Increases in weight and body size increase the odds for hypertension during 7 years of follow-up

Changes in BMI and body size were compared to incident hypertension in 24,550 men and 10,111 women followed prospectively as part of the National Runners' Health Study to test whether long-term weight change affects hypertension risk. Incident hypertensions were reported by 2,143 men and 430 women during (mean +/- s.d.) 7.8 +/- 1.8 and 7.5 +/- 2.0 years of follow-up, respectively. Despite being active, men's and women's BMI increased 1.15 +/- 1.70 and 0.95 +/- 1.89 kg/m(2), respectively, and their waist circumferences increased 2.97 +/- 5.02 and 3.29 +/- 6.67 cm, respectively. Compared to those whose BMI declined, those who gained >or=2.4 kg/m(2) had an odds ratio (95% confidence interval) of 1.68 (1.45, 1.94) for becoming hypertensive if male and 1.42 (1.05, 1.92) if female. Men whose waist circumference increased >or=6 cm had an odds ratio of 1.22 (1.01, 1.47) for becoming hypertensive compared to those whose waists decreased. In both sexes, the odds for hypertension were significantly related to BMI at follow-up when adjusted for baseline BMI, but generally not to baseline BMI when adjusted for follow-up BMI. In the subset whose weights remained relatively unchanged during follow-up (+/-0.4 kg/m(2)), each kg/m(2) increment in BMI was associated with an odds ratio for becoming hypertensive of 1.19 (1.14, 1.24) in men and 1.11 (1.02, 1.20) in women. Thus, even among lean, physically active individuals: (i) weight gain increases hypertension risk; (ii) higher body weight increases the hypertension risk in a dose-dependent manner in the absence of any weight change; and (iii) there is no advantage carried forward to having been previously lean.     

BMI, waist circumference, and incident urinary incontinence in older women

Overall body fat and central adiposity may reflect different mechanisms leading to urinary incontinence (UI). We examined the associations of BMI and waist circumference with incident UI, including the independent associations of BMI and waist circumference with UI type, among women aged 54-79 years in the Nurses' Health Study. Study participants reported their height in 1976 and their weight and waist circumference in 2000. From 2000 to 2002, we identified 6,790 women with incident UI at least monthly among 35,754 women reporting no UI in 2000. Type of incontinence was determined on questionnaires sent to cases with at least weekly incontinence. Relative risks (RRs) and 95% confidence intervals (CIs) were estimated using multiple logistic regression. There were highly significant trends of increasing risk of UI with increasing BMI and waist circumference (P for trend <0.001 for both). Multivariable RRs of developing at least monthly UI were 1.66 (95% CI 1.45-1.91) comparing women with a BMI of > or =35 kg/m(2) to women with BMI 21-22.9 kg/m(2) and 1.72 (95% CI 1.53-1.95) comparing women in extreme quintiles of waist circumference. When BMI and waist circumference were included in models simultaneously, BMI was associated with urge and mixed UI (P for trend 0.003 and 0.03, respectively), but not stress UI (P for trend 0.77). Waist circumference was associated only with stress UI (P for trend <0.001). These results suggest that women who avoid high BMI and waist circumference may have a lower risk of UI development.     

Predicting Incident Diabetes in Jamaica: The Role of Anthropometry

Objective: To evaluate the performance of the body mass index (BMI), waist circumference, waist‐to‐hip ratio (WHR), and waist‐to‐height ratio (WHTR) in predicting incident diabetes in Jamaica. Research Methods and Procedures: A cohort of 728 nondiabetic adults (290 men and 438 women), ages 25 to 74 years and residents of Spanish Town, Jamaica, were followed for a mean of 4 years. Participants had fasting and 2‐hour postchallenge glucose concentrations measured at baseline and follow‐up. Results: There were 51 cases of incident diabetes (17 men and 34 women). All indices were independent predictors of diabetes, and none was clearly superior. The area under the receiver operating characteristics curves (95% confidence interval) for BMI was 0.74 (0.59 to 0.88) for men and 0.62 (0.51 to 0.72) for women. For waist circumference, these values were 0.78 (0.65 to 0.91) in men and 0.61 (0.50 to 0.71) in women. Similar results were obtained for WHR and WHTR. “Optimal” cut‐off points for BMI were 24.8 kg/m² (men) and 29.3 kg/m² (women). For waist circumference, these were 88 cm and 84.5 cm for men and women, respectively. Corresponding values for WHR were 0.87 and 0.80 and for WHTR were 0.51 and 0.54, respectively. Discussion: Cut‐off points for waist circumference and WHR were similar to those proposed in developed countries for women but lower in men. Waist circumference could be useful in health promotion as an alternative to BMI.     

Changes in Body Weight and Waist Circumference Affect Incident Hypercholesterolemia During 7 Years of Follow‐up

Objective: To assess whether changes in total and regional adiposity affect the odds for becoming hypercholesterolemic. Methods and Procedures: Changes in BMI and waist circumference were compared to self‐reported physician‐diagnosed hypercholesterolemia in 24,397 men and 10,023 women followed prospectively in the National Runners' Health Study. Results: Incident hypercholesterolemia were reported by 3,054 men and 519 women during (mean ± s.d.) 7.8 ± 1.8 and 7.5 ± 2.0 years of follow‐up, respectively. Despite being active, men's BMI increased by 1.15 ± 1.71 kg/m² and women's BMI increased by 0.96 ± 1.89 kg/m². The odds for developing hypercholesterolemia increased significantly in association with gains in BMI and waist circumferences in both sexes. A gain in BMI ≥2.4 kg/m² significantly (P < 0.0001) increased the odds for hypercholesterolemia by 94% in men and 129% in women compared to those whose BMI declined (40 and 76%, respectively, adjusted for average of the baseline and follow‐up BMI, P < 0.0001). A gain of ≥6 cm in waist circumference increased men's odds for hypercholesterolemia by 74% (P < 0.0001) and women's odds by 70% (P < 0.0001) relative to those whose circumference declined (odds increased 40% at P < 0.0001 and 49% at P < 0.01, respectively adjusted for average circumference). BMI and waist circumference at the end of follow‐up were significantly associated (P < 0.0001) with the log odds for hypercholesterolemia in both men (e.g., coefficient ± s.e.: 0.115 ± 0.011 per kg/m²) and women (e.g., 0.119 ± 0.019 per kg/m²) when adjusted for baseline values, whereas baseline BMI and circumferences were unrelated to the log odds when adjusted for follow‐up values. Discussion: These observations are consistent with the hypothesis that weight gain acutely increases the risk for hypercholesterolemia.     

Associations of iron status with breast cancer risk factors in adult women: Findings from National Health and Nutrition Examination Survey 2017–2018

ObjectiveThis study examined the association between iron status and a set of breast cancer risk factors among U.S. adult women aged 20–80 years.MethodsData from National Health and Nutrition Examination Survey (2017–2018) were used to examine the relation between serum ferritin, serum iron and transferrin saturation with a set of breast cancer risk factors [body mass index (BMI), waist circumference, glycosylated hemoglobin (HbA1c), fasting plasma glucose, insulin and HOMA-IR]. The multivariable linear regressions were used controlling for age, race/ethnicity, menopause status, education level, smoking status, alcohol consumption, physical activity, high-sensitivity C-reactive protein (hsCRP) and total energy intake.ResultsHbA1c, BMI and waist circumference data were available for 1902 women with a fasting sample (n = 913) for fasting plasma glucose, insulin and HOMA-IR. Transferrin saturation had significant, inverse associations with BMI, waist circumference and HbA1c. The size of difference observed were that participants in the fourth quartile of transferrin saturation had a 4.50 kg/m² smaller BMI, a 9.36 cm smaller waist circumference and a 0.1 % lower HbA1c level than participants in the first quartile. Similarly, serum iron concentrations were inversely associated with BMI and waist circumference. In addition, serum iron had significant, inverse associations with insulin and HOMA-IR. Sensitivity analyses among men gave similar results. For serum ferritin, there was a trend towards a positive association between waist circumference, HbA1c and fasting plasma glucose with serum ferritin. However, the associations did not reach statistical significance among women.ConclusionsIron status may impact breast cancer risk via effects on adiposity or glucose metabolism. The findings should be confirmed with further prospective data.     

Neck Circumference,along with Other Anthropometric Indices,Has an Independent and Additional Contribution in Predicting Fatty Liver Disease

MethodsThis cross-sectional study comprised 4053 participants (1617 women and 2436 men, aged 20-88) recruited from the Health Examination Center in Guangzhou, China between May 2009 and April 2010. Anthropometric measurements were taken, abdominal ultrasonography was conducted and blood biochemical parameters were measured. Covariance, logistic regression and receiver operating characteristic curve analyses were employed.ResultsThe mean neck circumference was greater in subjects with fatty liver disease than those without the disease in both women and men after adjusting for age (P<0.001). Logistic regression analysis showed that the age-adjusted ORs (95% CI) of fatty liver disease for quartile 4 (vs. quartile 1) of neck circumference were 7.70 (4.95-11.99) for women and 12.42 (9.22-16.74) for men. After further adjusting for other anthropometric indices, both individually and combined, the corresponding ORs remained significant (all P-trends<0.05) but were attenuated to 1.94-2.53 for women and 1.45-2.08 for men. An additive interaction existed between neck circumference and the other anthropometric measures (all P<0.05). A high neck circumference value was associated with a much greater prevalence of fatty liver disease in participants with both high and normal BMI, waist circumference and waist-to-hip ratio values.ConclusionsNeck circumference was an independent predictor for fatty liver disease and provided an additional contribution when applied with other anthropometric measures.     

Waist Circumference,BMI, Smoking,and Mortality in Middle‐Aged Men and Women

Objective: Measurement of waist circumference alone as a proxy of abdominal fat mass has been suggested as a simple clinical alternative to BMI for detecting adults with possible health risks due to obesity. Research Methods and Procedures: From 1993 to 1997, 27, 178 men and 29, 875 women, born in Denmark, 50 to 64 years of age, were recruited in the Danish prospective study Diet, Cancer and Health. By the end of the year 2000, 1465 deaths had occurred. We evaluated the relationship between waist circumference and BMI (simultaneously included in the model) and all‐cause mortality. We used Cox regression models to estimate the mortality‐rate ratios and to consider possible confounding from smoking. Results: Waist circumference among both men and women showed a strong dose‐response type of relationship with mortality when adjusted for BMI, whereas the low range of BMI was inversely associated with mortality when adjusted for waist circumference. A 10% larger waist circumference corresponded to a 1.48 (95% confidence interval: 1.36 to 1.61) times higher mortality over the whole range of waist circumference. The associations were independent of age and time since baseline examination. Restriction to never smokers showed a similar pattern, but a weakening of the associations. Discussion: Despite the high correlation between waist circumference and BMI, the combination may be very relevant in clinical practice because waist circumference for given BMI was a strong predictor of all‐cause mortality. The inverse association between BMI and mortality for given waist circumference was diminished in never smokers, particularly for high values of BMI.     

BMI and Waist Circumference as Predictors of Well‐being in Older Adults: Findings From the English Longitudinal Study of Ageing

The aim of this study is to examine the association of BMI and waist circumference (WC), with a quality of life (QoL) indicator designed for older ages (CASP19), and with depressive symptoms (Centre for Epidemiologic Studies Depression Scale). We included 8,688 individuals aged ≥52 years who participants of Wave 2 (2004–2005) and Wave 3 (2006–2007) of the English Longitudinal Study of Ageing (ELSA). To explore cross‐sectional relationships (2004–2005), we fitted regression models for BMI and WC (included simultaneously) as our predictors of QoL and depressive symptoms adjusted for covariates. To explore longitudinal relationships, BMI and waist at baseline (2004–2005) were related to the each outcome variable measured at follow‐up (2006–2007), and adjusted for baseline characteristics (2004–2005). For a given BMI, larger WC was associated with lower QoL and higher risk of depressive symptoms for women in cross‐sectional and longitudinal analyses. By contrast for a given WC increased BMI for women was positively associated with QoL and lower odds of depressive symptoms. In men, for a given BMI, increased WC was related to QoL only cross‐sectionally; neither WC nor BMI at baseline were associated with depressive symptoms (cross‐sectionally or longitudinally). In conclusion among older people, for a given BMI, increased WC was related with higher risk of poor QoL and, for women, of depressive symptoms; whereas for a given WC, increased BMI had a protective effect on QoL for women.     

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.     

The relationship between measures of obesity and incident heart failure: The multi‐ethnic study of atherosclerosis

Objective : To evaluate the strength of association of body mass index (BMI) and waist circumference (WC) with incident heart failure (HF), exploring our associations by ethnicity and age. Design and Methods : 6,809 participants, aged 45‐84 years old, without clinical cardiovascular disease (2000–2002), from the Multi‐Ethnic Study of Atherosclerosis were included. Cox‐Proportional hazards models were used to examine associations of BMI and WC with incident HF. The predictive abilities of BMI and WC were compared using receiver operating characteristic curves. Results : Over a median follow‐up of 7.6 years, there were 176 cases. BMI and WC were associated with incident HF in men (1.33 [1.10‐1.61] and 1.38 [1.18‐1.62], respectively] and women (1.70 [1.33‐2.17] and 1.64 [1.29‐2.08], respectively). These associations became non‐significant after adjusting for obesity‐related conditions (hypertension, dysglycemia, hypercholesterolemia, left ventricular hypertrophy, kidney disease, and inflammation). The associations of BMI and WC did not vary significantly by ethnicity or age‐group, but were inverse in Hispanic men. The area under the curve for BMI and WC was 0.749 and 0.750, respectively, in men and 0.782 and 0.777, respectively, in women. Conclusions : The association between obesity and incident HF is largely mediated by obesity‐related conditions. BMI and WC have similar predictive abilities for incident HF.     

Visceral fat, waist circumference, and BMI: impact of race/ethnicity

Objective: BMI and waist circumference are used to define risk from excess body fat. Limited data in women suggest that there may be racial/ethnic differences in visceral adipose tissue (VAT) at a given BMI or waist circumference. This study tested the hypothesis that racial/ethnic differences exist in both men and women in the relationship of anthropometric measures of body composition and computed tomography (CT)‐determined VAT or subcutaneous adipose tissue (SAT). Methods and Procedures: Subjects included 66 African American, 72 Hispanic, and 47 white men and women, aged ≥ 45. Waist circumference and BMI were measured using standard methods. Total abdominal and L4L5 VAT and SAT were measured using CT. Results: Among both men and women, groups did not differ in waist circumference or BMI. White men had greater L4L5 VAT than African‐American men, and both white and Hispanic men had greater total VAT than African‐American men. Among women, Hispanics and whites had greater L4L5 VAT than African Americans, and Hispanics had greater total VAT than African Americans. The slope of the linear relationship between BMI or waist circumference and VAT was lower in African Americans than in Hispanics and/or whites. Discussion: Middle‐aged and older African‐American men and women had lower VAT despite similar BMI and waist circumference measurements. Altered relationships between anthropometric measures and VAT may have implications for defining metabolic risk in different populations. Different waist circumference or BMI cutoff points may be necessary to adequately reflect risk in different racial/ethnic groups.     

Age-dependent inverse association between alcohol consumption and obesity in Japanese men

The aim of this study was to determine whether age influences the relationship between alcohol drinking and obesity. Japanese men receiving periodic health checkups (20–70 years old, n = 36,121) were divided into non‐, light (<22 g ethanol/day), moderate (≥22 and <44 g ethanol/day), and heavy (≥44 g ethanol/day) drinkers. Relationships between alcohol intake and obesity‐related indices were compared among the quartiles of age. BMI was lower in light and moderate drinkers than in nondrinkers, and these differences were more prominent in the 1st and 2nd quartiles of age than in the higher quartiles. In the 1st and 2nd quartiles of age, waist circumference and waist‐to‐height ratio were significantly smaller and lower, respectively, in light and moderate drinkers than in nondrinkers, and these differences were less prominent in the 3rd quartile and were not found in the 4th quartile. In the 1st and 2nd quartiles of age, odds ratios vs. nondrinkers for large waist circumference were significantly low (P < 0.01) in light drinkers (1st quartile: 0.64 (0.54–0.75); 2nd quartile: 0.69 (0.60–0.80)) and moderate drinkers (1st quartile: 0.69 (0.61–0.78); 2nd quartile: 0.84 (0.76–0.93)), whereas the odds ratio was significantly low (P < 0.05) only in light drinkers in the 3rd quartile (0.84 (0.73–0.97)) and was not significant in any drinker groups of the 4th quartile. The results suggest that alcohol consumption is associated with lower risk of obesity in Japanese men and this association is more prominent in younger men than in older men.     

Waist Circumference as the Best Predictor of Noninsulin Dependent Diabetes Mellitus (NIDDM) Compared to Body Mass Index,Waist/hip Ratio and Other Anthropometric Measurements in Mexican Americans—A 7-Year Prospective Study

Although a number of obesity-related variables are recognized risk factors for NIDDM, few studies have addressed which one is the best predictor. A cohort of 721 Mexican Americans aged 25–64 years who were free of NIDDM at baseline were followed for an average of 7.2 years; 105 new cases of NIDDM were diagnosed. Body weight, body mass index (BMI), waist and hip circumferences, waist/hip ratio (WHR), triceps and subscapular skinfolds were all positively predictive of NIDDM independent of age and sex. There were modest to strong correlations between these anthropometric variables, however, waist circumference was the strongest predictor of NIDDM. The predictive power of a single measurement of waist circumference was at least equal to that of WHR and BMI combined. The risk of NIDDM for those in the highest quartile of waist circumference was 11 times greater than for those in the lowest quartile (95% confidence interval: 4.2–28.8). The waist-NIDDM relation was stronger in subjects with BMI ≤ 27 kg/m² (OR: 6.0 for a 1 SD difference) than in subjects with BMI > 27 kg/m2 (OR: 1.7 for a 1 SD difference). In multivariate analysis, waist circumference was the only significant predictor of NIDDM in models that included other anthropometric variables either separately or simultaneously. WHR and BMI were independent predictors of NIDDM after adjustment for each other, however, their predictive abilities disappeared after adjustment for waist circumference. The data indicate that waist is the best obesity-related predictor of NIDDM. This finding suggests that the distribution of body fat, especially abdominal localization, is a more important determinant than the total amount of body fat of the development of NIDDM in Mexican Americans.     

“A Body Shape Index” in Middle-Age and Older Indonesian Population: Scaling Exponents and Association with Incident Hypertension

Background

“A Body Shape Index” (ABSI) is a recently proposed index that standardizes waist circumference for body mass index (BMI) and height. This study aims to: (a) examine if the ABSI scaling exponents for standardizing waist circumference for BMI and height are valid in middle-aged and older Indonesian population, and (b) compare the association between incident hypertension and ABSI and other anthropometric measures.

Methods and Findings

The Indonesian Family Life Survey Wave 3 measured anthropometric variables and blood pressure of 8255 adults aged between 40 to 85 years in 2000. The relationship between two anthropometric quantities, e.g. weight (w) and height (h), can be expressed as the power law-equivalent , where p = 2 is the scaling exponent in the derivation of the BMI and can be estimated by linear regression analysis. This was extended to the regression analysis of the log-transformed waist circumference, weight and height to establish the scaling exponents in the ABSI. The values for men were similar to those developed by the previous American study, which were 2/3 (BMI) and 1/2 (height). Those for women were somewhat smaller, at 3/5 (BMI) and 1/5 (height). The original (American) ABSI leads to mild negative correlation with BMI (−0.14) and height (−0.12) in the female population. Analysis of the development of hypertension between Waves 3 and 4 (average interval 7.5 years) in relation to ABSI measured at Wave 3 showed stronger association if the locally derived (Indonesian) scaling exponents were used. However, both versions of the ABSI were less associated with incident hypertension than waist circumference and BMI.

Conclusions

The values for the scaling exponents for ABSI are roughly similar between the American population and the middle-aged and older Indonesian population, although larger discrepancy was found in women. The ABSI is less associated with incident hypertension than waist circumference and BMI.     

Alterations in vasomotor systems and mechanics of resistance-sized mesenteric arteries from SHR and WKY male rats following in vivo testosterone manipulation

Background

It remains unclear whether the increased risk of colorectal cancer (CRC) associated with obesity differs by gender, distribution of fat, tumour location and clinical (TNM) stage. The primary aim of this study was to examine these associations in 584 incident colorectal cancer cases from a Swedish prospective population-based cohort including 28098 men and women.

Methods

Seven anthropometric factors; height, weight, bodyfat percentage, hip circumference, waist circumference, BMI and waist-hip ratio (WHR) were categorized into quartiles of baseline anthropometric measurements. Relative risks of CRC, total risk as well as risk of different TNM stages, and risk of tumours located to the colon or rectum, were calculated for all cases, women and men, respectively, using multivariate Cox regression models.

Results

Obesity, as defined by all anthropometric variables, was significantly associated with an overall increased risk of CRC in both women and men. While none of the anthropometric measures was significantly associated with risk of tumour (T)-stage 1 and 2 tumours, all anthropometric variables were significantly associated with an increased risk of T-stage 3 and 4, in particular in men. In men, increasing quartiles of weight, hip, waist, BMI and WHR were significantly associated with an increased risk of lymph node positive (N1 and N2) disease, and risk of both non-metastatic (M0) and metastatic (M1) disease. In women, there were no or weak associations between obesity and risk of node-positive disease, but statistically significant associations between increased weight, bodyfat percentage, hip, BMI and M0 disease. Interestingly, there was an increased risk of colon but not rectal cancer in men, and rectal but not colon cancer in women, by increased measures of weight, hip-, waist circumference and bodyfat percentage.

Conclusions

This study is the first to show a relationship between obesity, measured as several different anthropometric factors, and an increased risk of colorectal cancer of more advanced clinical stage, in particular in men. These findings suggest that risk of CRC differs according to the method of characterising obesity, and also according to gender, location, and tumour stage.     

Socioeconomic status in relation to obesity and abdominal obesity in Korean adults: a focus on sex differences

Objective: We examined the relationship between income and education level with BMI and waist circumference to provide further understanding of the relationship between socioeconomic status and obesity and to identify the presence of sex differences. Research Methods and Procedures: A total of 7962 people ≥20 years of age (3597 men; 4365 women) who participated in the 1998 Korean National Health and Nutrition Examination Survey provided data including height, weight, waist circumference, education, and income level. We examined adjusted BMI and waist circumference according to level of income and education and the association between income and education with obesity and abdominal obesity by multiple logistic regression analysis. Results: In men, significant dose‐response relationships were noted between income and obesity (trend, p < 0.05) and abdominal obesity (trend, p < 0.05). Compared with the lowest income group, the adjusted odds ratios (ORs) (95% confidence interval) of the highest income group for obesity and abdominal obesity were 1.65 (1.18 to 2.32) and 1.37 (0.94 to 1.98), respectively. However, income was not associated with obesity or abdominal obesity in the fully adjusted models in women. With regard to education, women showed significantly decreased ORs, with inverse trends for obesity and abdominal obesity across all education levels. Compared with the lowest education group, the adjusted ORs (95% confidence interval) for obesity and abdominal obesity were 0.66 (0.57 to 0.76) and 0.40 (0.35 to 0.45), respectively, among women with 7 to 12 years of schooling and 0.27 (0.21 to 0.34) and 0.15 (0.12 to 0.18), respectively, among women with 13 or more years of schooling. Discussion: Socioeconomic difference has a considerable impact on the prevalence of obesity among the Korean population, and the patterns differ substantially across sex.     

Body fat measured by a near-infrared interactance device as a predictor of cardiovascular events: the FINRISK'92 cohort

We evaluated how body fat percentage, measured by a portable near-infrared interactance (NIR) device predicts cardiovascular (CVD), coronary heart disease (CHD), and ischemic stroke events in a prospective population-based survey. The study population consisted of 2,842 men and 3,196 women, who participated in the FINRISK'92 survey. Obesity was assessed with BMI, waist circumference, and waist-to-hip ratio (WHR) and body fat percentage measured with an NIR. Mean length of follow-up was 9 years and 3 months. In Cox proportional hazards regression analyses for men, BMI, waist circumference, and WHR as well as body fat percentage were predictors of a CVD event when adjusted for age and for major risk factors. Hazard ratio (HR) per 1 s.d. was 1.27 (95% confidence interval: 1.10-1.48) for body fat percentage, 1.30 (1.16-1.46) for BMI, and 1.31 (1.16-1.50) for waist circumference. Among women, the body fat lost its predictive power in a fully adjusted model. Body fat percentage, BMI, waist circumference, and WHR were predictors of a CHD event both among men and women, whereas body fat percentage did not predict ischemic stroke among either gender. We observed that body fat percentage measured by an NIR device was a significant predictor of CVD and CHD events among men and women, but in our population-based survey, it did not provide any additional predictive power over and above the simpler measures, such as BMI or WHR.     

Larger Thigh and Hip Circumferences Are Associated with Better Glucose Tolerance: The Hoorn Study

Objective: A higher waist‐to‐hip ratio, which can be due to a higher waist circumference, a lower hip circumference, or both, is associated with higher glucose levels and incident diabetes. A lower hip circumference could reflect either lower fat mass or lower muscle mass. Muscle mass might be better reflected by thigh circumference. The aim of this study was to investigate the contributions of thigh and hip circumferences, independent of waist circumference, to measures of glucose metabolism. Research Methods and Procedures: For this cross‐sectional study we used baseline data from the Hoorn Study, a population‐based cohort study of glucose tolerance among 2484 men and women aged 50 to 75. Glucose tolerance was assessed by a 75‐g oral glucose tolerance test; hemoglobin A_1c and fasting insulin were also measured. Anthropometric measurements included body mass index (BMI) and waist, hip, and thigh circumferences. Results: Stratified analyses and multiple linear regression showed that after adjustment for age, BMI, and waist circumference, thigh circumference was negatively associated with markers of glucose metabolism in women, but not in men. Standardized β values in women were ?0.164 for fasting, ?0.206 for post‐load glucose, ?0.190 for hemoglobin A_1c (all p < 0.001), and ?0.065 for natural log insulin levels (p = 0.061). Hip circumference was negatively associated with markers of glucose metabolism in both sexes (standardized betas ranging from ?0.093 to ?0.296, p < 0.05) except for insulin in men. Waist circumference was positively associated with glucose metabolism. Discussion: Thigh circumference in women and hip circumference in both sexes are negatively associated with markers of glucose metabolism independently of the waist circumference, BMI, and age. Both fat and muscle tissues may contribute to these associations.     

Adiposity and incident heart failure in older adults: the cardiovascular health study

While several studies have reported a positive association between overall adiposity and heart failure (HF) risk, limited and inconsistent data are available on the relation between central adiposity and incident HF in older adults. We sought to examine the association between waist circumference (WC) and incident HF and assess whether sex modifies the relation between WC and HF. Prospective study using data on 4,861 participants of the Cardiovascular Health Study (1989-2007). HF was adjudicated by a committee using information from medical records and medications. We used Cox proportional hazard models to compute hazard ratio (HR). The mean age was 73.0 years for men and 72.3 years for women; 42.5% were men and 15.3% were African Americans. WC was positively associated with an increased risk of HF: each standard deviation of WC was associated with a 14% increased risk of HF (95% CI: 3%-26%) in a multivariable model. There was not a statistically significant sex-by-WC interaction (P = 0.081). BMI was positively associated with incident HF (HR: 1.22 (95% CI: 1.15-1.29) per standard deviation increase of BMI); however, this association was attenuated and became nonstatistically significant upon additional adjustment for WC (HR: 1.09 (95% CI: 0.99-1.21)). In conclusion, a higher WC is associated with an increased risk of HF independent of BMI in community-living older men and women.     

BMI compared with central obesity indicators in relation to diabetes and hypertension in Asians

Objective: To compare BMI with waist circumference (WC), waist‐to‐hip ratio (WHR), and waist‐to‐stature ratio (WSR) in association with diabetes or hypertension. Methods and Procedures: Cross‐sectional data from 16 cohorts from the DECODA (Diabetes Epidemiology: Collaborative Analysis of Diagnostic criteria in Asia) study, comprising 9,095 men and 11,732 women, aged 35–74 years, of different ethnicities were included in this meta‐analysis. Results: Age‐adjusted odds ratios (ORs) for diabetes in men (women) for 1 s.d. increase in BMI, WC, WHR, and WSR were 1.52 (1.59), 1.54 (1.70), 1.53 (1.50), and 1.62 (1.70), respectively; and the corresponding ORs for hypertension were 1.68 (1.55), 1.66 (1.51), 1.45 (1.28), and 1.63 (1.50). Paired homogeneity tests (BMI with each of the three) adjusted for age and cohort showed that diabetes had stronger association with WSR than BMI (P = 0.001) in men but with WC and WSR than BMI (both P < 0.05) in women. Hypertension had stronger association with BMI than WHR in men (P < 0.001) and had the strongest with BMI than the others (WHR P < 0.001; WSR P < 0.01; and WC P < 0.05) in women. Areas under the receiver operating characteristic (ROC) curves adjusted for age and cohort were slightly larger for diabetes for WSR 0.735 (0.748) in men (women) and WC 0.749 (women only) than BMI 0.725 (0.742) while for hypertension larger for BMI 0.760 (0.766) than WHR 0.748 (0.751), but their 95% CIs were all overlapped. Discussion: WSR was stronger than BMI in association with diabetes, but these indicators were equally strongly associated with hypertension in Asians.