass estimated by skinfold thickness (SFT) measurements at 4 body sites at 3-5 d, 6 wk, and 4 and 12 mo postpartum. Secondary endpoints included sonographic assessment of abdominal subcutaneous and preperitoneal fat, fat distribution, and child growth.

RESULTS

Infants did not differ in the sum of their 4 SFTs at ≤1 y of life [intervention: 24.1 ± 4.4 mm (n = 85); control: 24.1 ± 4.1 mm (n = 80); mean difference: -0.0 mm (95% CI: -1.3, 1.3 mm)] or in growth. Likewise, longitudinal ultrasonography showed no significant differences in abdominal fat mass or fat distribution.

CONCLUSIONS

We showed no evidence that supplementation with n-3 fatty acids and instructions to reduce arachidonic acid intake during pregnancy and lactation relevantly affects fat mass in offspring during the first year of life. Prospective long-term studies are needed to explore the efficacy of this dietary approach for primary prevention. This trial was registered at clinicaltrials.gov as NCT00362089.

Prevalence of obesity and the relationship between the body mass index and body fat: cross-sectional, population-based data

Background

Anthropometric measures such as the body mass index (BMI) and waist circumference are widely used as convenient indices of adiposity, yet there are limitations in their estimates of body fat. We aimed to determine the prevalence of obesity using criteria based on the BMI and waist circumference, and to examine the relationship between the BMI and body fat.

Methodology/Principal Findings

This population-based, cross-sectional study was conducted as part of the Geelong Osteoporosis Study. A random sample of 1,467 men and 1,076 women aged 20–96 years was assessed 2001–2008. Overweight and obesity were identified according to BMI (overweight 25.0–29.9 kg/m²; obesity ≥30.0 kg/m²) and waist circumference (overweight men 94.0–101.9 cm; women 80.0–87.9 cm; obesity men ≥102.0 cm, women ≥88.0 cm); body fat mass was assessed using dual energy X-ray absorptiometry; height and weight were measured and lifestyle factors documented by self-report. According to the BMI, 45.1% (95%CI 42.4–47.9) of men and 30.2% (95%CI 27.4–33.0) of women were overweight and a further 20.2% (95%CI 18.0–22.4) of men and 28.6% (95%CI 25.8–31.3) of women were obese. Using waist circumference, 27.5% (95%CI 25.1–30.0) of men and 23.3% (95%CI 20.8–25.9) of women were overweight, and 29.3% (95%CI 26.9–31.7) of men and 44.1% (95%CI 41.2–47.1) of women, obese. Both criteria indicate that approximately 60% of the population exceeded recommended thresholds for healthy body habitus. There was no consistent pattern apparent between BMI and energy intake. Compared with women, BMI overestimated adiposity in men, whose excess weight was largely attributable to muscular body builds and greater bone mass. BMI also underestimated adiposity in the elderly. Regression models including gender, age and BMI explained 0.825 of the variance in percent body fat.

Conclusions/Significance

As the BMI does not account for differences in body composition, we suggest that gender- and age-specific thresholds should be considered when the BMI is used to indicate adiposity.

High prevalence of abdominal, intra-abdominal and subcutaneous adiposity and clustering of risk factors among urban Asian Indians in North India

Objective

To assess the prevalence of abdominal obesity including intra-abdominal and subcutaneous adiposity along with other cardiometabolic risk factors in urban Asian Indians living in New Delhi.

Methods

We conducted a cross-sectional epidemiological descriptive study with 459 subjects (217 males and 242 females), representing all socio-economic strata in New Delhi. The anthropometric profile [body mass index (BMI), waist circumference (WC) and skinfold thickness], fasting blood glucose (FBG) and lipid profile were recorded. Percent body fat (%BF), total abdominal fat (TAF), intra-abdominal adipose tissue (IAAT) and subcutaneous abdominal adipose tissue (SCAT) were quantified using predictive equations for Asian Indians.

Results

The overall prevalence of obesity was high [by BMI (>25 kg/m²), 50.1%]. The prevalence of abdominal obesity (as assessed by WC) was 68.9%, while that assessed by TAF was 70.8%. Increased IAAT was significantly higher in females (80.6%) as compared to males (56.7%) (p = 0.00) with overall prevalence being 69.3%. The overall prevalence of high SCAT was 67.8%, more in males (69.1%) vs. females (66.5%, p = 0.5). The prevalence of type 2 diabetes, the metabolic syndrome and hypertension was 8.5%, 45.3% and 29.2%, respectively. Hypertriglyceridemia, hypercholesterolemia and low levels of HDL-c were prevalent in 42.7%, 26.6% and 37% of the subjects, respectively. The prevalence of hypertriglyceridemia was significantly higher in males (p = 0.007); however, low levels of HDL-c were more prevalent in females as compared to males (p = 0.00).

Conclusion

High prevalence of generalized obesity, abdominal obesity (by measurement of WC, TAF, IAAT and SCAT) and dysmetabolic state in urban Asian Indians in north India need immediate public health intervention.

The role of obesity in kidney disease: recent findings and potential mechanisms

Obesity epidemic is in rise in almost every industrialized country and continues to be a growing problem worldwide. In fact, obesity per se has been recognized as a chronic disease. Consequently, there has been a cascade of metabolic changes initiated by the markedly risen prevalence that contributes to the increased incidence of diabetes, hypertension, and cardiovascular disease. Moreover, obesity is also associated with an increased risk of chronic kidney disease (CKD). The majority of the studies indicate a direct relationship between body mass index (BMI) and CKD risk. Moreover, current evidence emphasized the fact that central obesity measurements, such as waist circumference, could be a better predictor of CKD progression and mortality than BMI. The detrimental effects of obesity on kidney outcome have been recognized in nondialysis-dependent (NDD)-CKD patients. However, survival in overweight or obese CKD patients undergoing maintenance hemodialysis is paradoxically opposed compared with the general population. This "reverse epidemiology," however, is valid mainly for the inflammated end-stage renal disease (ESRD) patients. In fact, renal transplant recipients with higher BMI have inferior patient and graft survival compared to patients with lower BMI. This review also provides perspectives concerning the mechanisms associated with obesity, such as the renin-angiotensin-aldosterone system (RAAS) activation, and the role of leptin, adiponectin, fetuin-A, and adipose tissue, as factors that contribute to the development of CKD. Prevention strategies for CKD patients are also discussed and should be considered by clinicians.

Anthropometric measurements for the prediction of the metabolic syndrome: a cross-sectional study on adolescents and young adults from southern india

OBJECTIVES

To determine which anthropometric measurement correlates best with the metabolic abnormalities associated with the metabolic syndrome in adolescents and young adults.

DESIGN

Cross-sectional study.

SETTING

Schools, high schools and universities.

PARTICIPANTS

1359 adolescents and young adults aged 14-25 years.

MAIN OUTCOME MEASURES

Anthropometric predictors of metabolic abnormalities as classified by International Diabetes Federation definition.

RESULTS

The waist circumference (OR 1.56, 95% CI 1.0 to 2.43: p≤0.01) and the abdominal skin fold thickness (OR 1.44, 95% CI 1.02 to 2.04, p≤0.01) above the third quintile cut-offs were found to be significantly associated with metabolic abnormalities. The sensitivity of either one of these measurements in predicting metabolic abnormalities was 66.1% with a negative predictive value of 82.8%. Hyperglycaemia was significantly associated with an abdominal skin fold thickness over the fourth quintile alone (OR 1.63, 95% CI 1.24 to 2.1). All the anthropometric measurements correlated well with elevated triglycerides and hypertension.

CONCLUSIONS

In a large community-based cross-sectional survey of subjects aged 14-25 years, the waist circumference and the abdominal skin fold thickness are important predictors of the metabolic abnormalities associated with metabolic syndrome. This simple clinical tool may help in a primary care setting to identify subjects who require a further biochemical evaluation and would considerably reduce the cost of unwarranted testing.

Neck circumference: an additional tool of screening overweight and obesity in childhood

Obesity, particularly in the upper part of body, is a major health problem. Central obesity is related to cardiovascular disease and metabolic disorders. There are various techniques for assessing upper body fat content for the overweight and obese subjects other than waist circumference (WC). We tried to find out if neck circumference (NC) alone can be used to assess overweight and obesity. Four hundred twelve overweight and obese patients (208 girls and 204 boys) and 555 healthy children (284 girls and 271 boys) aged 6-18 years were recruited for this present study. There were significant and positive correlations between BMI-WC, BMI-NC, and WC-NC (p < 0.001). NC cutoffs for overweight and obesity were determined for each age and pubertal period. NC cutoffs of boys were increased from 28.0 to 38.0. This range was 27.0-34.5 for girls in the same range. We also calculated NC cutoffs for prepubertal and pubertal periods (respectively, 29.0 and 32.5 for boys and 28.0-31.0 for girls).

CONCLUSION

NC is a reliable and easy to use tool to determine overweight and obesity in children, and NC is not as good as WC in determining overweight and obesity, both providing similar information.

Anthropometry, lifestyles and fat patterning in Balinese women

BACKGROUND

In many parts of the developing world, modernization has resulted in an increase in the prevalence of overweight and obesity and a subsequent rise in nutrition-related, non-communicable diseases such as cardiovascular disease and Type 2 diabetes.

AIM

The study examined the impact of socio-economic and lifestyle changes associated with modernization on the body size and shape of Balinese women.

SUBJECTS AND METHODS

Anthropometric data including weight, height, body mass index (BMI) and seven skinfolds were collected from 564 Balinese women, aged between 15 and 45 years. The relationship between the degree of 'modernization' (using such parameters as household wealth and education level) and body size and shape was analysed using multiple regression analysis, as was the effect of age, family size and breast-feeding.

RESULTS

Using the WHO (WHO 1995) categories of BMI, 14% of Balinese women displayed Chronic Energy Deficiency (BMI < 18.5 kg m(-2)), 7% were overweight (BMI = 25.0-29.9 kg m(-2)) and less than 1% were obese (BMI > or = 30.0 kg m(-2)). Household wealth (p < 0.0001) and education level (p < 0.05) were significantly associated with fatness, while breast-feeding (p < 0.05) was significantly associated with leanness. Fat distribution was largely independent of biological and socio-economic variables.

CONCLUSIONS

The trend toward increasing fatness associated with greater household wealth and higher education has important health implications for Balinese women as they continue their rapid transition from subsistence agriculture towards a more 'western' lifestyle.

Identification of insulin resistance in Asian Indian adolescents: classification and regression tree (CART) and logistic regression based classification rules

OBJECTIVE

Biochemical measures for assessment of insulin resistance are not cost-effective in resource-constrained developing countries. Using classification and regression tree (CART) and multivariate logistic regression, we aimed to develop simple predictive decision models based on routine clinical and biochemical parameters to predict insulin resistance in apparently healthy Asian Indian adolescents.

DESIGN

Community based cross-sectional study.

SUBJECTS AND PATIENTS

Data of apparently healthy 793 adolescents (aged 14-19 years) were used for analysis. WHO's multistage cluster sampling design was used for data collection.

METHODS AND MEASUREMENTS

Homeostasis Model of Assessment value > 75th centile was used as cut-off for defining the main outcome variable insulin resistance. CART was used to develop the decision tree models and multivariate logistic regression used to develop the clinical prediction score.

RESULTS

Three classification trees and an equation for prediction score were developed and internally validated. The three decision trees were termed as CART I, CART II and CART III, respectively. CART I based on anthropometric parameters alone has sensitivity 88.2%, specificity 50.1% and area under receiver operating characteristic curve (aROC) 77.8%. CART II based on anthropometric and routine biochemical parameters has sensitivity 94.5%, specificity 38.3% and aROC 73.6%. CART III based on all anthropometric, biochemical and clinical parameters together has sensitivity 70.7%, specificity 79.2% and aROC 77.4%. Prediction score for insulin resistance = 1 x (waist circumference) + 1.1 x (percentage body fat) + 1.6 x (triceps skin-fold thickness) - 1.9 x (gender). A score cut-off of > 0 (using values marked for each) was a marker of insulin resistance in the study population (sensitivity 82.4%, specificity 56.7%, and aROC 73.4%).

CONCLUSION

These simple and cost-effective classification rules may be used to predict insulin resistance and implement population based preventive interventions in Asian Indian adolescents.

Relationship of anthropometric measurements of body fat distribution to metabolic profile in premenopausal women

Regional fat distribution has emerged as an independent predictor of metabolic aberrations including glucose intolerance, hyperinsulinemia, insulin resistance, hyperlipidemia and hypertension. We investigated the comparative efficacy of various body fat distribution indices in predicting these aberrations. The relationship of circumferential ratios, skinfold measurements, and computerized tomography (CT)-derived indices of intra- and extra-abdominal fat distribution to the metabolic variables and blood pressure was examined in a cohort of healthy premenopausal women. All indices denoting preponderance of fat in the central, upper body or abdominal region were predictive of the metabolic profile. The subscapular skinfold, subscapular-triceps ratio, waist-hip ratio (WHR), and the CT derived intra-abdominal fat area (CT-IFA) were closely related to alterations in glucose and insulin concentrations independent of age and obesity. The WHR and CT-IFA were better predictors of plasma triglyceride levels and blood pressure profile and thus the overall aberrations than skinfold measurements. Despite a high degree of intercorrelation between the anthropometric indices measured, only the relationship of WHR to CT-IFA remained significant after adjusting for the effects of age and degree of adiposity, suggesting that WHR indexes not only the relative distribution of truncal to gluteofemoral subcutaneous fat but also the abundance of intra-abdominal or visceral fat depots. The greater reproducibility of CT-IFA and WHR also suggests that these measurements are the most useful in predicting the regional obesity-associated metabolic abnormalities with their morbidity and mortality risks.

Physical training and changes in regional adipose tissue distribution

Obesity has been associated with numerous metabolic complications, such as changes in the concentration and/or composition of plasma lipoproteins, glucose intolerance and hyperinsulinemia leading to diabetes and hypertension. The relation of obesity to cardiovascular disease has not, however, been consistently reported. Recent prospective studies have clearly indicated that the distribution of adipose tissue was a significant cardiovascular risk factor and numerous studies have shown that metabolic disturbances were more closely associated with the level of abdominal fat than excess adiposity per se. As obese men generally store their energy excess in the abdominal region and women in the peripheral fat depots, the metabolic complications of obesity seem to be more closely related to adiposity in men than in women. It is suggested that the sex dimorphism observed in adipose tissue localization could partly explain the greater cardiovascular risk associated with obesity in men than in women. Indeed, obese women with a "male" (abdominal) distribution of body fat have greater metabolic complications than women with lower body fat. When aerobic exercise-training is used to induce weight loss, men generally lose more fat than women. In men, the loss of adipose tissue appears to be central, potentially reducing the risk of cardiovascular disease, whereas a relative resistance to fat loss is observed in women compared to men. Although resistance to fat loss is noted in women, those with a "male" distribution of adipose tissue (high waist-to-hip ratio and high intra-abdominal fat deposition) and with associated metabolic complications greatly benefit from aerobic exercise-training.(ABSTRACT TRUNCATED AT 250 WORDS)

Regional obesity and serum lipids in European women born in 1948. A multicenter study

In five different cities in four European countries, women born in 1948 were randomly selected. Anthropometric measurements (i.e. circumferences and skinfolds) were taken. Serum lipids were determined in one laboratory. Different levels of waist circumferences gave different averages and distribution of waist/hip ratio, which confirms the need of precise standardization of these measurements. Women in southern parts of Europe were more overweight than in Northern Europe (partly due to selection bias in Naples) and, when adjusted for that, southern women had a more central distribution of fat (higher waist/thigh, lower triceps/subscapula). When data were pooled, circumference ratios were positively correlated with triglycerides and total cholesterol and negatively with HDL cholesterol. Occupation of husband and body mass index were associated with fat distribution and triglycerides and HDL cholesterol. In multiple regression fat distribution was still correlated with serum lipids but differences in serum lipids between countries did not diminish.

Genotype by diabetes interaction effects on the detection of linkage of glomerular filtration rate to a region on chromosome 2q in Mexican Americans

OBJECTIVE

Glomerular filtration rate (GFR) is used to assess the progression of renal disease. We performed linkage analysis to localize genes that influence GFR using estimated GFR data from the San Antonio Family Diabetes/Gallbladder Study. We also examined the effect of genotype by diabetes interaction (G x DM) on the detection of linkage to address whether genetic effects on GFR differ in diabetic and nondiabetic subjects.

RESEARCH DESIGN AND METHODS

GFR (N = 453) was estimated using the recently recalculated Cockcroft-Gault (GFR-CGc) and the simplified Modification of Diet in Renal Disease (GFR-4VMDRD) formulae. Both estimates of GFR exhibited significant heritabilities, but only GFR-CGc showed significant G x DM interaction. We therefore performed multipoint linkage analyses on both GFR measures using models that did not include G x DM interaction effects (Model 1) and that included G x DM interaction effects (Model 2, in the case of GFR-CGc).

RESULTS

The strongest evidence for linkage (Model 1) of both GFR-CGc (logarithm of odds [LOD] 2.9) and GFR-4VMDRD (LOD 2.6) occurred between markers D9S922 and D9S1120 on chromosome 9q. However, using Model 2, the strongest evidence for linkage of GFR-CGc on chromosome 2q was found near marker D2S427 (corrected LOD score [LOD(C)] 3.3) compared with the LOD score of 2.7 based on Model 1. Potential linkages (LOD or LOD(C) >or=1.2) were found only for GFR-CGc on chromosomes 3p, 3q, 4p, 8q, 11q, and 14q.

CONCLUSIONS

We found a major locus on chromosome 2q that differentially influences GFR in diabetic and nondiabetic environments in the Mexican-American population.

Body composition in children and adolescents born after in vitro fertilization or spontaneous conception

CONTEXT

Increasing evidence suggests that adverse conditions during prenatal life are associated with the development of chronic diseases in adult life. It is still unclear whether in vitro fertilization (IVF) conception could affect the vulnerable developmental processes in humans occurring during early prenatal development with long-term perturbations of developmental pathways.

OBJECTIVE

Our objective was to examine body composition in 8- to 18-yr-old IVF singletons and spontaneously conceived controls born from subfertile parents.

DESIGN AND SETTING

This follow-up study was conducted at the VU University Medical Center in Amsterdam, The Netherlands.

PARTICIPANTS

Participants included 233 IVF children (139 pubertal children) and 233 age- and gender-matched control children (143 pubertal children).

MAIN OUTCOME MEASURES

Body composition measures were assessed by anthropometry and dual-energy x-ray absorptiometry in the pubertal subpopulation.

RESULTS

IVF children had a significantly lower subscapular-triceps skinfold ratio and a significantly higher sum of peripheral skinfolds, peripheral body mass, and percentage of peripheral body fat as compared with controls. Although not reaching statistical significance, both dual-energy x-ray absorptiometry and skinfold measurements suggested that total body fat in IVF children is increased. Neither current and early risk factors nor parental factors, such as subfertility cause, could explain the differences in peripheral fat assessed by anthropometry between IVF children and controls. No differences in bone mineral composition between IVF children and controls were found.

CONCLUSIONS

Our observations indicate that body fat composition in IVF children is disturbed. Follow-up of IVF children to monitor body fat pattern and potentially related health problems from adolescence into adulthood is of great importance.

Drug therapy of high-risk lipid abnormalities in children and adolescents: a scientific statement from the American Heart Association Atherosclerosis, Hypertension, and Obesity in Youth Committee, Council of Cardiovascular Disease in the Young, with the Council on Cardiovascular Nursing

Despite compliance with lifestyle recommendations, some children and adolescents with high-risk hyperlipidemia will require lipid-lowering drug therapy, particularly those with familial hypercholesterolemia. The purpose of this statement is to examine new evidence on the association of lipid abnormalities with early atherosclerosis, discuss challenges with previous guidelines, and highlight results of clinical trials with statin therapy in children and adolescents with familial hypercholesterolemia or severe hypercholesterolemia. Recommendations are provided to guide decision-making with regard to patient selection, initiation, monitoring, and maintenance of drug therapy.

High-density lipoprotein subfractions in normolipidemic individuals without clinical atherosclerosis lipoprotein subfractions in an adult population

This study evaluated the serum concentrations of lipids, lipoproteins, apolipoproteins, and high-density lipoprotein (HDL) subfractions in Brazilian adults. We analyzed the distribution of lipids in HDL2 and HDL3 in a normolipidemic population without evidence of established cardiovascular disease (CVD). A total of 93 males and 92 females, healthy and normolipidemic, volunteered to be submitted to a clinical examination, a blood collection, and to answer a questionnaire aimed at determining signs and symptoms of atherosclerotic disease. Their fasting plasma lipid, lipoproteins, apolipoproteins, and the cholesterol and triglyceride concentrations in HDL2 and HDL3, isolated by microultracentrifugation, were determined by enzymatic-colorimetric methods. The interpercentile intervals (2.5-97.5) for the population were established as being 5-18 mg/dL in men and 4-28 mg/dL in women for HDL2 cholesterol (HDL2chol) and 1-57 mg/dL in men and 2-61 mg/dL in women for HDL3 cholesterol (HDL3chol). HDL2 triglyceride levels (HDL2Tg) in men were 1-26 mg/dL and in women 2-28 mg/dL; moreover, the HDL3 triglyceride (HDL3Tg) intervals were established as 4-46 mg/dL for both sexes. The determination of reference ranges for lipids in HDL subfractions in populations without clinical atherosclerosis, is an useful tool for metabolic, diagnostic, and therapeutic approaches. We determined the intervals for HDL2chol, HDL3chol, HDL2Tg, and HDL3Tg. There were variations with sex and/or age for HDL2chol, HDL3chol, and HDL2Tg in the studied population.

Estimation of deep-abdominal-adipose-tissue (DAAT) accumulation from simple anthropometric measurements in Indian men and women

OBJECTIVE

To develop gender-specific predictive equations to measure the amount of deep-abdominal-adipose-tissue (DAAT) accumulation from simple anthropometric measurements.

DESIGN

Cross-sectional study.

SUBJECTS

A total of 120 healthy men and women (40-79 years).

MEASUREMENTS

Body weights, circumferences, skinfolds, computed-Tomography (CT)-derived sagittal-diameters and the DAAT areas.

RESULTS

High significant correlations are seen between the indices of waist-circumferences, sagittal diameters and body weights to DAAT areas in both the sexes. Stepwise multiple regression analysis with all anthropometric measures gave 84% (SEE 38.7 cm(2)) of the variance in men and 72% (SEE 29 cm(2)) in women. Body weights, waist-circumferences and sagittal-diameters had more predictive power in men, and in women, the arm-circumferences replaced the sagittal diameters. Five models with categorical measures of circumferences, skinfolds, and sagittal diameters explained 74.8-82% of the variance in men and 62-70% in women. The simplest equation with least measurement indices, that is, body-weight, waist-circumference and body mass index explained 74% (SEE 27.7 cm(2)) of the variance in men: DAAT (cm(2))= -382.9+(1.09 x weight-(kg))+(6.04 x waist-(cm))+(-2.29 x BMI). For women, body-weight and waist-circumference explained 63% (SEE 31.79 cm(2)) of the variance: DAAT (cm(2))= -278+(-0.86 x weight-(kg))+(5.19 x waist-(cm)).

CONCLUSION

Body weight emerged as the outstanding index to measure the DAAT areas. Following anthropometric measures are the waist circumferences, sagittal diameters and BMI. Although the ability to estimate the amount of DAAT from anthropometry is limited, practical predictive models have been developed.

Anthropometric indicators of body composition in young adults: relation to size at birth and serial measurements of body mass index in childhood in the New Delhi birth cohort

BACKGROUND

South Asians have a muscle-thin but adipose body phenotype and high rates of obesity-related disease. Adult body composition may be predictable in early life.

OBJECTIVE

Anthropometric indexes of adult body composition were examined in relation to birth size and body mass index (BMI) during childhood.

DESIGN

A population-based cohort of 1526 men and women aged 26-32 y in Delhi, India, who were measured sequentially from birth until 21 y of age were followed up. Adult weight, height, skinfold thicknesses, and waist and hip circumferences were measured. BMI and indexes of adiposity (sum of skinfold thicknesses), central adiposity (waist-hip ratio), and lean mass (residual values after adjustment of BMI for skinfold thicknesses and height) were derived.

RESULTS

Mean birth weight was 2851 g. As children, many subjects were underweight-for-age (>2 SDs below the National Center for Health Statistics mean; 53% at 2 y), but as adults, 47% were overweight, 11% were obese, and 51% were centrally obese (according to World Health Organization criteria). Birth weight was positively related to adult lean mass (P < 0.001) and, in women only, to adiposity (P = 0.006) but was unrelated to central adiposity. BMI from birth to age 21 y was increasingly strongly positively correlated with all outcomes. BMI and BMI gain in infancy and early childhood were correlated more strongly with adult lean mass than with adiposity or central adiposity. Higher BMI and greater BMI gain in late childhood and adolescence were associated with increased adult adiposity and central adiposity.

CONCLUSIONS

Birth weight and BMI gain during infancy and early childhood predict adult lean mass more strongly than adult adiposity. Greater BMI gain in late childhood and adolescence predicts increased adult adiposity.

Maternal body composition, offspring blood pressure and the hypothalamic-pituitary-adrenal axis

We tested the hypothesis that women who are thin or have poor pregnancy weight gain have offspring with higher blood pressure and examined whether this link is mediated by increased secretion of cortisol. We studied a cohort of 388 children born in Kingston, Jamaica. From hospital records we obtained information about their mother's body mass index (BMI) and weight gain during pregnancy. At age 8.5 years we measured the children's fasting plasma cortisol concentrations and blood pressure and assessed their mother's anthropometry. There were no relationships between the mother's BMI or weight gain during pregnancy and offspring blood pressure. However, mothers with a greater subscapular to triceps skinfold thickness ratio (SSTR) had offspring with higher blood pressure (5.6 mmHg systolic and 3.7 mmHg diastolic increase per unit change in SSTR, P = 0.002 and P = 0.008 respectively). Fasting plasma cortisol concentrations correlated with the children's systolic (r = 0.33, P < 0.0001) and diastolic pressures (r = 0.12, P = 0.02) independently of age, gender, weight or socio-economic status and were also predicted by the mother's SSTR. These findings suggest that maternal truncal obesity rather than thinness is associated with raised blood pressure in the offspring, and that this link may be mediated by increased cortisol secretion.

Type 2 diabetes in rural and urban population: diverse prevalence and associated risk factors in Bangladesh

AIMS

To describe differences in prevalence of Type 2 diabetes mellitus with its associated risk factors between rural and urban populations in Bangladesh. Diagnostic criteria [fasting blood glucose (FBG) and oral glucose tolerance tests (OGTT)] were compared and reviewed for both populations.

METHODS

A total of 1555 subjects from urban and 4757 from rural communities (age > or = 20 years) with similar cultural and ethnic backgrounds were randomly selected in a cross-sectional survey. FBG values were determined from all and 2-h post-glucose capillary blood samples were determined after a 75-g oral glucose load for a selected number (urban 476, rural 1046).

RESULTS

A higher prevalence of diabetes was found in urban (8.1%) compared with rural populations (2.3%). Age, sex and waist-to-hip ratio for men were significant risk factors for both urban and rural subjects following fasting and 2-h post-glucose values adjusted for a number of confounding variables. Poor agreement was observed between FBG and OGTT for both urban (kappa 0.41) and rural (kappa 0.40) areas.

CONCLUSIONS

A higher prevalence of diabetes mellitus (DM) in the urban population was observed compared with rural subjects despite similar body mass indexes (BMI). Differences in obesity, waist/hip ratio or hypertension failed to explain the increasing occurrence of T2DM in the urban population.

Effect of adiposity and fat distribution on endometrial cancer risk in Shanghai women

The authors conducted a population-based case-control study of 832 endometrial cancer cases and 846 frequency-matched controls in Shanghai, China (1997-2001), to examine the association of overall adiposity and body fat distribution with disease risk. Overall adiposity was estimated using weight and body mass index (BMI); upper body fat distribution was evaluated using waist circumference and waist:hip ratio. Overall and upper-body obesity were both associated with an elevated risk of endometrial cancer. Adjusted odds ratios and 95% confidence intervals for highest-versus-lowest quartile comparisons were 2.6 (95% confidence interval (CI): 2.0, 3.5) for weight, 2.9 (95% CI: 2.2, 3.9) for BMI, 4.7 (95% CI: 3.4, 6.4) for waist circumference, and 3.5 (95% CI: 2.6, 4.8) for waist:hip ratio. The positive associations with weight and BMI vanished after results were controlled for waist circumference, while associations with waist circumference and waist:hip ratio persisted after adjustment for BMI. The positive association with upper-body obesity was more pronounced among younger women, women who had never used oral contraceptives, and women with a history of diabetes mellitus (p for multiplicative interaction < 0.05). Upper-body obesity was related to increased risk among women with low BMI. These results suggest that obesity, particularly upper-body fat deposition, is associated with an increased risk of endometrial cancer.

An evaluation of candidate definitions of the metabolic syndrome in adult Asian Indians

OBJECTIVES

We aimed to evaluate eight candidate definitions of the metabolic syndrome (MS) against the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATPIII) definition as the reference for optimally defining MS in adult Asian Indians.

RESEARCH DESIGN AND METHODS

We used clinical and biochemical data from our previous cross-sectional epidemiological studies. Candidate definitions of MS were proposed by modifying the NCEP ATPIII definition. These modifications included the following: waist circumference cutoffs as >90 cm in men and >80 cm in women, BMI cutoff as >23 kg/m(2), and a measure of truncal subcutaneous fat (subscapular skinfold thickness [SST] >18 mm).

RESULTS

The highest prevalence (29.9%) of MS was observed by the inclusion of modified cutoffs of waist circumference and BMI and SST in place of the existing cutoffs of waist circumference in the NCEP ATPIII criteria. Further, this modified definition showed the maximum absolute gain in the percentage of prevalence of MS over the NCEP ATPIII definition, and it was the best predictor for MS in subjects with impaired fasting glucose, type 2 diabetes, and different age-groups. The lowest percentage of prevalence of MS was observed with the definition that excluded biochemical variables and blood pressure.

CONCLUSIONS

The criteria for defining MS in adult Asian Indians need revision. Inclusion of modified cutoffs of waist circumference and BMI and measures of truncal subcutaneous fat in the NCEP ATPIII definition requires further validation.

Associations between prenatal and infancy weight gain and BMI, fat mass, and fat distribution in young adulthood: a prospective cohort study in males and females born very preterm

BACKGROUND

Increasing evidence indicates that adult body composition is associated with prenatal and infancy weight gain, but the relative importance of different time periods has not been elucidated.

OBJECTIVE

The objective was to study the association between prenatal, early postnatal, and late infancy weight gain and body mass index (BMI), fat mass, and fat distribution in young adulthood.

DESIGN

We included 403 men and women aged 19 y from a Dutch national prospective follow-up study who were born at <32 wk of gestation. BMI, waist circumference, and waist-to-hip ratio SD scores and subscapular-to-triceps ratio, percentage body fat, fat mass, and fat-free mass at age 19 y were studied in relation to birth weight SD scores, weight gain from preterm birth until 3 mo postterm (early postnatal weight gain), and weight gain from 3 mo until 1 y postterm (late infancy weight gain).

RESULTS

Birth weight SD scores were positively associated with weight, height, BMI SD scores, and fat-free mass at age 19 y but not with fat mass, percentage body fat, or fat distribution. Early postnatal and late infancy weight gain were positively associated with adult height, weight, BMI, waist circumference SD scores, fat mass, fat-free mass, and percentage body fat but not with waist-to-hip ratio SD scores or subscapular-to-triceps ratio.

CONCLUSIONS

In infants born very preterm, weight gain before 32 wk of gestation is positively associated with adult body size but not with body composition and fat distribution. More early postnatal and, to a lesser extent, late infancy weight gain are associated with higher BMI SD scores and percentage body fat and more abdominal fat at age 19 y.

The epidemiology of central fat distribution in relation to disease

The effect of fat distribution on disease risk is a subject of great interest. Central fat has been measured anthropometrically, by computed tomography, and by magnetic resonance imaging. Both cross-sectional and longitudinal studies have related central fat to type 2 diabetes mellitus and cardiovascular disease, independent of body mass index. The mechanism may relate to increased lipolysis causing the liver to increase glucose and very low density lipoprotein output, while muscle uses less. This leads to a rise in blood glucose and triglycerides, a drop in HDL cholesterol, and an increase in small, dense LDL particles. There is also an increase in blood pressure and inflammatory markers. Certain populations put on excess fat more centrally than others. These include Asian populations. It is likely that with better differentiation of abdominal fat into visceral and subcutaneous depots, clearer data will accrue on their impact on disease risk.

Secular Trends in Obesity in México City and in San Antonio

The San Antonio Heart Study--conducted from 1979 to 1996--and the Mexico City Diabetes Study--conducted from 1990 to 1999--both show significant secular increases in obesity as indicated by mean body mass index values and proportions of the populations who were obese or overweight. The increase in obesity accounts for an estimated 28% of the increase in the incidence of diabetes in San Antonio. This increase in the incidence of diabetes occurred across all age groups (25-34, 35-44, 45-54, and 55-64). Thus the generational acceleration of diabetes, expected as a result of the greater tendency for people whose mothers were diabetic when pregnant to become diabetic themselves, may not be as severe as would be expected had the increases in diabetes incidence occurred disproportionately more among women prior to or during their child-bearing years.

Indexes of abdominal adiposity in patients with type 2 diabetes

OBJECTIVE

To assess the relationship of waist circumference and weight/height ratio with height, and their association with components of the metabolic syndrome, in Type 2 diabetic patients.

DESIGN

multicenter cross-sectional survey on a cohort enrolled in a prospective observational study.

SUBJECTS

13,232 patients (6816 women and 6416 men) with Type 2 diabetes, not currently affected by macrovascular complications.

MEASUREMENTS

height, weight, waist and hip circumference, waist/hip and waist/height ratios.

RESULTS

waist circumference was significantly correlated with height after adjustment for potential confounders (adjusted r=0.19 and 0.23 in women and men, respectively), while waist/height ratio showed an inverse correlation with height (r=-0.14 and -0.15, respectively). Elevated waist/height ratio was more predictive of hypertension and hypertriglyceridemia, than waist circumference or waist/hip ratio.

CONCLUSIONS

Waist circumference is correlated with height; thresholds for waist circumference could need adjustment for height. Waist/height ratio, although inversely correlated with height, could be a better predictor of abnormalities associated with abdominal adiposity than waist circumference alone.

Association between size at birth, truncal fat and obesity in adult life and its contribution to blood pressure and coronary heart disease; study in a high birth weight population

OBJECTIVE

The aim of the study was to assess the relationship between size at birth and obesity as well as truncal fat, and its contribution to cardiovascular risk in a high birth weight population.

DESIGN

Cohort-study with retrospectively collected data on size at birth.

SETTING

Reykjavik, Iceland.

SUBJECTS

A total of 1874 men and 1833 women born in Reykjavik during 1914-1935.

MAIN OUTCOME MEASURES

Size at birth. Adult weight, height and skinfold thickness measurements, systolic and diastolic blood pressure, fatal and nonfatal coronary heart disease (CHD).

RESULTS

Birth weight was positively related to adult body mass index (BMI) in both genders (B=0.35+/-0.14 kg/m(2), adj. R(2)=0.015, P=0.012 and B=0.34+/-0.17 kg/m(2), adj. R(2)=0.055, P=0.043 in men and women, respectively). However, high birth weight was not a risk factor for adult obesity (BMI>/=30 kg/m(2)). In the highest birth weight quartile, the odds ratio (95% CI) for being above the 90th percentile of truncal fat was 0.7 (0.6-1.0, P=0.021) for men and 0.4 (0.3-0.8, P=0.002) for women, compared with the lowest birth weight quartile. Truncal fat and BMI were positively related to blood pressure in both genders (P<0.05), but not to CHD. The regression coefficient for the inverse association between birth weight and blood pressure hardly changed when adding truncal fat to the model.

CONCLUSION

In this high birth weight population, high birth weight was related to higher BMI in adulthood without being a risk factor for adult obesity. The inverse association between birth weight and truncal fat in adulthood suggests a role for foetal development in determining adult fat distribution. The inverse relationship of birth weight to blood pressure seems not to be mediated through the same pathway as to truncal fat.

A central body fat distribution is related to renal function impairment, even in lean subjects

BACKGROUND

Overweight and obesity are believed to be associated with renal damage. Whether this depends on fat distribution is not known. We hypothesize that in addition to overweight, fat distribution may be associated with renal function abnormalities.

METHODS

We studied the relation between body weight and fat distribution and microalbuminuria and elevated or diminished filtration in 7,676 subjects without diabetes. Microalbuminuria is defined as urinary albumin excretion (UAE) of 30 to 300 mg/24 h. Elevated and diminished filtration are defined as filtration plus or minus 2 SDs of a nondiabetic lean group with a peripheral fat distribution and UAE of 0 to 15 mg/24 h, corrected for age and sex. The total population was divided into six groups according to body weight (overweight is defined as body mass index [BMI] > 25 and < or = 30 kg/m2; obesity, as BMI > 30 kg/m2) and fat distribution.

RESULTS

In logistic regression analysis, obese subjects with central fat distribution had a greater risk for microalbuminuria (relative risk, 1.7; 95% confidence interval, 1.19 to 2.35). Obese subjects with either peripheral or central fat distribution had a greater risk for elevated filtration (relative risk, 3.2; 95% confidence interval, 1.19 to 8.47; relative risk, 2.6; 95% confidence interval, 1.59 to 4.28, respectively). Furthermore, subjects with central fat distribution, either lean, overweight, or obese, had a greater risk for diminished filtration (relative risk, 1.9; 95% confidence interval, 1.19 to 3.12; relative risk, 2.0; 95% confidence interval, 1.19 to 3.19; and relative risk, 2.7; 95% confidence interval, 1.46 to 4.85, respectively). Finally, by dividing waist-hip ratio (WHR) into quartiles, greater WHR was associated with a greater risk for diminished filtration, even when corrected for BMI.

CONCLUSION

Not only overweight and obese subjects, but also lean subjects with central fat distribution are at risk for diminished filtration. Therefore, a central pattern of fat distribution, not overweight or obesity by itself, seems to be important for renal impairment.

The rising prevalence of diabetes and impaired glucose tolerance: the Australian Diabetes, Obesity and Lifestyle Study

OBJECTIVE

To determine the population-based prevalence of diabetes and other categories of glucose intolerance (impaired glucose tolerance [IGT] and impaired fasting glucose [IFG]) in Australia and to compare the prevalence with previous Australian data.

RESEARCH DESIGN AND METHODS

A national sample involving 11,247 participants aged > or =25 years living in 42 randomly selected areas from the six states and the Northern Territory were examined in a cross-sectional survey using the 75-g oral glucose tolerance test to assess fasting and 2-h plasma glucose concentrations. The World Health Organization diagnostic criteria were used to determine the prevalence of abnormal glucose tolerance.

RESULTS

The prevalence of diabetes in Australia was 8.0% in men and 6.8% in women, and an additional 17.4% of men and 15.4% of women had IGT or IFG. Even in the youngest age group (25-34 years), 5.7% of subjects had abnormal glucose tolerance. The overall diabetes prevalence in Australia was 7.4%, and an additional 16.4% had IGT or IFG. Diabetes prevalence has more than doubled since 1981, and this is only partially explained by changes in age profile and obesity.

CONCLUSIONS

Australia has a rapidly rising prevalence of diabetes and other categories of abnormal glucose tolerance. The prevalence of abnormal glucose tolerance in Australia is one of the highest yet reported from a developed nation with a predominantly Europid background.

Basal and postglucagon C-peptide levels in Ethiopians with diabetes

OBJECTIVE

To study basal C-peptide (BCP) and postglucagon C-peptide (PGCP) levels in Ethiopians with diabetes.

RESEARCH DESIGN AND METHODS

A total of 56 subjects with type 1 diabetes, 97 subjects with type 2 diabetes, and 50 control subjects were recruited from a hospital in Ethiopia. BCP was determined in all subjects and PGCP in 86 subjects.

RESULTS

Mean (+/- SEM) BCP, PGCP, and the increment after glucagon in type 1 diabetic subjects (0.14 +/- 0.04, 0.22 +/- 0.11, and 0.08 +/- 0.05 nmol/l, respectively) were lower (P < 0.001) than those in type 2 diabetic subjects (0.66 +/- 0.04, 1.25 +/- 0.10, and 0.56 +/- 0.06 nmol/l, respectively) or control subjects (0.54 +/- 0.04, 1.52 +/- 0.26, and 1.11 +/- 0.24 nmol/l, respectively). The mean BCP level was higher in type 2 diabetic subjects than control subjects (P=0.015), whereas the mean increment was lower (P=0.005). Insulin-treated type 2 diabetic subjects, compared with non-insulin-treated type 2 diabetic subjects, had lower mean BCP (0.55 +/- 0.08 nmol/l [n=37] vs. 0.73 +/- 0.04 [n=60], P=0.001), lower PGCP (0.97 +/- 0.20 nmol/l [n=18] vs. 1.40 +/- 0.11 [n=35], P=0.010), and a lower C-peptide increment (0.34 +/- 0.06 [n=18] vs. 0.67 +/- 0.07 nmol/l [n=35], P=0.003). In both the type 1 and type 2 diabetic groups, those with BCP levels <0.2 nmol/l had lower BMI than those with higher BCP levels (P=0.023 and P < 0.001, respectively).

CONCLUSIONS

Combined with clinical criteria, C-peptide levels are good discriminators between type 1 and type 2 diabetes in Ethiopians and may also be useful in identifying subjects with type 2 diabetes who require insulin therapy. There is a subgroup of type 2 diabetic subjects with features of type 1 diabetes.

Dietary medium-chain triacylglycerols suppress accumulation of body fat in a double-blind, controlled trial in healthy men and women

We investigated the effect of long-term ingestion of dietary medium-chain triacylglycerols (MCT) on body weight and fat in humans. Using a double-blind, controlled protocol, we assessed the potential health benefits of MCT compared with long-chain triacylglycerols (LCT) in 78 healthy men and women [body mass index (BMI) > or = 23 kg/m(2): n = 26 (MCT), n = 30 (LCT); BMI < 23 kg/m(2): n = 15 (MCT), n = 7 (LCT)]. Changes in anthropometric variables, body weight and body fat during the 12-wk MCT treatment period were compared with those in subjects consuming the LCT diet. The subjects were asked to consume 9218 kJ/d and 60 g/d of total fat. The energy, fat, protein and carbohydrate intakes did not differ significantly between the groups. Body weight and body fat in both groups had decreased by wk 4, 8 and 12 of the study. However, in the subjects with BMI > or = 23 kg/m(2), the extent of the decrease in body weight was significantly greater in the MCT group than in the LCT group. In subjects with BMI > or = 23 kg/m(2), the loss of body fat in the MCT group (-3.86 +/- 0.3 kg) was significantly greater than that in the LCT group (-2.75 +/- 0.2 kg) at 8 wk. In addition, in subjects with BMI > or = 23 kg/m(2), the decrease in the area of subcutaneous fat in the MCT group was significantly greater than that in the LCT group at wk 4, 8 and 12. These results suggest that the MCT diet may reduce body weight and fat in individuals (BMI > or = 23 kg/m(2)) more than the LCT diet.

Increased visceral adipose tissue is associated with increased circulating insulin and decreased sex hormone binding globulin levels in massively obese adolescent girls

The current study was designed to examine the relationship between body fat distribution, as evaluated by anthropometry and magnetic resonance imaging (MRI), and circulating insulin, sex hormone and SHBG levels in obese adolescent girls. Twenty-nine obese adolescent girls, aged 12.6-16.9 years with a mean BMI of 30.51+/-1.86 participated in this study. All girls had breast stage B4-5 and pubic hair stage P4-5. Percent obesity and BMI as indices of being overweight were calculated; the waist-to-hip ratio (WHR) and the waist-to-thigh ratio (WTR) were calculated to obtain two anthropometric indices for the pattern of body fat distribution. The areas of visceral (VAT) and subcutaneous adipose tissue (SAT) were evaluated by MRI at the L4-L5 level. Serum concentrations of total T, DHEAS, 17beta-estradiol, progesterone and SHBG were measured. Plasma glucose and insulin concentrations were evaluated during an oral glucose tolerance test. WHR was the only anthropometric parameter that was significantly associated with the area of VAT. Insulin level showed correlation with both WHR and the area of VAT; no correlation was found between insulin levels and WTR. Both WHR and VAT were negatively correlated with serum DHEAS level and positively correlated with T level. There were strong negative correlations between serum SHBG level and the area of VAT and WHR. Inverse correlation was found between serum SHBG level and insulin. Serum 17beta-estradiol and progesterone levels showed no significant correlation with all the patterns of body fat distribution. SAT was not significantly correlated with both anthropometric parameters and any of the sex hormones evaluated. We can draw two main conclusions. Firstly, in massively obese adolescent girls, the WHR seems to be a good indicator for the accumulation of VAT, and abdominal obesity, rather than adiposity per se, appears to be related to biochemical complications. Secondly, increased upper body adiposity and, in particular, the intra-abdominal fat area are associated with increased insulin levels in massively obese adolescent girls. The associated reductions in SHBG and DHEAS levels represent an early general risk factor for the development of metabolic and cardiovascular diseases in this population, as previously described for obese adult women.

A major locus for fasting insulin concentrations and insulin resistance on chromosome 6q with strong pleiotropic effects on obesity-related phenotypes in nondiabetic Mexican Americans

Insulin resistance and hyperinsulinemia are strong correlates of obesity and type 2 diabetes, but little is known about their genetic determinants. Using data on nondiabetics from Mexican American families and a multipoint linkage approach, we scanned the genome and identified a major locus near marker D6S403 for fasting "true" insulin levels (LOD score 4.1, empirical P<.0001), which do not crossreact with insulin precursors. Insulin resistance, as assessed by the homeostasis model using fasting glucose and specific insulin (FSI) values, was also strongly linked (LOD score 3.5, empirical P<.0001) with this region. Two other regions across the genome were found to be suggestively linked to FSI: a location on chromosome 2q, near marker D2S141, and another location on chromosome 6q, near marker D6S264. Since several insulin-resistance syndrome (IRS)-related phenotypes were mapped independently to the regions on chromosome 6q, we conducted bivariate multipoint linkage analyses to map the correlated IRS phenotypes. These analyses implicated the same chromosomal region near marker D6S403 (6q22-q23) as harboring a major gene with strong pleiotropic effects on obesity and on lipid measures, including leptin concentrations (e.g., LOD(eq) for traits-specific insulin and leptin was 4.7). A positional candidate gene for insulin resistance in this chromosomal region is the plasma cell-membrane glycoprotein PC-1 (6q22-q23). The genetic location on chromosome 6q, near marker D6S264 (6q25.2-q26), was also identified by the bivariate analysis as exerting significant pleiotropic influences on IRS-related phenotypes (e.g., LOD(eq) for traits-specific insulin and leptin was 4.1). This chromosomal region harbors positional candidate genes, such as the insulin-like growth factor 2 receptor (IGF2R, 6q26) and acetyl-CoA acetyltransferase 2 (ACAT2, 6q25.3-q26). In sum, we found substantial evidence for susceptibility loci on chromosome 6q that influence insulin concentrations and other IRS-related phenotypes in Mexican Americans.