Associations of Body Mass Index, Visceral Fat Area, Waist Circumference, and Waist-to-Hip Ratio with Cognitive Function in Western China: Results from WCHAT Study

OBJECTIVES

This study examined the relationship between cognitive performance and obesity parameters, such as body mass index (BMI), visceral fat area (VFA), waist circumference (WC), and waist-to-hip ratio (WHR) in western China.

STUDY DESIGN

A cross-sectional study.

METHODS

3914 participants, aged ≥50 years, were recruited in this study. Anthropometrics measurements, life-style factors, chronic disease comorbidities, and sleep qualities were recorded for each participant. Among the anthropometrics, BMI, WC, and WHR were assessed using standard procedures, while VFA was calculated using bioelectrical impedance analysis. Cognitive performance was estimated using the Short Portable Mental Status Questionnaire (SPMSQ). Finally, relationships between cognitive abilities and BMI, VFA, WC, and WHR were evaluated using univariate and multivariate regression analyses.

RESULTS

Cognitive decline (CD) occurred at a rate of 13.29% among the 3914 participants. A strong correlation was observed between cognitive abilities and BMI of male patients aged 50-59 yrs (OR 1.116,95% CI1.002-1.242), in the adjusted model. Alternately, WHR was shown to be significantly related to CD in females aged ≥70 years (OR 0.041, 95% CI0.002-0.671). WC was shown to have a strong association with CD in males (OR 1.023,95% CI1.003-1.024). Lastly, WHR was closely connected to CD in participants with BMI < 25 kg/m2 (OR 0.022,95% CI0.002-0.209).

CONCLUSIONS

Our findings suggest that a higher middle age BMI is associated with CD, whereas, in the elderly population, a higher WHR is related to improved cognitive performance. Further investigation is warranted to elucidate a relationship between VFA and CD.

Associations between general and abdominal obesity and incident diabetic neuropathy in participants with type 2 diabetes mellitus

BACKGROUND

Previous epidemiological evidence on the sex-specific association of obesity, particularly abdominal obesity, as reflected by larger waist circumference (WC), with incident diabetic neuropathy (DN) remains limited.

METHODS

We used data from a patient cohort with a median 10-year history of type 2 diabetes mellitus at the time of recruitment. A composite outcome of four types of predefined DN (Neuro 1-4) was used as the outcome of interest. Because of sex differences in abdominal obesity, analyses were conducted separately for men and women.

RESULTS

Among the 7442 participants (4551 men and 2891 women) recruited in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study, 3999 cases of incident DN were documented (2529 in men and 1470 in women). Larger WCs were associated with a higher risk of DN among both men and women. Compared with the lowest quintile, the hazard ratio (HR) for the highest quintile was 1.30 (95% CI 1.13-1.49) among men (P_trend <.001). For women, the HR for the highest vs lowest quintile was 1.25 (95% CI 1.04-1.51) (P_trend <.001). A linear relationship between WC and DN was observed in men, and in women, the risk of DN increased as the WC quintile increased before it appeared to plateau. The relationship between body mass index and incident DN was similar to the results observed for WC.

CONCLUSION

General and abdominal obesity were both associated with an increased risk of incident DN among individuals with type 2 diabetes mellitus, regardless of sex.

Body size, body composition and endometrial cancer risk among postmenopausal women in UK Biobank

Previous studies on the association of adiposity with endometrial cancer risk have mostly used body mass index (BMI) as the main exposure of interest. Whether more precise measures of body fat, such as body fat percentage and fat mass estimated by bioimpedance analyses, are better indicators of risk than BMI is unknown. The role of central adiposity and fat-free mass in endometrial cancer development remains unclear. We used Cox regression models to estimate hazard ratios (HR) and corresponding 95% confidence intervals (CI) for the associations of various measures of body size/composition with the risk of endometrial cancer among 135 110 postmenopausal women enrolled in UK Biobank. During a mean follow up of 6.8 years, 706 endometrial cancers were diagnosed, with a mean age at diagnosis of 65.5 years. The HRs (95% CIs) for endometrial cancer per 1 SD increase in BMI, body fat percentage and fat mass were broadly comparable, being 1.71 (1.61-1.82), 1.92 (1.75-2.11) and 1.73 (1.63-1.85), respectively. There was an indication of positive association between central adiposity, as reflected by waist circumference (HRper 1-SD increase = 1.08, 95% CI: 1.00-1.17) and waist to hip ratio (HRper 1-SD increase = 1.13, 95% CI: 1.01-1.26), and endometrial cancer risk after accounting for BMI. Fat-free mass was not an independent predictor of risk in this cohort. These findings suggest that body fat percentage and fat mass are not better indicators of endometrial cancer risk than BMI. Further studies are needed to establish whether central adiposity contributes to risk beyond overall adiposity.

Central adiposity at diagnosis may reduce prostate cancer-specific mortality in African-Caribbean men with prostate cancer: 10-year follow-up of participants in a case-control study

PURPOSE

General and central adiposity are associated with the risk of developing prostate cancer (PCa), but the role of these exposures on PCa survival among men of African ancestry are less studied. This study aimed to investigate the association of anthropometry at diagnosis with all-cause and PCa-specific mortality and evaluate whether androgen deprivation therapy (ADT) modulated this risk.

METHODS

Associations between body mass index (BMI), waist circumference (WC), and waist-to-hip ratio (WHR) at diagnosis and mortality were examined in 242 men with newly diagnosed PCa enrolled between 2005 and 2007 and re-evaluated 10.9 years later. Multi-variable Cox proportional hazard models were used to examine associations of body size variables (using standard WHO cut-points and as continuous variables) with mortality, adjusted for sociodemographic characteristics, Gleason score, smoking, diabetes, primary treatment, and ADT therapy.

RESULTS

A total of 139 deaths (all-cause mortality 6.98/100 person-years) occurred (PCa-specific deaths, 56; other causes, 66; causes unknown, 17). In multi-variable analysis BMI, WC and WHR categories at diagnosis were not associated with all-cause mortality even after adjusting for ADT. While WHR (but not BMI or WC) when included as a continuous variable predicted lower PCa-specific mortality (multi-variable adjusted WHR per 0.1 difference: HR, 0.50; 95%CI 0.28, 0.93), the effect disappeared with ADT covariance and excluding deaths within the first 2 years.

CONCLUSION

Our study suggests that central adiposity as measured by WHR may improve long-term survival among men of African ancestry. Metabolic studies to understand the mechanism for this association are needed.

Association of Abdominal Adiposity with Cardiovascular Mortality in Incident Hemodialysis

BACKGROUND

The risk of cardiovascular mortality is high among adults with end-stage renal disease (ESRD) undergoing hemodialysis. Waist-to-hip ratio (WHR), a metric of abdominal adiposity, is a predictor of cardiovascular disease (CVD) and mortality in the general population; however, no studies have examined the association with CVD mortality, particularly sudden cardiac death (SCD), in incident hemodialysis.

METHODS

Among 379 participants incident (< 6 months) to hemodialysis enrolled in the Predictors of Arrhythmic and Cardiovascular Risk in ESRD study, we evaluated associations between WHR and risk of CVD mortality, SCD, and non-CVD mortality in Cox proportional hazards regression models.

RESULTS

At study enrollment, mean age was 55 years with 41% females, 73% African Americans, and 57% diabetics. Mean body mass index was 29.3 kg/m2, and mean WHR was 0.95. During a median follow-up time of 2.5 years, there were 35 CVD deaths, 15 SCDs, and 48 non-CVD deaths. Every 0.1 increase in WHR was associated with higher risk (hazard ratio [95% CI]) of CVD mortality (1.75 [1.06-2.86]) and SCD (2.45 [1.20-5.02]), but not non-CVD mortality (0.93 [0.59-1.45]), independently of demographics, body mass index, comorbidities, inflammation, and traditional CVD risk factors.

CONCLUSIONS

WHR is significantly associated with CVD mortality including SCD, independently of other CVD risk factors in incident hemodialysis. This simple, easily obtained bedside metric may be useful in dialysis patients for CVD risk stratification.

Body mass index, abdominal fatness, and the risk of sudden cardiac death: a systematic review and dose-response meta-analysis of prospective studies

Although overweight and obesity are established risk factors for some types of heart disease including ischemic heart disease, heart failure and atrial fibrillation, less is known about the association between adiposity and sudden cardiac death. We conducted a systematic review and meta-analysis of prospective studies to clarify the association between adiposity and risk of sudden cardiac death. PubMed and Embase databases were searched up to July 20th 2017. Summary relative risks (RRs) and 95% confidence intervals (CIs) were calculated using random effects models. The summary RR was 1.16 (95% CI 1.05-1.28, I2 = 68%, n = 14) per 5 unit increment in BMI, and 1.82 (95% CI 1.61-2.07, I2 = 0%, n = 3) per 0.1 unit increase in waist-to-hip ratio, and 1.03 (95% CI 0.93-1.15, I2 = 0%, n = 2) per 10 cm increase in waist circumference. The heterogeneity in the analysis of BMI and sudden cardiac death persisted across most subgroup analyses. The association was stronger among studies with longer follow-up compared to short follow-up and was observed in the European and American studies, but not in the Asian studies. There was a J-shaped association between BMI and sudden cardiac death and the lowest risk was observed in the normal weight range, however, the increased risk with a low BMI was attenuated among studies with a longer duration of follow-up. This meta-analysis suggest an increased risk of sudden cardiac death with increasing BMI and waist-to-hip ratio, however, further studies with stratification for smoking status are needed of waist circumference, weight changes and adiposity at younger ages.

An increased waist-to-hip ratio is a key determinant of atherosclerotic burden in overweight subjects

AIMS

The association of overweight status and cardiovascular disease is not clear. In this study we aimed to investigate coronary atherosclerotic disease, evaluated as coronary artery calcium score (CACs), in overweight patients with or without abdominal obesity as defined by waist-to-hip ratio (WHR).

METHODS

We enrolled 276 patients aged between 40 and 70 years, with a body mass index of 25-29.9 kg/m² and at least one cardiovascular risk factor. Exclusion criteria were history of diabetes, cardiovascular or renal disease. Patients were stratified in high WHR (H-WHR) or low WHR (L-WHR) group according to WHR (≥ 0.85 for women and ≥ 0.90 for men) and underwent multi-detector computed tomography for CACs. Mean carotid intima-media thickness (IMT) and plaque presence were equally assessed.

RESULTS

CACs was higher in the H-WHR group compared to L-WHR (9.05 [0.0-83.48] vs 0.0 [0.0-64.7] AU, p < 0.01); the prevalence of CACs > 0 in the H-WHR group was significantly higher than subjects with L-WHR (59.6% vs 38.5%, p < 0.001). Moreover, H-WHR group had higher mean IMT (0.64 [0.56-0.72] vs 0.59 [0.55-0.67] mm, p < 0.05) and higher carotid plaque prevalence (63.7% vs 50.8%, p < 0.05) compared to subjects with L-WHR. Logistic regression showed that H-WHR was associated with presence of CACs and carotid plaque (p < 0.01). In a multiple linear regression, WHR was positively associated with CACs and IMT (p < 0.01).

CONCLUSIONS

H-WHR is a marker of coronary and peripheral atherosclerotic burden in overweight patients.

Associations Between Anthropometric Measurements and Cardiometabolic Risk Factors in White European and South Asian Adults in the United Kingdom

OBJECTIVE

To investigate the association of 4 anthropometric measurements with cardiometabolic risk factors in a UK biethnic sample of South Asians (SAs) and white Europeans (WEs).

PATIENTS AND METHODS

Baseline data were collected from adults of WE and SA origin participating in the Leicester arm of the Anglo-Danish-Dutch Study of Intensive Treatment in People with Screen Detected Diabetes in Primary Care (ADDITION-Leicester) study between August 2004 and December 2007. Overall, 6268 WE and SA adults had measures of body mass index, waist circumference, waist-to-hip ratio, and waist-to-height ratio assessed between June 18, 2004, and December 4, 2007. Hypertension, dyslipidemia, and dysglycemia were established from venous blood samples using standard definitions. Crude and adjusted (covariates used were age, sex, ethnicity, smoking, and alcohol consumption) odds ratios were calculated using multivariate logistic regression. Receiver operating characteristic curves and the area under the curve were used to calculate optimal cut points for the whole cohort and for both ethnic groups.

RESULTS

Increases in all anthropometric measurements resulted in a higher odds ratio for each of the risk factors in both the crude and adjusted models (P<.001). The adjusted odds ratios for dyslipidemia, hypertension, and dysglygemia ranged from 1.30 to 1.35, from 1.36 to 1.52, and from 1.62 to 1.75 (P<.001 for all), respectively, in WEs. The adjusted odds ratio for dyslipidemia, hypertension, and dysglygemia ranged from 1.50 to 1.65 (P<.01), from 1.40 to 1.60 (P<.01), and from 1.96 to 2.11 (P<.001 for all), respectively, in SAs. The areas under the receiver operating characteristic curves for all the anthropometric measurements had low accuracy (P<.70) for the whole cohort and when stratified by ethnicity and sex.

CONCLUSION

There is insufficient evidence to recommend replacing body mass index with another anthropometric measurement for the ethnically diverse population in the United Kingdom.

TRIAL REGISTRATION

clinicaltrials.gov Identifier: NCT00318032.

Receiving Support, Giving Support, Neighborhood Conditions, and Waist/Hip Ratios

Obesity is a major health problem in the USA, and as a result, it is important to identify the factors that help people keep their body weight within healthy limits. The purpose of this study was to see whether receiving support at church and giving support at church buffer (i.e., moderate) the effects of living in rundown neighborhoods on a key marker of obesity-waist/hip ratios (WHR). The data are provided from a recent nationwide survey of people age 18 and older (N = 1456). The findings reveal that giving support to fellow church members tends to offset the effects of living in dilapidated neighborhoods on WHR. In contrast, receiving support from coreligionists does not appear to perform a similar stress-moderating function. The theoretical underpinnings of providing support at church are discussed.

Anthropometry and the Risk of Lung Cancer in EPIC

The associations of body mass index (BMI) and other anthropometric measurements with lung cancer were examined in 348,108 participants in the European Investigation Into Cancer and Nutrition (EPIC) between 1992 and 2010. The study population included 2,400 case patients with incident lung cancer, and the average length of follow-up was 11 years. Hazard ratios were calculated using Cox proportional hazard models in which we modeled smoking variables with cubic splines. Overall, there was a significant inverse association between BMI (weight (kg)/height (m)(2)) and the risk of lung cancer after adjustment for smoking and other confounders (for BMI of 30.0-34.9 versus 18.5-25.0, hazard ratio = 0.72, 95% confidence interval: 0.62, 0.84). The strength of the association declined with increasing follow-up time. Conversely, after adjustment for BMI, waist circumference and waist-to-height ratio were significantly positively associated with lung cancer risk (for the highest category of waist circumference vs. the lowest, hazard ratio = 1.25, 95% confidence interval: 1.05, 1.50). Given the decline of the inverse association between BMI and lung cancer over time, the association is likely at least partly due to weight loss resulting from preclinical lung cancer that was present at baseline. Residual confounding by smoking could also have influenced our findings.

Fluctuations of the anthropometric indices and mortality of patients with incident heart failure: a prospective study in the community

BACKGROUND

The relationship between the fluctuations of the anthropometric indices (AIs) and the prognosis of patients with incident heart failure (HF) in a population-based cohort is unknown.

AIMS

To assess the relationship between the fluctuations of the AIs, body mass index (BMI), waist hip ratio (WHR), and weight height ratio (WHeR) and the prognosis of patients with incident HF.

METHODS

Anthropometric indices were prospectively measured in a 10-year population-based study of 6492 patients with incident HF (GAMIC cohort). 4530 patients (66.7%) died, during a mean follow-up of 72.7 ± 14.2 months. A time-updated analysis of the changes of the AIs was performed to assess their association with mortality and morbidity (hospitalisations and visits).

RESULTS

Patients with incident HF presenting ≥ 5% decrease or ≥ 7% increase of the AIs have an increased mortality [HR ≥ 1.65 (1.52-2.34) or HR ≥ 1.71 (1.58-1.85), respectively, p < 0.001]. Mortality risk increased ≥ 1.43-fold (p = -0.0003) for each 10% change in the AIs. There was an accelerated pattern of reduction in the AIs in the 6 months prior to death, and an accelerated increase in the AIs in the 3 months prior to hospitalisation. These observations were independent of the aetiology (ischaemic vs. non-ischaemic), the type of HF (systolic vs. non-systolic), and other predictors of mortality.

CONCLUSIONS

Time-updated changes (increase or decrease) of the AIs, BMI, WHR and weight height ratio are independently associated with the mortality of patients with incident HF.

Associations between body size and serum estradiol and sex hormone-binding globulin levels in premenopausal African American women

CONTEXT

African American (AA) women have the highest rates of premenopausal breast cancer; however, it is unclear whether body size contributes to the hormonal patterns potentially associated with increased breast cancer risk in these women.

OBJECTIVE

To characterize the association between body size and serum levels of estradiol and sex hormone-binding globulin (SHBG) levels in a sample of premenopausal AA women.

DESIGN

A total of 164 premenopausal AA women who were not pregnant or breastfeeding were recruited for this study. Serum samples were collected during the early follicular phase, and trained staff collected body size measurements. Multiple linear regression models were performed to assess potential associations.

MAIN OUTCOME MEASURES

Serum estradiol and SHBG levels.

RESULTS

Many (81%) of the women enrolled were overweight or obese. Both waist-to-hip ratio (WHR) (β = 2.68, P = .008) and waist circumference (WC) (β = 2.02, P = .046) were positively associated with higher levels of estradiol. All measures of body was significantly and inversely associated with SHBG levels (all P < .05).

CONCLUSIONS

Premenopausal AA women with higher WHR or larger WC may have higher levels of estradiol and lower levels of SHBG. Thus, WHR or WC may be better indicators for assessing hormonal patterns implicated in breast cancer pathogenesis in these women.

Comparisons of the strength of associations with future type 2 diabetes risk among anthropometric obesity indicators, including waist-to-height ratio: a meta-analysis

The aim of this meta-analysis was to compare the association of waist-to-height ratio (WHtR) with risk of incident diabetes with the associations of 3 other conventional obesity indicators (body mass index (BMI), waist circumference (WC), and waist-to-hip ratio (WHR)) with risk of incident diabetes. Literature searches in MEDLINE (January 1950 to April 27, 2011) and EMBASE (January 1974 to April 27, 2011) were conducted for prospective studies that made it possible to estimate the relative risk of diabetes per 1-standard deviation increase in WHtR, in addition to the RR of BMI, WC, or WHR. Strength of the estimated pooled relative risk for a 1-standard deviation increase of each indicator (expressed as RR(WHtR), RR(BMI), RR(WC), and RR(WHR)) was compared with a bivariate random-effects model. Pooled relative risks of the 15 eligible studies with 6,472 diabetes cases were 1.62 (95% CI: 1.48, 1.78) for RR(WHtR), 1.55 (95% CI: 1.43, 1.69) for RR(BMI), 1.63 (95% CI: 1.49, 1.79) for RR(WC), and 1.52 (95% CI: 1.40, 1.66) for RR(WHR). WHtR had an association stronger than that of BMI (P<0.001) or WHR (P<0.001). The present meta-analysis showed that WHtR has a modestly but statistically greater importance than BMI and WHR in prediction of diabetes. Nevertheless, measuring height in addition to WC appeared to have no additional benefit.

[Synergistic effect of diabetes family history and abnormal waist-to-hip ratio on the incidence of type 2 diabetes]

OBJECTIVE

To explore the synergistic effect between diabetes family history and abnormal waist-to-hip ratio (WHR) on the incidence of type 2 diabetes.

METHODS

Population-based case-control study was conducted. The interaction between diabetes family history and abnormal WHR was analysed by an additive model.

RESULTS

After adjusting confounding factors by multiple logistic regression analysis, the synergy index was 5.63, the attributable risk was 1.49, and the attributable interaction percent was 52.9%.

CONCLUSION

There was a synergistic effect between diabetes family history and abnormal WHR on the incidence of type 2 diabetes.

Waist-to-hip ratio and woman's education level as predictors of breastfeeding duration

The possible existence of a relationship between breastfeeding duration, educational status and waist-hip ratio (WHR) as a measure of fertility and biological fitness in a sample of the Polish population is examined in this article. Data on age, height, weight, waist and hip circumferences, educational level (as a proxy for socio-economic status), and duration of breast feeding were collected for women using questionnaires in 11 outpatients' surgeries for healthy children, and in 5 general practices in three districts of Wroclaw, Poland. An ordinal multinominal linear model with logit link was used to determine the extent to which duration of lactation was influenced by maternal WHR and level of education. The best single predictor for the duration of lactation was WHR. While WHR decreases according to increasing duration of lactation for mothers with university or high school education, no such differences were observed among women at the lowest level of education. This study confirms the greater biological fitness of women with low WHR in the Polish population, and shows that this is mediated by level of educational attainment of the women.

Influence of lifestyle aspects on the association of body size and shape with all-cause mortality in middle-aged men and women

OBJECTIVE

Waist circumference, BMI and hip circumference are differentially associated with mortality. We investigated the potential influence of selected lifestyle aspects such as smoking, alcohol intake, sports activity and education.

METHOD

The Danish prospective study 'Diet, Cancer and Health' recruited 27,179 men and 29,875 women from 1993 to 1997. Cox regression models were used to estimate mortality rate ratios.

RESULTS

Adjustment for smoking habits attenuated the associations between mortality and the three body size measurements in both sexes. Adjustment for sport activity and, to a lesser extent, alcohol intake weakened the associations further for the men, whereas alcohol intake slightly weakened associations for the women. In the fully adjusted models, mortality increased highly significantly with higher waist circumference and lower hip circumference, and decreased highly significantly with higher BMI for BMI below 25 kg/m(2). This pattern was seen for all levels of the selected lifestyle factor.

CONCLUSION

A large waist circumference remained a strong risk indicator for mortality, and a large hip circumference appeared to be protective when smoking habits, alcohol intake and sport activity were accounted for. BMI below 25 kg/m(2) remained a risk factor, but not above 25 kg/m(2) once waist circumference was adjusted for.

Interethnic differences in the accuracy of anthropometric indicators of obesity in screening for high risk of coronary heart disease

BACKGROUND

Cut points for defining obesity have been derived from mortality data among Whites from Europe and the United States and their accuracy to screen for high risk of coronary heart disease (CHD) in other ethnic groups has been questioned.

OBJECTIVE

To compare the accuracy and to define ethnic and gender-specific optimal cut points for body mass index (BMI), waist circumference (WC) and waist-to-hip ratio (WHR) when they are used in screening for high risk of CHD in the Latin-American and the US populations.

METHODS

We estimated the accuracy and optimal cut points for BMI, WC and WHR to screen for CHD risk in Latin Americans (n=18 976), non-Hispanic Whites (Whites; n=8956), non-Hispanic Blacks (Blacks; n=5205) and Hispanics (n=5803). High risk of CHD was defined as a 10-year risk > or =20% (Framingham equation). The area under the receiver operator characteristic curve (AUC) and the misclassification-cost term were used to assess accuracy and to identify optimal cut points.

RESULTS

WHR had the highest AUC in all ethnic groups (from 0.75 to 0.82) and BMI had the lowest (from 0.50 to 0.59). Optimal cut point for BMI was similar across ethnic/gender groups (27 kg/m(2)). In women, cut points for WC (94 cm) and WHR (0.91) were consistent by ethnicity. In men, cut points for WC and WHR varied significantly with ethnicity: from 91 cm in Latin Americans to 102 cm in Whites, and from 0.94 in Latin Americans to 0.99 in Hispanics, respectively.

CONCLUSION

WHR is the most accurate anthropometric indicator to screen for high risk of CHD, whereas BMI is almost uninformative. The same BMI cut point should be used in all men and women. Unique cut points for WC and WHR should be used in all women, but ethnic-specific cut points seem warranted among men.

Prevalence of diabetes and impaired fasting glucose in a selected population with special reference to influence of family history and anthropometric measurements--the Kolkata policeman study

AIMS AND OBJECTIVES

The aim of this study was to estimate the prevalence of diabetes as well as IFG in a population of policemen and to evaluate the possible influence of some risk factors.

MATERIAL AND METHODS

It was an epidemiological study on a group of policemen in Kolkata. Diagnosis of diabetes was based on history and fasting plasma glucose. The study population was divided in three categories: normoglycaemic, IFG and diabetes. BMI, waist circumference, WHR and waist-to-height ratio were estimated.

RESULTS

Out of 2160 subjects with a mean age of 36.4 yrs (between 20 and 60 yrs), diabetes was found in 11.5% (10.4% known and 1.1% newly diagnosed) and 6.2% had IFG. Prevalence of diabetes was found to be increasing with age (p < 0.001). There was no statistically significant difference in BMI when compared between groups (normoglycaemic, IFG and diabetes). Waist circumference, waist-to-height ratio and WHR of normoglycaemic group were significantly less than those with IFG and diabetes; however there was no statistically significant difference between the diabetes and IFG groups. Parental history had significant influence on the prevalence of diabetes; a 37.5% prevalence was found in persons with history of biparental diabetes and 20.8% with uniparental diabetes, whereas it was only 9.9% without any family history (p < 0.01 and p < 0.05, respectively.).

CONCLUSION

The prevalence of diabetes in the study population was high and was strongly influenced by family history, age and abdominal adiposity, without having any appreciable impact of BMI.

Optimal cut-points for body mass index, waist circumference and waist-to-hip ratio using the Framingham coronary heart disease risk score in an Arab population of the Middle East

We aimed to determine the gender-specific optimal cut-points for body mass index (BMI), waist circumference (WC) and waist-to-hip ratio (WHR) associated with risk of cardiovascular disease, using Framingham risk score and receiver-operating characteristic (ROC) analysis, among Omani Arabs. Nine percent of men, compared to 3% of women, had a 10-year total coronary heart disease (CHD) risk > or = 20%. In both genders, WHR was a better predictor of CHD (area under the ROC curve 0.771 for men and 0.802 for women), followed by WC (0.710 and 0.727) and BMI (0.601 and 0.639), respectively. For a 10-year CHD risk of > or = 20%, the optimal cut-points to assess adiposity in Omani men and women were > 22.6 and 22.9 kg/m2 for BMI, > 78.5 and 84.5 cm for WC, and > 0.96 and > 0.98 for WHR, respectively. To identify obesity among Omani Arabs, different cut-points for BMI, WC and WHR than the currently recommended ones are needed.

Sex differences in insulin action and body fat distribution in overweight and obese middle-aged and older men and women

Controversy exists as to whether there are differences in insulin action between older men and women, and what factors contribute to these differences. This study tests the hypothesis that sex differences in regional fat distribution contribute to a disparity in insulin sensitivity in older men vs. older women. Healthy, older (50-71 years), sedentary men (n = 28) and women (n = 29) were recruited to participate in the study. Body fat, fat-free mass (FFM), and visceral (VAT) and subcutaneous abdominal (SAT) adipose tissue areas were measured by DXA and computed tomography (CT). For measurements of insulin-stimulated glucose disposal (M), insulin was infused at a constant rate of 240 pmol.m(-2).min(-1), and M was calculated between the 90th and 120th min of the hyperinsulinemic-euglycemic clamp. The men weighed 16% more and had 16% higher waist and 4% lower hip circumferences than women (p < 0.05 for all). Total fat mass and SAT were 21% and 33% lower and FFM was 49% higher in men than in women, whereas waist-to-hip ratio (WHR) and VAT:SAT ratio were 21% and 56% higher in men than in women (p < 0.05 for all). Although insulin concentrations during the glucose clamp were higher in men, M was 47% lower in men vs. women (21.7 +/- 1.1 vs. 46.7 +/- 3.1 micromol.L(-1).kg FFM(-1).min(-1), p < 0.05). The sex-related differences in M persisted after controlling for insulin concentrations during the glucose clamp, for waist, WHR, and VAT:SAT. Older men are more insulin resistant than women, despite lower body fat and subcutaneous abdominal fat. This difference in insulin sensitivity is not explained by abdominal fat distribution, therefore other metabolic factors contribute to the sex differences in insulin sensitivity.

Relationship between dietary calcium intake, body mass index, and waist circumference in MABAT--the Israeli National Health and Nutrition Study

BACKGROUND

It has been suggested that increased calcium intake plays a role in preventing obesity and promoting weight loss.

OBJECTIVES

To assess the association between calcium intake, body mass index and waist circumference in Israel.

METHODS

MABAT was a cross-sectional survey based on a random sample of 3246 Israelis aged 25 to 64. Of the 3246 survey participants, height and weight measurements were recorded for 2782 (1371 men and 1411 women). These were divided into three groups according to their BMI (group A < or = 24.9, group B 25-29.9, and group C > or = 30) and given a 24 hour dietary recall questionnaire. Waist circumference was measured in 2601 participants (1760 men and 841 women) and was considered to be excessive if > or = 102 cm for men or > or = 88 cm for women.

RESULTS

The mean calcium intake was 511.5 +/- 301.8 mg for group A, 499.4 +/- 283.7 mg for group B, and 464.7 +/- 280.1 mg for group C (group A significantly differed from group C, P < 0.002). The mean daily milk consumption in group A was higher than in groups B and C (103.4 +/- 147.5, 85.7 +/- 122.25, and 84.5 +/- 135.1 g, respectively; P< 0.01). There was no correlation between daily dietary calcium intake and waist circumference for men, but women with a waist circumference below 88 cm consumed significantly more dietary calcium than those with a waist circumference > or = 88 cm (P< 0.03).

CONCLUSIONS

The study confirms the inverse relationship between daily dietary calcium intake and obesity. This linkage relates to the intake of milk, but not to other dairy products.

Association of general and abdominal obesities and metabolic syndrome with subclinical atherosclerosis in asymptomatic Chinese postmenopausal women

OBJECTIVE

This study aimed to investigate the relationships between obesity, especially abdominal obesity, andmetabolic syndrome (MS) with carotid intima-media thickness (IMT) and plaque, markers of subclinical atherosclerosis, in asymptomatic Chinese postmenopausal women in Hong Kong.

DESIGN

A total of 518 postmenopausal women aged 50 to 64 years were recruited through random telephone dialing. Body mass index (BMI), waist circumference, waist-to-hip ratio, sociodemographic characteristics, blood pressures, medical, biochemical and lifestyle factors were obtained. MS was defined on the basis of the National Cholesterol and Education Program, Adult Treatment Panel III criteria. Subclinical atherosclerosis was determined by measuring IMT and plaque using high-resolution B-mode ultrasonography.

RESULTS

Women with a BMI of 25 kg/mor greater, a waist circumference of 80 cm or greater, a waist-to-hip ratio of 0.85 or greater, or MS were observed to have higher IMT values and prevalence of plaque. Multivariate analyses revealed that waist circumference was significantly associated with IMT independent of age, hormone therapy, lifestyle and sociodemographic factors, and BMI (P < 0.05), whereas a waist-to-hip ratio of 0.85 or greater was significantly associated with plaque (odds ratio = 1.7; 95% CI: 1.0-2.8) after controlling for age, hormone therapy, lifestyle and sociodemographic factors, BMI, and the traditional cardiovascular risk factors. MS was also associated with IMT after adjustment for age, hormone therapy, lifestyle and sociodemographic factors, and BMI (P < 0.05), whereas its association with plaque was also significant (odds ratio = 1.7; 95% CI: 1.0-2.6) after controlling for age.

CONCLUSIONS

Abdominal obesity and MS are independent of general obesity markers of subclinical atherosclerosis in Chinese postmenopausal women.

[Standardization and reliability of anthropometric measurements for population surveys]

In this paper we describe the standardization and reliability of anthropometric measurements carried out by five population survey anthropometrists. For the standardization of anthropometric measurement techniques, one expert anthropometrist conducted two theoretical and practical workshops, in September 2006 and March 2007, where the intra- and interobserver technical errors of measurement (TEMs) were assessed, respectively. For the intraobserver assessment of anthropometric measurements, we studied 121 schoolchildren on two different days. For interobserver assessment, we studied 22 schoolchildren that were measured, during the same period, once by each of the five anthropometrists and by an expert anthropometrist. For skinfold thickness, intraobserver TEMs in general were smaller than 1 mm; for circumferences, TEMs in general were smaller than 1 cm. For the subscapular, suprailiac and calf skinfolds, the intraobserver relative TEMs were greater than the acceptable limit for beginner anthropometrists. Intraobserver reliability for skinfold thickness was greater than 0.95 and for circumferences was greater than 0.99 in almost all cases. The results of interobserver TEMs and reliability were similar to intraobserver assessment. The anthropometrists performed better in the intraobserver relative TEMs because their values were smaller than the acceptable limit. We conclude that the anthropometrists showed a better performance after two assessments of the error of measurement. This suggests that the standardization process of anthropometric measurements was carried out with success.

[Epidemiology of over- and underweight in Swiss college students]

Overweight and obesity rates are increasing worldwide. In this study 409 adolescents and young adults (age range 15-22 years) in a Swiss college were studied. The prevalence of overweight was 6.13% in the girls and 5.95% in the boys. 9.52% of the boys and 16.51% of the girls were underweight (BMI < 18.5 kg/m2). 16.98% of the girls had a fat mass > 30%. 2.98% of the boys had a fat mass of > 20%. Male adolescents with a fat mass > 15% judged their physical activity on a visual analogue scale (VAS) significantly lower than male adolescents with a fat mass of < 15% (mean +/- SD VAS score: 4.49 +/- 2.08 vs. 6.00 +/- 2.08, p = 0.03). The same was found in female adolescents: girls with a fat mass > 30% reported a lower physical activity level than females with a fat mass < 30% (mean +/- SD VAS score: 4.84 +/- 1.74 vs. 5.68 +/- 1.82, p = 0.04). Obesity and fatness, but also underweight, is a serious problem in Swiss adolescents. Well chosen public health strategies to address both sides of the energy balance equation are strongly needed.

How does ethnicity affect the association between obesity and diabetes?

AIMS

To examine the utility of body mass index (BMI), waist circumference (WC) and waist-to-height ratio (WHR) in assessing diabetes risk across different ethnic groups.

METHODS

Cross-sectional analysis of data for eight ethnic groups from the 2003-2004 National Health and Nutrition Examination Survey and 2003-2004 Health Survey for England was performed. In 11 624 adults > or = 20 years old, self-reported as US White, US Black, Mexican American, English White, English Black, Bangladeshi, Pakistani, Indian or Chinese the presence of diabetes, defined as self-report of doctor diagnosis or glycated haemoglobin (HbA1c) > 6.1%, was ascertained. Comparisons of proportions were made using chi2-tests. Receiver operating characteristic (ROC) curves were calculated for BMI, WC and WHR predicting diabetes.

RESULTS

Other ethnic groups had a higher prevalence of diagnosed diabetes than English Whites. The crude prevalence of diabetes in English Whites of normal weight (BMI < 25 kg/m2) was 3.4%. Higher prevalences were seen in other ethnic groups (5.0-10.9%). Based on ROC curves, both WC and WHR had better discriminating ability for diabetes than BMI for both genders and some ethnic groups.

CONCLUSIONS

Ethnic differences exist in the crude prevalence of diabetes, even in those characterized as normal weight by BMI. Thus, clinicians need to exercise caution in interpreting diabetes risk associated with a normal BMI. The use of other anthropometric measures, such as WC or WHR, may improve risk determination across different ethnic groups. More research is needed to determine the thresholds for different anthropometric measures that improve diabetes risk determination.

Determination of central body fat by measuring natural waist and umbilical abdominal circumference in Guatemalan schoolchildren

BACKGROUND

Obesity prevalence is rising in many developing countries, also among children. Waist circumference (WC) is a good measure of central obesity.

OBJECTIVES

Our aim was to compare umbilical waist circumference (UWC) and natural waist circumference (NWC) in children between socio-economic status (SES) and between sex; to describe correlations between body mass index (BMI), UWC and NWC; and to compare waist-to-height ratio (WHtR) between stunted and non-stunted children.

STUDY POPULATION AND METHODS

We measured height, weight and waist circumference at the natural and at the umbilical level in 583 boys and girls aged 8 to 10 years of two different social strata in Quetzaltenango, Guatemala.

RESULTS

Mean UWC and mean NWC (cm) were significantly larger in high SES than in low SES children (66.6 vs. 62.7, p<0.001, and 62.6 vs. 59.8, p<0.001, respectively). Boys had a larger mean NWC than girls (62.8 vs. 60.3, p<0.001). The mean difference between UWC and NWC (UWC-NWC) was larger in high SES and in boys. Overall, Pearson correlation of BMI vs. NWC is high (r=0.902, p<0.001), of BMI vs. UWC is higher (r=0.919, p<0.001) and of NWC vs. UWC is highest (r=0.965, p<0.001). The proportion of WHtR>/=0.500 was significantly higher in non-stunted than in stunted boys (p=0.03) and in high SES as compared with low SES children (p<0.001). Results for mean WHtR were not significant.

CONCLUSIONS

Based on these results, in Quetzaltenango high SES, non-stunted schoolchildren are most likely to have a centralized body fat pattern.

[A four-year prospective study of the relationship between body mass index and waist circumstances and hypertension in Chinese adults]

OBJECTIVE

To explore whether the increase of body mass index (BMI) and waist circumstances (WC) can predict the higher risk of hypertension in Chinese adults.

METHODS

The data were collected in the China Health and Nutrition Survey (CHNS). A total of 4552 adults aged 18-60 years old were selected as the subjects who were healthy in the baseline survey in 2000 and followed up in 2004. Logistic regression models were used to estimate the relative risk (RR) of developing hypertension associated with the BMI and WC in baseline and the four-year change of BMI and WC.

RESULTS

The incidence of hypertension of men and women was 20.01% and 13.52% respectively during the four years of follow-up. The risk of developing hypertension rose with the increase of either BMI or WC in baseline. Compared with the group of neither general obesity (defined by BMI) nor abdominal obesity (defined by WC) group with both general obesity and abdominal obesity had the highest risk (men RR = 2.840, 95% CI: 2.139-3.771, women RR = 2.734, 95% CI: 2.050-3.647) among the different combinations of BMI and WC. Adjusted for other factors the risk of developing hypertension also increased with the four-year augment of either BMI or WC (BMI: men, RR = 1.141, 95% CI: 1.087-1.199, women, RR = 1.109, 95% CI: 1.056-1.164, WC: men, RR = 1.038, 95% CI: 1.022-1.055, women, RR = 1.035, 95% CI: 1.018-1.052).

CONCLUSION

The increase of BMI and WC can predict the higher risk of the development of hypertension. The combination of BMI and WC can increase the predictive efficacy of the incidence of hypertension.

Superiority of skinfold measurements and waist over waist-to-hip ratio for determination of body fat distribution in a population-based cohort of Caucasian Dutch adults

OBJECTIVE

To determine which anthropometric measurement is the most reliable alternative for fat distribution as measured by dual-energy X-ray absorptiometry (DXA).

DESIGN

Population-based survey carried out in Amsterdam, The Netherlands.

SUBJECTS AND METHODS

A total of 376 individuals (200 women) with a mean age of 36.5 years and mean body mass index (BMI) of 24.0 (+/-3.1) kg/m2 underwent various anthropometric and DXA measurements of central (CFM) and peripheral fat mass (PFM). Furthermore, for the assessment of apple-shaped body composition, CFM-to-PFM ratio was calculated. Anthropometric measurements were waist and hip circumference, waist-to-hip ratio (WHR), BMI, waist/length and the skinfold thickness of biceps, triceps, suprailiacal (SI), subscapular (SS) and upper leg. We determined whether equations of combined anthropometrics were even more reliable for the assessment of fat mass.

RESULTS

In both women and men, reliable alternatives for CFM are central skinfolds and waist (Pearson's correlation (r) >or= 0.8). Peripheral skinfolds are the best predictors of PFM (r >or= 0.8). In contrast, WHR correlated only marginally with any of the DXA measurements. Equations based on several anthropometric variables correlate with CFM even better (R2 >or= 0.8). CFM-to-PFM ratio has the highest correlation with the ratio (SS+SI)/BMI in women (r = 0.66) and waist/length in men (r = 0.71). Equations are reasonable alternatives of CFM-to-PFM ratio (R2 >or= 0.5).

CONCLUSION

Waist and skinfolds are reliable alternatives for the measurement of body fat mass in a cohort of Caucasian adults. WHR is not appropriate for the measurement of fat distribution.

First reference curves of waist and hip circumferences in an Asian population of youths: CASPIAN study

The Objective of the present study is to develop the first age- and gender-specific reference curves for waist and hip circumferences in an Asian population of youths. This cross-sectional population survey was conducted in 2003-04 on a nationally representative sample of 21111 school-students living in urban (84.6%) and rural (15.4%) areas of 23 provinces in Iran. After anthropometric measurements, smoothed reference curves for waist and hip circumference (WC, HiC) and waist-to-hip ratio (WHR) were developed by the LMS method. In both genders, WC and HiC percentile values increased with age. For girls, the 50th to 95th percentile curves for WC had a sharp increase between 8 and 13 years and 11-15 years, respectively, and began to plateau after this age, whereas for boys, these curves had a persistent and less sharp increase with age, until the age of 18 years. The WHR curves of girls decreased with age until 15 years and began to plateau thereafter, whereas for boys the 25th to 95th curves had a plateau pattern. Comparison of the current reference curves with the British ones showed that in boys, the 5th and 50th percentile curves were similar in both studies, but the 95th percentile curve of our study was higher than the British curves. For girls, the 5th percentile curves of both studies were similar, but the 50th and 95th percentile curves of our study were higher than the British ones. These curves represent the first childhood WC, HiC and WHR reference curves obtained in Asia. These curves can provide baseline data for analysis of time trends, as well as for international comparisons.

Association of waist and hip circumference with 12-year progression of carotid intima-media thickness in elderly women

OBJECTIVE

To test the hypothesis that waist and hip circumferences together provide additional information on the progression of preclinical atherosclerosis beyond either of them alone in elderly women.

DESIGN

A 12-year follow-up study.

SUBJECTS

A population-based sample of 102 women 60-70 years of age at baseline.

MEASUREMENTS

Waist and hip circumferences and body mass index (BMI) were assessed and carotid intima-media thickness (IMT) was quantified noninvasively by ultrasonography.

RESULTS

There was a significant increase in the 12-year carotid IMT progression across the thirds of waist circumference (0.080, 0.277, 0.279 mm, P=0.02 for difference) and hip circumference (0.030, 0.342, 0.260 mm, P=0.001 for difference) adjusted for conventional risk factors (age, smoking, systolic blood pressure, serum low-density lipoprotein and high-density lipoprotein cholesterol, blood glucose). The association of waist circumference with IMT progression was not significant after further adjustment for hip circumference or BMI. Further adjustment for waist circumference and BMI did not change the association of hip circumference with IMT progression. The IMT progression was greatest in women with waist circumference >83 cm and hip circumference </=98 cm adjusted for conventional risk factors (P=0.003 for interaction).

CONCLUSION

Not only waist circumference but also hip circumference is associated with the progression of carotid atherosclerosis during 12 years in elderly women. Women with both a larger waist circumference and a smaller hip circumference had the greatest progression of carotid atherosclerosis.

Perceptions of female body weight and shape among indigenous and urban Europeans

Two important cues to female physical attractiveness are body mass index (BMI) and body shape as measured by the waist-to-hip ratio (WHR). This study examined the relative contribution of both cues in three culturally distinct populations. A total of 119 Finnish, Sámi and British male observers rated a set of un-edited photographs of women with known BMI and WHR. The results showed that there were significant differences in preferences for physical attractiveness, with the indigenous Sámi preferring figures with larger BMIs and more tolerant of heavyweight figures than either Finnish participants in Helsinki or Britons in London, who were indistinguishable in their preferences for slim figures. The findings are discussed in terms of evolutionary psychological explanations of mate selection, and sociocultural theories which emphasizes the learning of preferences for body sizes in social and cultural contexts.

Defining constant versus variable phenotypic features of women with polycystic ovary syndrome using different ethnic groups and populations

CONTEXT

The phenotype of women with polycystic ovary syndrome (PCOS) is variable, depending on the ethnic background.

OBJECTIVE

The phenotypes of women with PCOS in Iceland and Boston were compared.

DESIGN

The study was observational with a parallel design.

SETTING

Subjects were studied in an outpatient setting.

PATIENTS

Women, aged 18-45 yr, with PCOS defined by hyperandrogenism and fewer than nine menses per year, were examined in Iceland (n = 105) and Boston (n = 262).

INTERVENTION

PCOS subjects underwent a physical exam, fasting blood samples for androgens, gonadotropins, metabolic parameters, and a transvaginal ultrasound.

MAIN OUTCOME MEASURES

The phenotype of women with PCOS was compared between Caucasian women in Iceland and Boston and among Caucasian, African-American, Hispanic, and Asian women in Boston.

RESULTS

Androstenedione (4.0 +/- 1.3 vs. 3.5 +/- 1.2 ng/ml; P < 0.01) was higher and testosterone (54.0 +/- 25.7 vs. 66.2 +/- 35.6 ng/dl; P < 0.01), LH (23.1 +/- 15.8 vs. 27.6 +/- 16.2 IU/liter; P < 0.05), and Ferriman Gallwey score were lower (7.1 +/- 6.0 vs. 15.4 +/- 8.5; P < 0.001) in Caucasian Icelandic compared with Boston women with PCOS. There were no differences in fasting blood glucose, insulin, or homeostasis model assessment in body mass index-matched Caucasian subjects from Iceland or Boston or in different ethnic groups in Boston. Polycystic ovary morphology was demonstrated in 93-100% of women with PCOS in all ethnic groups.

CONCLUSIONS

The data demonstrate differences in the reproductive features of PCOS without differences in glucose and insulin in body mass index-matched populations. These studies also suggest that measuring androstenedione is important for the documentation of hyperandrogenism in Icelandic women. Finally, polycystic ovary morphology by ultrasound is an almost universal finding in women with PCOS as defined by hyperandrogenism and irregular menses.

Prospective study of body size and risk for stroke amongst women below age 60

The relation between obesity, particularly abdominal obesity, and risk of stroke amongst women remains unclear. In 1991-1992, a prospective study was initiated in Sweden amongst women who returned a self-administered questionnaire. Through linkage with nation-wide registries, 45,449 women, free of stroke at entry, were followed up until diagnosis of first incident stroke, death, or the end of follow-up in 2002. We estimated multivariate relative risks (RRs) with 95% confidence intervals (CIs) from Cox proportional hazards regression models. A total of 170 incident stroke cases occurred during an average of 11 years of follow-up. The RR of stroke amongst women in the highest compared with the lowest quintile was 2.4 (95% CI 1.3-4.2; P for trend 0.04) for waist-to-hip ratio, 2.5 (95% CI 1.5-4.3; P for trend 0.01) for waist-to-height ratio and 2.3 (95% CI 1.2-4.3; P for trend 0.02) for waist circumference. Adjustment for hypertension and diabetes attenuated these risk estimates. In contrast, birth weight, body mass index (BMI) at age 18, BMI at entry, weight change in adulthood and adult height were not significantly associated with risk of stroke. This study provides evidence that, in contrast to BMI, several different measures of abdominal obesity are strong predictors of stroke in women.

Non-fatal disease burden associated with excess body mass index and waist circumference in New Zealand adults

OBJECTIVE

To describe the relationship between two measures of body fat and selected non-fatal health conditions in the New Zealand adult population in 2003.

METHOD

Data were obtained from the 2002/03 New Zealand Health Survey. A total of 10,026 adults aged 25 years and over were classified according to measured body mass index (BMI) and waist circumference (WC). BMI classes were 18.5-24.9, 25.0-29.9, 30.0-34.9, > or = 35.0 kg/m2. WC classes were < 94, 94-102, > 102 centimetres (cm) for males and < 80, 80-88, > 88 cm for females. Prevalence rate ratio estimates for selected self-reported health conditions were calculated for males and females separately, adjusting for age, ethnicity, deprivation and smoking using logistic regression.

RESULTS

Increasing BMI or WC class was associated with increasing prevalence of cardiovascular disease, diabetes, high blood pressure, high blood cholesterol, osteoarthritis, asthma and sleep disorders in both males and females. The association with depression was not statistically significant in either gender. Associations were strongest for diabetes and blood pressure, with adults in the highest BMI or WC class at least 3.5 times more likely to have diabetes and 2-3 times more likely to have high blood pressure compared with those in the lowest classes.

CONCLUSIONS

Increasing body fatness, defined by either BMI or WC, was associated with increased prevalence of many important health conditions. If the obesity epidemic is not halted or reversed, the impact on both the New Zealand population and health system will be considerable.

Waist/Height Ratio as a Better Predictor of Type 2 Diabetes Compared to Body Mass Index in Tehranian Adult Men - a 3.6-Year Prospective Study

OBJECTIVE

To investigate whether central obesity variables are more important than general obesity variables in predicting the incidence of type 2 diabetes in Iranians.

METHODS

In this population-based longitudinal study, a representative sample of 1852 males aged > or = 20 years, participants of the Tehran Lipid and Glucose Study, were followed for a mean duration of 3.6 years. Demographic data were collected; blood pressure and anthropometric variables such as body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR) were measured according to a standard protocol. Biochemical analyses including measurements of plasma glucose in the fasting state and 2 hours after ingestion of 75 g glucose as well as fasting serum lipids were done. Diabetes and abnormal glucose tolerance (impaired fasting glucose or impaired glucose tolerance) were defined according to ADA criteria. Logistic regression models with the stepwise conditional method were used to estimate the relative risk (RR) of developing diabetes associated with each quartile of each anthropometric variable in a multivariate model adjusted for age, hypertension, smoking, family history of diabetes (model 1), and a full model adjusted for all the variables in model 1 plus abnormal glucose tolerance (model 2). Receiver operating characteristic (ROC) curves were used to determine the predictive power of each variable for development of type 2 diabetes, after adjustment for age.

RESULTS

A total of 69 new cases of type 2 diabetes (3.7%) were diagnosed during 3.6 years of follow-up, with an incidence rate of approximately one percent per year. The RR of developing diabetes associated with the highest quartile of anthropometric variables, was highest for WHtR in model 1. After further adjustment for abnormal glucose tolerance (model 2) only WHtR and WC were significantly associated with type 2 diabetes. According to the ROC curve analysis, among central obesity variables only WHtR had a higher ROC curve than BMI. WHtR also continued to be the best predictive central obesity variable compared to BMI, even when the analysis was restricted to subjects with BMI < 27 kg/m2 (0.678 vs. 0.631, p < 0.05). In those with BMI > or = 27 kg/m2, none of the central obesity variables proved to be superior to BMI.

CONCLUSION

Among abdominal obesity variables, WHtR appears to be stronger than BMI in identifying men with type 2 diabetes in the future.

[Influence of fat tissue distribution on metabolic complications in children and adolescents with simple obesity]

BACKGROUND

Increased prevalence of obesity in children and adolescents results in more common metabolic complications characteristic for adults, particularly those with abdominal obesity. The objective of the study was to determine the relation between the fat tissue distribution and metabolic complications and to estimate the prevalence of the metabolic syndrome in obese children and adolescents.

MATERIAL AND METHODS

We studied 64 children (42 girls and 22 boys) with simple obesity (BMI =97 pc) in the mean age 12.4+/-3.4 years. The fat tissue distribution was assessed on the basis of waist circumference, hip circumference, waist to hip ratio (WHR) and skinfold thickness (suprailiac, subscapular, biceps and triceps). In all children plasma concentrations of total cholesterol, HDL and LDL cholesterol as well as triglycerides were estimated. Plasma glucose and insulin levels were measured in fasting state and during the oral glucose tolerance test (OGTT). Fasting insulin to glucose ratio (FIGR) was calculated. Blood pressure was measured in triplicate.

RESULTS

In 33 (51.6%) of children dyslipidemia, in 10 (15.6%) hyperinsulinemia or impaired glucose tolerance and in 12 (18%) hypertension was diagnosed. The Metabolic syndrome was present in 9 (14%) children. The anthropometric predictor for the risk of metabolic complications was a greater waist circumference, while greater hip circumference decreased the risk.

CONCLUSIONS

The metabolic complications characteristic of metabolic syndrome, previously diagnosed exclusively in adults, may occur also in obese children and adolescents. As in adults, abdominal obesity is the most relevant risk factor of the metabolic syndrome.

Diabetes among Inuit migrants in Denmark

OBJECTIVES

The study aimed to estimate the prevalence of diabetes and impaired glucose intolerance (IGT) among Inuit migrants living in Denmark, and to compare with findings from Greenland. Further, we analyzed determinants for diabetes and impaired glucose metabolism.

STUDY DESIGN

Cross-sectional, population-based epidemiological study.

METHODS

This cross-sectional study included randomly selected Inuit migrants in Denmark aged 34 years and above. Diabetes and IGT were diagnosed using the oral glucose tolerance test. Body mass index (BMI) and waist circumference were measured, and blood samples were taken from each subject. Socio-demographic characteristics were investigated using a questionnaire. For comparison, data from the Greenland Population Study were used (n = 917).

RESULTS

Of 506 eligible subjects, 256 (51%) participated. Twenty-six subjects had diabetes (10.2%) and twenty-eight had IGT (10.9%). Of those with diabetes, 64% had not been previously diagnosed. The prevalences of diabetes and IGT were not significantly different from those among Inuit in Greenland. Significant predictors of diabetes and impaired glucose metabolism (IGM) were found to be age, waist circumference and physical inactivity. The association between waist circumference and diabetes was significantly stronger among Inuit migrants in Denmark than among Inuit in Greenland.

CONCLUSIONS

The prevalence of diabetes is high among the Inuit migrants in Denmark. However, unlike that reported in most studies, the prevalence was not significantly higher in the migrant population compared with the population of origin.

Cardiovascular disease and risk factors in three Alaskan Eskimo populations: the Alaska-Siberia project

OBJECTIVES

To determine the prevalence of CVD and to identify and characterize associated risk factors in three distinct Eskimo populations.

STUDY DESIGN

Cross-sectional.

METHODS

A slightly modified Strong Heart Study protocol was followed to examine 454 participants, aged 25-91, from four villages.

RESULTS

Overall, 6% of the participants under 55 years of age and 26% of those > or = 55 years of age showed evidence of CHD by ECG, or in patient records. The prevalence of "definite coronary heart disease" (CHD) in women with glucose intolerance (GI) was 21.0%, compared to 2.4% in those with normal glucose tolerance (NGT). Men had comparable values of 26.7% and 6.3%. In addition, comparable values for "possible CHD" were 29.7% vs 6.0% for women and 21.4% vs 8.0% for men. GI was associated with relatively higher prevalences of CHD in women than in men (prevalence ratio = 8.5 vs 4.3). CHD was significantly related to age, glucose intolerance and insulin. Hypertension and obesity were significantly associated with CHD only in some ethnic groups. The prevalence of current smokers was 56%.

CONCLUSIONS

Recent changes in lifestyle and diet of Alaskan Eskimos, leading to obesity, hypertension, insulin resistance and DM, contribute to an increased risk for cardiovascular disease.

Omega-3 fatty acids improve glucose tolerance and components of the metabolic syndrome in Alaskan Eskimos: the Alaska Siberia project

OBJECTIVES

To test the hypothesis that the unusually low prevalences of insulin resistance (IR), metabolic syndrome (MS) and diabetes (DM) in Alaskan Eskimos, compared to American Indians, is related to the traditional Eskimo diet, high in C20-C22 omega-3 fatty acids (FAs). To determine if the relatively low blood pressures, low serum triglycerides and high HDL cholesterol levels in Eskimos result from high omega-3 FA consumption.

STUDY DESIGN

Cross-sectional study.

METHODS

We measured plasma FA concentrations in 447 Norton Sound Eskimos (35-74 years of age) and screened for DM, CHD and associated risk factors. A dietary assessment (24-hr recall) was obtained for comparison the day before the blood sampling.

RESULTS

Plasma omega-3 FA concentrations were highly correlated with dietary omega-3 FAs and HDL levels and inversely correlated with plasma levels of insulin, 2-h insulin (OGTT), HOMI-IR, 2-h glucose (OGTT), triglyceride levels and diastolic blood pressure.

CONCLUSIONS

High consumption of omega-3 FAs positively affects components of the MS, insulin sensitivity and glucose tolerance. This finding suggests that high consumption of C20-C22 omega-3 FAs protects against the development of the MS and glucose intolerance.

Circunferencia de la cintura como predictor de resistencia insulínica en varones jóvenes

BACKGROUND AND OBJECTIVE

Waist circumference (WC) is a measure of upper body fat and so should be useful for identifying overweight and obese men at risk of developing metabolic complications. The objective was to determine the relations of WC to cardiovascular risk factors in a sample of young men and to assess the clinical relevance of WC in identifying insulin resistance.

SUBJECTS AND METHOD

This study included 194 male Spanish subjects aged 26 (5) years who were divided in 3 groups according to the WC: Normal (< 94 cm), moderate risk (> or = 94 cm) and elevated risk (> or = 102 cm). Body mass index (BMI), WC, blood pressure, serum levels of total cholesterol, triglycerides (TG), HDL-cholesterol, LDL-cholesterol, glucose, uric acid and insulin were measured by standard methods. The homeostasis model assessment was applied to estimate the degree of insulin resistance (HOMAIR).

RESULTS

The prevalence of overweight and obesity was 46.9% and 6.7% respectively. Men with moderate and elevated risk showed higher concentrations of glucose (p < 0.004), uric acid (p < 0.001), TG (p < 0.001), LDL-cholesterol/HDL-cholesterol index (p < 0.001), insulin (p < 0.001) and HOMAIR (p < 0.001). WC was significantly correlated with age (r = 0,282; p < 0.001), TG (r = 0.308; p < 0,001), insulin (r = 0.282; p < 0.001) and HOMAIR (r = 0.281; p < 0.001). A multivariate linear correlation analysis showed that HOMAIR was significantly associated with WC (p < 0.009) and TG (p < 0.003; r2 = 0.13).

CONCLUSIONS

WC of these young men was independently associated with certain cardiovascular risk factors, in particular insulin resistance. This suggests that WC may be reasonably included in clinical practice as a simple tool that may help identify sub-groups of overweight or obese young men at higher metabolic risk.

Waist-to-hip ratio is positively associated with bioavailable testosterone but negatively associated with sexual desire in healthy premenopausal women

OBJECTIVE

We examined whether high waist-to-hip ratio (WHR) in women is a biomarker for increased testosterone (T) and higher levels of sexual desire.

METHODS

Participants were 99 healthy nonobese premenopausal women. Trait levels of mean bioavailable T were estimated from three saliva samples collected at 8:00 am, 9:30 am, and 6:00 pm to 9:00 pm, controlling for phase of the menstrual cycle. Sexual desire was measured with the Sexual Desire Inventory.

RESULTS

WHR was positively, although moderately, correlated with bioavailable T. WHR, but not T, was negatively correlated with level of sexual desire.

CONCLUSIONS

These results confirm that the positive association between WHR and androgens seen in clinical populations also exists in the general population of healthy adult women. However, the relationship may not be strong enough in healthy women for WHR to serve as a useful biomarker of androgen levels in sexuality studies, especially given its association with other, perhaps negatively valued, morphologic attributes.

Alcohol and Atherosclerotic Vascular Disease Risk Factors in French Men: Relationships Are Linear, J-Shaped, and U-Shaped

BACKGROUND

Although it is well admitted that alcohol displays a U-shaped relationship with atherosclerotic vascular disease, individual relationships between alcohol and atherosclerosis risk factors may be different and have not been determined precisely for several of them.

METHODS

A cross-sectional study within the SU.VI.MAX French cohort study was performed to assess the curve of potential relationships between alcohol and atherosclerosis risk factors in 2126 healthy men. Mean daily alcohol intake was derived from 37 alcoholic beverages in twelve 24-hr dietary recalls. Logistic models were adjusted for age.

RESULTS

Apolipoprotein B (ApoB), fasting glucose, body mass index, waist-to-hip ratio, and waist circumference displayed a linear relationship with alcohol. The odds ratios and 95% confidence intervals associated with abnormal values of the markers for the highest quintile of alcohol intake were 1.45 (1.06-1.97) for ApoB, 1.98 (1.40-2.80) for fasting glucose, and 1.74 (1.30-2.34) for body mass index. An inverse J-shaped relationship was assumed for ApoA1 and ApoB/ApoA1 ratio, whereas a U-shaped relationship was observed for serum triglycerides and mixed hyperlipidemia. Only the highest quintile of alcohol was associated with hypertension, although the test for linearity was also significant. No association was observed for Lp(a) or homocysteine. Associations were unmodified by further adjustment for carbohydrates, fiber, lipids, tobacco, or exercise.

CONCLUSIONS

The aggregate of the disparate alcohol risk factor relationships suggests probable net benefit at 15 to 25 g of alcohol/day.

Correlates of body mass index and waist-to-hip ratio among Mexican women in the United States: implications for intervention development

INTRODUCTION

This study contributes to our understanding of acculturation and obesity by examining the association between several measures of acculturation, including a bidimensional scale of acculturation, body mass index (BMI), and waist-to-hip ratio (WHR).

METHODS

Exploratory analyses were performed using baseline data from 357 Mexican women recruited into a Spanish-language randomized community trial. The women were randomly sampled by telephone and interviewed in their homes. Women's height, weight, waist, and hip were measured to obtain estimates of their BMI and WHR. A face-to-face interview collected data on dietary intake, physical activity, acculturation, and other demographic and psychosocial variables.

RESULTS

Less than a quarter of the women were normal weight (39% overweight and 41% obese). Univariate analyses revealed that more years living in the United States and less integration into the Anglo culture were associated with a larger BMI and WHR. However, in the multivariate analyses, significant correlates of a larger BMI were less moderate physical activity and unemployment. There were trends linking a larger BMI with older age, no vigorous physical activity, more energy intake, and less integration into the Anglo culture. These same variables plus less household income were associated with a higher WHR. Exploratory analyses on acculturation revealed that bicultural Mexican-American women were more educated, more likely to be employed, reported a higher household income, and perceived fewer barriers to a healthy diet compared with traditional Mexican women.

CONCLUSIONS

Intervention designed to prevent overweight/obesity should consider promoting maintenance of Mexican cultural practices, as well as teach women how to effectively integrate into the Anglo culture.