Differences in Resting Metabolic Rate between White and African‐American Young Adults

Objective: A reported lower resting metabolic rate (RMR) in African‐American women than in white women could explain the higher prevalence of obesity in the former group. Little information is available on RMR in African‐American men. Research Methods and Procedures: We assessed RMR by indirect calorimetry and body composition by DXA in 395 adults ages 28 to 40 years (100 African‐American men, 95 white men, 94 African‐American women, and 106 white women), recruited from participants in the Coronary Artery Risk Development in Young Adults (CARDIA), Birmingham, Alabama, and Oakland, California, field centers. Results: Using linear models, fat‐free mass, fat mass, visceral fat, and age were significantly related to RMR, but the usual level of physical activity was not. After adjustment for these variables, mean RMR was significantly higher in whites (1665.07 ± 10.78 kcal/d) than in African Americans (1585.05 ± 11.02 kcal/d) by 80 ± 16 kcal/d (p < 0.0001). The ethnic × gender interaction was not significant (p = 0.9512), indicating that the difference in RMR between African‐American and white subjects was similar for men and women. Discussion: RMR is ～5% higher in white than in African‐American participants in CARDIA. The difference was the same for men and women and for lean and obese individuals. The prevalence of obesity is not higher in African‐American men than in white men. Because of these reasons, we believe that RMR differences are unlikely to be a primary explanation for why African‐American women are more prone to obesity than white women.     

Waist Circumference,BMI, and Visceral Adipose Tissue in White Women and Women of African Descent

Although waist circumference (WC) is a marker of visceral adipose tissue (VAT), WC cut‐points are based on BMI category. We compared WC‐BMI and WC‐VAT relationships in blacks and whites. Combining data from five studies, BMI and WC were measured in 1,409 premenopausal women (148 white South Africans, 607 African‐Americans, 186 black South Africans, 445 West Africans, 23 black Africans living in United States). In three of five studies, participants had VAT measured by computerized tomography (n = 456). Compared to whites, blacks had higher BMI (29.6 ± 7.6 (mean ± s.d.) vs. 27.6 ± 6.6 kg/m², P = 0.001), similar WC (92 ± 16 vs. 90 ± 15 cm, P = 0.27) and lower VAT (64 ± 42 vs. 101 ± 59 cm², P < 0.001). The WC‐BMI relationship did not differ by race (blacks: β (s.e.) WC = 0.42 (.01), whites: β (s.e.) WC = 0.40 (0.01), P = 0.73). The WC‐VAT relationship was different in blacks and whites (blacks: β (s.e.) WC = 1.38 (0.11), whites: β (s.e.) WC = 3.18 (0.21), P < 0.001). Whites had a greater increase in VAT per unit increase in WC. WC‐BMI and WC‐VAT relationships did not differ among black populations. As WC‐BMI relationship did not differ by race, the same BMI‐based WC guidelines may be appropriate for black and white women. However, if WC is defined by VAT, race‐specific WC thresholds are required.     

Lower Serum Adiponectin Levels in African‐American Boys

Objective: To examine adiponectin, an adipocyte‐secreted hormone with anti‐inflammatory and insulin‐sensitizing effects, in relation to race or gender in younger subjects. Research Methods and Procedures: The relationship of adiponectin, quantitated by radioimmunoassay, to anthropometric and metabolic factors (fasting insulin, glucose, and leptin) and reproductive hormones was examined in 46 healthy African Americans (25 girls/21 boys) and 40 whites (20 girls/20 boys) ranging in age from 12 to 21 years. Results: There was no statistical difference in BMI or in BMI percentile among the four groups. Sums of skinfolds, but not skinfold percentile, were significantly lower in boys than girls (p = 0.001 and p = 0.896, respectively), whereas there was no difference between racial groups. Leptin was significantly greater in girls (p = 0.0002). There was no difference in fasting serum glucose, insulin, or homeostasis model assessment score among any of the groups. There was a significant negative univariate relationship between serum adiponectin and both BMI and BMI percentile for the entire group (p = 0.006 and p = 0.005). In a multivariate model, BMI percentile (p = 0.005) and the interaction between race and gender (p = 0.026) were significant predictors of serum adiponectin. In this model, African‐American boys had the lowest serum adiponectin level, 37% less than white boys, who had the highest adiponectin levels. Discussion: Serum adiponectin levels are reduced in young obese subjects (African Americans and whites) and are lower in African‐American boys than white boys. A lower adiponectin level in African‐American boys may predispose this group to a greater risk of diabetes and cardiovascular disease.     

Combination of BMI and Waist Circumference for Identifying Cardiovascular Risk Factors in Whites

Objective: BMI (kilograms per meters squared) and waist circumference (WC) (measured in centimeters) are each associated with the risk of developing cardiovascular disease (CVD). Therefore, a combination of the two may be more effective in identifying subjects at risk than either alone. The present study sought to identify the combination of BMI and WC that has the strongest association with CVD risk factors in whites. Research Methods and Procedures: Subjects were 8712 white men and women from the Third National Health and Nutrition Examination Survey. The optimal combination of BMI and WC was developed using logistic regression models with BMI and WC as predictors and CVD risk factors as outcomes. The combined measure of BMI and WC using current cut‐off points was also examined. Sensitivity, specificity, and receiver operating characteristics curves were compared between the combined measures and BMI alone. Results: For white men, the optimal combination of BMI and WC for identifying CVD risk factors was 0.68 × BMI + 0.32 × WC. This combination generated a score that better estimated the odds of having CVD risk factors than either alone. For white women, WC alone largely determined the likelihood of having CVD risks. The combination of BMI and WC using current cut‐off points may provide an improved measure of CVD risk. Combined measures showed a higher sensitivity or a shorter distance in receiver operating characteristic curves in the identification of CVD risk factors. Discussion: Combined measures of BMI and WC may provide a higher overall test performance for CVD risk factors and may be useful in some ethnic groups as an improved means of screening subjects for further evaluation in the clinical setting.     

Fitness Alters the Associations of BMI and Waist Circumference with Total and Abdominal Fat

Objective: We tested the following hypotheses in black and white men and women: 1) for a given BMI or waist circumference (WC), individuals with moderate cardiorespiratory fitness (CRF) have lower amounts of total fat mass and abdominal subcutaneous and visceral fat compared with individuals with low CRF; and 2) exercise training is associated with significant reductions in total adiposity and abdominal fat independent of changes in BMI or WC. Research Methods and Procedures: The sample included 366 sedentary male (111 blacks and 255 whites) and 462 sedentary female (203 blacks and 259 whites) participants in the HERITAGE Family Study. The relationships between BMI and WC with total fat mass (determined by underwater weighing) and abdominal subcutaneous and visceral fat (determined by computed tomography) were compared in subjects with low (lower 50%) and moderate (upper 50%) CRF. The effects of a 20‐week aerobic exercise training program on changes in these adiposity variables were examined in 86% of the subjects. Results: Individuals with moderate CRF had lower levels of total fat mass and abdominal subcutaneous and visceral fat than individuals with low CRF for a given BMI or WC value. The 20‐week aerobic exercise program was associated with significant reductions in total adiposity and abdominal fat, even after controlling for reductions in BMI and WC. With few exceptions, these observations were true for both men and women and blacks and whites. Discussion: These findings suggest that a reduction in total adiposity and abdominal fat may be a means by which CRF attenuates the health risk attributable to obesity as determined by BMI and WC.     

Waist circumference correlates with metabolic syndrome indicators better than percentage fat

Objective : Percent fat is often considered the reference for establishing the magnitude of adipose tissue accumulation and the risk of excess adiposity. However, the increasing recognition of a strong link between central adiposity and metabolic disturbances led us to test whether waist circumference (WC) is more highly correlated with metabolic syndrome components than percent fat and other related anthropometric measures such as BMI. Research Methods and Procedures : BMI, WC, and percent fat, measured by DXA, were evaluated in 1010 healthy white and African‐American men and women [age, 48.3 ± 17.2 (standard deviation) years; BMI, 27.0 ± 5.3 kg/m²]. The associations of BMI, WC, and percent fat with age and laboratory‐adjusted health risk indicators (i.e., serum glucose, insulin, triglycerides, high‐density lipoprotein cholesterol, blood pressure) in each sex and ethnicity group were examined. Results : For 18 of 24 comparisons, the age‐ and laboratory‐adjusted correlations were lowest for percent fat and in 16 of 24 comparisons were highest for WC. Fifteen of the between‐method differences reached statistical significance. With health risk indicator as the dependent variable and anthropometric measures as the independent variable, the contribution of percent fat to the WC regression model was not statistically significant; in contrast, adding WC to the percent fat regression model did make a significant independent contribution for most health risk indicators. Discussion : WC had the strongest associations with health risk indicators, followed by BMI. Although percent fat is a useful measure of overall adiposity, health risks are best represented by the simply measured WC.     

Insulin Sensitivity in African‐American and White Women: Association With Inflammation

Whether the contribution of inflammation to risk for chronic metabolic disease differs with ethnicity is not known. The objective of this study was to determine: (i) whether ethnic differences exist in markers of inflammation and (ii) whether lower insulin sensitivity among African Americans vs. whites is due to greater inflammatory status. Subjects were African‐American (n = 108) and white (n = 105) women, BMI 27–30 kg/m². Insulin sensitivity was assessed with intravenous glucose tolerance test and minimal modeling; fat distribution with computed tomography; body composition with dual‐energy X‐ray absorptiometry; markers of inflammation (tumor necrosis factor (TNF)‐α, soluble tumor necrosis factor receptor (sTNFR)‐1, sTNFR‐2, C‐reactive protein (CRP), and interleukin (IL)‐6) with enzyme‐linked immunosorbent assay (ELISA). Whites had greater intra‐abdominal adipose tissue (IAAT), insulin sensitivity, and concentrations of TNF‐α, sTNFR‐1, and sTNFR‐2 than African Americans. Greater TNF‐α in whites vs. African Americans was attributed to greater IAAT in whites. Among whites, but not African Americans, CRP was independently and inversely associated with insulin sensitivity, after adjusting for IAAT (r = ?0.29 P < 0.05, and r = ?0.13 P = 0.53, respectively). Insulin sensitivity remained lower in African Americans after adjusting for CRP (P < 0.001). In conclusion, greater IAAT among whites may be associated with greater inflammation. Insulin sensitivity was lower among African Americans, independent of obesity, fat distribution, and inflammation.     

Ethnic Differences in Visceral Adipose Tissue and Type 2 Diabetes: Filipino,African‐American,and White Women

Objective: To compare ethnic differences in visceral adipose tissue (VAT), assessed by computed tomography, and type 2 diabetes risk among 55‐ to 80‐year‐old Filipino, African‐American, and white women without known cardiovascular disease. Research Methods and Procedures: Subjects were participants in the Rancho Bernardo Study (n = 196), the Filipino Women's Health Study (n = 181), and the Health Assessment Study of African‐American Women (n = 193). Glucose and anthropometric measurements were assessed between 1995 and 2002. Results: African‐American women had significantly higher age‐adjusted BMI (29.7 kg/m²) and waist girth (88.1 cm) compared with Filipino (BMI, 25.5 kg/m²; waist girth, 81.9 cm) or white (BMI: 26.0 kg/m²; waist girth: 80.7 cm) women. However, VAT was significantly higher among Filipino (69.1 cm³) compared with white (62.3 cm³; p = 0.037) or African‐American (57.5 cm³, p < 0.001) women. VAT correlated better with BMI (r = 0.69) and waist (r = 0.77) in whites, compared with Filipino (r = 0.42; r = 0.59) or African‐American (r = 0.50; r = 0.56) women. Age‐adjusted type 2 diabetes prevalence was significantly higher in Filipinas (32.1%) than in white (5.8%) or African‐American (12.1%) women. Filipinas had higher type 2 diabetes risk compared with African Americans [adjusted odds ratio, 2.30; 95% confidence interval (CI), 1.09 to 4.86] or whites (adjusted odds ratio, 7.51; 95% CI, 2.51 to 22.5) after adjusting for age, VAT, exercise, education, and alcohol intake. Discussion: VAT was highest among Filipinas despite similar BMI and waist circumference as whites. BMI and waist circumference were weaker estimates of VAT in Filipino and African‐American women than in whites. Type 2 diabetes prevalence was highest among Filipino women at every level of VAT, but VAT did not explain their elevated type 2 diabetes risk.     

Total and Central Obesity among Elderly Hispanics and the Association with Type 2 Diabetes

Objective: To report the prevalence of total and central obesity in a representative sample of Puerto Rican and Dominican elders in Massachusetts, to compare them with a neighborhood‐based group of non‐Hispanic white elders, and to examine associations of obesity indices with the presence of type 2 diabetes. Research Methods and Procedures: We examined the prevalence of overweight, obesity, and central obesity in 596 Hispanics of Caribbean origin, ages 60 to 92 years, and 239 non‐Hispanic whites, and tested linear and logistic regression models to determine associations among body mass index (BMI), waist circumference (WC), and diabetes. Results: Obesity (BMI ≥ 30 kg/m²) was prevalent among all ethnic groups, ranging from 17% to 29% for Dominican and Puerto Rican men, respectively, and from 29% to 40% for non‐Hispanic white and Dominican women, respectively. These differences were not statistically significant. Among Hispanic men and women, diabetes was prevalent across all BMI and WC categories but tended to be greatest among those with BMI of 25 to 29 kg/m² (41% to 43%). In contrast, diabetes was most prevalent in the obese group (36% to 45%) of non‐Hispanic whites. Both BMI and WC were associated with the presence of diabetes, but the coefficients were greater for non‐Hispanic whites than for Hispanics. Discussion: Caribbean Hispanics and non‐Hispanic whites living in the same Massachusetts localities had high prevalences of overweight and obesity. Total and central obesity exerted a differential effect on the presence of diabetes among ethnic groups; for Hispanics, diabetes was prevalent even among non‐obese individuals, whereas for non‐Hispanic white women, the prevalence of diabetes was strongly associated with total and central obesity. Additional research is needed to investigate the factors associated with the differential effect of obesity on the prevalence of type 2 diabetes among Hispanic and non‐Hispanic white elders.     

Adiponectin and ghrelin levels and body size in normoglycemic Filipino, African-American, and white women

Objective: Prior studies have reported ethnic differences in adiponectin and ghrelin, but few have assessed the role of body size in normoglycemic women. We compared fasting adiponectin and ghrelin concentrations in normoglycemic 40‐ to 80‐year‐old Filipino, African‐American, and white women. Methods: Participants included women from the Rancho Bernardo Study (n = 143), the University of California‐San Diego Filipino Women's Health Study (n = 136), and the Health Assessment Study of African‐American Women (n = 212). A 2‐hour oral glucose tolerance test was administered; glucose, insulin, lipid, and anthropometric measurements were obtained. Fasting adiponectin and ghrelin were measured by radioimmunoassay. Results: Whites and Filipinas had similar BMI (23.7 and 24.3 kg/m², respectively), waist girth (75.6 and 77.2 cm, respectively), and total body fat (27.4 and 28.5%, respectively); African‐Americans had significantly larger BMI (28.8 kg/m²), waist girth (86.3 cm), and body fat (39.6%, p < 0.0001). Adiponectin was lower in Filipinas (8.90 µg/mL) and African‐Americans (9.67 µg/mL) compared with whites (15.6 µg/mL, p < 0.001) after adjusting for age, homeostasis model assessment of insulin resistance (HOMA‐IR), and waist‐to‐hip ratio. Compared with whites, Filipinas (β = ?5.06, p < 0.0001) and African‐Americans (β = ?6.85, p < 0.0001) had significantly lower adiponectin levels after adjusting for age, waist‐to‐hip ratio, HOMA‐IR, triglycerides, high‐density lipoprotein (HDL) cholesterol, exercise, and alcohol use. Ghrelin was significantly lower in Filipinas compared with African‐Americans (1146.9 vs. 1412.2 pg/mL, p < 0.001), and this observation persisted in multivariable analysis (β = ?245.4, p < 0.0001). Ghrelin levels did not differ between whites (1356.9 pg/mL) and either ethnic group. Discussion: Normoglycemic Filipino and African‐American women had significantly lower adiponectin concentrations than white women, and Filipinas had lower ghrelin levels than African‐Americans, independently of body size or indices of insulin resistance or lipids.     

Race and gender differences in the relationships between anthropometrics and abdominal fat in youth

Objective: We examined the influence of race and gender on abdominal adipose tissue (AT) distribution for a given anthropometric measure including waist circumference (WC), waist‐to‐hip ratio (WHR) and waist‐to‐height (W/Ht) in youth. Methods and Procedures: Subjects included healthy 62 black and 98 white youth. A single transverse image of the abdomen (L4–L5) was obtained using computed tomography. Results: For a given BMI, there was a significant (P < 0.05) main effect of race and sex on the relationship between BMI and WC, such that boys and whites had a higher WC than girls and blacks. There was a significant (P < 0.05) main effect and interaction effect of gender on the relationship between WC and visceral AT, such that boys had a higher visceral AT than girls, and the difference was magnified with increasing WC. For a given WC, black boys and girls had higher abdominal subcutaneous AT (SAT) than white peers, wherein the magnitude of the difference is increased with increasing WC. For a given W/Ht, black boys had significantly (P < 0.05) lower visceral AT than white boys, but with no difference in girls. Black boys and girls had higher SAT than white peers, wherein the magnitude of the difference is increased with increasing W/Ht. Discussion: Our findings demonstrate a significant race and gender differential in the abdominal AT distribution for a given BMI, WC, WHR, and W/Ht. Future studies should take these differences into consideration when developing race‐ and gender‐specific anthropometric cut‐offs for obesity and obesity‐related health risks in youth.     

Insulin Resistance is the Best Predictor of the Metabolic Syndrome in Subjects With a First‐Degree Relative With Type 2 Diabetes

Although obesity is associated with insulin resistance and the metabolic syndrome (MetS), some obese individuals are metabolically healthy. Conversely, some lean individuals are insulin resistant (IR) and at increased cardiometabolic risk. To determine the relative importance of insulin sensitivity, BMI and waist circumference (WC) in predicting MetS, we studied these two extreme groups in a high‐risk population. One thousand seven hundred and sixty six subjects with a first‐degree relative with type 2 diabetes were stratified by BMI and homeostasis model assessment of insulin resistance (HOMA_IR) into groups. IR groups had higher triglycerides, fasting glucose, and more diabetes than their BMI‐group insulin sensitive (IS) counterparts. Within both IS and IR groups, obesity was associated with higher HOMA_IR and diastolic blood pressure (BP), but no difference in other metabolic variables. MetS (Adult Treatment Panel III (ATPIII)) prevalence was higher in IR groups (P < 0.001) and more subjects met each MetS criterion (P < 0.001). Within each BMI category, HOMA_IR independently predicted MetS (P < 0.001) whereas WC did not. Within IS and IR groups, age and WC, but not BMI, were independent determinants of MetS (P < 0.001). WC was a less meaningful predictor of MetS at higher values of HOMA_IR. HOMA_IR was a better predictor of MetS than WC or BMI (receiver operating characteristic (ROC) area under the curve 0.76 vs. 0.65 vs. 0.59, P < 0.001). In conclusion, insulin sensitivity rather than obesity is the major predictor of MetS and is better than WC at identifying obese individuals with a healthier metabolic profile. Further, as many lean individuals with a first‐degree relative with type 2 diabetes are IR and metabolically unhealthy, they may all benefit from metabolic testing.     

Genetic and Environmental Influences on Body‐Fat Measures among African‐American Twins

Objective: To investigate the genetic and environmental influences on body‐fat measures including waist circumference (WC), waist‐to‐hip ratio (WHR), and body mass index (BMI) among African‐American men and women. Research Methods and Procedures: Measurements were taken as part of the Carolina African American Twin Study of Aging. This sample currently comprises 146 same‐sex African‐American twins with an average age of 50 years (range, 22 to 88 years). This analysis included 26 monozygotic and 29 dizygotic men and 45 monozygotic and 46 dizygotic women. Maximum likelihood quantitative genetic analysis was used. Results: In men, additive genetic effects accounted for 77% of the variance in WC, 59% in WHR, and 89% in BMI. In women, additive genetic effects accounted for 76% of the variance in WC, 56% in WHR, and 73% in BMI. The remaining variance in both men and women was attributed to unique environmental effects (WC, 21%; WHR, 36%; BMI, 11% in men and WC, 22%; WHR, 38%; BMI, 27% in women) and age (WC, 2%; WHR, 5% in men and WC, 2%; WHR, 6% in women). When BMI was controlled in the analysis of WC and WHR, it accounted for a portion of the genetic and environmental variance in WHR and over one‐half of the genetic and environmental variance in WC. Discussion: There are both genetic and environmental influences on WC, WHR, and BMI, and independent of BMI, there are genetic and environmental effects on WC and WHR among both genders. The results from this African‐American twin sample are similar to findings among white twin samples.     

Impact of Obesity and Body Fat Distribution on Cardiovascular Risk Factors in Hong Kong Chinese

Objective: Body fat distribution has been reported to differentially contribute to the development of cardiovascular risk. We report the relative associations between general and central obesity and risk factors in 2893 Chinese subjects recruited from the Hong Kong population. Research Methods and Procedures: Anthropometric parameters [waist circumference (WC) and BMI], surrogate measures of insulin resistance (fasting plasma glucose and insulin, oral glucose tolerance test, 2 hours glucose and insulin), fasting lipids (total, low‐density lipoprotein‐cholesterol, high‐density lipoprotein‐cholesterol, and triglycerides) and systolic and diastolic blood pressure were measured. General obesity was classified as BMI ≥25.0 kg/m² and central obesity as a WC ≥80 or ≥90 cm in women and men, respectively. Results: A total of 39.2% of the population was found to be obese. Obesity per se increased the levels of the risk factors, but central adiposity contributed to a greater extent to adverse high‐density lipoprotein‐cholesterol, triglyceride, and insulin resistance levels. There was a continuous relationship between increasing obesity, both general and central, and cardiovascular risk, with lowest risk associated with the lowest indices of obesity. In the 1759 nonobese subjects divided into quartiles of BMI or WC, the levels of the cardiovascular risk factors still significantly increased with increasing quartiles of adiposity. Discussion: Central adiposity appears to contribute to a greater extent than general adiposity to the development of cardiovascular risk in this population. The relationship between obesity parameters and risk is a continuum, with risk factors significantly increasing even at levels usually considered nonobese. These observations support the proposed redefinition of overweight and obesity in Asian populations using lower cut‐off points.     

Weight loss and health outcomes in African Americans and whites after gastric bypass surgery

Objective: The objective was to describe differences in weight loss, dietary intake, and cardiovascular risk factors between white and African‐American patients after gastric bypass (GBP). Research Methods and Procedures: This was a retrospective database review of a sample of 84 adult patients (24 African‐American and 60 white women and men) between the ages of 33 and 53 years. All subjects had GBP surgery in 2001 at the Bariatric Surgery Program at Boston Medical Center in Boston, MA, and were followed for one year postoperatively. Patients were excluded if weight data were missing at baseline, 3 months, or 1 year after GBP. A total of 9 African Americans and 41 whites provided data at all 3 time‐points and were included in the study. Differences in weight loss, diet, and cardiovascular risk factors were analyzed. Results: There were no differences in baseline characteristics between African Americans and whites. Mean weight loss for the entire sample was 36 ± 9%, with a range of 8% to 54% relative to initial body weight. Whites lost more weight (39 ± 8%) than African Americans (26 ± 10%) (p < 0.05). Dietary parameters, as well as improvements in blood pressure and lipid profiles, were similar in the two racial groups. Discussion: Differences in weight loss between severely obese African Americans and whites undergoing open GBP are unlikely to be related to postoperative dietary practices. Our data are consistent with previous reports implicating metabolic differences between the two racial groups.     

Associations of Fat Distribution and Obesity with Hypertension in a Bi‐ethnic Population: The ARIC Study

Objective: To examine associations of hypertension with obesity and fat distribution among African American and white men and women. Research Methods and Procedures: The analysis sample included 15,063 African American and white men and women between the ages of 45 and 64 years who were participants in the 1987 through 1989 examination of the Atherosclerosis Risk in Communities Study (ARIC). Odds ratios and adjusted prevalences of hypertension were calculated across sexspecific quintiles of body mass index (BMI), waist‐to‐hip ratio (WHR), waist circumference, and waist‐to‐height ratio (waist/height) and adjusted for age, research center, smoking, education, physical activity, alcohol consumption, hormone replacement therapy, and menopausal status. Results: The prevalence of hypertension was higher among African Americans than whites. In the lowest quintile of BMI, 41% of African American women and 43% of African American men had hypertension compared with 14% of white women and 19% of white men. Elevated BMI, WHR, waist circumference, and waist/height were associated with increased odds of hypertension in African American and white men and women. In women, but not in men, there were significant interactions between ethnicity and the anthropometric variables studied here. The direction of the interaction indicated larger odds ratios for hypertension with increasing levels of anthropometric indices in white compared with African American women. Discussion: Obesity and abdominal fat preponderance were associated with increased prevalence of hypertension in African American and white men and women. Associations were similar among African American and white men, but obesity and fat patterning were less strongly associated with hypertension in African American than in white women.     

Leptin Predicts a Worsening of the Features of the Metabolic Syndrome Independently of Obesity

Objective: The term metabolic syndrome (MS) describes a cluster of cardiovascular risk factors including dyslipidemia, glucose intolerance, insulin resistance, and hypertension. Obesity increases the risk of MS, but as obesity is neither necessary nor sufficient to cause the syndrome, there is considerable interest in identifying obesity‐independent pathways. One such pathway may involve the actions of the adipokine leptin, which is associated cross‐sectionally with MS and prospectively with coronary heart disease and stroke, independently of obesity. Our goal was to test the hypothesis that leptin predicts the development of the features of MS independently of obesity. Research Methods and Procedures: This study used a prospective population‐based cohort of 748 middle‐aged whites in whom baseline measures of leptin and repeated measurement of the subcomponents of the MS at 5 and 10 years were available. The features of the MS were characterized as five factors (obesity, dyslipidemia, elevated blood pressure, glucose intolerance, and insulin resistance), which were combined to create an MS summary score. Results: Baseline leptin significantly predicted the development of obesity (p = 0.001) and, after adjustment for BMI, development of glucose intolerance (p = 0.016) and insulin resistance (p < 0.0001). Leptin levels did not independently predict a change in lipids or blood pressure. Leptin levels significantly predicted the development of the MS (p = 0.036), independently of baseline BMI. Discussion: Leptin predicts the development of the MS independently of baseline obesity. This association is specifically related to the development of glucose intolerance and insulin resistance. The extent to which these relationships are explained through residual confounding by obesity remains to be determined.     

Effect of Family History of Type 2 Diabetes on White Blood Cell Count in Adult Women

Objective: To evaluate the effect of a first‐degree family history of type 2 diabetes on white blood cell (WBC) count, a risk factor for atherosclerotic vascular disease, in glucose‐tolerant adult women Research Methods and Procedures: WBC count was measured in 174 normal weight, overweight, and obese female offspring of type 2 diabetic patients (FH⁺) and 174 age‐ and BMI‐matched female controls with no family history of type 2 diabetes (FH^?). Other measurements included fat mass (FM), measured by body impedance analysis; central fat accumulation, evaluated by waist circumference; insulin resistance, estimated by homeostatic model assessment for insulin resistance (HOMA_IR); systolic and diastolic blood pressure; and fasting concentrations of glucose, insulin, and lipids. Results: WBC count, waist circumference, systolic blood pressure, and fasting levels of glucose, insulin, and triglycerides were significantly higher in FH⁺ than in FH^? subjects. In FH⁺ individuals, WBC count was positively associated with BMI, FM, waist circumference, HOMA_IR, and triglyceride and insulin concentrations, and negatively correlated with age and high‐density lipoprotein‐cholesterol. In FH^? subjects, WBC count was directly associated with BMI, FM, waist circumference, and triglyceride and insulin concentrations, and inversely correlated with age and high‐density lipoprotein‐cholesterol. After multivariate analyses, WBC count maintained a significant association with age, systolic blood pressure, and HOMA_IR in FH⁺ subjects and with age, BMI, FM, and triglycerides in FH^? individuals. Discussion: This study indicates that WBC count is increased in adult women with genetic predisposition to type 2 diabetes, and its main correlates are insulin resistance in FH⁺ and adiposity in FH^? individuals.     

RETRACTION: C-reactive Protein and Metabolic Syndrome in Youth: A Strong Relationship?

Retraction: Note from the Editor‐in‐Chief: This paper is retracted Objective: Metabolic syndrome (MS) is on the rise in youth. As high‐sensitivity C‐reactive protein (hs‐CRP) is associated with cardiovascular/metabolic disorders, we evaluated the association between MS and its components and hs‐CRP in a sample of Brazilian overweight and obese youth. Methods and Procedures: A total of 407 students (229 girls, 273 with excessive weight, 11.3 ± 3.2 years) were evaluated. Measurement included BMI, waist circumference (WC), blood pressure, lipids, insulin, and hs‐CRP. Excessive weight was defined using BMI z ‐score; MS by the modified National Cholesterol Education Program—Adult Treatment Panel III. Results: Subjects were classified into two groups: with MS (n = 72) and without (n = 335). hs‐CRP means and medians were higher in MS group (1.41 mg/l vs. 1.06 mg/l, P < 0.001; 2.21 mg/l vs. 1.23 mg/l, P < 0.001). Associations between hs‐CRP quartiles and insulin resistance (IR) (P < 0.001), MS (P < 0.001), WC (P < 0.000), BMI z‐score (P < 0.001), hypertension (P < 0.001), hypertriglyceridemia (P < 0.001), and low HDL‐c (P = 0.023) were significant; adjustment of hs‐CRP for BMI z‐score eliminated the previous association, except for the number of MS components (nMSc) (P < 0.001). Adjusting for homeostasis model assessment method of IR (HOMA‐IR) did not eliminate the relation between hs‐CRP and MS components. Furthermore, increases in BMI z ‐score and nMSc were associated with an increased hs‐CRP. Excessive weight (odds ratio (OR), 7.9; confidence interval (CI), 4.7–13.4; P = 0.000), hypertension (OR, 2.3; CI, 1.3–4.2; P = 0.003), and hypertriglyceridemia (OR, 2.3; CI, 1.5–3.7; P < 0.001) were independently associated with hs‐CRP. Discussion: In youth, hs‐CRP is strongly related with MS and its components, and is also determined by the body composition. This association indicates a precocious proinflammatory state.     

Sequence Variants of the POMC Gene and Their Associations with Body Composition in Children

We investigated POMC sequence variants in 242 overweight and nonoverweight African‐American and white children and examined the associations between body composition and POMC polymorphisms. Three novel polymorphisms and two previously identified sequence variants were found: A7301G, A7429G, and C8246T were all in untranslated regions. A 9‐bp (AGC AGC GGC) duplication/insertion was found between positions 7677 and 7678, and one normal‐weight African‐American girl had a 45‐bp triple duplication/insertion at this location. Compared with whites, African‐American children were significantly more likely to have polymorphisms A7301G, A7429G, and the 9‐bp insertion. However, there were no significant associations between any of the polymorphisms and body composition. Five African‐American subjects who were homozygous for A7429G had a trend (p = 0.08) for a greater BMI‐SD score (5.3 ± 5.3 kg/m²) compared with wild‐type children (BMI‐SD score, 2.4 ± 3.2 kg/m²) or heterozygotes (BMI‐SD score, 2.7 ± 3.7 kg/m²). However, there were no differences in BMI‐SD score for A7429G when African American subjects were studied separately and both gender and height were taken into account. The contribution of the POMC gene variants we studied to pediatric‐onset obesity seems to be limited.