Minimum waist and visceral fat values for identifying Japanese Americans at risk for the metabolic syndrome

OBJECTIVE: Japanese American is an ethnic group with a high risk for type 2 diabetes, which is linked to the metabolic syndrome. Central adiposity is considered to play a key role in the metabolic syndrome. Not known are the optimal cut point values for central and visceral adiposity to identify Japanese Americans at risk for the metabolic syndrome. RESEARCH DESIGN AND METHODS: Study subjects included 639 Japanese Americans. The nonadipose variables of the metabolic syndrome were defined using modified International Diabetes Federation criteria, and the accuracy of identifying at least two of these by intra-abdominal fat area (IAFA) as measured by computed tomography and waist circumference was cross-sectionally assessed using area under receiver operating characteristic (ROC) curves. The values for IAFA and waist circumference that resulted in maximizing the Youden index were defined as "optimal." RESULTS: The area under the ROC curve for IAFA exceeded that for waist circumference (men 0.787 vs. 0.686; women 0.792 vs. 0.721). For women, the optimal cut points for IAFA and waist circumference were 51.5 cm(2) and 80.8 cm (age < or = 56 years) and 86.3 cm(2) and 89.0 cm (age > 56 years). For men, the optimal cut points for IAFA and waist circumference were 88.6 cm(2) and 90.0 cm (age < or = 57 years) and 96.1 cm(2) and 87.1 cm (age > 57 years). CONCLUSIONS: These results argue that current Japanese waist circumference cut points for the metabolic syndrome need to be revised. Moreover, the waist circumference and IAFA cut points should be age specific, especially in women. Appropriate waist circumference cut points are from 80 to 90 cm in women and from 87 to 90 cm in men.     

Clinical usefulness of quantitative evaluation of visceral fat by ultrasonography

Purpose The aim of this work was to evaluate the usefulness of a proposed method for visceral fat volume assessment by ultrasonography (US) in identifying those at risk of metabolic syndrome, and also to establish the most suitable cutoff level of waist circumference for the diagnosis of visceral adiposity. Methods One hundred and fifty-two outpatients with metabolic diseases such as hypertension, diabetes, or dyslipidemia were studied. The total visceral fat volume (total-VFA) was measured by computed tomography (CT), the visceral fat area at the level of the umbilicus was measured by CT (CT-VFA), and the visceral fat area was also measured by US (US-VFA), as we recently proposed. Results Significant correlation coefficients were found between total-VFA and CT-VFA, US-VFA, and waist circumference in men but not in women. The correlation co-efficient between US-VFA and waist circumference was significantly positive in men and weakly positive in women. According to receiver–operator characteristic curves, the cutoff value of waist circumference yielding the maximal sensitivity plus specificity for predicting more than 100 cm² of US-VFA was 85 cm in men and 84 cm in women. The change in US-VFA was significantly larger than that in waist circumference after a 6-month interval. Conclusion The US-measured visceral fat area is more useful than waist circumference in a clinical setting.     

人体测量学指标对老年人群代谢综合征的预测价值

目的筛查预测任丘地区老年人群代谢综合征(metabolic syndrome,MS)的简易人体测量学指标。方法采用整群随机抽样的方法,对任丘市常住人群60～70岁共4 412例,进行面对面问卷调查、体格检查及实验室检测。将男女分组后,采用ROC曲线分析法判断颈围、体质量指数(body mass index,BMI)、腰身指数(waist height ratio,WHtR)对老年代谢综合征的筛查作用,并确定最佳切点、敏感度、特异度和曲线下面积。结果颈围、BMI、WHtR均对老年男女MS的预测有显著意义（P<0.01）。在老年男性中,颈围37.75 cm,BMI 24.95 kg/m2,WHtR 0.56为预测MS的最佳切点, 曲线下面积分别为0.779、0.797、0.817;而在老年女性中,颈围34.15 cm,BMI 24.55 kg/m2,WHtR 0.56为预测MS的最佳切点,曲线下面积分别为0.769、0.766、0.775。其中,在老年男女性中, 腰身指数的曲线下面积在所有参数中均最大。结论颈围、体质量指数、腰身指数此类简易人体测量学指标在MS的筛查以及预测均有重要意义,腰身指数为最佳的预测指标。     

A Pooled Analysis of Waist Circumference and Mortality in 650,000 Adults

ObjectivesTo assess the independent effect of waist circumference on mortality across the entire body mass index (BMI) range and to estimate the loss in life expectancy related to a higher waist circumference.Patients and MethodsWe pooled data from 11 prospective cohort studies with 650,386 white adults aged 20 to 83 years and enrolled from January 1, 1986, through December 31, 2000. We used proportional hazards regression to estimate hazard ratios (HRs) and 95% CIs for the association of waist circumference with mortality.ResultsDuring a median follow-up of 9 years (maximum, 21 years), 78,268 participants died. After accounting for age, study, BMI, smoking status, alcohol consumption, and physical activity, a strong positive linear association of waist circumference with all-cause mortality was observed for men (HR, 1.52 for waist circumferences of ≥110 vs <90 cm; 95% CI, 1.45-1.59; HR, 1.07 per 5-cm increment in waist circumference; 95% CI, 1.06-1.08) and women (HR, 1.80 for waist circumferences of ≥95 vs <70 cm; 95% CI, 1.70-1.89; HR, 1.09 per 5-cm increment in waist circumference; 95% CI, 1.08-1.09). The estimated decrease in life expectancy for highest vs lowest waist circumference was approximately 3 years for men and approximately 5 years for women. The HR per 5-cm increment in waist circumference was similar for both sexes at all BMI levels from 20 to 50 kg/m², but it was higher at younger ages, higher for longer follow-up, and lower among male current smokers. The associations were stronger for heart and respiratory disease mortality than for cancer.ConclusionsIn white adults, higher waist circumference was positively associated with higher mortality at all levels of BMI from 20 to 50 kg/m². Waist circumference should be assessed in combination with BMI, even for those in the normal BMI range, as part of risk assessment for obesity-related premature mortality.     

Upper body fat predicts metabolic syndrome similarly in men and women

Background

The metabolic syndrome is a constellation of risk factors including dyslipidemia, dysglycemia, hypertension, a pro‐inflammatory state, and a prothrombotic state. All of these factors are accentuated by obesity. However, obesity can be defined by body mass index (BMI), percent body fat, or by body fat distribution. The latter consists of upper body fat (subcutaneous and visceral fat) and lower body fat (gluteofemoral fat). Waist circumference is a common surrogate marker for upper body fat.

Methods

Data from the National Health and Nutrition Examination Survey (NHANES) for the years 1999‐2006 was examined for associations of metabolic risk factors with percent body fat, waist circumference, and BMI.

Results

Associations between absolute measures of waist circumference and risk factors were similiar for men and women. The similarities of associations between waist circumference and risk factors suggests that greater visceral fat in men does not accentuate the influence of upper body fat on risk factors.

Conclusions

Different waist concumference values should not be used to define abdominal obesity in men and women.     

Association between Waist-to-Height Ratio and Metabolic Risk Factors in Korean Adults with Normal Body Mass Index and Waist Circumference

There is little consensus on the best obesity index associated with metabolic risk factors among the population with normal both body mass index (BMI) and waist circumference (WC). We therefore evaluated the association between anthropometric indices and metabolic risk factors in a Korean population with normal BMI and WC. This cross-sectional study involved 2,952 participants aged 20-79 years who had normal BMI and WC, based on the Fourth Korea National Health and Nutrition Examination Surveys conducted in 2008. The receiver operating characteristic (ROC) curves were generated to identify the optimal measurement of obesity for the prediction of metabolic risk factors in this population. The area under the ROC curve value for waist-to-height ratio (WHtR) in prediction of metabolic syndrome (MetS) and its components was higher than that for BMI and WC. Among individuals with normal BMI and WC, prevalence of all metabolic risk factors and MetS significantly increased across the quartiles of WHtR in both men and women. After adjustment for potential confounders, the Odds Ratios (95% confidence intervals) for MetS in the second, third, and fourth quartiles of WHtR compared to the first quartile of WHtR were 3.53 (2.12-5.89), 6.06 (3.52-10.43), and 7.11 (4.08-12.38) in men, and 1.66 (1.01-2.72), 2.79 (1.81-4.30), and 2.82 (1.76-4.52) in women, respectively. In conclusion, WHtR has the best predictive value for evaluating the metabolic risk factors compared to BMI or WC alone among subjects with normal BMI and WC.     

Comparability and utility of body composition measurement vs. anthropometric measurement for assessing obesity related health risks in Korean men

Background: Obesity is commonly assessed by body mass index (BMI) of which limitations come from an inability to distinguish body fat mass from lean mass. Several anthropometric measurements, including BMI, waist circumference, waist‐to‐height ratio and waist‐to‐hip ratio have been used to predict metabolic syndrome. The purpose of this study was to evaluate the utility of FMI or BF% combined with previous known anthropometric indices to assess the risk of metabolic syndrome in clinical practice. Methods: In 5534 men visiting a hospital for health check‐ups, blood tests, anthropometric measurements and body composition analysis using BIA were performed. Logistic regression analysis was performed to compare the odds ratios for metabolic syndrome and each component of metabolic syndrome among BMI, waist‐to‐height ratio, waist‐to‐hip ratio, FMI and BF%. The area under the curve (AUC) of the receiver operating characteristic curve (ROC) for metabolic syndrome was compared between several measurements. The net reclassification improvement with integrated discrimination improvement was used for assessing value of body composition measurement. Results: The adjusted odds ratios of metabolic syndrome was 1.80 (95% CI, 1.71–1.89) for FMI and 1.15 (95% CI, 1.13–1.17) for BF%. Odds ratio of each metabolic component was highest for FMI among several anthropometric and body composition measurements. AUCs using the ROC curve for metabolic syndrome was highest for waist‐to‐height ratio, 0.823 (95% CI, 0.808–0.837) by National Cholesterol Education Program criteria. FMI caused a mild increase in integrated discrimination improvement when combined with waist‐to‐height ratio. Conclusions: Waist‐to‐height ratio seems to be the best screening tool for evaluating metabolic syndrome in Korean men, and adding FMI could result in a modest increase in integrated discrimination improvement.     

Leptin and variables of body adiposity, energy balance, and insulin resistance in a population-based study. The Hoorn Study.

OBJECTIVE: Leptin is thought to play a key role in the control of body weight. There is a complex interrelationship between leptin and insulin or insulin resistance, but it is unknown how leptin is regulated. We therefore explored, in a large population-based study of 2,484 Caucasian subjects aged 50-74 years, the relationship between leptin and variables of body adiposity, energy balance, and insulin resistance. RESEARCH DESIGN AND METHODS: Leptin was measured by means of a radioimmunoassay. Multiple linear regression analyses were performed with leptin as dependent variable and age, sex, BMI, waist circumference, daily energy intake, physical activity, smoking, hypertension, fasting triglyceride concentrations, HDL cholesterol, fasting plasma glucose, and fasting plasma insulin concentrations as independent variables (determinants) RESULTS: Leptin concentrations were found to be four times higher in women than in men. Effect modification between sex and potential determinants was expected, and the analyses were performed separately for women and men. BMI was the strongest determinant of leptin in women and waist circumference the strongest determinant in men. BMI, waist circumference, insulin, and triglyceride concentrations were independently and significantly (P < 0.05) associated with leptin, while inverse associations were shown for smoking and daily energy intake (borderline significance). CONCLUSIONS: This study confirms the relationship between insulin and leptin and, in addition, suggests a relationship between triglyceride concentrations and leptin independent of sex, BMI, waist circumference, and insulin.     

上臂围和小腿围在社区老年肌少症患者筛查诊断中的应用

目的 探讨上臂围和小腿围与肌肉量的相关关系及其对肌量减少和肌少症的筛查诊断效果和最佳诊断截断值。方法 2020年3月至8月,方便抽取831例社区老年人(≥ 60岁)作为研究对象,采用身体成分测试仪检测肌肉量等指标,同时进行上臂围和小腿围的测量,握力及步速测试。上臂围、小腿围与肌肉量等指标的相关性行Pearson相关分析,受试者操作特征(ROC)曲线分析上臂围和小腿围对肌量减少和肌少症的诊断效果,并利用约登指数(YI)确定最佳诊断截断值。结果 上臂围和小腿围与四肢骨骼肌含量(ASM)和骨骼肌质量指数(SMI)呈显著正相关(r = 0.6~0.8, P < 0.001)。上臂围诊断肌量减少的ROC曲线下面积(AUC)是男性0.888、女性0.787,小腿围是男性0.933、女性0.854;上臂围最佳截断值男性和女性均为26 cm,小腿围男性34 cm、女性33 cm。上臂围诊断肌少症的AUC是男性0.902、女性0.744,小腿围是男性0.923、女性0.832;其最佳截断值无性别差异,分别是26 cm和33 cm。在社区老年男性和女性中,年龄、上臂围、小腿围、握力和步速等多指标对肌量减少和肌少症联合诊断的AUC均大于0.85。结论 社区老年人中,上臂围和小腿围均与肌肉量呈正相关,且对肌量减少和肌少症具有较好的诊断效果;多指标的联合诊断可显著提高上臂围在女性中的诊断效果。     

社区慢性病共病老年患者肌少症筛查工具的比较研究

目的 比较指环测试与小腿围对社区慢性病共病老年患者肌少症的筛查效果。 方法 2022年2月—5月,采用方便抽样法,选取河南省郑州市15个社区的慢性病共病老年患者330例,分别应用指环测试、小腿围对其进行评估,基于2019年亚洲肌肉减少症工作组提出的诊断标准,采用SPSS 26.0软件计算灵敏度、特异度和预测值,绘制受试者操作特征曲线,计算曲线下面积,并通过约登指数,确定小腿围的最佳截断值。 结果 最终纳入320例社区慢性病共病老年患者,肌少症的发生率为20.63%,指环测试、小腿围的筛查率分别为28.13%、21.25%。2种肌少症筛查工具在社区慢性病共病老年患者中的灵敏度为68.2%、73.0%,特异度为82.3%、80.0%,受试者操作特征曲线下面积为0.752、0.810,小腿围对应的最佳截断值为男性<34.5 cm、女性<33.5 cm。 结论 小腿围对社区慢性病共病老年患者肌少症的筛查更具灵敏度和准确性。     

Neck Circumference Positively Related With Central Obesity, Overweight, and Metabolic Syndrome in Chinese Subjects With Type 2 Diabetes: Beijing Community Diabetes Study 4

OBJECTIVE

To investigate the association between neck circumference and central obesity, overweight, and metabolic syndrome in Chinese individuals with type 2 diabetes.

RESEARCH DESIGN AND METHODS

A total of 3,182 diabetic subjects (aged 20–80 years) were recruited from 15 community health centers in Beijing using a multistage random sampling approach.

RESULTS

Receiver operating characteristic analysis showed that the area under the curve for neck circumference and central obesity was 0.77 for men and 0.75 for women (P < 0.001). Furthermore, a neck circumference of ≥38 cm for men and ≥35 cm for women was the best cutoff point for determining overweight subjects. A neck circumference of ≥39 cm for men and ≥35 cm for women was the best cutoff point to determine subjects with metabolic syndrome.

CONCLUSIONS

In the present study, neck circumference is positively related with BMI, waist circumference, and metabolic syndrome in Chinese individuals with type 2 diabetes.Neck circumference (NC) as an index for upper-body subcutaneous adipose tissue distribution has been evaluated in relation to cardiovascular risk factors, insulin resistance, and biochemical components of metabolic syndrome (MS) (1–4). However, epidemiological population-based studies on the clinical significance of NC in connection with overweight and MS in diabetic people are lacking. The aim of this study was to determine whether NC alone can predict overweight and central obesity and to evaluate the association between NC and MS.     

An observational cohort study of the performance of the REDS score compared to the SIRS criteria,NEWS2, CURB65, SOFA,MEDS and PIRO scores to risk-stratify emergency department suspected sepsis

ObjectiveTo compare the performance of the Risk-stratification of Emergency Department suspected Sepsis (REDS) score to the SIRS criteria, NEWS2, CURB65, SOFA, MEDS and PIRO scores, to risk-stratify Emergency Department (ED) suspected sepsis patients for mortality.MethodA retrospective observational cohort study of prospectively collected data. Adult patients admitted from the ED after receiving intravenous antibiotics for suspected sepsis in the year 2020, were studied. Patients with COVID-19 were excluded. The scores stated above were calculated for each patient. Receiver operator characteristics (ROC) curves were constructed for each score for the primary outcome measure, all-cause in-hospital mortality. The area under the ROC (AUROC) curves and cut-off points were identified by the statistical software. Scores above the cut-off point were deemed high-risk. The test characteristics of the high-risk groups were calculated. Comparisons were based on the AUROC curve and sensitivity for mortality of the high-risk groups. Previously published cut-off points were also studied. Calibration was also studied.ResultsOf the 2594 patients studied, 332 (12.8%) died. The AUROC curve for the REDS score 0.73 (95% confidence interval [CI] 0.72–0.75) was significantly greater than the AUROC curve for the SIRS criteria 0.51 (95% CI 0.49–0.53), p < .0001 and the NEWS2 score 0.69 (95% CI 0.67–0.70), p = .005, and similar to all other scores studied. Sensitivity for mortality at the respective cut-off points identified (REDS ≥3, NEWS2 ≥ 8, CURB65 ≥ 3, SOFA ≥3, MEDS ≥10 and PIRO ≥10) was greatest for the REDS score at 80.1% (95% CI 75.4–84.3) and significantly greater than the other scores. The sensitivity for mortality for an increase of two points from baseline in the SOFA score was 63% (95% CI 57.5–68.2).ConclusionsIn this single centre study, the REDS score had either a greater AUROC curve or sensitivity for mortality compared to the comparator scores, at the respective cut-off points identified.

KEY MESSAGES

• The REDS score is a simple and objective scoring system to risk-stratify for mortality in emergency department (MED) patients with suspected sepsis.
• The REDS score is better or equivalent to existing scoring systems in its discrimination for mortality.

     

Type 2 diabetes in older well-functioning people: who is undiagnosed? Data from the Health, Aging, and Body Composition study.

OBJECTIVE: To assess, in an older population, the prevalence of diagnosed and undiagnosed diabetes, the number needed to screen (NNTS) to identify one individual with undiagnosed diabetes, and factors associated with undiagnosed diabetes. RESEARCH DESIGN AND METHODS: Socioeconomic and health-related factors were assessed at the baseline examination of the Health, Aging, and Body Composition (Health ABC) Study, a cohort of 3,075 well-functioning people aged 70-79 years living in Memphis, Tennessee and Pittsburgh, Pennsylvania (42% blacks and 48% men). Diabetes was defined according to the 1985 World Health Organization criteria (fasting glucose > or =7.8 mmol/l or 2-h glucose > or =11.1 mmol/l) and the 1997 American Diabetes Association criteria (fasting glucose > or =7.0 mmol/l). RESULTS: The prevalence of diagnosed and undiagnosed diabetes was 15.6 and 8.0%, respectively, among all participants (NNTS 10.6), 13.9 and 9.1% among white men (NNTS 9.5), 7.8 and 7.4% among white women (NNTS 12.4), 22.7 and 9.1% among black men (NNTS 8.5), and 21.6 and 6.2% among black women (NNTS 12.6). In multivariate analyses, compared with individuals without diabetes, individuals with undiagnosed diabetes were more likely to be men and were more likely to have a history of hypertension, higher BMI, and larger waist circumference. NNTS was lowest in men (9.1), individuals with hypertension (8.7), individuals in the highest BMI quartile (6.9), and individuals in the largest waist circumference quartile (6.8). CONCLUSIONS: In approximately one-third of all older people with diabetes, the condition remains undiagnosed. Screening for diabetes may be more efficient among men and individuals with hypertension, high BMI, and large waist circumference.     

High-Sensitivity C-Reactive Protein Is Associated With Incident Type 2 Diabetes Among African Americans: The Jackson Heart Study

OBJECTIVE

Previous studies on the association between hs-CRP and incident type 2 diabetes among African Americans have been inconclusive. We examined the association between hs-CRP and incident diabetes in a large African American cohort (Jackson Heart Study).

RESEARCH DESIGN AND METHODS

hs-CRP was measured in 3,340 participants. Incident diabetes was defined by fasting glucose ≥126 mg/dL, physician diagnosis, use of diabetes drugs, or A1C ≥6.5% (48 mmol/mol) at follow-up. Cox regression was used to estimate hazard ratios (HRs) for incident diabetes, adjusting for age, sex, education, diabetes family history, alcohol, HDL, triglycerides, hypertension status, hypertension medications, physical activity, BMI, HOMA-insulin resistance (HOMA_IR), and waist circumference.

RESULTS

Participants (63% women) were aged 53.3 ± 12.5 years. During a median follow-up of 7.5 years, 17.4% developed diabetes (23.1/1,000 person-years, 95% CI 21.3–25.1). After adjustment, the HR (hs-CRP third vs. first tertile) was 1.64 (95% CI 1.26–2.13). In separate models, further adjustment for BMI and waist circumference attenuated this association (HR 1.28 [95% CI 0.97–1.69] and 1.35 [95% CI 1.03–1.78, P < 0.05 for trend], respectively). Upon adding HOMA_IR in the models, the association was no longer significant. In adjusted HOMA_IR-stratified analysis, the hs-CRP–diabetes association appeared stronger in participants with HOMA_IR <3.0 compared with HOMA_IR ≥3.0 (P < 0.0001 for interaction). The association was also stronger among nonobese participants, although not significant when adjusted for HOMA_IR.

CONCLUSIONS

Low-grade inflammation, as measured by hs-CRP level, may have an important role in the development of diabetes among African Americans with a lesser degree of insulin resistance.     

首钢水钢员工体质量指数、腰围与血压、高血压患病率的关系

目的 探讨首钢水钢员工体质量指数(body mass index,BMI),腰围与血压、高血压患病率的关系.方法 对2496名首钢水钢员工采用多阶段随机整群抽样方法进行调查.同时对2496名首钢水钢员工进行体格检查,包括:测量血压(SBP、DBP)、身高、体质量及腰围.结果 2496名员工中,BMI(23.18±3.34)kg · m-2,超重与肥胖占38.22%(954/2 496),腹型肥胖占36.26% (905/2 496),腰围(80.37±10.02)cm.男性BMI为<18,≥ 18～<24,≥24～<28,≥28 kg·m-2高血压患病率均明显高于女性(P<0.05),男性腰围为<75,)75～<85,≥85 cm高血压患病率均明显高于女性(P<0.05).男性BMI<24 kg·m-2,腰围<85 cm,BMI<24 kg·m-2、腰围≥85 cm,BMI 24～27.9 kg " m-z、腰围<85 cm,BMI 24～27.9 kg·M-2,腰围)85 cm,BMI>,28 kg·M-2,腰围≥85 cm高血压患病率均明显高于女性BMI< 24 kg·m-2,腰围<80 cm,BMI< 24 kg·M-2,腰围≥80 cm,BMI24～27.9 kg·M-2,腰围<80 cm,BMI 24～27.9 kg·m-2,腰围≥80 cm,BMI>,28 kg·m-2、腰围≥80 cm(P<0.05或P<0.01).结论 首钢水钢员工中男性高血压患病率显著高于女性,控制BMI和腰围有利于高血压的防控.     

Clinical implication of the body mass and waist/thigh indices in hypertensive patients: correlations with blood uric acid levels

Body mass index (BMI) and waist/thigh circumference (WTC) were estimated in 104 patients with mild and moderate arterial hypertension (AH) lasting for 8.4 +/- 3.2 years (63 men, 41 women, mean age 50.2(+)-9.6 years). Blood concentration of uric acid was tested with enzymes (Boehringer Mannheim kits). Only 5 of 104 examinees had BMI under 25. The majority of the patients (79%) had high WTC. Hyperuricemia was detected in 32 of 104 patients. Uric acid level in the blood correlates (r = 0.43) with WTC but not with BMI.     

Diagnostic accuracy of cardiovascular magnetic resonance imaging of right ventricular morphology and function in the assessment of suspected pulmonary hypertension results from the ASPIRE registry

Background

Cardiovascular Magnetic Resonance (CMR) imaging is accurate and reproducible for the assessment of right ventricular (RV) morphology and function. However, the diagnostic accuracy of CMR derived RV measurements for the detection of pulmonary hypertension (PH) in the assessment of patients with suspected PH in the clinic setting is not well described.

Methods

We retrospectively studied 233 consecutive treatment naïve patients with suspected PH including 39 patients with no PH who underwent CMR and right heart catheterisation (RHC) within 48hours. The diagnostic accuracy of multiple CMR measurements for the detection of mPAP ≥ 25 mmHg was assessed using Fisher’s exact test and receiver operating characteristic (ROC) analysis.

Results

Ventricular mass index (VMI) was the CMR measurement with the strongest correlation with mPAP (r = 0.78) and the highest diagnostic accuracy for the detection of PH (area under the ROC curve of 0.91) compared to an ROC of 0.88 for echocardiography calculated mPAP. Late gadolinium enhancement, VMI ≥ 0.4, retrograde flow ≥ 0.3 L/min/m² and PA relative area change ≤ 15% predicted the presence of PH with a high degree of diagnostic certainty with a positive predictive value of 98%, 97%, 95% and 94% respectively. No single CMR parameter could confidently exclude the presence of PH.

Conclusion

CMR is a useful alternative to echocardiography in the evaluation of suspected PH. This study supports a role for the routine measurement of ventricular mass index, late gadolinium enhancement and the use of phase contrast imaging in addition to right heart functional indices in patients undergoing diagnostic CMR evaluation for suspected pulmonary hypertension.     

腰围与体重指数对无偿献血者脂肪血的预测价值

目的 通过研究脂肪血与腰围、体重指数的关联,探索减少脂肪血采集的方法。方法 召回献血者249人,其中不同程度的脂肪血献血者161人作为观察组,随机抽取非脂肪血的献血者88人作为对照组。测量献血者身高、腰围、餐后血脂的浓度,让献血者填写问卷。结果 男性,有吸烟、喝酒习惯及药物史的献血者更倾向于出现脂肪血; 观察组中,献血者的体重指数(BMI)和腰围(WC)大于对照组,总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)高于对照组,高密度脂蛋白胆固醇(HDL-C)低于对照组,差异均有统计学意义(P<0.05); BMI、腰围与餐后TG呈正相关(r=0.471,P<0.05; r=0.273,P<0.05); 经ROC曲线分析,BMI预测脂肪血的最佳截点为25.92,ROC曲线下面积为0.769(95%CI:0.709～0.830,P<0.05),WC在预测脂肪血的最佳截点为91.50cm,ROC曲线下面积为0.811(95%CI:0.756～0.867,P<0.05)。结论 BMI,WC在无偿献血初筛中的应用能减少脂肪血的采集。     

Increases in Waist Circumference and Weight As Predictors of Type 2 Diabetes in Individuals With Impaired Fasting Glucose: Influence of Baseline BMI: Data from the DESIR study

OBJECTIVE

To evaluate in impaired fasting glucose (IFG) the relative importance of increases in waist circumference and weight on progression to type 2 diabetes.

RESEARCH DESIGN AND METHODS

The 9-year incidence of diabetes was studied in 979 men and women with baseline IFG, from the Data from an Epidemiological Study on the Insulin Resistance Syndrome (DESIR) cohort.

RESULTS

Increases in both waist circumference and weight were significantly associated with diabetes incidence. Standardized odds ratios (95% CI) were 1.79 (1.45–2.21) and 1.86 (1.51–2.30), respectively, after controlling for baseline risk factors. The impact of waist circumference increase was greater for BMI <25 kg/m² (2.40 [1.63–3.52]) than for BMI ≥25 kg/m² (1.66 [1.28–2.16]) and persisted after adjusting for concurrent changes in either insulinemia or the homeostasis model assessment of insulin resistance index. Weight change had a similar impact in both BMI groups.

CONCLUSIONS

In individuals with IFG, it is important to monitor and prevent increases in waist circumference, in particular for those with BMI <25 kg/m².Individuals with impaired fasting glucose (IFG) are at high risk for type 2 diabetes (1,2). Although visceral adiposity and waist circumference are strong risk factors for type 2 diabetes (3), the consequence of an increase in waist circumference among individuals with IFG at baseline has not been fully investigated, in particular in those who are not overweight or obese at baseline (4,5). This report investigates the relative importance of increases in waist circumference and weight on progression to diabetes in individuals with baseline IFG, according to baseline BMI strata.     

Exploring the Association Between Measures of Obesity and Measures of Trip-induced Fall Risk Among Older Adults

ObjectiveTo explore the association between measures of obesity and measures of trip-induced fall risk among community-dwelling older adults.DesignCase-control.SettingGait laboratory.ParticipantsVoluntary sample of 55 community-dwelling older adults (aged ≥65y; N=55) with body mass index (BMI) of 18.84-44.68 kg/m².InterventionsNot applicable.Main Outcome MeasuresMeasures of obesity included 6 anthropometry-based measures (BMI; thigh, hip and waist circumferences; ratio of waist-to-hip circumference; index of central obesity) and 4 dual-energy x-ray absorptiometry–based measures (percentage trunk, leg, and total fat; fat mass index). Measures of risk of tripping during overground walking included median and interquartile range of toe clearance and area under the swing phase toe trajectory. Measures of trip recovery after a laboratory-induced trip included trunk angle and angular velocity at ground contact of the first recovery step, anteroposterior distance from stepping foot to center of mass at the same instant, and step time of the first recovery step.ResultsRisk of tripping was associated with waist-to-hip ratio and thigh circumference. After grouping participants by waist-to-hip ratio, those with high ratios (≥0.9 cm for men and ≥0.85 cm for women) exhibited significantly greater variability in toe clearance. Trip recovery was associated with hip circumference, thigh circumference, fat mass index, and total fat. After grouping participants by fat mass index, those with high indices (>9 kg/m² for men and >13 kg/m² for women) exhibited less favorable trunk kinematics after a laboratory-induced trip (Cohen d=0.84).ConclusionsWaist-to-hip ratio and fat mass index may more closely relate to trip-induced fall risk than BMI among community-dwelling older adults.