The Quételet index revisited in children and adults

BackgroundThe body mass index (BMI) is based on the original concept that body weight increases as a function of height squared. As an indicator of obesity the modern BMI assumption postulates that adiposity also increases as a function of height in states of positive energy balance.ObjectiveTo evaluate the BMI concept across different adiposity magnitudes, in both children and adults.MethodsWe studied 975 individuals who underwent anthropometric evaluation: 474 children and 501 adults. Tetrapolar bioimpedance analysis was used to assess body fat and lean mass.ResultsBMI significantly correlated with percentage of body fat (%BF; children: r = 0.893; adults: r = 0.878) and with total fat mass (children: r = 0.967; adults: r = 0.953). In children, body weight, fat mass, %BF and waist circumference progressively increased as a function of height squared. In adults body weight increased as a function of height squared, but %BF actually decreased with increasing height both in men (r = −0.406; p < 0.001) and women (r = −0.413; p < 0.001). Most of the BMI variance in adults was explained by a positive correlation of total lean mass with height squared (r² = 0.709), and by a negative correlation of BMI with total fat mass (r = −0.193).ConclusionsBody weight increases as a function of height squared. However, adiposity progressively increases as a function of height only in children. BMI is not an ideal indicator of obesity in adults since it is significantly influenced by the lean mass, even in obese individuals.     

Anthropometric and body composition characteristics during pregnancy: A study from West Bengal,India

The present cross-sectional study was aimed at investigating changes in anthropometric, body composition and blood pressure characteristics during pregnancy. A total of 406 healthy, pregnant women aged between 16 and 33 years participated in the study. Pregnant women were recruited from the outpatient department of the two-referral hospital in Bolpur subdivision of Birbhum district, West Bengal, India. Anthropometric measures such as height, weight, three circumferences and skinfold thickness at four sites (biceps, triceps, subscapular and suprailaic) were obtained using standard techniques. Percentages of body fat (%BF), intra abdominal visceral fat (IVF), basal metabolic rate (BMR) and body mass index (BMI) were measured using an Omron body fat analyser. Two forenoon blood pressure measurements were also taken and averaged for analysis. Subjects were categorized into three trimester groups: Group I, n = 30; Group II, n = 163; and Group III, n = 213. ANOVA with Scheffe's post-hoc test revealed that Group I had significantly lower mean than both Group II and Group III for systolic blood pressure and IVF, whereas Group I had significantly lower mean than Group III for BMI, BMR, %BF, diastolic blood pressure and skinfolds. The mean change in maternal weight from the first to the third trimester was merely 3 kg. Mean waist circumference varied from the first to the third trimester but not from the first to the second trimester. Furthermore, significantly increased systolic and diastolic blood pressure was observed across the trimesters. However, longitudinal studies involving interaction of body fat topography and pregnancy-induced hormones are required to further our understanding of gestation mechanism.     

Evaluation of Para- and Perirenal Fat Thickness and its Association with Metabolic Disorders in Polycystic Ovary Syndrome

Objective: The aim of this study was to compare para- and perirenal fat (PFT) and subcutaneous abdominal fat (SFT) measurements between patients with polycystic ovary syndrome (PCOS) and control subjects and to assess the possible relation with metabolic disorders.Methods: This study included 68 patients with PCOS and 40 age- and body mass index (BMI)-matched healthy controls. We evaluated anthropometric, hormonal, and metabolic parameters, and abdominal ultrasonography was performed to measure PFT and SFT.Results: The mean PFT values were 6.1 ± 2.9 mm in patients with PCOS and 4.3 ± 2.3 mm in healthy controls (P = .002). SFT values were also higher in the patient group (9.6 ± 5 mm) compared to healthy subjects (3.5 ± 0.5 mm) (P = .017). A significant positive correlation was found between PFT and BMI (r = 0.368), waist circumference (WC) (r = 0.441), Ferriman-Gallwey (FG) score (r = 0.313), blood pressure (systolic, SBP, r = 0.213; diastolic, DBP, r = 0.215), plasma glucose (r = 0.195), homeostasis model assessment-insulin resistance (HOMA-IR, r = 0.273), SFT (r = 0.555). Conversely, negative correlations were found between PFT and estradiol (r = -0.218) and sex hormone-binding globulin (SHBG, r = -0.304). Nonobese PCOS patients (6.1 ± 3.07 mm) had higher PFT values than nonobese controls (3.47 ± 1.5 mm); however, SFT measurements did not differ (P = .086). In multiple linear regression analysis, SFT (P = .006) was a significant and independent predictor for PFT, along with WC (P = .023). In a stepwise model, SFT was the predictor of PFT (P = .001).Conclusion: PFT values were higher particularly in nonobese PCOS patients compared to nonobese control subjects. There was a significant interaction between PCOS and obesity on PFT.Abbreviations: BMI = body mass index; CT = computed tomography; DBP = diastolic blood pressure; FPG = fasting plasma glucose;; HDL-cholesterol = high-density lipoprotein cholesterol; HOMA-IR = homeostasis model assessment-insulin resistance; hsCRP = high-sensitivity C-reactive protein; LDL-cholesterol = low-density lipoprotein cholesterol; LH = luteinizing hormone; NCAH = nonclassic congenital adrenal hyperplasia; 17-OHP = 17-hydroxyprogesterone; PCOS = polycystic ovary syndrome; PFT = para- and perirenal fat; SAT = subcutaneous abdominal adipose tissue; SBP = systolic blood pressure; SFT = abdominal subcutaneous fat thickness; TG = triglyceride; US = ultrasound; VAT = visceral abdominal adipose tissue; WC = waist circumference     

Distribución de la circunferencia de la cintura y de la relación circunferencia de la cintura con respecto a la talla según la categoría del índice de masa corporal en los pacientes atendidos en consultas de endocrinología y nutrición

IntroductionWaist circumference (WC) and the waist-to-height ratio (WHtR) are anthropometric measures widely used in clinical practice to evaluate visceral fat and the consequent cardiovascular risk. However, risk thresholds should be standardized according to body mass index (BMI).ObjectiveTo determine the distribution of WC and WHtR according to the BMI cut-points currently used to describe overweight and obesity.Materials and methodsWC, WHtR and BMI were measured in 3521 adult patients (>18 years) attended in Endocrinology and Nutrition units.ResultsA total of 20.8% (734 patients) were diabetic. Obesity was found in 82.1% of diabetic patients and in 75% of non-diabetic patients. The WC thresholds proposed by the National Institute of Health (102 cm in men, 88 cm in women), Bray (100 cm in men, 90 cm in women) and the International Diabetes Federation (94 cm in men, 80 cm in women) were exceeded by 92.9%, 94.8% and 98.4% of obese men, 96.8%, 95.5% and 99.7% of obese women, 79.1%, 83.1% and 90% of diabetic men and 95.5%, 81.5% and 97.4% of diabetic women, respectively. Thresholds adapted to the degree of obesity (90, 100, 110 and 125 cm in men and 80, 90, 105 and 115 cm in women for normal BMI, overweight, obesity I and obesity greater than I) were exceeded by 58.4% of obese men, 54.2% of obese women, 57.5% of diabetic men and 60.7% of diabetic women. WC was higher in men, and BMI and the WHtR were higher in women. The WC of diabetic women equalled that of men, and WC, WHtR and BMI were higher in diabetic than in non-diabetic women (p<0.001). WC (p<0.005), WHtR (p<0.001) and BMI (p<0.5) were also higher in diabetic than in non-diabetic men.ConclusionWC and WHtR thresholds by BMI discriminated diabetic and obese patients better than single thresholds, and can be represented graphically by the distribution of percentile ranks of WC and WHtR by BMI.ik     

Hypovitaminosis D and Bone Mineral Density in Human Immunodeficiency Virus-Infected Men from India,with or without Antiretroviral Therapy

ObjectiveTo study the vitamin D status and bone mineral density (BMD) in men infected with human immunodeficiency virus (HIV) in a tertiary care center from southern India.MethodsWe conducted a cross-sectional study of 35 HIV-infected men (between 20 and 50 years old) receiving highly active antiretroviral therapy (HAART) (group 1) in comparison with 35 ageand body mass index-matched HIV-positive antiretroviral therapy-naïve men (group 2) and 35 HIV-negative healthy control subjects (group 3).ResultsA significantly greater proportion (P = .002) of patients (74%) in the HAART group had vitamin D deficiency (< 20 ng/mL) in comparison with the other 2 groups (37% in each group). The mean intact parathyroid hormone level was higher (P < .001) and the mean duration of exposure to sunlight was lower (P = .001) in the HAART group than in the other 2 groups. By logistic regression analysis, HAART was found to be significantly associated with vitamin D deficiency. The BMD in the femoral neck was significantly lower in men with HIV infection who were receiving HAART in comparison with the other 2 groups (P = .006). On multivariate logistic regression, older age, low body mass index, and high parathyroid hormone levels emerged as factors significantly associated with decreased BMD at the femoral neck.ConclusionA significant proportion of patients receiving HAART had vitamin D deficiency. The secondary hyperparathyroidism probably due to vitamin D deficiency is an important contributing factor for the observed changes in BMD. Vitamin D deficiency noted in this group is probably multifactorial, and further research is needed to determine whether the effect of HAART on vitamin D metabolism is an additional causative factor and what benefit vitamin D supplementation might confer in these patients. (Endocr Pract. 2010;16:547-553)     

Serum concentrations of fibroblast growth factor 21 are elevated in patients with congenital or acquired lipodystrophy

ObjectivePatients with lipodystrophy (LD) suffer from loss of subcutaneous adipose tissue accompanied by dysregulation of several adipocyte-secreted factors. However, regulation of adipocyte-expressed fibroblast growth factor (FGF) 21 which acts in an insulin-mimetic, lipid-lowering, and anti-atherogenic manner has not been investigated in non-human immunodeficiency virus (HIV) LD.Material and methodsCirculating serum FGF21 levels were quantified in 37 patients with non-HIV LD and 37 controls matched for age, gender, and body mass index. Moreover, FGF21 plasma levels and mRNA expression were measured in LD mice and control animals. Additionally, serum FGF21 levels were assessed in 10 LD patients before and during metreleptin therapy.ResultsMedian FGF21 serum concentrations were significantly higher in LD patients (381.2 ng/l) as compared to the control group (231.2 ng/l; p = 0.023). There was an independent and positive association between circulating FGF21 and serum triglycerides (TG), as well as fibrate treatment, in multiple linear regression analysis. LD mice showed significantly upregulated FGF21 plasma levels (4.5-fold), as well as mRNA expression in various adipose tissue depots and liver as compared to controls (p < 0.05). Metreleptin treatment did not significantly alter circulating FGF21 levels in human subjects.ConclusionsSerum concentrations of FGF21 are elevated in patients with non-HIV LD with adipose tissue and liver being potential sources of increased production. TG and fibrate treatment are independent positive predictors of circulating FGF21.     

Hígado graso no alcohólico y su asociación con variables clínicas y bioquímicas en niños y adolescentes obesos: efecto de un año de intervención en el estilo de vida

ObjectiveTo study the frequency of non-alcoholic fatty liver disease (NAFLD), its relationship to clinical and biochemical variables, and the effect 12-month's lifestyle intervention in obese children and adolescents.MethodsThirty-six obese patients aged 7 to 18 years, 42% female and 58% male, 72.2% prepubertal and 27.8% pubertal, were selected. Anthropometric measurements and glucose, insulin (baseline and after a glucose load), lipid profile, C-reactive protein, and aminotransferase tests were performed before and 12 months after dietary and physical activity intervention. Liver ultrasound was performed to determine the presence of NAFLD.ResultsNAFLD was found in 66.7% (n = 24), and was mild in 30.6%, moderate in 27.8%, and severe in 8.3%. Subjects with NAFLD had higher body mass index (BMI, p = 0.007), waist (p = 0.005), fat area (p = 0.002), basal insulin (p = 0.01), and HOMA-IR (p = 0.008) values and lower QUICKI (p = 0.02) values than those with no NAFLD. After intervention, physical activity increased (p = 0.0001) and calorie intake remained unchanged. NAFLD disappeared in 9 patients (37.5%, p = 0.02) and disease severity decreased in 3 patients (12.5%). In addition, BMI Z-score (p = 0.005), fat area (p = 0.0001), basal insulin (p < 0.05), insulin resistance (p < 0.005), lipid profile (p < 0.03), and transaminases decreased. Weight loss was the main variable accounting for NAFLD improvement.ConclusionThis group of obese children and adolescents showed a high frequency of NAFLD. The lifestyle intervention with weight reduction is effective for the treatment of NAFLD.     

Correlation between Insulin Resistance Surrogates and Echocardiographic Findings in Asymptomatic Patients with Morbid Obesity: A Cross-Sectional Study

ObjectiveTo assess the relationship between insulin resistance (IR) and left ventricular diastolic dysfunction (LVDD) in asymptomatic patients with morbid obesity (MO).MethodsThe study cohort consisted of 231 patients (165 women and 66 men) with MO (mean body mass index [BMI] of 46.0 kg/m²) and a control group of 93 ageand sex-matched apparently healthy control subjects (56 women and 37 men; mean BMI of 24.1 kg/m²). Tissue Doppler imaging echocardiography was used to provide measurements of ejection fraction, LVDD (peak early tissue Doppler velocity/peak late tissue Doppler velocity or Em/Am ratio), left ventricular mass (LVM), and left ventricular hypertrophy (LVH). Adiponectin levels, the homeostasis model assessment index, and the ratio of triglycerides to high-density lipoprotein cholesterol (TG/HDL) were used as surrogate markers of IR.ResultsThe ejection fraction was normal and similar in the patient and control groups. LVDD (Em/Am ratio < 1.0) and LVH prevalences were 52% and 30%, respectively, in the group with MO (significantly higher than in the control group; P < 0.0005). The patients with MO displayed higher IR on the basis of all 3 surrogate markers (P < 0.0005, respectively). Log-transformed adiponectin showed the strongest correlations with LVM and Em/Am ratios; log-transformed homeostasis model assessment index and TG/HDL ratio displayed less robust yet significant correlations. Stepwise multiple linear regression analysis identified hypertension and the TG/HDL ratio as independent predictors of 35.5% of the variance of LVDD. In contrast, LVM was mainly predicted by BMI, hypertension, and sex.ConclusionLVH and LVDD are highly prevalent in asymptomatic patients with MO. IR is significantly correlated with both variables. Furthermore, LVDD is independently predicted by the presence of hypertension and the TG/HDL ratio. The prognostic implications of these findings warrant further studies. (Endocr Pract. 2007;13: 590-600)     

Development of subcutaneous fat in Spanish and Latin American children and adolescents: Reference values for biceps,triceps, subscapular and suprailiac skinfolds

Subcutaneous fat skinfolds represent a reliable assessment instrument of adiposity status. This study provides current percentile references for four subcutaneous skinfolds (biceps, triceps, subscapular, suprailiac) applicable to children and adolescents in Spain and in Latin American countries where data are scarce.The design consisted of a cross-sectional multicenter study performed with identical methods in 5 countries (Argentina, Cuba, Mexico, Spain and Venezuela). Total sample comprised 9163 children and youths (boys 4615 - girls 4548) aged 6–18 years, healthy and without apparent pathologies. Percentiles 3, 5, 10, 25, 50, 75, 90, 95 and 97 were calculated by the LMS method. Sexual dimorphism was assessed using the t-test and age differences with ANOVA. Normalized growth percentile references were obtained according to sex and age for each skinfold. The mean values of four skinfolds were significantly greater in girls than boys (p < 0.001) and, in both sexes, all skinfolds show statistical differences through age (p < 0.001) with different magnitudes.Except triceps in girls, peaks between 11 and 12 years of age are more noticeable in boys than in girls. Although the general model of growth is known, the skinfold measurements show variability among populations and differences of magnitude are presented according to the analyzed population. Therefore, these age and sex-specific reference percentile values for biceps, triceps, subscapular and suprailiac skinfolds, derived from a large sample of Spanish and Latin American children and adolescents, are a useful tool for adiposity diagnosis in this population for which no reference values were available.     

Aumento del peso corporal y calidad seminal: una asociación controvertida

BackgroundInfertility is a public health disorder affecting 10% of the population worldwide. Research on the impact of body mass index (BMI) on male fertility is very limited as compared to the multiple studies evaluating the impact of overweight in women's fertility. Although 25%-30% of the cases of couples consulting for infertility are attributable to male factors, studies evaluating the association between semen parameters and BMI are controversial.ObjectiveTo assess the impact of BMI on semen parameters in a selected group of men with unexplained infertility.MethodA retrospective analysis of 168 patients during the 2008-2010 period. They all had at least one semen analysis and related studies to rule out known causes of infertility. Median age of patients was 35 years (22-55), and they were divided into three groups: normal weight (BMI: 20-24.9 kg/m²), overweight (BMI 25-29.9 kg/m²), and obese (BMI ≥ 30 kg/m²).ResultsThere were no significant differences in semen parameters evaluated between the three groups, and no significant correlation was found between the same parameters and BMI.ConclusionsThere was no significant association between BMI and conventional semen parameters, but we cannot exclude an impairment in other semen parameters that are not routinely assessed, which could result in a lower potential fertility in these individuals.     

Body mass index,height and early-onset basal cell carcinoma in a case-control study

IntroductionBasal cell carcinoma (BCC) is the most common malignancy in the US. Body mass index (BMI) and height have been associated with a variety of cancer types, yet the evidence regarding BCC is limited. Therefore, we evaluated BMI and height in relation to early-onset BCC (under age 40) and explored the potential role of ultraviolet (UV) radiation exposure and estrogen-related exposures in the BMI-BCC relationship.MethodsBCC cases (n = 377) were identified through a central dermatopathology facility in Connecticut. Control subjects (n = 389) with benign skin conditions were randomly sampled from the same database and frequency matched to cases on age (median = 36, interquartile range 33–39), gender, and biopsy site. Participants reported weight (usual adult and at age 18), adult height, sociodemographic, phenotypic, and medical characteristics, and prior UV exposures. We calculated multivariate odds ratios (ORs) and 95% confidence intervals (CIs) using unconditional logistic regression models.ResultsAdult BMI was inversely associated with early-onset BCC (obese vs. normal OR = 0.43, 95% CI = 0.26–0.71). A similar inverse association was present for BMI at age 18 (OR = 0.54, 95% CI = 0.34–0.85). Excluding UV exposures from the BMI models and including estrogen-related exposures among women only did not alter the association between BMI and BCC, indicating limited mediation or confounding. We did not observe an association between adult height and BCC (OR per cm = 1.00, 95% CI = 0.98–1.02).ConclusionsWe found a significant inverse association between BMI and early-onset BCC, but no association between height and BCC. This association was not explained by UV exposures or estrogen-related exposures in women.     

Increased Arterial PET/CT 18F-Fluorodeoxyglucose Uptake in Obese and Overweight Patients

ObjectivesWe aimed to investigate the association between BMI and early atherosclerotic activity in cancer patients. We also compared the inflammatory and macroscopic calcification processes of atherosclerosis in the aortic segments and large arteries by ¹⁸F-FDG PET/CT of between normal and high BMI patients.MethodsWe conducted a retrospective review of cancer patients presented to our institution within the period between February and May 2018. Patients were classified according to their BMI into two groups: normal BMI group and high BMI group. Data of average SUVmax and SUVmean for four segments of the aorta, common iliac arteries, and femoral arteries were estimated and compared between both groups. Moreover, the macroscopic calcification on CT images for each vascular section was also reported.ResultsNinety-eight patients were classified into two groups: normal BMI group (n = 52; 53.1%), and high BMI group (n = 46; 46.9%). Average SUVmax was significantly higher in obese participants in all arterial segments (P < 0.05). However, the SUVmean was significantly higher in obese patients in only three arterial segments aortic arch, left femoral artery and descending thoracic aorta (P < 0.05).Moreover, the differences between the two study groups in terms of the frequency of macroscopic calcifications were not statistically significant for all vascular segments. BMI positively correlated with SUVmax and SUVmean of the vascular segments (r value from 0,219 to 0,575/p value between 0,023 and 0,0001).ConclusionsFluorine-18-FDG PET/CT imaging revealed that patients with high BMI have more accelerated atherosclerotic inflammatory process in their major vessels compared to their age-matched controls with normal BMI. Future studies should assess the associated between these findings and the cardiovascular events in the long term.     

Relationships between skinfold thickness and electromyographic and mechanomyographic amplitude recorded during voluntary and non-voluntary muscle actions

IntroductionThe purpose of this study was to examine possible correlations between skinfold thicknesses and the a terms from the log-transformed electromyographic (EMG_RMS) and mechanomyographic amplitude (MMG_RMS)-force relationships, EMG M-Waves, and MMG gross lateral movements (GLM).MethodsForty healthy subjects performed a 6-s isometric ramp contraction from 5% to 85% of their maximal voluntary contraction with EMG and MMG sensors placed on the vastus lateralis (VL) and rectus femoris (RF). A single electrical stimulus was applied to the femoral nerve to record the EMG M-waves and MMG GLMs. Skinfold thickness was assessed at the site of each electrode. Pearson’s product correlation coefficients were calculated comparing skinfold thicknesses with the a terms from the log-transformed EMG_RMS-and MMG_RMS-force relationships, EMG M-waves, and MMG GLMs.ResultsThere were no significant cor1relations (p > 0.05) between the a terms and skinfold thicknesses for the RF and VL from the EMG_RMS and MMG_RMS-force relationships. However, there were significant correlations (p < 0.05) between skinfold thicknesses and the EMG M-waves and MMG GLMs for the RF (r = −0.521, −0.376) and VL (r = −0.479, −0.484).DiscussionRelationships were only present between skinfold thickness and the amplitudes of the EMG and MMG signals during the non-voluntary muscle actions.     

Association between nesfatin-1 levels and metabolic improvements in severely obese patients who underwent biliopancreatic derivation with duodenal switch

ContextNesfatin-1 is a neuroendocrine peptide with potent anorexigenic activity in rodents. The potential role of nesfatin-1 on the regulation of energy balance, metabolic functions and inflammation is currently debated in obese humans. In the present study, nesfatin-1 fluctuations and their associations with metabolic factors were investigated in severely obese patients who underwent biliopancreatic diversion with duodenal switch (BPD/DS) and severely obese controls (SOC).Basic proceduresSixty severely obese patients who underwent BPD/DS and 15 SOC (matched for BMI and age) were included in the study. Associations between nesfatin-1 levels and body composition, glucose metabolism, lipid profile as well as inflammatory markers were evaluated at baseline and over a post-surgery12-month (12 M) period.Main findingsBody weight was reduced at 6 M and at 12 M in BPD/DS patients (P < 0.001). Nesfatin-1 levels were reduced at 6 M (women: P < 0.05) and at 12 M (men and women; P < 0.001) in BPD/DS patients. At baseline, nesfatin-1 levels negatively correlated with weight, fat (FM) and fat-free mass (FFM) in the whole population (combined BPD/DS and SOC patients). At 12 M, nesfatin-1 concentrations positively correlated with weight, FM, fasting insulin, insulin resistance, total cholesterol, LDL-cholesterol, triglyceride and apoB values. At 12 M, % changes in nesfatin-1 were positively associated with% changes in weight, FM, FFM, fasting insulin, insulin resistance, total cholesterol, LDL-cholesterol, apoB and C-reactive protein.ConclusionNesfatin-1 levels decrease following BPD/DS-induced weight loss and are significantly associated with parameters of metabolic health.     

Factores determinantes del índice de masa corporal en escolares españoles a partir de las Encuestas Nacionales de Salud

IntroductionSpanish National Health Surveys do not establish synergistic relations between variables. The purpose of this study was to perform a deeper historical analysis of body mass index (BMI) and its relation to other parameters included in the questionnaire for children.Material and methodsData from interviews conducted (between 1987 and 2006) to parents and guardians of schoolchildren aged 9-15 years were analyzed. Height and weight reported by parents were selected and used to calculate BMI. Subjects were stratified by age, gender, time spent sleeping and watching television and, finally, frequency of physical activity. The historical trend of BMI and its dependence on the above factors were analyzed using ANOVA tests.Results and conclusionsSignificant weight and height increases were seen, which were more marked in boys aged 12 to 15 years. Influence of physical activity on BMI was shown, but decreased (P < .001) as exercise time increased. By contrast, BMI increased (P < .001) as time spent watching television increased. On the other hand, the role of sleep as modulator of body size was confirmed, since schoolchildren aged 9-11 years who slept over 9 h had lower BMIs (P < .001). In subjects aged 12 to 15, BMI decreased (P < .001) from 6 h of sleep.     

Clinical Markers Implying the Need for Treatment in Women with Gestational Diabetes Mellitus

ObjectiveTo assess the association of the point-of-care hemoglobin A_1c (POC A1C), fasting blood glucose (FBG), and BMI with fetal macrosomia and the need for medication in women with gestational diabetes (GDM).MethodsPOC A1C, FBG, and BMI values at GDM diagnosis and fetal weight at delivery were obtained for women identified from a prospective patient registry. These outcomes were compared between women who did not require medication for GDM and women who did require medication.ResultsMean values of POC A1C, FBG, and BMI in 67 patients who required medication were higher than those in 71 patients who did not require medication (POC A1C: 5.72 ± 0.45% vs 5.35 ± 0.46% [P < .001]; FBG: 97.4 ± 12.3 mg/dL vs 86.4 ± 9.5 mg/dL [P < .001]; BMI: 35.4 ± 6.4 kg/m2 vs 30.4 ± 6.2 kg/m2 [P < .001]). There was a modest correlation between POC A1C and FBG (Spearman rho 0.4, P < .001) and between POC A1C and BMI (Spearman rho 0.366, P < .001). Maternal POC A1C was not correlated with fetal weight at delivery (Spearman rho –0.010, P = .915).ConclusionsHigher POC A1C, FBG, and BMI values were associated with the need for medication in women with GDM. The use of clinical markers to assess glycemic control sooner in pregnancy may lead to the earlier identification of women at risk for GDM and earlier intervention to decrease the risk for complications. (Endocr Pract. 2012;18:62-65)     

Prevalencia de hiperandrogenismo y síndrome de ovario poliquístico en transexuales de mujer a hombre

IntroductionPrevalence of hyperandrogenism (HA), including the polycystic ovary syndrome (PCOS), in female-to-male transsexuals (FMT) is high. This has been related to metabolic syndrome (MS), which appears to increase cardiovascular morbidity and mortality throughout cross-sex hormone (CSH) therapy.ObjectivesTo assess the prevalence of HA and PCOS in FMT patients before the start of CSH therapy, and their association to MS and its components, insulin resistance (IR) and other cardiovascular risk (CVR) factors.Materials and methodsSeventy-seven FMTs underwent clinical and biochemical assessment for HA before the start of CSH therapy. CVR, IR, and other MS parameters were also assessed.ResultsPrevalence of HA was 49.4% (73.7% were cases of PCOS [Rotterdam criteria]), and prevalence of PCOS in the overall sample was 36.4%. Prevalence of MS was 38.4% and 51.7% according to ATP-III and IDF criteria respectively). MS (according to ATP-III and IDF criteria respectively) was found in 36.8% and 57.9% as compared to 25.6% and 41% of patients with and without HA respectively (p < 0.0001 and P < 0.01 respectively). Of total patients, 54.5% had normal weight (body mass index [BMI] 18.5-24.9 kg.m^-2), 26% were overweight (BMI 25-29.9 kg.m^-2), and 19.5% were obese (BMI ≥ 30 kg.m^-2). After adjusting for BMI, the comparison of hormonal, metabolic, and anthropometric parameters showed statistically significant differences in plasma glucose, HOMA-IR, and abdominal circumference (P < 0.001 for all), as well as HDL cholesterol (HDL) (P = 0.033), but not in total testosterone or calculated free testosterone levels. In the total sample, 27.3% had HDL levels less than 50 mg/dL.ConclusionsOverall HA, and PCOS in particular, are highly prevalent in FMTs. HA and PCOS are related to early development of SM, IR, and other CVR factors with unknown consequences in adulthood.     

Anthropometric dimensions provide reliable estimates of abdominal adiposity: A validation study

Abdominal fat accumulation is a major risk factor for cardiometabolic morbidity and mortality. The purpose of the study is to assess the possibility of developing accurate estimation equations based on body measurements to determine total abdominal (TFA), subcutaneous (SFA) and visceral fat area (VFA). Hungarian volunteers (n = 198) aged between 20 and 81 years were enrolled in the study, which was conducted between July and November 2014. All persons underwent anthropometric measurements and computer tomographic (CT) scanning. Sex-specific multiple linear regression analyses were conducted in a subgroup of 98 participants to generate estimation models, then Bland–Altman's analyses were applied in the cross-validation group to compare their predictive efficiency. The variables best predicting VFA were hip circumference, calf circumference and waist-to-hip ratio (WHR) for males (R² = 0.713; SEE = 5602.1 mm²) and sagittal abdominal diameter (SAD), WHR, thigh circumference and triceps skinfold for females (R² = 0.845; SEE = 3835.6 mm²). The SFA prediction equation included SAD, thigh circumference and abdominal skinfold for males (R² = 0.848; SEE = 4124.1 mm²), body mass index and thigh circumference for females (R² = 0.861; SEE = 5049.7 mm²). Prediction accuracy was the highest in the case of TFA: hip circumference and WHR for males (R² = 0.910; SEE = 5637.2 mm²), SAD, thigh circumference and abdominal skinfold for females (R² = 0.915; SEE = 6197.5 mm²) were used in the equations. The results suggested that deviations in the predictions were independent of the amount of adipose tissue. Estimation of abdominal fat depots based on anthropometric traits could provide a cheap, reliable method in epidemiologic research and public health screening to evaluate the risk of cardiometabolic events.     

Abdominal visceral adiposity influences CD4+ T cell cytokine production in pregnancy

Women with pre-gravid obesity are at risk for pregnancy complications. While the macrophage response of obese pregnant women categorized by body mass index (BMI) has been documented, the relationship between the peripheral CD4⁺ T cell cytokine profile and body fat compartments during pregnancy is unknown. In this study, third trimester peripheral CD4⁺ T cell cytokine profiles were measured in healthy pregnant women [n = 35; pre-pregnancy BMI: 18.5–40]. CD4⁺ T cells were isolated from peripheral blood mononuclear cells and stimulated to examine their capacity to generate cytokines. Between 1 and 3 weeks postpartum, total body fat was determined by dual-energy X-ray absorptiometry and abdominal subcutaneous and visceral fat masses were determined by magnetic resonance imaging. Pearson’s correlation was performed to assess relationships between cytokines and fat mass. Results showed that greater abdominal visceral fat mass was associated with a decrease in stimulated CD4⁺ T cell cytokine expression. IFN-gamma, TNF-alpha, IL-12p70, IL-10 and IL-17A were inversely related to visceral fat mass. Chemokines CCL3 and IL-8 and growth factors G-CSF and FLT-3L were also inversely correlated. Additionally, total body fat mass was inversely correlated with FGF-2 while abdominal subcutaneous fat mass and BMI were unrelated to any CD4⁺ T cell cytokine. In conclusion, lower responsiveness of CD4⁺ T cell cytokines associated with abdominal visceral fat mass is a novel finding late in gestation.