Waist-To-Height Ratio Is a More Accurate Tool for Predicting Hypertension Than Waist-To-Hip Circumference and BMI in Patients With Type 2 Diabetes: A Prospective Study

Left Ventricular Systolic Function in Asymptomatic Men Aged 65-75 Years, Relation to Insulin Resistance and Pre-Diabetes: A DANCAVAS Cross-Sectional Sub-Study

AIM

Insulin resistance (IR) and hyperglycemia have been associated with increased risk of heart failure (HF) in patients with and without diabetes. Global longitudinel strain (GLS) has been shown to be superior in the detection of left ventricular (LV) systolic dysfunction when compared to ejection fraction (EF). In this study, we aimed to assess GLS in relation to IR and pre-diabetes.

METHOD

All participants underwent an echocardiography to assess LV systolic function using GLS. IR was evaluated using homeostatic model assessment for IR (HOMA-IR), and the participants were divided into tertiles based on their HOMA-IR values. An oral glucose tolerance test (OGTT) was performed to divide participants into normal glucose tolerance (NGT) and pre-diabetes. A multivariable linear regression model was used to assess GLS in relation to IR and glycemic groups.

RESULTS

In total, 359 men without significant coronary artery disease (CAD) and without diabetes were enrolled. Participants in the higher HOMA-IR tertile had significantly reduced GLS when compared with participants in the lower HOMA-IR tertile (-17.9% vs. -18.7%, p < 0.01). A significant trend was observed towards reduced GLS with increasing HOMA-IR tertile (p-trend 0.005). However, in the multivariable regression model, only waist-to-height-ratio (WH) (β 7.1 [95% CI 3.1-11.1, p = 0.001) remained significantly associated with GLS, whereas HOMA-IR tertile and pre-diabetes were not.

CONCLUSIONS

In asymptomatic elderly men with no diabetes or CAD, neither IR nor pre-diabetes was associated with GLS in the adjusted regression model. Increased WH seems to be associated with reduced systolic function by GLS measurement.

Association of the triglyceride glucose-waist height ratio with asymptomatic intracranial arterial stenosis

BACKGROUND AND OBJECTIVE

This study evaluated the associations of the triglyceride-glucose (TyG) index or its attendant parameters, known as reliable measures of insulin resistance, with asymptomatic intracranial arterial stenosis (aICAS), along with their value for distinguishing individuals with a notable aICAS burden.

METHODS

This study enrolled 2000 participants (aged ≥ 40 years) based on the Rose asymptomatic IntraCranial Artery Stenosis study. Transcranial Doppler ultrasound combined with magnetic resonance angiography was utilized to confirm aICAS. Logistic regression was applied to assess the associations between TyG or TyG-related indices (TyG-body mass index, TyG-waist circumference [TyG-WC], TyG-waist-to-hip ratio [TyG-WHR], or TyG-waist-to-height ratio [TyG-WHtR]) and aICAS. The diagnostic potential of them was investigated using receiver operating characteristic (ROC) analysis.

RESULTS

Among the 2000 participants, 146 (7.3%) had a diagnosis of aICAS. TyG-WC, TyG-WHR, or TyG-WHtR were independently related to the prevalence of aICAS (TyG-WC: OR 1.26, 95%CI 1.03-1.54; TyG-WHR: OR 1.29, 95%CI 1.07-1.55; TyG-WHtR: OR 1.25, 95%CI 1.04-1.51). ROC analysis disclosed that TyG-WHtR had significant superior performance in identifying aICAS compared with other parameters (all P < 0.05). Subgroup analysis revealed that higher TyG-WHtR values showed a positive association with a heightened prevalence of aICAS observed in elderly participants aged ≥ 65 years (OR 1.69, 95%CI 1.20-2.38), and hypertensive patients (OR 1.30, 95%CI 1.06-1.59).

CONCLUSION

The association of TyG-WHtR with aICAS showed that TyG-WHtR might be a more effective indicator for identifying populations with early-stage aICAS.

Comparative analysis of combined exercise programs in middle-aged obese males: impact on energy expenditure, body composition, and metabolic rate

Introduction

This study compares energy expenditure, body composition, and metabolic rate between serial (SCG) and integrated (ICG) combined training in untrained middle-aged obese males. Method: Twenty untrained obese males (age: 50 ± 3 years) were randomly assigned to a SCG (n = 10) or an ICG (n = 10). Both groups completed a 3-month training program (3 sessions/week) consisting of walking and bodyweight exercises, differing only in the sequence of aerobic and strength training. In SCG, strength training was performed before aerobic training, while in ICG, aerobic and strength exercises alternated in a predetermined order.

Results

After a 3-month training period, both groups significantly improved all health indices compared to pre-training values (p < 0.005, g = 0.40-2.71), indicating small to large effects. Specifically, there were moderate reductions in body fat percentage, small decreases in body circumferences, and moderate-to-large reductions in arterial blood pressure and resting heart rate. Additionally, respiratory function showed a large improvement. No significant differences were observed between SCG and ICG in energy expenditure, resting metabolic rate, total daily energy expenditure, macronutrient composition, or health indices after the intervention (p > 0.05).

Conclusion

In conclusion, both SCG and ICG are effective strategies for improving metabolic health, respiratory function, and body composition in middle-aged obese males. These findings highlight the flexibility of combined training approaches in promoting overall health and fitness in this population and suggest that both combined training programs can be implemented in structured exercise programs to promote cardiometabolic health in middle-aged adults.

Relationship Between Physical Activity Levels and Type 2 Diabetes in Adults: Zahedan Adult Cohort Study, Iran

Background

Given the influence of lifestyle on type 2 diabetes mellitus (T2DM), the present study aimed to investigate the association between physical activity (PA) intensity and T2DM among sedentary and active participants in the Zahedan Adult Cohort Study (ZACS), Iran.

Methods

This cross-sectional study was conducted as part of the population-based Persian Prospective Epidemiological Research Studies in Iran (Persian Cohort). The baseline data from the ZACS collected between 2015 and 2019 were utilized. A total of 10,004 adults aged 35-70 years were included in the analysis. Data were gathered through self-reported questionnaires covering general information, socioeconomic status, sleep status, medical history, and PA. Anthropometric measurements and biochemical parameters were obtained from participants after a 12-h fasting period. The data were analyzed using descriptive statistics, independent-sample t-test, chi-square, and logistic regression tests in SPSS22.

Results

The study found that the majority of the 10,004 adult participants (81.2%) were sedentary, while only 18.8% were classified as active. Sedentary participants exhibited significantly higher mean values for various health markers, including age, education, sleep duration, weight, body mass index (BMI), and blood lipid levels, as well as higher prevalence of hypertension, cardiac conditions, and stroke compared to active participants. Additionally, 21.7% of the participants had T2DM, which was associated with older age, longer sleep duration, higher weight and BMI, and abnormal waist circumference. The prevalence of diabetes increased with higher BMI, from 4.8% in underweight to 27.1% in obese participants, and was 77% in sedentary individuals compared to 16% in active individuals. Even after adjusting for demographic factors (OR = 0.65, p < 0.001), lipid levels (odds ratio [OR] = 0.68, p = 0.001), sleep status (OR = 0.72, p = 0.001), and family history (OR = 0.66, p = 0.001), active individuals were found to have a significantly lower likelihood of being diabetic compared to their sedentary counterparts.

Conclusions

The findings revealed a clear association between sedentary lifestyles and an increased risk of T2DM. Physical inactivity was correlated with adverse health markers and an elevated incidence of T2DM, which was mitigated by an active lifestyle. These results underscore the importance of public health initiatives to promote PA as a critical strategy for diabetes prevention.

Mobile Phone App to Promote Lifestyle Change in People at Risk of Type 2 Diabetes: Feasibility 3-Arm Randomized Controlled Trial

Background

The use of mobile health interventions, such as apps, are proposed to meet the challenges faced by preventive health care services due to the increasing prevalence of type 2 diabetes (T2D). Thus, we developed and conducted initial feasibility testing of the Plunde app for promoting and monitoring individual goals related to lifestyle change for people at risk of T2D.

Objective

The primary aim of this study was to assess the feasibility of an app for promoting lifestyle change in people at risk of T2D. The secondary aim was to assess recruitment rate, resource requirements, and change in potential outcomes for a full scale randomized controlled trial (RCT) study .

Methods

A 3-arm feasibility RCT lasting 12 weeks was designed. Participants were recruited from 9 general practitioners in Norway. Eligible participants were randomized to either (1) app follow-up; (2) app follow-up and referral to care as usual in Healthy Life Centers; or (3) referral to care as usual in a Healthy Life Center, only. The primary outcome was feasibility and was measured by app adherence (actual usage of the app), the System Usability Scale, and app motivation score gained from a questionnaire designed for this study. Criteria for success were preset based on these measures. Secondary outcomes included recruitment rate, resource requirements, and potential primary outcomes of a full-scale RCT. This included change in body weight, waist circumference, and self-evaluated functional health status, assessed with the Dartmouth Primary Care Cooperative Research Network/World Organization of Family Doctors (COOP/WONCA) functional health assessment chart.

Results

Within 8 months, 9 general practitioners recruited a total of 54 participants, of which 45 were eligble for participation in the study. Mean age was 61 (SD 13) years and 53% (n=24) were female. App adherence was 86%, the mean System Usability Scale score was 87.3 (SD 11.9), and the mean app motivation score was 74.8 (SD 30.3). Throughout the intervention period, health care professionals spent on average 3.0 (SD 1.0) minutes per participant per week providing follow-up. Statistically significant reduction in body weight and waist circumference was shown in group 1 and 3.

Conclusions

Based on the preset criteria for success, the Plunde app is feasible in providing support for lifestyle change. The Plunde app had excellent user satisfaction. The amount of time spent on monitoring and promoting lifestyle change through the app was low; however, the recruitment was slow. Results from this study will guide the development of further research within this field.

Association of triglyceride glucose-related obesity indices with sarcopenia among U.S. adults: a cross-sectional study from the National Health and Nutrition Examination Survey

The triglyceride glucose (TyG) index-related obesity indices have been proposed as reliable indicators of insulin resistance. This study aims to investigate the association between TyG index-related obesity indices and sarcopenia as well as their potential as a tool for screening sarcopenic patients. A cross-sectional study was conducted involving 7,161 participants aged 18 and above from the National Health and Nutrition Examination Survey. TyG index and TyG index-related obesity indices, including triglyceride glucose-body mass index (TyG-BMI), triglyceride glucose-waist circumference (TyG-WC), and triglyceride glucose-waist-to-height ratio (TyG-WHtR) were determined using standard formulas. The ratio of appendicular skeletal muscle mass to BMI were used to assess sarcopenia. The relationship between the TyG index as well as TyG index-related obesity indices and sarcopenia was investigated using restricted cubic spline analysis and multivariate logistic regression analysis. The diagnostic value of the TyG index and TyG index -related obesity indices for sarcopenia was compared using the receiver operating characteristic (ROC) curve. In the fully adjusted regression model, a positive correlation was observed between the TyG-WHtR index and sarcopenia (for each one-unit increase in TyG-WHtR index: OR = 3.57, 95% CI: 2.71-4.71, P < 0.001). Additionally, regression analyses demonstrated TyG-WHtR as a significant predictor of sarcopenia with the highest odds ratio, reaching 12.50 (95% CI: 6.13-25.70, P < 0.001) for the upper fourth quartile (Q4) compared to the first quartile, followed by followed by TyG-BMI (Q4: 3.34; 95% CI: 1.92-5.80, P < 0.001) and TyG-WC (Q4: 1.95; 95% CI: 1.04-3.68, P < 0.001). The RCS curve fitting analysis indicated a U-shaped relationship between TyG-WHtR and the diagnosis of sarcopenia, with an inflection point at 4.02. Furthermore, in the ROC analysis, the AUC for the diagnosis of sarcopenia was largest for TyG-WHtR (0.79, P < 0.001). The TyG ndex-related obesity indices, especially TyG-WHtR, have been shown to be more effective in identifying sarcopenia patients than TyG alone.

Anthropometric Measures, Cardiometabolic and Hepatic Indices, and Cut-off Points for Predicting Type 2 Diabetes Mellitus in Southwest Iran: A Cross-Sectional Study from the Enrolment Phase of the Hoveyzeh Cohort Study

Background: Cut-off points for anthropometric measures associated with diabetes may vary across different ethnic groups. Objectives: This study aimed to identify the optimal cut-off values for these measures and their relationship with cardiometabolic and hepatic indices to predict type 2 diabetes mellitus (T2DM) in southwest Iran. Methods: This cross-sectional study was conducted in Hoveyzeh, Iran, and included a total of 7,300 individuals (1,607 with T2DM and 5,693 healthy participants). Anthropometric, cardiometabolic, and hepatic indices were calculated. Results: The visceral adiposity index (VAI) showed the highest correlation with cardiometabolic indices, such as the cardiometabolic index and lipid accumulation product. The conicity index (CI) had the strongest correlation with hepatic indices, including the hepatic steatosis index and the Alcoholic Liver Disease/Non-alcoholic Fatty Liver Disease (ALD/NAFLD) index. The atherogenic index of plasma was the most significant predictor of T2DM in the Hoveyzeh population for both men (OR: 3.39; CI: 2.38 - 4.81) and women (OR: 5.68; CI: 4.20 - 7.68). The optimal cut-off values for several anthropometric measures were higher in men than in women: BMI (28.0 vs. 25.48), Waist/Height ratio (0.64 vs. 0.56), Weight-adjusted waist index (11.83 vs. 10.76), CI (1.35 vs. 1.29), body roundness index (8.43 vs. 7.33), relative fat mass (44.63 vs. 28.5), and lipid accumulation product (67.23 vs. 67.04). Conversely, the cut-off values for optimal waist circumference (99.45 vs. 98.35), Waist/Hip ratio (0.99 vs. 0.96), VAI (2.22 vs. 2.19), and abdominal volume index (20 vs. 19.6) were higher in women than in men. Conclusions: The atherogenic index of plasma is a highly predictive indicator of T2DM. Our results suggest that novel anthropometric and cardiometabolic indices could serve as accessible and cost-effective strategies for assessing health outcomes related to T2DM.

Physical activity, obesity and risk of atherosclerotic cardiovascular diseases among patients with hypertension and diabetes attending a teaching hospital in Edo State, Nigeria

INTRODUCTION

Preventing Atherosclerotic Cardiovascular Diseases (ASCVD) can best be achieved by promoting a healthy lifestyle through improvements in diet, physical activity, and avoidance of tobacco use and exposure to second-hand smoke. The study aimed to determine the association between physical activity as well as obesity and the risk of atherosclerotic cardiovascular diseases among patients with hypertension and diabetes attending Irrua Specialist Teaching Hospital (ISTH), Irrua, Nigeria.

METHODOLOGY

The research was a descriptive, cross-sectional study of 394 systematically selected consenting patients with hypertension and diabetes presenting to a teaching hospital in Irrua, Edo State, Nigeria. The Cardiovascular risk assessment was determined using the Framingham 10year Risk of General Cardiovascular Disease. Anthropometric assessment, blood pressure and blood glucose were determined. Data was collected with a semi-structured questionnaire and analysed with Stata version 16. Chi square and logistic regression was used to test for association and significance level was set at p = 0.05.

RESULTS

The study included 394 participants with a mean age of 54±15.47years. Respondents were mostly females (55.3%), physically inactive (70.3%), overweight (42.4%) and had a high risk (41.8%) of developing CVD in 10 years using Framingham categorisation. There was a significant association between physical activity (P<0.01; OR 2.45; CI: 1.53-3.92), obesity (P<0.01; OR 2.52; CI: 1.64-3.86) and risk of developing CVD.

CONCLUSION

The study found a statistically significant relationship between physical inactivity, obesity, and the risk of atherosclerotic cardiovascular diseases. Increasing physical activity levels need to be a top priority at all levels of healthcare as well as the general population.

Setting Ranges in Potential Biomarkers for Type 2 Diabetes Mellitus Patients Early Detection By Sex-An Approach with Machine Learning Algorithms

Type 2 diabetes mellitus (T2DM) is one of the most common metabolic diseases in the world and poses a significant public health challenge. Early detection and management of this metabolic disorder is crucial to prevent complications and improve outcomes. This paper aims to find core differences in male and female markers to detect T2DM by their clinic and anthropometric features, seeking out ranges in potential biomarkers identified to provide useful information as a pre-diagnostic tool whie excluding glucose-related biomarkers using machine learning (ML) models. We used a dataset containing clinical and anthropometric variables from patients diagnosed with T2DM and patients without TD2M as control. We applied feature selection with three different techniques to identify relevant biomarker models: an improved recursive feature elimination (RFE) evaluating each set from all the features to one feature with the Akaike information criterion (AIC) to find optimal outputs; Least Absolute Shrinkage and Selection Operator (LASSO) with glmnet; and Genetic Algorithms (GA) with GALGO and forward selection (FS) applied to GALGO output. We then used these for comparison with the AIC to measure the performance of each technique and collect the optimal set of global features. Then, an implementation and comparison of five different ML models was carried out to identify the most accurate and interpretable one, considering the following models: logistic regression (LR), artificial neural network (ANN), support vector machine (SVM), k-nearest neighbors (KNN), and nearest centroid (Nearcent). The models were then combined in an ensemble to provide a more robust approximation. The results showed that potential biomarkers such as systolic blood pressure (SBP) and triglycerides are together significantly associated with T2DM. This approach also identified triglycerides, cholesterol, and diastolic blood pressure as biomarkers with differences between male and female actors that have not been previously reported in the literature. The most accurate ML model was selection with RFE and random forest (RF) as the estimator improved with the AIC, which achieved an accuracy of 0.8820. In conclusion, this study demonstrates the potential of ML models in identifying potential biomarkers for early detection of T2DM, excluding glucose-related biomarkers as well as differences between male and female anthropometric and clinic profiles. These findings may help to improve early detection and management of the T2DM by accounting for differences between male and female subjects in terms of anthropometric and clinic profiles, potentially reducing healthcare costs and improving personalized patient attention. Further research is needed to validate these potential biomarkers ranges in other populations and clinical settings.

Associations between different triglyceride glucose index-related obesity indices and periodontitis: results from NHANES 2009-2014

BACKGROUND

This study aimed to explore the associations between triglyceride glucose (TyG) index-related obesity indices and periodontitis within the American population.

METHODS

This cross-sectional investigation utilized data from the National Health and Nutrition Examination Survey (NHANES) for 2009-2014. The association between the TyG-waist-to-height ratio (TyG-WHtR), TyG-weight-adjusted-waist index (TyG-WWI), TyG-waist circumference (TyG-WC), or TyG-body mass index (TyG-BMI) and periodontitis was investigated utilizing multivariable logistic regression model, subgroup, and dose-response curve analyses.

RESULTS

This study enrolled 4,808 adult participants. Except for TyG-BMI, which did not exhibit a relationship with periodontitis, TyG-WHtR, [odds ratio (OR) (95% confidence interval (CI))] = 2.83 [1.58-5.10], P = 0.002], TyG-WWI [OR (95% CI) = 7.50 (3.06-18.34), P < 0.001], and TyG-WC [OR (95% CI) = 2.12 (1.23-3.64), P = 0.011] were all associated with periodontitis. Participants in the highest quartile displayed an elevated risk of periodontitis relative to their counterparts in the lowest quartile, as evidenced for TyG-WWI [OR (95% CI) = 1.72 (1.26-2.33), P = 0.001] and TyG-WC [OR (95% CI) = 1.50 (1.13-1.99), P = 0.009] in the full adjustment model. Subgroup analyses suggested more pronounced positive associations between these indices and periodontitis in participants who were < 60 years old, had a BMI ≥ 25, and did not have diabetes. The dose-response curve indicated linear responses in these associations.

CONCLUSIONS

This investigation identified a significant and stable association between TyG-WHtR, TyG-WWI, or TyG-WC and periodontitis, which implies a robust correlation between high insulin resistance and susceptibility to periodontitis in the American population.

Alterations in salivary biomarkers in relation to periodontal health and obesity among Hong Kong adolescents

OBJECTIVES

To explore the association among salivary biomarkers, periodontal inflammation, and adiposity status in adolescents.

METHODS

This study included 180 Hong Kong adolescents aged 12-15 years. Anthropometric measurements including central obesity surrogate, waist-to-height ratio (WHtR), and dental examinations were conducted. The participants were classified into four groups as follows: with normal WHtR and less extensive periodontal inflammation (NW+LP); with high WHtR and less extensive periodontal inflammation (HW+LP); with normal WHtR and more extensive periodontal inflammation (NW+P); and with high WHtR and more extensive periodontal inflammation (HW+P). Saliva were collected to measure salivary physicochemical parameters, total bacterial load, and levels of protein biomarkers including secretory phospholipase A2 group IIA (sPLA2-IIA) and interleukin-6 (IL-6). Data were analysed by Kruskal-Wallis test and Spearman correlation coefficient.

RESULTS

Salivary IL-6 levels and sPLA2-IIA and IL-6 output differed significantly between groups (P = 0.041, 0.027, and 0.043, respectively). The NW+P group had significantly higher salivary IL-6 output than the NW+LP group (P = 0.034) and significantly lower salivary sPLA2-IIA output than the HW+LP group (P = 0.038). Salivary IL-6 levels were negatively correlated with the number of sextants with healthy gingivae and positively correlated with salivary sPLA2-IIA levels in participants with normal WHtR. Salivary sPLA2-IIA levels were negatively correlated with total salivary bacterial load in participants with high WHtR.

CONCLUSIONS

Salivary IL-6 levels were associated with the extent of periodontal inflammation in participants with normal WHtR but not in those with high WHtR. Adolescents with different adiposity status may have different mechanisms of periodontal inflammation.

CLINICAL SIGNIFICANCE

Investigating salivary biomarkers of periodontal health holds potential benefits in identifying individuals at risk and customizing oral health promotion strategies for individuals with varying levels of adiposity, even as early as adolescence.

Hypertension Prevalence and Related Risk Factors Among Mexican American Adults Are Increasing: National Health and Nutrition Examination Survey 1999 to 2018

BACKGROUND

Acculturation affects hypertension prevalence among Hispanic people, but there have been no recent analyses specifically focused on Mexican American (MA) people. We sought to determine age-adjusted hypertension prevalence, abdominal obesity, and acculturation trends among MA adults and non-Hispanic White adults.

METHODS AND RESULTS

Data from the NHANES (National Health and Nutrition Examination Survey) were analyzed in 2-year increments to observe trends in hypertension and risk factors (age, sex, body mass index, smoking status, abdominal obesity, waist-to-height ratio (WHtR), education, and income). Acculturation was based on three commonly used measures. The sample included 30 920 adults. Age-adjusted hypertension prevalence is higher in MA adults (52.7%) than White adults (48.3%). Hypertension risk factors-age, obesity prevalence, WHtR, acculturation-all significantly increased among MA adults, while smoking declined. Higher acculturation scores increased hypertension likelihood (odds ratio [OR], 1.44 [95% CI, 0.91-1.97]) for MA adults compared with those with lower acculturation scores. White adults with elevated WHtR >0.5 had a 40% higher risk of hypertension than those with WHtR <0.5, but among MA adults, elevated WHtR did not increase risk for hypertension. There was a significant increase in hypertension prevalence among MA adults from 2003 to 2018 at an average biennial rate of 2.23%. There was no change in hypertension prevalence among White adults from 1999 to 2018.

CONCLUSIONS

Over 20 years of NHANES, more highly acculturated MA adults were at greater risk for hypertension, despite declines in smoking and controlling for age, sex, obesity status, education, and income. Finding ways to promote more traditional lifestyle and eating habits for MA adults could be a beneficial approach to reducing hypertension risk factors in this population.

The relationship between anthropometric indices and the presence of hypertension in an Iranian population sample using data mining algorithms

Hypertension (HTN) is a common chronic condition associated with increased morbidity and mortality. Anthropometric indices of adiposity are known to be associated with a risk of HTN. The aim of this study was to identify the anthropometric indices that best associate with HTN in an Iranian population. 9704 individuals aged 35-65 years were recruited as part of the Mashhad Stroke and Heart Atherosclerotic Disorder (MASHAD) study. Demographic and anthropometric data of all participants were recorded. HTN was defined as a systolic blood pressure (SBP) ≥ 140 mmHg, and/ or a diastolic blood pressure (DBP) ≥ 90 mmHg on two subsequent measurements, or being treated with oral drug therapy for BP. Data mining methods including Logistic Regression (LR), Decision Tree (DT), and Bootstrap Forest (BF) were applied. Of 9704 participants, 3070 had HTN, and 6634 were normotensive. LR showed that body roundness index (BRI), body mass index (BMI) and visceral adiposity index (VAI) were significantly associated with HTN in both genders (P < 0.0001). BRI showed the greatest association with HTN (OR = 1.276, 95%CI = (1.224, 1.330)). For BMI we had OR = 1.063, 95%CI = (1.047, 1.080), for VAI we had OR = 1.029, 95%CI = (1.020, 1.038). An age < 47 years and BRI < 4.04 was associated with a 90% probability of being normotensive. The BF indicated that age, sex and BRI had the most important role in HTN. In summary, among anthropometric indices the most powerful indicator for discriminating hypertensive from normotensive patients was BRI.

Obesity- and lipid-related indices as a predictor of type 2 diabetes in a national cohort study

Objective

Type 2 diabetes mellitus (T2DM) remains a major and widespread public health concern throughout the world. The prevalence of T2DM in the elderly has risen to the top of the list of public health concerns. In this study, obesity- and lipid-related indices were used to predict T2DM in middle-aged and elderly Chinese adults.

Methods

The data came from the China Health and Retirement Longitudinal Study (CHARLS), including 7902 middle-aged and elderly participants aged 45 years or above. The study assessed the association of obesity- and lipid-related indices and T2DM by measuring 13 indicators, including body mass index (BMI), waist circumference(WC), waist-height ratio (WHtR), conicity index(CI), visceral adiposity index (VAI), Chinese visceral adiposity index (CVAI), lipid accumulation product (LAP), a body shape index (ABSI), body roundness index (BRI), triglyceride glucose index (TyG-index) and its correlation index (TyG-BMI, TyG-WC, TyG-WHtR). The association of 13 obesity- and lipid-related indices with T2DM was investigated by binary logistic regression. Additionally, the predictive anthropometric index was evaluated, and the ideal cut-off value was established using the receiver operating characteristic (ROC) curve analysis and area under the curve (AUC).

Results

The study included 7902 participants, of whom 3638(46.04) and 4264(53.96) were male and female. The prevalence of T2DM in mid-aged and old adults in China was 9.02% in males and 9.15% in females. All the above 13 indicators show a modest predictive power (AUC>0.5), which was significant for predicting T2DM in adults (middle-aged and elderly people) in China (P<0.05). The results revealed that TyG-WHtR [AUC =0.600, 95%CI: 0.566-0.634] in males and in females [AUC =0.664, 95%CI: 0.636-0.691] was the best predictor of T2DM (P<0.05).

Conclusion

Most obesity- and lipid-related indices have important value in predicting T2DM. Our results can provide measures for the early identification of T2DM in mid-aged and elderly Chinese to reduce the prevalence of T2DM and improve health.

There was a similar U-shaped nonlinear association between waist-to-height ratio and the risk of new-onset hypertension: findings from the CHNS

Background

The association between waist-to-height ratio (WHtR) with hypertension has not been adequately explained, so in this study we sought to clarify the predictive role of WHtR on the incidence of hypertension as well as the potential nonlinear associations in the general population.

Methods

In this large prospective cohort study, a total of 4,458 individuals from the China Health and Nutrition Survey (CHNS) were included in the analysis. Multivariate Cox regression analyses, subgroup analyses, receiver operator characteristic (ROC) and restricted cubic spline (RCS) analyses were used to examine the association of WHtR with the risk of new-onset hypertension.

Results

Hypertension occurred in 32.8% of participants during the maximum six-year follow-up period. Compared with the group with lower WHtR, the group with higher WHtR had a higher incidence of hypertension (p < 0.001). Multivariate Cox regression analysis showed that the risk of hypertension was 1.45 times higher in the high WHtR group than in the low WHtR group, and that the risk of hypertension increased by 30.4% for every 0.1 unit increase in WHtR (p < 0.001). Subgroup analyses also validated the stratified associations between WHtR and the risk of new-onset hypertension in most subgroups (p < 0.05). ROC analyses also revealed that WHtR was superior to body mass index in predicting new-onset hypertension (AUC: 0.626 vs. 0.607, p = 0.009). Further RCS analysis detected a nonlinear association between WHtR and risk of new-onset hypertension (P for nonlinearity <0.001).

Conclusion

WHtR was nonlinearly associated with the risk of new-onset hypertension in the general population.

Relationship between obesity indicators and hypertension-diabetes comorbidity in an elderly population: a retrospective cohort study

BACKGROUND

The prevalence of obesity, hypertension and diabetes is increasing. Hypertension and diabetes are common complications. Additionally, obesity and hypertension-diabetes comorbidity (HDC) are both closely related to insulin resistance. The aim of this study was to determine the association of obesity indicators with HDC in elderly individuals.

METHODS

This retrospective cohort study included 74,955 subjects aged ≥ 60 years living in Xinzheng, Henan Province, from January 2011 to December 2019. The data were collected from the annual health examination dataset. Cox proportional hazard regression models and competing-risk survival regression models were used to examine the relationships between the three indicators and HDC risk.

RESULTS

After 346,504 person-years of follow-up, HDC developed in 9,647 subjects. After further adjustments for confounders and death competing risks, compared with a body mass index (BMI) of 18.5-23.9 kg/m2, the fully adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of BMI < 18.5, 24-27.9 and ≥ 28 kg/m2 for HDC morbidity were 0.651(0.538,0.788),1.00,1.396(1.336,1.459) and 1.769(1.666,1.878), respectively. Moreover, participants with abdominal obesity measured via waist circumference (WC) or waist-to-height ratio (WtHR) had a higher risk of HDC (HR:1.513; 95% CI: 1.45,1.578 and HR:1.412;95% CI: 1.353,1.473), respectively, than participants with low WC or with low WtHR. In the joint analyses, the highest risk was observed in participants who were overweight and who had central obesity (HR: 1.721; 95% CI: 1.635, 1.811) compared with the nonoverweight and noncentral obesity groups.

CONCLUSIONS

Increased BMI, WC and WtHR were associated with an increased risk of HDC. There was an additive interaction between general body adiposity (as measured via BMI) and central obesity (as measured via WC and WtHR) for HDC. Therefore, reasonable control of BMI, WC and WtHR may be an effective measure to prevent HDC among elderly individuals.

Lower Adherence to a Mediterranean Diet Is Associated with High Adiposity in Community-Dwelling Older Adults: Results from the Longevity Check-Up (Lookup) 7+ Project

High adiposity impacts health and quality of life in old age, owing to its association with multimorbidity, decreased physical performance, and frailty. Whether a high adherence to a Mediterranean diet (Medi-Diet) is associated with reduced body adiposity in older adults is unclear. The present study was conducted to assess the prevalence of high adiposity in a large sample of community-dwelling older adults. We also explored the relationship between whole-body adiposity estimated through relative fat mass (RFM) and Medi-Diet adherence. Data were obtained from the Longevity Check-up 7+ (Lookup7+) project database. RFM was estimated from anthropometric and personal parameters using a validated equation. RFM was categorized as high if ≥40% in women and ≥30% in men. Information on diet was collected using a food frequency questionnaire, while Medi-Diet adherence was assessed through a modified version of the Medi-Lite scoring system. Analyses were conducted in 2092 participants (mean age 73.1 ± 5.9 years; 53.4% women). Mean RFM was 39.6 ± 5.14% in women and 29.0 ± 3.6% in men. High adiposity was found in 971 (46.4%) participants and was more frequent in those with a low (54.2%) or moderate (46.4%) Medi-Diet adherence compared with the high-adherence group (39.7%, p < 0.001). Logistic regression indicated that older adults with high Medi-Diet adherence were less likely to have a high RFM. Other factors associated with a greater risk of having high adiposity were older age, female sex, and physical inactivity. Our findings support an association between healthy lifestyles, including a greater adherence to a Mediterranean-style diet, and lower body adiposity in older adults.

Comparison of bioelectrical body and visceral fat indices and anthropometric measures in relation to type 2 diabetes by sex among Chinese adults, a cross-sectional study

Objectives

We aim to compare the efficacies of the bioelectrical indices (percentage of body fat, PBF; visceral fat area, VFA) with the conventional anthropometric measures (body mass index, BMI; waist-hip ratio, WHR) for predicting type 2 diabetes (T2D) risk by sex and to determine the sex-specific optimal adiposity indices to predict the T2D risk.

Design

Cross-sectional design.

Setting

Tianjin First Central Hospital and Tianjin Union Medical Center, Tianjin, China.

Participants

A total of 9,332 adults (41.35% men) undergoing physical examination.

Primary and secondary outcome measures

T2D was defined using the WHO's criteria: fasting blood glucose (FBG) ≥7.0 mmol/L and/or previous diagnosis of T2D. Height, weight, waist, hip, PBF, VFA, and fasting plasma glucose were measured.

Results

All studied adiposity indices were associated with T2D among both males and females, and the observed associations differed by sex. The standardized aORs of BMI, WHR, PBF and VFA for T2D were 1.60 (95% CI 1.42-1.81), 1.43 (95% CI 1.25-1.64), 1.42 (95% CI 1.23-1.62) and 1.53 (95% CI 1.35-1.75) for females, and 1.47 (95% CI 1.31-1.66), 1.40 (95% CI 1.25-1.58), 1.54 (95% CI 1.36-1.74) and 1.47 (95% CI 1.31-1.65) for males, respectively. The AUCs of VFA, WHR and BMI were 0.743, 0.742 and 0.717 in women, respectively, whereas none of the indices had AUC larger than 0.70 in men. The AUCs were not significantly different between VFA and WHR, while both demonstrate larger AUCs than BMI and PBF in females (all p < 0.05). The optimal cutoff values of VFA, WHR, and BMI for T2D in women were 103.55 cm2, 0.905, and 24.15 kg/m2, respectively.

Conclusion

Although BMI, WHR, and PBF and VFA as measured by bioelectrical impedance analysis (BIA) were all positively associated with T2D, their efficacy for predicting the risk of T2D differed by sex. VFA, WHR and BMI could be used as biomarkers to predict T2D risk in women, however none of the study indicators demonstrated favorable efficacy of predicting T2D risk in men.

Relationship between measures of adiposity and hypertension amongst secondary school adolescents in an urban setting in Cameroon

Introduction

measures of obesity such as body mass index (BMI), waist circumference (WC) and waist-to-height ratio (WHtR) have been shown to be associated with high blood pressure (BP) in children and adolescents. The purpose of this study was to determine the proportion of secondary school adolescents with elevated BP and high BP in relation to some measures of adiposity (BMI, WC, WHtR) and to examine the association between BP and adiposity indices amongst the children.

Methods

the study was an institutional-based cross-sectional study involving 534 adolescents (mean age 15.1 ± 2.3 years) attending 4 secondary schools (2 public and 2 private) in the Bamenda municipality of the North West Region of Cameroon. Anthropometric and BP measurements were carried out following standard procedures. Diagnosis of hypertension in the children was done by obtaining three elevated systolic or diastolic BP readings (BP ≥ 95th percentile for the child's age, sex and height). Linear regression was used to determine the relationship between BP and some measures of adiposity (BMI, WC, WHtR) amongst the children.

Results

the prevalence of elevated BP and hypertension amongst the study participants was 33.3% and 33.3% in the BMI-obese children, 25.9% and 25.2% in the WC overweight/obese children and 29.4% and 41.2% in the "high risk" (WHtR ≥ 0.5) children respectively. Body mass index-obese, WC overweight/obese and "high risk" (WHtR ≥ 0.5) children had a significantly (p <0.05) higher mean SBP and DBP compared to their healthy weight counterparts. Linear regression indicated a significant association (p <0.001) between WC (β=0.75; 95% CI = 0.57, 0.92), BMI (β=0.88; 95% CI = 0.49, 1.25) and WHtR (β= 67.08; 95% CI = 45.64, 88.51) with systolic BP for the unadjusted analysis. After adjusting for age, gender and school type, only WC (β= 0.66; 95% CI = (0.43, 0.89) showed a positive significant (p <0.001) relationship with systolic BP.

Conclusion

this study has demonstrated that WC is positively associated with high BP in children and adolescents. Thus, WC can be used in predicting children and adolescents with a high risk of developing high BP in our setting.

Waist-to-Height Ratio: A Sensitive Tool for Assessing the Need for Nutritional Risk Management in Elderly Populations from Brazil

INTRODUCTION

Nutritional status assessment commonly relies on body mass index (BMI), which overlooks lean mass and adipose tissue distribution. However, waist circumference (WC) and waist-to-height ratio (WHtR) provide additional insights into fat accumulation. By combining these indices, it may be possible to identify older adults needing weight management interventions.

OBJECTIVES

To assess the WC and WHtR as strategies for identifying individuals requiring weight management.

METHODS

A cross-sectional study was conducted with 509 elderly individuals in Northeast Brazil. Weight, height, hip circumference, and waist circumference were measured, and combined with indices such as BMI WC, WHR, and WHtR to identify those who require weight management. The DeLong test compared areas under the curves using receiver operating characteristic curves and statistical significance. Sensitivity, specificity, and positive and negative predictive values were calculated to verify usefulness for clinical application. A validation sample of 599 elderly individuals from the country's Southern region was used to confirm the results.

RESULTS

Both WC and WHtR showed adequate diagnostic accuracy with no statistically significant difference in AUCs. WHtR ≥ 0.50 had 92% sensitivity in identifying men and women requiring nutritional management. WC presented lower sensitivity but 93% specificity, useful for excluding elderly individuals from the nutritional risk category. These results were consistent in the validation sample.

CONCLUSION

WHtR is a valuable index for screening nutritional risk management in the elderly population, applicable to men and women. Conversely, WC performs better in excluding individuals who do not need nutritional risk management.

A randomized-controlled trial to evaluate the app-based multimodal weight loss program zanadio for patients with obesity

OBJECTIVE

This study aimed to evaluate the effectiveness of the app-based, multimodal weight loss program zanadio.

METHODS

A randomized-controlled trial was conducted from January 2021 to March 2022. A total of 150 adults with obesity were randomized into an intervention group and used zanadio for 1 year or into a wait list control group. The primary end point, weight change, and the secondary end points, quality of life, well-being, and waist to height ratio, were assessed every 3 months for up to 1 year via telephone interviews and online questionnaires.

RESULTS

After 12 months, participants of the intervention group lost, on average, -7.75% (95% CI: -9.66% to -5.84%) of their initial weight, achieving a clinically relevant and statistically stronger weight reduction than the control group (mean = 0.00% [95% CI: -1.98% to 1.99%]). All secondary end points improved significantly in the intervention group, with significantly greater improvements in well-being and waist to height ratio than in the control group.

CONCLUSIONS

This study showed that adults with obesity who have used zanadio achieved a significant and clinically relevant weight loss within 12 months and improved further obesity-related health variables compared with a control group. Because of its effectiveness and flexible applicability, the app-based multimodal treatment zanadio might alleviate the present care gap for patients with obesity in Germany.

Relationship between novel anthropometric indices and the incidence of hypertension in Chinese individuals: a prospective cohort study based on the CHNS from 1993 to 2015

BACKGROUND

Recently, novel anthropometric indices (AHIs), including the body roundness index (BRI) and a body shape index (ABSI), were proposed to evaluate a subject's nutritional status and metabolic disorders. In the present study, we mainly analyzed the relationship between AHIs and the incidence of hypertension and preliminarily compared their abilities to discriminate hypertension incidence in the Chinese population from the China Health and Nutrition Survey (CHNS).

METHODS

A total of 12,154 participants were included in this longitudinal study. The age range of this cohort was 18-94 years old (mean age: 40.73 ± 13.85 years old). 4511 participants developed hypertension during a median of 7.00 years of follow-up. Cox regression analysis, stratified analysis, and interaction tests were used to analyze the relationship between AHIs and the incidence of hypertension. Time-dependent receiver operating characteristic (ROC) curves, integrated discrimination improvement (IDI) and net reclassification index (NRI) were calculated to appraise the AHIs' discrimination value of new-onset hypertension.

RESULTS

Kaplan‒Meier curves demonstrated that the participants in higher quartiles of AHIs (ABSI or BRI) at baseline were at greater risk of hypertension incidence during the follow-up. After adjusting for confounding factors, multivariate Cox regression models showed that the quartiles of BRI were significantly associated with an increased risk of hypertension in the whole cohort but were relatively weak for ABSI quartiles (P for trend = 0.387). In addition, ABSI z score (HR = 1.08, 95% CI: 1.04-1.11) and BRI z score (HR = 1.27, 95% CI: 1.23-1.30) were positively associated with increased incident hypertension in the total population. Stratified analysis and interaction tests showed a greater risk of new-onset hypertension in those < 40 years old (HR = 1.43, 95% CI: 1.35-1.50) for each z score increase in BRI and a higher incidence of hypertension in participants who were drinkers (HR = 1.10, 95% CI: 1.04-1.14) for each z score increase in ABSI. In addition, we observed that the area under the curve for identifying hypertension incidence for BRI was significantly higher than that for ABSI at 4, 7, 11, 12, and 15 years (all P < 0.05). However, the AUC of both indices decreased over time. Furthermore, the addition of BRI improved the differentiation and reclassification of traditional risk factors with a continuous NRI of 0.201 (95% CI: 0.169-0.228) and an IDI of 0.021 (95% CI: 0.015-0.028).

CONCLUSION

Increased ABSI and BRI were associated with an increased risk of hypertension in Chinese individuals. BRI performed better than ABSI in identifying the new onset of hypertension, and the discrimination ability of both indices decreased over time.

Comparing the performance of body mass index, waist circumference and waist-to-height ratio in predicting Malaysians with excess adiposity

BACKGROUND

Body mass index (BMI) is a widely used surrogate tool to screen for obesity/adiposity, but it cannot differentiate between lean and fat mass. Thus, alternative tools to detect excess adiposity should be identified.

AIM

This study aimed to compare the performance of BMI, waist circumference (WC) and waist-to-height ratio (WtHR) in predicting Malaysians with excess body fat defined by dual-energy X-ray absorptiometry (DXA).

SUBJECTS AND METHODS

A total of 399 men and women aged ≥40 years were recruited from Klang Valley, Malaysia. The body composition of the subjects, including body fat percentage, was measured by DXA. The weight, height, WC and WHtR of the subjects were also determined.

RESULTS

BMI [sensitivity = 55.7%, specificity = 86.1%, area under curve (AUC) = 0.709] and WC (sensitivity = 62.7%, specificity = 90.3%, AUC = 0.765) performed moderately in predicting excess adiposity. Their performance and sensitivity improved with lower cut-off values. The performance of WHtR (sensitivity = 96.6%, specificity = 36.1, AUC = 0.664) was optimal at the standard cut-off value and no modification was required.

CONCLUSION

The performance of WC in identifying excess adiposity was greater than BMI and WHtR based on AUC values. Modification of cut-off values for BMI and WC could improve their performance and should be considered by healthcare providers in screening individuals with excess adiposity.

Waist-to-height ratio is a simple and practical alternative to waist circumference to diagnose metabolic syndrome in type 2 diabetes

BACKGROUND

As an indicator of abdominal obesity, waist circumference (WC) varied with race and gender in diagnosing metabolic syndrome (MetS). Therefore, it is clinically important to find an alternative indicator of abdominal obesity independent of these factors to diagnose MetS. Our aims were to evaluate the association between waist-to-height ratio (WHtR) and MetS and further determine whether WHtR could be used as a simple and practical alternative to WC to diagnose MetS in patients with type 2 diabetes mellitus (T2DM).

METHODS

This cross-sectional, real-world study recruited 8488 hospitalized T2DM patients including 3719 women (43.8%) aged from 18 to 94 years and 4769 men (56.2%) aged from 18 to 91 years. A WHtR cut-off of 0.52 was used to diagnose MetS in both men and women T2DM patients based on our previous study. The association of WHtR with MetS in T2DM patients was analyzed by binary logistic regression. The consistency of two diagnostic criteria for MetS according to WC and WHtR was determined by Kappa test.

RESULTS

The prevalence of MetS according to WHtR was 79.4% in women and 68.6% in men T2DM patients, which was very close to the prevalence of MetS according to WC in both women (82.6%) and men (68.3%). The prevalence of MetS diagnosed by WC in both men and women with WHtR ≥ 0.52 was significantly higher than in those with WHtR < 0.52 after adjustment for age and duration of diabetes (89.2 vs. 38.7% for men; 92.8 vs. 57.4% for women; respectively, all p < 0.001). Binary logistic regression analysis displayed that after adjusting for confounding factors, WHtR was significantly associated with the presence of MetS in both men and women (men: OR = 4.821, 95% CI: 3.949-5.885; women: OR = 3.096, 95% CI: 2.484-3.860; respectively, all p < 0.001). Kappa test revealed that there was an excellent consistency between the diagnosis of MetS based on WC and on WHtR in T2DM patients (men: kappa value = 0.929, 95% CI: 0.918-0.940; women: kappa value = 0.874, 95% CI: 0.854-0.894; total: kappa value = 0.911, 95% CI: 0.901-0.921; respectively, all p < 0.001).

CONCLUSION

WHtR is independently associated with the presence of MetS and can be used as a simple and practical alternative to WC to diagnose MetS regardless of gender in T2DM patients.

Physical Fitness, Screen Time and Sleep Habits According to Obesity Levels in Schoolchildren: Findings from the Health Survey of the Extreme South of Chile

Obesity is a worry because it is associated with a greater burden of disease, and it has been shown to be related to the health habits and physical condition of children and adolescents.

OBJECTIVE

To associate physical fitness, screen time, and sleep habits with the different categories of obesity in schoolchildren from the extreme south of Chile.

METHODS

583 schoolchildren were included in this cross-sectional analysis. The screen time and sleep habits were measured with the Sleep Self-Report questionnaire, while the physical fitness was assessed with the Alpha Fitness test battery. The Body Mass Index/age (BMI/age) and the Waist-to-Height ratio (WtHr) were used to define adiposity using the following categories: healthy weight/low-risk waist-to-height ratio (H/LR), healthy weight/high-risk waist-to-height ratio (H/HR), overweight/low-risk waist to height ratio (O/LR), and overweight/high-risk waist to height ratio (O/HR).

RESULTS

A considerable number of schoolchildren (23.2%) presented sleep problems, while the mean screen time was 9.3 (95% CI: 8.4; 10.1) hours/day. Schoolchildren classified as H/HR showed better physical fitness than the O/HR group but worse physical fitness than the H/LR group.

CONCLUSIONS

Significant differences were evidenced in the physical fitness between the adiposity categories, which could open future lines of research concerning the characterization of the healthy weight-obese adiposity categories in children.

Comparison of waist-height ratio and other obesity indices in the prediction of diabetic peripheral neuropathy

Background

Waist-height ratio (WHtR) is increasingly being studied as a simple and effective measure of central obesity. Reports have shown that WHtR is a better predictor of hypertension, diabetes, and cardiovascular diseases when compared to traditional obesity indices like body mass index (BMI), waist circumference (WC), and waist-hip ratio (WHR). This study is therefore aimed at comparing WHtR with other obesity indices in the prediction of peripheral neuropathy in persons with diabetes mellitus (DM).

Methodology

One thousand and forty persons with DM were enrolled following consent. Relevant details of history were obtained, followed by physical examinations. Data were analyzed using IBM-SPSS version 23. Logistic regression was used to compare the odds ratio of obesity indices in the prediction of peripheral neuropathy. The level of significance used was p = 0.05.

Results

Logistic regression showed that WHtR had the highest odds ratio (OR) for the prediction of "probable" diabetic peripheral neuropathy (OR 9.11, 95% CI 3.07-47.97, p = 0.002), followed by WC (OR 2.01, 95% CI 1.09-4.05, p = 0.004), and BMI (OR 1.26, 95% CI 1.00-3.99, p = 0.019) after correction for age; systemic hypertension; duration of DM; control of SBP, DBP, HbA1c, FPG, and 2HrPP.

Conclusion

WHtR has the highest odds ratio in the prediction of "probable" diabetic peripheral neuropathy in both genders, followed by WC in the males and BMI in the females.

Anthropometric Cut-Off Values for Detecting the Presence of Metabolic Syndrome and Its Multiple Components among Adults in Vietnam: The Role of Novel Indices

Recent studies have shown that using international guidelines to diagnose metabolic syndrome (MetS) may underestimate its prevalence in different Asian populations. This study aims to determine the validity of anthropometric indicators and appropriate cut-off values to predict MetS for Vietnamese adults. We analyzed data on 4701 adults across four regions of Vietnam. Four conventional and five novel anthropometric indexes were calculated. The area under a receiver operating characteristic (ROC) curve (AUC) and Youden’s J statistic were applied to evaluate the diagnostic ability and optimal cut-off values. Regardless of diagnostic criteria and gender, Abdominal volume index (AVI), Body roundness index (BRI), and Waist-height ratio (WHtR) had the highest AUC values, followed by Body mass index (BMI) and Waist-hip ratio (WHR). However, it was seen that differences among the AUC values of most indices were minor. In men, using International Diabetes Federation (IDF) criteria, the threshold of indices was 3.86 for BRI, 16.20 for AVI, 0.53 for WHtR, 22.40 for BMI, and 0.90 for WHR. In women, the threshold for these figures were 3.60, 12.80, 0.51, 23.58, and 0.85, respectively. It is recommended that health personnel in Vietnam should apply appropriate thresholds of anthropometry, which are lower than current international guidelines, for MetS screening to avoid under-diagnosis.

Nomogram Including Serum Ion Concentrations to Screen for New-Onset Hypertension in Rural Chinese Populations Over a Short-Term Follow-up

BACKGROUND

This study aimed to establish a clinically useful nomogram to evaluate the probability of hypertension onset in the Chinese population.

METHODS AND RESULTS

A prospective cohort study was conducted in 2012-2013 and followed up in 2015 to identify new-onset hypertension in 4,123 participants. The dataset was divided into development (n=2,748) and verification (n=1,375) cohorts. After screening risk factors by lasso regression, a multivariate Cox regression risk model and nomogram were established. Among the 4,123 participants, 818 (19.8%) developed hypertension. The model identified 10 risk factors: age, waist-to-hip ratio, systolic blood pressure, diastolic blood pressure, high pulse rate, history of diabetes, family history of hypertension and stroke, intake frequency of bean products, and intensity of physical labor. The C-indices of the model in the development and validation cohorts were 0.744 and 0.768, respectively. After the inclusion of serum calcium and magnesium concentrations, the C-indices in the development and validation cohorts were 0.764 and 0.791, respectively, with areas under the curve for the updated model of 0.907 and 0.917, respectively. The calibration curve showed that the nomogram accurately predicted the probability of hypertension. The updated nomogram was clinically beneficial across thresholds of 10-60%.

CONCLUSIONS

The newly developed nomogram has good predictive ability and may effectively assess hypertension risk in high-risk rural areas in China.

Sex Difference in the Associations among Obesity-Related Indices with Incident Hypertension in a Large Taiwanese Population Follow-Up Study

Hypertension is a major risk factor for stroke, atherosclerosis, and other cardiovascular diseases, and obesity is a major risk factor for hypertension. The aim of this longitudinal study was to investigate sex differences in the correlations among obesity-related indices and incident hypertension in a large Taiwanese cohort. We included 21,466 enrollees in the Taiwan Biobank and followed them for 4 years. Of the 21,466 patients enrolled in this study, 6899 (mean age, 49.6 ± 10.9 years) were male and 14,567 (mean age, 49.7 ± 10.0 years) were female. Data on visceral adiposity index (VAI), waist-to-height ratio (WHtR), waist-to-hip ratio (WHR), lipid accumulation product (LAP), conicity index (CI), body roundness index (BRI), body mass index (BMI), body adiposity index (BAI), and abdominal volume index (AVI) were collected and analyzed. The results showed that all of the studied obesity-related indices were significantly associated with incident hypertension. Among them, WHtR was the strongest predictor of hypertension in both sexes. In addition, interactions between VAI, LAP, CI, BMI, and AVI with sex on incident hypertension were also statistically significant. CI and AVI were more strongly associated with hypertension in the men than in the women, while VAI, LAP, and BMI were more strongly associated with hypertension in the women. In conclusion, the studied obesity-related indices were found to be predictors of incident hypertension, and there were differences in the associations between the male and female participants. Our findings may imply that reducing body weight may be associated with a lower risk of developing hypertension.

Association of Physical Fitness, Screen Time, and Sleep Hygiene According to the Waist-to-Height Ratio in Children and Adolescents from the Extreme South of Chile

OBJECTIVE

To analyze the perception of physical fitness, screen time, and self-reported sleep hygiene in children and adolescents (CA) from the extreme south of Chile and its associations with waist-to-height ratio (WtHr).

MATERIAL AND METHODS

An observational cross-sectional study was conducted in a sample of 594 schoolchildren from 5th to 8th grade of primary education, belonging to municipal educational establishments in the Magallanes region, Chile. Cardiorespiratory fitness was assessed through the 20-m shuttle run test, muscle strength through handgrip and the standing broad jump test, physical fitness perception through the International Fitness Scale, and central obesity through the waist-to-height index. In addition, sleep hygiene and screen time were measured.

RESULTS

More than 92% of CA spent more than two hours a day watching or using screens. In addition, CA with excess central adiposity had a lower perception of physical fitness, and lower muscle strength and cardiorespiratory fitness compared to CA with normal values of adiposity.

CONCLUSIONS

CA of the present study spent a high number of hours watching or using screens and had poor sleep quality. In addition, excessive central adiposity was associated with lower physical fitness.