γ‐Glutamyltransferase,Obesity, Physical Activity,and the Metabolic Syndrome in Indigenous Australian Adults

The aim of this study is to examine the association between obesity, metabolic syndrome, physical activity, and elevated γ‐glutamyltransferase (GGT) among Indigenous Australian adults who did not drink alcohol. A cross‐sectional study of 791 Indigenous adults in rural North Queensland communities was conducted between 1999 and 2001. Measures included serum GGT, fasting glucose, cholesterol, and triglycerides; resting blood pressure, BMI, and waist circumference; and self‐reported physical activity, alcohol intake, and tobacco smoking. Central obesity measured by waist circumference in this population was significantly associated with elevated GGT independently of lifestyle behaviors (Adjusted odds ratio (OR) = 2.7, 95% confidence interval (CI): 1.2–6.0). Metabolic syndrome (International Diabetes Federation definition) was also strongly associated with increased GGT (OR = 2.6, 95% CI: 1.5–4.6). Habitual physical activity may be slightly protective (OR = 0.9, 95% CI: 0.5–1.6) in this group, but this was not clearly demonstrated in this study. Prevention of type 2 diabetes and cardiovascular disease in this population should emphasize “waist loss” and metabolic health through dietary and other interventions.     

Body size phenotypes and inflammation in the Women's Health Initiative Observational Study

Individuals with "metabolically benign" obesity (obesity unaccompanied by hypertension, dyslipidemia, and diabetes) are not at elevated 10-year risk of cardiovascular disease (CVD) compared to normal weight individuals. It remains unclear whether these obese individuals or normal weight individuals with clustering of cardiometabolic factors display heightened immune activity. Therefore, we characterized levels of acute-phase reactants (C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), white blood cell (WBC) count), adhesion molecules (E-selectin, vascular cell adhesion molecule-1), and coagulation products (fibrinogen, plasminogen activator inhibitor-1 (PAI-1)) among four body size phenotypes (normal weight with 0/1 vs. ≥2 metabolic syndrome components/diabetes and overweight/obesity with 0/1 vs. ≥2 metabolic syndrome components/diabetes) in cross-sectional analyses of 1,889 postmenopausal women from the Women's Health Initiative Observational Study (WHI-OS) nested case-control stroke study. Higher levels of all three inflammatory marker categories were found among women with overweight/obesity or ≥2 metabolic syndrome components or diabetes. Compared to normal weight women with 0 or 1 metabolic syndrome components, normal weight women with ≥2 metabolic syndrome components or diabetes were more likely to have ≥3 inflammatory markers in the top quartile (multivariate odds ratio (OR) 2.0, 95% confidence interval (CI): 1.3-3.0), as were overweight/obese women with 0 or 1 metabolic syndrome components (OR 2.3; 95% CI: 1.5-3.5). Overweight/obese women with ≥2 metabolic syndrome components or diabetes had the highest OR (OR 4.2; 95% CI: 2.9-5.9). Despite findings that metabolically benign obese individuals are not at increased 10-year risk of CVD compared to normal weight individuals, the current results suggest that overweight/obese women without clustering of cardiometabolic risk factors still possess abnormal levels of inflammatory markers.     

Cardiovascular Disease Risk of Abdominal Obesity vs. Metabolic Abnormalities

It remains unclear whether abdominal obesity increases cardiovascular disease (CVD) risk independent of the metabolic abnormalities that often accompany it. Therefore, the objective of this study was to evaluate the independent effects of abdominal obesity vs. metabolic syndrome and diabetes on the risk for incident coronary heart disease (CHD) and stroke. The Framingham Offspring, Atherosclerosis Risk in Communities, and Cardiovascular Health studies were pooled to assess the independent effects of abdominal obesity (waist circumference >102 cm for men and >88 cm for women) vs. metabolic syndrome (excluding the waist circumference criterion) and diabetes on risk for incident CHD and stroke in 20,298 men and women aged ≥45 years. The average follow‐up was 8.3 (s.d. 1.9) years. There were 1,766 CVD events. After adjustment for demographic factors, smoking, alcohol intake, number of metabolic syndrome components, and diabetes, abdominal obesity was not significantly associated with an increased risk of CVD (hazard ratio (HR) (95% confidence interval): 1.09 (0.98, 1.20)). However, after adjustment for demographics, smoking, alcohol intake, and abdominal obesity, having 1–2 metabolic syndrome components, the metabolic syndrome and diabetes were each associated with a significantly increased risk of CVD (2.12 (1.80, 2.50), 2.82 (1.92, 4.12), and 5.33 (3.37, 8.41), respectively). Although abdominal obesity is an important clinical tool for identification of individuals likely to possess metabolic abnormalities, these data suggest that the metabolic syndrome and diabetes are considerably more important prognostic indicators of CVD risk.     

Effects of smoking and obesity on the association between CDH13 (rs3865188) and adiponectin among Korean men: the KARE study

Adiponectin is secreted exclusively by adipocytes. Adiponectin is regulated by obesity, smoking, and genetic factors, including CDH13, which may contribute to development of diseases such as cardiovascular disease. Therefore, we aim to explore the joint effect of smoking and obesity on the association between CDH13 (rs3865188) and adiponectin among Korean men. This study included 1,570 Korean men aged 40-69 years who participated in the KARE cohort study (community-based cohorts, South Korea) from 2001. Hypoadiponectinemia was defined as the lowest quartile of adiponectin. In this study, individuals with at least one at-risk allele, the T allele, had an increased risk for hypoadiponectinemia, particularly current smokers with at least one T allele together with obesity when compared to those without the T allele. In addition, individuals with the TT genotype of CDH13 rs3865188, as well as obesity, were significantly associated with a 1.8-fold (odds ratio (OR) = 9.4, 95% confidence interval (CI) = 4.4-19.6, P < 0.001) increased risk for hypoadiponectinemia compared to individuals with the TT genotype of CDH 13 rs3865188 and normal waist circumference (WC) (OR = 5.1, 95% CI = 3.5-7.6, P < 0.001). However, in the joint effect of smoking and obesity, current smokers with the TT genotype of CDH13 rs3865188, as well as obesity, were significantly associated with a 6.2-fold (OR = 24.2, 95% CI = 3.0-196.6, P < 0.001) increased risk for hypoadiponectinemia compared to nonsmokers with the TT genotype of CDH 13 rs3865188 with normal WC (OR = 3.9, 95% CI = 1.7-9.3, P < 0.001). This study suggested that the association between CDH13 and adiponectin can be modified by lifestyle factors, such as smoking and obesity, among Korean men.     

Association between Noninvasive Fibrosis Markers and Cardio-Vascular Organ Damage among Adults with Hepatic Steatosis

Evidence suggests that advanced fibrosis, as determined by the noninvasive NAFLD fibrosis score (NFS), is a predictor of cardiovascular mortality in individuals with ultrasonography-diagnosed NAFLD. Whether the severity of histology (i.e., fibrosis stage) is associated with more pronounced cardiovascular organ damage is unsettled. In this study, we analyzed the clinical utility of NFS in assessing increased carotid intima-media thickness (cIMT), and left ventricular mass index (LVMI). In this cross-sectional study NFS, cIMT and LVMI were assessed in 400 individuals with ultrasonography-diagnosed steatosis. As compared with individuals at low probability of liver fibrosis, individuals both at high and at intermediate probability of fibrosis showed an unfavorable cardio-metabolic risk profile having significantly higher values of waist circumference, insulin resistance, high sensitivity C-reactive protein (hsCRP), fibrinogen, cIMT, and LVMI, and lower insulin-like growth factor-1 (IGF-1) levels. The differences in cIMT and LVMI remained significant after adjustment for smoking and metabolic syndrome. In a logistic regression model adjusted for age, gender, smoking, and diagnosis of metabolic syndrome, individuals at high probability of fibrosis had a 3.9-fold increased risk of vascular atherosclerosis, defined as cIMT>0.9 mm, (OR 3.95, 95% CI 1.12–13.87) as compared with individuals at low probability of fibrosis. Individuals at high probability of fibrosis had a 3.5-fold increased risk of left ventricular hypertrophy (LVH) (OR 3.55, 95% CI 1.22–10.34) as compared with individuals at low probability of fibrosis. In conclusion, advanced fibrosis, determined by noninvasive fibrosis markers, is associated with cardiovascular organ damage independent of other known factors.     

The Relationship Between Visceral Adiposity and the Risk of Erosive Esophagitis in Severely Obese Chinese Patients

A higher prevalence of erosive esophagitis is found in obese than in nonobese patients; however, it remains unclear why some obese patients develop this disease, whereas others do not. Accordingly, we elucidated the risk factors associated with erosive esophagitis in severely obese Chinese patients. Between June 2007 and January 2009, a total of 260 Chinese patients with morbid obesity referred for bariatric surgery were enrolled in this cross‐sectional study. All patients received preoperative endoscopy for evaluation of the presence and severity of erosive esophagitis. Demographic variables, anthropometric measurements, and metabolic factors were included in a logistic regression model to identify the factors predictive of erosive esophagitis. The prevalence of erosive esophagitis was 32.3%. Multiple logistic regression showed that increased waist circumference (odds ratio (OR) = 1.03, 95% confidence interval (CI) = 1.01–1.04), increased insulin resistance (OR = 1.57, 95% CI = 1.06–2.31), and presence of reflux symptoms (OR = 2.40, 95% CI = 1.22–4.74) were independent risk factors associated with erosive esophagitis. In conclusion, among Chinese patients with morbid obesity, increased waist circumference and insulin resistance were risk factors for erosive esophagitis, which highlights the critical role of visceral adiposity in the pathogenesis of erosive esophagitis.     

Obesity,Metabolic Syndrome and Risk of Atrial Fibrillation: A Swedish,Prospective Cohort Study

AimWe aimed to investigate whether different measures of obesity could similarly predict atrial fibrillation, and whether the atrial fibrillation risk associated with obesity is dependent on presence of metabolic syndrome.ResultsDuring a mean follow-up of 13.6 years, 285 incident atrial fibrillation cases were recorded. One standard deviation increment of each obesity measure was associated with increased atrial fibrillation risk as: body mass index 1.25 (1.12 – 1.40), waist circumference 1.35 (1.19 – 1.54) and sagittal abdominal diameter 1.28 (1.14 – 1.44). Compared to normal weight subjects without metabolic syndrome, increased atrial fibrillation risk was noted for overweight subjects with metabolic syndrome, 1.67 (1.16 – 2.41), obese subjects without metabolic syndrome, 1.75 (1.11 – 2.74) and obese subjects with metabolic syndrome, 1.92 (1.34 – 2.74). Compared to subjects with normal waist circumference without metabolic syndrome, subjects with elevated waist circumference and metabolic syndrome suffered increased atrial fibrillation risk, 2.03 (1.44 – 2.87).ConclusionsBody mass index, waist circumference and sagittal abdominal diameter could similarly predict atrial fibrillation. Obesity was associated with an increased atrial fibrillation risk regardless of metabolic syndrome, whereas overweight and elevated waist circumference was associated with increased atrial fibrillation risk only if metabolic syndrome was present.     

Lactation and cardiovascular risk factors in mothers in a population-based study: the HUNT-study

ABSTRACT: BACKGROUND: Lactation has beneficial short term effects on maternal metabolic health, but the long term effects are less well known. METHODS: We studied the association between lifetime duration of lactation and cardiovascular risk factors in mothers later in life among 21,368 parous women aged 20 to 85 years attending the second Nord-Trondelag Health Study (HUNT2) in 1995-1997, Norway, a cross-sectional population-based study. General linear modelling was used to calculate mean values of known cardiovascular risk factor levels in five categories of lifetime duration of lactation. Logistic regression was conducted to estimate odds ratios of hypertension, obesity and diabetes. RESULTS: Among women aged 50 years or younger, lifetime duration of lactation was significantly and inversely associated with body mass index (P-trend, < 0.001), waist circumference (P-trend, < 0.001), systolic and diastolic blood pressure (both P-trends, < 0.001), and serum levels of triglycerides, total cholesterol and low density lipoprotein cholesterol (all P-trends, < 0.001) after adjustment for covariates. Parous women aged 50 years or younger who had never lactated had higher prevalence of hypertension, obesity and diabetes. In this age group, compared to women who had lactated for 24 months or more, parous women who had never lactated had an OR for hypertension of 1.88 (95% CI 1.41, 2.51), an OR for obesity of 3.37 (95% CI 2.51, 4.51) and an OR for diabetes of 5.87 (95% CI 2.25, 15.3). Among women older than 50 years there were no clear associations. CONCLUSION: Lifetime duration of lactation was associated with long term reduced cardiovascular risk levels in mothers aged 50 years or younger.     

The Current Waist Circumference Cut Point Used for the Diagnosis of Metabolic Syndrome in Sub-Saharan African Women Is Not Appropriate

The waist circumference cut point for diagnosing the metabolic syndrome in sub-Saharan African subjects is based on that obtained from studies in European populations. The aim of this study was to measure the prevalence of obesity and related metabolic disorders in an urban population of African females, a group at high risk for such diseases, and to determine the appropriate waist cut point for diagnosing the metabolic syndrome. Anthropometry and fasting lipid, glucose and insulin levels were measured in a cohort of 1251 African females participating in the Birth to Twenty cohort study in Soweto, Johannesburg. The waist circumference cut points for diagnosing metabolic syndrome (as defined using the new harmonised guidelines), insulin resistance, dysglycaemia, hypertension and dyslipidaemia were obtained using receiver operator characteristic curve analysis. The prevalence of obesity, type 2 diabetes and metabolic syndrome were 50.1%, 14.3% and 42.1%, respectively. The appropriate waist cut point for diagnosing metabolic syndrome was found to be 91.5 cm and was similar to the cuts points obtained for detecting increased risk of insulin resistance (89.0 cm), dysglycaemia (88.4 cm), hypertension (90.1 cm), hypo-high density lipoproteinaemia (87.6 cm) and hyper-low density lipoproteinaemia (90.5 cm). The present data demonstrates that urban, African females have a high prevalence of obesity and related disorders and the waist cut point currently recommended for the diagnosis of the metabolic syndrome (80.0 cm) in this population should be increased to 91.5 cm. This latter finding demonstrates a clear ethnic difference in the relationship between abdominal adiposity and metabolic disease risk. The similar waist cut points identified for the detection of the individual components of the metabolic syndrome and related cardiovascular risk factors demonstrates that the risk for different metabolic diseases increases at the same level of abdominal adiposity suggesting a common aetiological pathway.     

Prevalence and determinants of obesity in children in public schools of Sintra, Portugal

Objective: To assess the prevalence of and the factors related to overweight and obesity in a sample of children from the region of Sintra, Portugal. Methods and Procedures: Cross‐sectional study, stratified for freguesia with random selection of schools. Height, weight, triceps skinfold, upper arm and waist circumferences were measured, and overweight/obesity defined according to international criteria. Breast‐feeding, number of daily meals and parents' height and weight data were also collected. Results: One thousand two hundred and twenty‐five children aged 6–10 years were assessed. Overall prevalence of overweight and obesity was 35.6% (23% overweight and 12.6% obesity). Overweight or obese children had higher triceps skinfold, upper arm circumference, arm muscle area, and waist circumference than their normal weight counterparts (P < 0.001). On multivariate analysis, relatively to a child without obese progenitors, a child with one obese progenitor had an obesity risk multiplied by 2.78 (95% confidence interval (CI): 1.76–4.38), while a child with two obese progenitors had a risk multiplied by 6.47 (95% CI: 5.59–16.19). Conversely, being picky was significantly related with a smaller risk of obesity: for boys, odds ratio (OR) = 0.15 (95% CI: 0.04–0.63); for girls, OR = 0.19 (95% CI: 0.06–0.64). Finally, no relationships were found between obesity, birth weight, birth height or breast‐feeding. Discussion: Prevalence of overweight and obesity are elevated among children of the Sintra region in Portugal compared to most other regions of Europe. The relationship with the parents' nutritional state stresses the need to target families for preventing obesity.     

Waist circumference, not the metabolic syndrome, predicts glucose deterioration in type 2 diabetes

We sought to assess the relationship between the metabolic syndrome, abdominal obesity, and glucose deterioration amongst patients with type 2 diabetes. Our prospective cohort consisted of 164 adult patients with established diabetes who have a history of poor glycemic control, have just completed an intensive intervention aimed at improved control, and have demonstrated reduced HbA1c prior to enrollment. Waist circumference and presence of metabolic syndrome were assessed at baseline, and patients were followed up (median 24 months) for assessment of the study outcome, namely, time-to-hyperglycemic relapse, predefined as HbA1c >8% and >1% rise over baseline. Kaplan-Meier estimates of relapse-free glucose maintenance and multivariable Cox regression models were used for quantifying the independent effects of the metabolic syndrome and waist circumference on risk of glucose deterioration. The mean baseline waist circumference was 42.9 5.5 inches. Prevalence of the metabolic syndrome was 80%. During follow-up, 39 patients (24%) experienced hyperglycemic relapse. The metabolic syndrome was not associated with time-to-relapse (P = 0.15). The waist circumference component by itself, however, was associated with increased likelihood of hyperglycemic relapse with an unadjusted hazard ratio of 3.4 (95% confidence interval (CI) 1.2-9.7) and a hazard ratio of 3.2 (95% CI 1.1-9.1) after adjusting for age, gender, insulin use, weight change, and physical activity level. The National Cholesterol Education Program Adult Treatment Panel III (NCEP ATPIII) metabolic syndrome had limited ability to predict glucose deterioration in this type 2 diabetes cohort. Waist circumference by itself, however, is a strong predictor of future glucose control, and may be a parsimonious tool for risk stratification. BMI may also be a useful predictive tool.     

Correlation between body composition and risk factors for cardiovascular disease and metabolic syndrome

Body mass index (BMI) is an important diagnostic tool for determining obesity; however, while BMI reflects the influence of body height over body weight, it does not reveal body fat percentage (BF%). We explored whether BF% correlated with risk factors for cardiovascular disease and metabolic syndrome and whether metabolically obese, normal weight people were at risk for these diseases. A total of 2,867 healthy volunteers participated in this study. Blood pressure, height, weight, waist circumference, BMI, BF%, lipid profile, fasting glucose, uric acid, and lifestyle factors were collected from healthy subjects during their annual health examinations. In both males and females, BF% correlated positively with BMI and waist circumference. Participants were divided into three groups according to BF% and data were compared between groups. The results suggest that BF% correlates with risk factors for cardiovascular disease and metabolic syndrome for both men and women, and that BF% may be a useful predictor of risk, particularly in metabolically obese, normal weight individuals. ? 2012 International Union of Biochemistry and Molecular Biology, Inc.     

New "pre-diabetes" category and the metabolic syndrome in Japanese.

BACKGROUND: Recently, impaired fasting glucose (IFG) was redefined as fasting plasma glucose of 100-125 mg/dl, and individuals with IFG and/or impaired glucose tolerance (IGT) were referred to as having "pre-diabetes". However, there is a lack of data using the new definition of IFG and "pre-diabetes". OBJECTIVE: The aim of this study was to examine associations of the metabolic syndrome components with the new "pre-diabetes" category in relatively lean Japanese. METHODS: Six hundred and sixty-one Japanese study participants underwent a 75 g oral glucose tolerance test. They were classified into three groups-normal (n=225), pre-diabetes (n=308), and diabetes (n=128). The metabolic syndrome was defined according to the National Cholesterol Education Program Adult Treatment Panel III, as modified for waist circumference criteria by the Regional Office for the Western Pacific Region of WHO. RESULTS: Prevalence of the metabolic syndrome in each group was 10.7%, 27.9%, and 53.9%, respectively. Of the metabolic syndrome components, the OR for prevalent pre-diabetes was 2.00 (95% CI, 1.73-2.31, p<0.001) for fasting glucose, 1.93 (95% CI, 1.54-2.42, p<0.001) for waist circumference, and 1.36 (95% CI, 1.10-1.68, p=0.005) for triglycerides. Similar associations were found in prevalent diabetes. Insulin resistance assessed using Stumvoll's index was significantly associated with both pre-diabetes and diabetes. CONCLUSION: Pre-diabetes and the metabolic syndrome frequently coexist in relatively lean Japanese. This association seems to link with abdominal adiposity and insulin resistance.     

Discrimination of Health Risk by Combined Body Mass Index and Waist Circumference

Objective: NIH Clinical Guidelines (1998) recommend the measurement of waist circumference (WC, centimeters) within body mass index (BMI, kilograms per square meter) categories as a screening tool for increased health risk. Research Methods and Procedures: The Canada Heart Health Surveys (1986 through 1992) were used to describe the prevalence of the metabolic syndrome in Canada and to test the use of the NIH guidelines for predicting metabolic risk factors. The sample included 7981 participants ages 20 to 74 years who had complete data for WC, BMI, high‐density lipoprotein‐cholesterol, triglycerides, diabetic status, and systolic and diastolic blood pressures. National Cholesterol Education Program Adult Treatment Panel III risk categories were used to identify the metabolic syndrome and associated risk factors. Logistic regression was used to test the hypothesis that WC improves the prediction of the metabolic syndrome, within overweight (25 to 29.9 kg/m²) and obese I (30 to 34.9 kg/m²) BMI categories. Results: The prevalence of the metabolic syndrome was 17.0% in men and 13.2% in women. The odds ratios (OR) for the prediction of the metabolic syndrome were elevated in overweight [OR, 1.85; 95% confidence interval (95%CI), 1.02 to 3.35] and obese (OR, 2.35; 95%CI, 1.25 to 4.42) women with a high WC compared with overweight and obese women with a low WC, respectively. On the other hand, WC was not predictive of the metabolic syndrome or component risk factors in men, within BMI categories. Discussion: In women already at increased health risk because of an elevated BMI, the additional measurement of WC may help identify cardiovascular risk.     

Sex differences in risk factors for cardiovascular disease: the PERU MIGRANT study

Introduction

Although men and women have similar risk factors for cardiovascular disease, many social behaviors in developing countries differ by sex. Rural-to-urban migrants have different cardiovascular risk profiles than rural or urban dwellers. The objective of this study was to evaluate the sex differences with specific cardiovascular risk factors in rural-to-urban migrants.

Methods and Results

We used the rural-to-urban migrant group of the PERU MIGRANT cross-sectional study to investigate the sex differences in specific cardiovascular risk factors: obesity, hypertension, metabolic syndrome, as well as exposures of socioeconomic status, acculturation surrogates and behavioral characteristics. Logistic regression analysis was used to characterize strength of association between sex and our outcomes adjusting for potential confounders. The sample of migrants was 589 (mean age 46.5 years) and 52.4% were female. In the adjusted models, women were more likely to be obese (OR=5.97; 95%CI: 3.21–11) and have metabolic syndrome (OR=2.22; 95%CI: 1.39–3.55) than men, explaining the greatest variability for obesity and metabolic syndrome but not for hypertension.

Conclusions

Our results suggest that interventions for CVD in Peru should be sex-specific and address the unique health needs of migrant populations living in urban shantytowns since the risk factors for obesity and metabolic syndrome differ between males and females.     

Waist-to-Height Ratio and Cardiovascular Risk Factors in Elderly Individuals at High Cardiovascular Risk

Introduction

Several anthropometric measurements have been associated with cardiovascular disease, type-2 diabetes mellitus and other cardiovascular risk conditions, such as hypertension or metabolic syndrome. Waist-to-height-ratio has been proposed as a useful tool for assessing abdominal obesity, correcting other measurements for the height of the individual. We compared the ability of several anthropometric measurements to predict the presence of type-2 diabetes, hyperglycemia, hypertension, atherogenic dyslipidemia or metabolic syndrome.

Materials and Methods

In our cross-sectional analyses we included 7447 Spanish individuals at high cardiovascular risk, men aged 55–80 years and women aged 60–80 years, from the PREDIMED study. Logistic regression models were fitted to evaluate the odds ratio of presenting each cardiovascular risk factor according to various anthropometric measures. The areas under the receiver-operating characteristic curve (AUC) were used to compare the predictive ability of these measurements.

Results

In this relatively homogeneous cohort with 48.6% of type-2 diabetic individuals, the great majority of the studied anthropometric parameters were significantly and positively associated with the cardiovascular risk factors. No association was found between BMI and body weight and diabetes mellitus. The AUCs for the waist-to-height ratio and waist circumference were significantly higher than the AUCs for BMI or weight for type-2 diabetes, hyperglycemia, atherogenic dyslipidemia and metabolic syndrome. Conversely, BMI was the strongest predictor of hypertension.

Conclusions

We concluded that measures of abdominal obesity showed higher discriminative ability for diabetes mellitus, high fasting plasma glucose, atherogenic dyslipidemia and metabolic syndrome than BMI or weight in a large cohort of elderly Mediterranean individuals at high cardiovascular risk. No significant differences were found between the predictive abilities of waist-to-height ratio and waist circumference on the metabolic disease.     

Simple anthropometric indices in relation to cardiovascular risk factors in Chinese type 2 diabetic patients

To determine which is the best anthropometric index among body mass index (BMI), waist circumference (WC), waist to hip ratio (WHR) and waist to height ratio (WHtR) in type 2 diabetic patients, we examined the relationship between these indices and cardiovascular risk factors using partial correlation analysis, chi-square test, logistic regression analysis and Receiver Operator Characteristic (ROC) curves. Partial correlation analysis showed that among the 4 obesity indices, WHtR had the highest r values for all the cardiovascular risk factors in both sexes, followed by WC. Chi-square analysis which revealed that an increased WHtR was more strongly associated with hypertension, hypertriglyceridemia (high TG) and low high-density lipoprotein cholesterol (HDL-C) than the other indices. Logistic regression analysis showed that, after controlling for age, the hypertension, high TG and low HDL-C odds ratios of WHtR > or = 0.5 were 2.56 (95% CI: 1.24, 5.29), 2.87 (95% CI: 1.43, 5.78), 2.59 (95% CI: 1.03, 6.59) in men and 3.75 (95% CI: 1.75, 8.05), 3.21 (95% CI: 1.52, 6.79), 3.62 (95% CI: 1.43, 9.21) in women, respectively. In ROC analysis, the areas under curve of WHtR were the largest for at least one risk factor in both men and women. These results indicated that WHtR had a higher correlation with cardiovascular risk factors than WC, WHR or BMI in newly diagnosed type 2 diabetes. We proposed the measurement of WHtR as a screening tool for cardiovascular risk factors in this population.     

Association of physical activity and the metabolic syndrome in children and adolescents: CASPIAN Study

BACKGROUND/AIM: To determine the association of physical activity and the metabolic syndrome in a large national-representative sample of children. METHODS: This study was performed in 2003-2004 on 4,811 school students aged 6-18 years, selected by multi-stage random cluster sampling from six provinces in Iran. We assessed the level of physical activity using a standardized questionnaire, and categorized it to the tertiles. The metabolic syndrome was defined based on criteria analogous to those of the Adult Treatment Panel III. RESULTS: The participants comprised 2,248 boys and 2,563 girls with a mean age of 12.07 +/- 3.2 years. In all age groups, boys were more physically active than girls. The metabolic syndrome was detected in 14.1% of participants, and its prevalence was higher in those subjects in the 1st, 2nd and 3rd tertiles of physical activity, respectively (15.1 vs.14.2 and 13.1%, respectively, p <0.05). This difference was seen in boys, while no difference was found between girls in the 2nd and 3rd tertiles of physical activity. Physical activity was linked to a cluster of factors consisting of high-density lipoprotein-cholesterol and waist circumference, followed by triglycerides in boys, and of triglycerides, waist circumference and blood pressure in girls. In both genders, before and after adjustment for age and body mass index, low levels of physical activity significantly increased the risk of having the metabolic syndrome [in boys: OR: 1.8, 95% CI: 1.1, 2.1; and in girls, OR: 1.6 (1.1, 1.9)]. CONCLUSION: We found an association between physical activity and the metabolic syndrome, which was independent of body mass index and age. Children should be encouraged to have greater physical activity.     

Total body fat and the risk of Barrett's oesophagus – A bioelectrical impedance study

BackgroundBody mass index is associated with the risk of Barrett's oesophagus (BO). It is uncertain whether this is related to total body fat or other factors that correlate with body mass index. We aimed to quantify the association between total body fat (measured by bioelectrical impedance) and risk of BO and examine if this association was modified by gastro-oesophageal reflux (GOR) and abdominal obesity.MethodsIn 2007–2009, we surveyed 235 cases (69% Males, Mean age 62.1 years) and 244 age and sex matched population controls from a population based case–control study of BO. We conducted structured interviews, standard anthropometry and bioimpedance analysis of total body fat. Odds ratios (OR) and 95% confidence intervals (CI) were estimated using multivariable logistic regression analysis.ResultsThere was a significantly increased risk of BO among those in the highest tertile of total body fat weight (OR 2.01; 95%CI 1.26–3.21) and total body fat percentage (OR 1.86; 95%CI 1.10–3.15). These risks were largely attenuated after adjustment for GOR and waist circumference. There was a significantly increased risk of BO among those in the highest tertile of waist circumference (OR 2.21; 95%CI 1.39–3.51) and this was minimally attenuated after adjustment for total body fat and moderately attenuated after adjustment for GOR.ConclusionsTotal body fat is associated with an increased risk of BO but this appears to be mediated via both abdominal obesity and GOR. These findings provide evidence that abdominal obesity is more important than total body fat in the development of BO.     

P wave indices, obesity, and the metabolic syndrome: the atherosclerosis risk in communities study

Atrial fibrillation and obesity are increasing in prevalence and are interrelated epidemics. There has been limited assessment of how obesity and the metabolic syndrome impact P wave indices, established electrocardiographic predictors of atrial fibrillation. We conducted a cross-sectional analysis to determine the association of obesity and the components of the metabolic syndrome with P wave indices in the population-based Atherosclerosis Risk in Communities (ARIC) study. Analyses were adjusted for demographic, anthropometric and clinical variables, and cardiovascular diseases and risk factors. Following relevant exclusions, 14,433 subjects were included (55% women and 24.7% black). In multivariable analyses, we identified significant, progressive increases in PR interval, P wave maximum duration, and P wave terminal force with BMI 25-30 kg/m(2) and BMI ≥30 kg/m(2) compared to the reference group <25 kg/m(2) (P < 0.0001 for trend for all P wave indices). These effects were present in both blacks and whites. Presence of metabolic syndrome was also associated with longer P wave indices. When components of the metabolic syndrome were examined separately, hypertension resulted in significant (P < 0.001) augmentation of the three P wave indices. Similarly, waist circumference was associated with greater P wave maximum duration in both races (P < 0.001). We concluded that P wave indices are significantly associated with obesity and particularly with hypertension and waist circumference. P wave indices may comprise intermediate markers, independent of age and cardiovascular risk, of the pathway linking obesity and with the risk of atrial fibrillation (AF).