Changes in waist circumference and the incidence of acute myocardial infarction in middle-aged men and women

Background

Waist circumference (WC) measured at one point in time is positively associated with the risk of acute myocardial infarction (MI), but the association with changes in WC (DWC) is not clear. We investigated the association between DWC and the risk of MI in middle-aged men and women, and evaluated the influence from concurrent changes in BMI (DBMI).

Methodology/Principal Findings

Data on 38,593 participants from the Danish Diet, Cancer and Health study was analysed. Anthropometry was assessed in 1993–97 and 1999–02. Information on fatal and non-fatal MI was obtained from National Registers. Cases were validated by review of the medical records. Hazard ratios (HR) were calculated from Cox proportional hazard models with individuals considered at risk from 1999–02 until December 30 2009. During 8.4 years of follow-up, 1,041 incident cases of MI occurred. WC was positively associated with the risk of MI, but weakly after adjustment for BMI. DWC was not associated with the risk of MI (HR per 5 cm change  = 1.01 (0.95, 1.09) with adjustment for covariates, baseline WC, BMI and DBMI). Associations with DWC were not notably different in sub-groups stratified according to baseline WC or DBMI, or when individuals with MI occurring within the first years of follow-up were excluded.

Conclusions/Significance

WC was positively associated with the risk of MI in middle-aged men and women, but changes in WC were not. These findings suggest that a reduction in WC may be an insufficient target for prevention of MI in middle-aged men and women.     

Alpha-linolenic acid intake and 10-year incidence of coronary heart disease and stroke in 20,000 middle-aged men and women in the Netherlands

Background

Whether intake of alpha-linolenic acid (ALA), the plant-derived n-3 polyunsaturated fatty acid (PUFA), could prevent cardiovascular diseases is not yet clear. We examined the associations of ALA intake with 10-year incidence of coronary heart disease (CHD) and stroke in the Netherlands.

Methods

Data were collected from a general population of 20,069 generally healthy men and women, aged 20 to 65 years. Habitual diet was assessed at baseline (1993–1997) with a validated 178-item food frequency questionnaire. Incidences of CHD and stroke were assessed through linkage with mortality and morbidity registers. Hazard ratios (HR) were calculated with multivariable Cox proportional hazards models, adjusted for age, gender, lifestyle, and dietary factors.

Results

During 8–13 years of follow-up, we observed 280 incident CHD events (19% fatal) and 221 strokes (4% fatal). Intakes of energy-adjusted ALA in quintiles ranged from less than 1.0 g/d in the bottom quintile (Q1) to more than 1.9 g/d in the top quintile (Q5). ALA intake was not associated with incident CHD, with HRs varying between 0.89 and 1.01 (all p>0.05) in Q2–Q5 compared with the bottom quintile of ALA intake. For incident stroke, however, participants in Q2–Q5 had a 35–50% lower risk compared with the reference group. HRs were 0.65 (0.43–0.97), 0.49 (0.31–0.76), 0.53 (0.34–0.83), and 0.65 (0.41–1.04) for Q2–Q5 respectively.

Conclusion

In this general Dutch population, ALA intake was not associated with incident CHD. The data suggested that a low intake of ALA may be a risk factor for incident stroke. These results warrant confirmation in other population-based studies and in trials.     

Interrelationship of waist circumference and subcutaneous fat with metabolic and blood pressure measures among Asian Indian men

People of South Asian origin (e.g. Indians) usually have a more centralized distribution of body fat with thick trunk skinfolds and markedly higher mean waist circumference (WC) for a given level of body fat percentage compared to Europeans and are exceedingly susceptible to coronary heart disease (CHD) worldwide. Owing to ethnic heterogeneity, population specific information on the interrelationship of fat topography with metabolic and blood pressure measures in different Indian populations is immediately required. In view of the above consideration the present work was undertaken to study the interrelationship of the WC and the sum of four (biceps, triceps, subscapular, suprailiac) skinfolds (SF4) with metabolic and blood pressure variables among the well-off Bengalee men aged 30 years and above from Calcutta and suburbs. The sample of the present study comprises 212 male railway employees of the Eastern Railway, Government of India. All 212 subjects were residents of Calcutta and its suburbs. Anthropometrics, lipids (total cholesterol, fasting triglyceride, high, low and very low density lipoprotein cholesterol), fasting plasma glucose and blood pressure measures were taken from each participant. Two-sample (unpaired) t-test revealed that centrally obese men (waist circumference=90 cm) had significantly greater means compared to centrally non-obese subjects for metabolic risk factors and blood pressure. Inter-tertile comparison of lipids, lipoproteins and glucose revealed that there existed no significant differences in their distribution according to SF4 tertiles. The results of multiple regression analyses (after controlling for the linear, cubic and quadratic effect of age) using waist circumferences and SF4 as independent variables demonstrated the significant effect of central obesity on metabolic and blood pressure variables in the study population. This finding indicated the clinical and physiological importance of central body fat accumulation particularly in and around the waist line in explaining risk factors for chronic diseases, e.g. CHD.     

Similar level of impairment in exercise performance and oxygen uptake kinetics in middle-aged men and women with type 2 diabetes

The present study tested the hypothesis that the magnitude of the type 2 diabetes-induced impairments in peak oxygen uptake (Vo(2)) and Vo(2) kinetics would be greater in females than males in middle-aged participants. Thirty-two individuals with type 2 diabetes (16 male, 16 female), and 32 age- and body mass index (BMI)-matched healthy individuals (16 male, 16 female) were recruited. Initially, the ventilatory threshold (VT) and peak Vo(2) were determined. On a separate day, subjects completed four 6-min bouts of constant-load cycling at 80% VT for the determination of Vo(2) kinetics using standard procedures. Cardiac output (CO) (inert gas rebreathing) was recorded at rest, 30, and 240 s during two additional bouts. Peak Vo(2) (ml·kg(-1)·min(-1)) was significantly reduced in men and women with type 2 diabetes compared with their respective nondiabetic counterparts (men, 27.8 ± 4.4 vs. 31.1 ± 6.2 ml·kg(-1)·min(-1); women, 19.4 ± 4.1 vs. 21.4 ± 2.9 ml·kg(-1)·min(-1)). The time constant (s) of phase 2 (τ(2)) and mean response time (s) of the Vo(2) response (MRT) were slowed in women with type 2 diabetes compared with healthy women (τ(2), 43.3 ± 9.8 vs. 33.6 ± 10.0 s; MRT, 51.7 ± 9.4 vs. 43.5 ± 11.4s) and in men with type 2 diabetes compared with nondiabetic men (τ(2), 43.8 ± 12.0 vs. 35.3 ± 9.5 s; MRT, 57.6 ± 8.3 vs. 47.3 ± 9.3 s). The magnitude of these impairments was not different between males and females. The steady-state CO responses or the dynamic responses of CO were not affected by type 2 diabetes among men or women. The results suggest that the type 2 diabetes-induced impairments in peak Vo(2) and Vo(2) kinetics are not affected by sex in middle aged participants.     

Hypertriglyceridemic waist phenotype is associated with decreased insulin sensitivity and incident diabetes in elderly men

Objective: To investigate the association between hypertriglyceridemic waist (HTGW) and insulin sensitivity (assessed by euglycemic clamp method), and the development of diabetes in a longitudinal community‐based cohort of elderly men without diabetes at baseline. Design and Methods: The present cross‐sectional study comprised 1,026, 70‐year‐old men without diabetes. The gold standard euglycaemic–hyperinsulinaemic clamp technique was used. Six‐year follow‐up on diabetes status were available in n = 667. The HTGW phenotype was defined as having waist circumference ≥ 90 cm, and triglycerides ≥ 2 mmol L^?1. The men were stratified into those having normal WC and TG (n = 299), one HTGW component (n = 606), and HTGW (n = 121). Results: The association between insulin sensitivity and one HTGW component as well as HTGW was highly significant (P < 0.001) in the whole sample, as well as in individuals with high/low BMI (stratified at ≥25). In longitudinal analyses, participants with HTGW was associated with a more than fourfold increased risk for diabetes (Odds ratio 4.64, 95% CI 1.61–13.4, P = 0.004) compared to those with normal WC and TG. Conclusion: The present study both confirm and extend previous research suggesting that the HTGW‐phenotype portrays an increased glucometabolic risk, also in lean individuals.     

Age at menarche, the leg length to sitting height ratio, and risk of diabetes in middle-aged and elderly Chinese men and women

Aims

To evaluate the associations of age at menarche and the leg length-to-sitting-height ratio, markers of adolescent growth, with risk of diabetes in later life.

Materials and Methods

Information from 69,385 women and 55,311 men, aged 40–74 years from the Shanghai Women''s Health Study and Shanghai Men''s Health Study, were included in the current analyses. Diabetes status was ascertained through biennial in person follow-up. Cox models, with age as the time scale, were used.

Results

There were 2369 cases of diabetes (1831 women; 538 men) during an average of 7.3 and 3.6 years of follow-up of the women and men, respectively. In females, menarche age was inversely associated with diabetes risk after adjustment for birth cohort, education, and income (HR = 0.95, 0.92–0.98). In both genders, leg length-to-sitting-height ratio was inversely related to diabetes (HR = 0.88, 0.80–0.97 for men; HR = 0.91, 0.86–0.96 for women) after adjustment for birth cohort, education, and income. Further adjustment for adult BMI at study enrollment completely eliminated the associations of age at menarche (HR = 0.99, 0.96–1.02) and the leg length-to-sitting-height ratio (HR = 1.00, 0.91–1.10 for men; HR = 1.01, 0.96–1.07 for women) with diabetes risk.

Conclusions

Our study suggests that markers of an early age at peak height velocity, i.e. early menarche age and low leg-length-to-sitting height ratio, may be associated with diabetes risk later in life and this association is likely to be mediated through obesity.     

Abdominal depth and waist circumference as influential determinants of human female attractiveness

Previous research based largely on two-dimensional (2D) line drawings and picture stimuli has established that both body mass index (BMI) and waist-to-hip ratio (WHR) influence the perceived attractiveness of human female bodies. Here, we extend these studies by (1) creating a more ecologically valid stimulus set consisting of 3D videos and 2D still shots from real female “models” rotating in space, and (2) measuring and examining the influence of several additional anthropometric variables that previously have not been considered. Multiple linear regression analysis revealed that the depth of the lower torso at the umbilicus, or abdominal depth, and waist circumference were the strongest predictors of attractiveness, stronger than either BMI or WHR. Women with shallow abdominal depth and small waist circumference are more likely to be healthy and nonpregnant, suggesting that this may be an adaptive male preference that has been shaped by natural selection. Leg length was a consistent positive predictor of attractiveness, perhaps because it has been correlated with biomechanical efficacy or healthy prepubertal growth that is unhindered by nutritional or energetic deficiency. Our results show that conclusions regarding anthropometric predictors of attractiveness are influenced by the visual perspective of the perceiver, as well as the anthropometric variables considered for analysis.     

Blood pressure and waist circumference: an empirical study of the effects of waist circumference on blood pressure among Bengalee male jute mill workers of Belur,West Bengal,India

An investigation of 150 adult Bengalee Hindu male jute mill workers in Belur, a suburb of Kolkata, West Bengal, India, was conducted to study the relationship between central obesity and blood pressure. In accordance with their waist circumference measurement, the subjects were divided into two categories: centrally non-obese (CNO) and centrally obese (CO). The participants were classified as the CO group if they had a WC of 80 cm or more. Results showed that none of the CNO subjects was mild hypertensive (SBP>/=140 mmHg and/or DBP>/=90 mmHg) while 85 of the CO subjects (82.5%) were mild hypertensives, the difference being statistically significant (chi-square=9.33; p<0.0025). Moreover, the data also revealed that the CO subjects had much (p<0.001) greater mean weight, body mass index (BMI), systolic (SBP), diastolic (DBP) and mean arterial (MAP) blood pressure than the CNO group members. The significant difference in blood pressure was found even after correcting the confounding effects of age and BMI variables. The results of this study showed that, the Bengalee male jute mill workers in the CO group had significantly higher blood pressure irrespective of age and overall adiposity (BMI). Therefore, the presence of central obesity is deemed a risk factor, for hypertension regardless of age and BMI. Thus, a WC cut-off point of 80 cm could be employed for health promotion among Bengalee men so as to prevent and manage hypertension effectively.     

Amerindians normalized waist circumference and obesity diagnosis standarized by biochemical and HLA data

Metabolic syndrome (MS) and obesity are principal causes of morbidity all over the World, particularly for their association to cardiovascular risk. Amerindians are often living in countries and remote areas with unavailable sophisticated diagnoses methodologies. However, waist-circumference is a reliable and easy to record parameter of visceral obesity and MS. Waist circumference normal values are not yet established in Amerindians: South Asian and Japanese values have been recommended for Amerindian use. The purpose of this study is to objectively define for the first time the waist circumference measure cut-off points for Amerindians. A total of 303 unrelated Amerindian adults recently immigrated to Madrid were studied; they were healthy, since they were questioned and tested as appropriate for blood donation. Waist-circumference was measured in these voluntary blood donors after written consent. Chosen subjects for study had HLA quasi-specific Amerindian genes and not gained weight since their relatively short time living in Spain. Amerindians with Type I or II diabetes or family antecedents were removed from the study. The biochemical parameter used to define normality for MS was the reliable serum HDL-cholesterol levels, whose values are diet independent. A Receiver Operating Characteristic analysis was used to compare the predictive validity and to find out the optimal cut-off points of waist circumference normal values. Cut-off points were ≤88.5 cm in males and ≤82.5 cm in females; these values were close to the median values (88 and 82.2 cm, respectively). Obtained waist circumference values recorded here in normal Amerindians are different to those previously recommended indirectly (those of South Asian/Japanese populations). These parameters may be of great value for American countries health care in order to predict and control MS and its cardiovascular complications. Other countries having a heavy Amerindian immigration (i.e.: USA, Spain) may also benefit for establishing specific Preventive Medicine programs.     

Changes in sexual behaviour and the fall in incidence of HIV infection among homosexual men.

To investigate the epidemiology and normal course of infection with HIV the prevalence and incidence of the infection were studied among two cohorts of homosexual men in Amsterdam in 1980-7. The cumulative incidence of infection increased from a weighted 2.2% in 1980 to 39.0% in 1987. The estimated yearly incidence of HIV was 3.0% in 1981, rose to 8.8% in 1984, and fell gradually to 0% in 1987. During the study the sexual behaviour of the cohorts was examined. The number of men with whom anopenetrative intercourse was practised fell from a mean of 10.6 to 1.4 for those positive for HIV antibody, whereas the number with whom anoreceptive intercourse was practised fell from a mean of 3.7 to 0.5 for those negative for the antibody. In addition, there was a reduction in the number of cases of hepatitis B and syphilis among men in general. The decline in infection with HIV was assumed to be linked to changes in sexual behaviour. Such changes practised early in the course of the epidemic probably had a strong effect on the number of cases of AIDS among homosexual men in Amsterdam.     

Low molecular weight adiponectin negatively correlates with the waist circumference and monocytic IL-6 release

Adiponectin circulates as trimer (LMW), hexamer (MMW) and high molecular weight multimer (HMW) but the distribution and effects of these isoforms have not been studied in detail. Monocytes were isolated from normal weight and overweight controls and patients with type 2 diabetes mellitus (T2D) and monocytic release of IL-6 positively correlated with the body mass index (BMI). HMW-adiponectin further enhanced and LMW-adiponectin reduced IL-6 release in monocytes. Systemic total adiponectin, and the HMW isoform were not different in these groups but MMW-adiponectin was lower in T2D, and LMW-adiponectin was reduced in the obese and T2D. Circulating LMW-adiponectin negatively correlated to monocytic IL-6 release. Systemic IL-6 was higher in the obese control group and T2D, respectively, but did not correlate with monocytic IL-6 secretion. Therefore, the current study indicates that HMW-adiponectin exerts pro- and LMW-adiponectin antiinflammatory effects and reduced LMW-adiponectin in obesity may partly contribute to elevated monocytic IL-6 release.     

A weekly administered sustained-release growth hormone reduces visceral fat and waist circumference in abdominal obesity

Administration of recombinant human growth hormone (rhGH) in obesity has been known to lead to a decrease in visceral adiposity and an increase in lean body mass. Most studies have used supraphysiological doses of rhGH, which were administered daily or every other day. We aimed to evaluate whether weekly administered low dose of sustained-release rhGH (SR-rhGH) could play a therapeutic role in the treatment of abdominal obesity. Prospective, single-arm, open-label, multicenter pilot study was carried out. Participants were 26 adults aged 40-65 years old with abdominal obesity (male: waist circumference >90?cm, female: waist circumference >85?cm). The subjects were given 3?mg of SR-rhGH, administered subcutaneously, weekly for 26 weeks. SR-rhGH treatment for 26 weeks increased the IGF-1 level by 56.53±76.09?μg/l (SDS 0.77±1.12) compared to the baseline (p=0.0022). After 26 weeks, SR-rhGH treatment reduced abdominal visceral adipose tissue (VAT) (140.35±75.97 to 128.43±73.85?cm2, p=0.0038). Average waist circumference decreased from 96.25±6.41 to 91.93±6.13?cm (p<0.0001) after treatment. However, body weight or lean body mass did not show any significant change. In conclusion, SR-rhGH treatment for 26 weeks reduced abdominal visceral fat and waist circumference without severe adverse events. Further studies may be considered on the role of weekly administered SR-rhGH as a treatment for abdominal obesity.     

The epidemiology of low- and high-energy distal radius fracture in middle-aged and elderly men and women in southern norway

Background

Distal radius is one of the most frequent sites for fractures in the elderly population. Despite this, there is a paucity of epidemiological data for distal radius fracture, in particular, distinguishing between high- and low-energy fractures. Our aim was to study the epidemiology of high- and low-energy distal radius fracture in middle-aged and elderly men and women in Southern Norway, and search for associates with high- or low-energy distal radius fracture in this population.

Methodology/Principal Findings

Patients with distal radius fractures aged ≥50 years were identified from all four hospitals in Southern Norway between 2004 and 2005. Age-adjusted and age-specific incidence rates for men and women were calculated, and potential associates with high- and low-energy distal radius fracture were explored both in univariate and multivariate analyses. A total of 799 individuals (118 men and 681 women) aged ≥50 years with low-energy and 84 (48 men and 36 women) with high-energy distal radius fracture were identified. The overall age-adjusted incidence rate per 10,000 person-years was 18.9 for men (low energy, 12.8 vs. high-energy, 6.1) and 75.1 for women (low energy, 71.1 vs. high energy, 4.0). In multivariate model, younger age, male gender, summer season, and living in a rural area were independently associated with an increased risk of high-energy fracture.

Conclusion

An approximately fourfold higher age-adjusted incidence rate for distal radius fracture was found among women, when compared with men. However, the proportion of patients with high-energy distal radius fracture was approximately fivefold higher in men than in women. Our data suggest that younger age, male gender, summer seasons, and living in rural areas are independent risk factors for increased risk of high-energy distal radius fracture.     

Body mass index, waist circumference and waist-to-hip ratio: which anthropometric indicator is better predictor for the hypertension development in women population of the island Cres

The aim of this research was to investigate the prevalence of obesity and high blood pressure and to prove which of three anthropometric indicators of obesity - waist circumference, body mass index (BMI) waist-to-hip ratio - is better predictor for the development of hypertension in women population of the island of Cres. We approached separately groups of women with measured high blood pressure and with previously diagnosed. The research was preformed within the research project "Genetic and biomedical characteristics of the population of the island of Cres". This was the cross sectional study and data were obtained on the sample of 247 females over 18 years old that voluntarily participated in this study. In our study group the prevalence of overweight was 39.0%, obesity 27.5%, increased waist circumference was present in 69.4% while increased blood pressure was found in 53.0% examinees. Our results indicate that age, BMI, impaired glucose concentration and serum cholesterol could be considered as predictors for the development of arterial hypertension, whether measured or previously diagnosed.     

Inter-generation social mobility modifies framingham risk score in Polish middle-aged men, but not in women

In modern societies, there are regular social gradients in most health parameters, and also in the structure of morbidity and mortality. However, the significance of inter-generation social mobility for general health status still remains equivocal. This study was therefore performed in order to compare the effect of social mobility on coronary heart disease (CHD) risk between middle-aged Polish men and women. A total of 342 men and 458 women, aged 40 and 50 and inhabitants of Wroc?aw, were examined. Risk of CHD was estimated using the Framingham Risk Score (FRS), calculated for each individual. Social mobility was defined as an inter-generation change in social status expressed as educational level between the examined individual and his/her father. Using two-variable regression models, it was demonstrated that FRS in men was determined by both their father's education level (beta=0.33, p<0.0001) and inter-generation change in educational status (beta=0.18, p=0.008). In contrast, FRS in women was related only to their father's education level (beta=0.35, p<0.0001), but not to inter-generation social mobility (beta=0.35, p=0.25). In particular, an incremental change in educational level among those men whose father had finished primary school at the very most or among those whose father had finished basic trade school was accompanied by a significant decrease in FRS (F=4.12, p=0.009 and F=3.25, p=0.04, respectively). It is concluded that inter-generation social mobility modifies CHD risk (as estimated using FRS) in middle-aged Polish men, but not in women. The precise mechanisms responsible for the observed sex difference in this phenomenon need to be established in further studies.     

Hypertriglyceridemia and waist circumference predict cardiovascular risk among HIV patients: a cross-sectional study

Background

Although half of HIV-infected patients develop lipodystrophy and metabolic complications, there exists no simple clinical screening tool to discern the high from the low-risk HIV-infected patient. Thus, we evaluated the associations between waist circumference (WC) combined with triglyceride (TG) levels and the severity of lipodystrophy and cardiovascular risk among HIV-infected men and women.

Methods

1481 HIV-infected men and 841 HIV-infected women were recruited between 2005 and 2009 at the metabolic clinic of the University of Modena and Reggio Emilia in Italy. Within each gender, patients were categorized into 4 groups according to WC and TG levels. Total and regional fat and fat-free mass were assessed by duel-energy x-ray absorptiometry, and visceral adipose tissue (VAT) and abdominal subcutaneous AT (SAT) were quantified by computed tomography. Various cardiovascular risk factors were assessed in clinic after an overnight fast.

Results

The high TG/high WC men had the most VAT (208.0±94.4 cm²), as well as the highest prevalence of metabolic syndrome (42.2%) and type-2 diabetes (16.2%), and the highest Framingham risk score (10.3±6.5) in comparison to other groups (p<0.05 for all). High TG/high WC women also had elevated VAT (150.0±97.9 cm²) and a higher prevalence of metabolic syndrome (53.3%), hypertension (30.5%) and type-2 diabetes (12.0%), and Framingham risk score(2.9±2.8) by comparison to low TG/low WC women (p<0.05 for all).

Conclusions

A simple tool combining WC and TG levels can discriminate high- from low-risk HIV-infected patients.