Incident obesity and cardiovascular risk factors between young adulthood and middle age by religious involvement: the Coronary Artery Risk Development in Young Adults (CARDIA) study

Background

Religious involvement has been associated with improved health outcomes but greater obesity in older adults. No longitudinal study of young adults has examined the prospective association of religious involvement with incident cardiovascular risk factors (RFs) and subclinical disease (subCVD).

Methods

We included 2433 participants of the CARDIA study, aged 20 to 32 in 1987 when religiosity was assessed, who were followed for 18 years. Multivariable-adjusted regression models were fitted to assess prospective associations of frequency of religious participation at baseline with incidence of RFs and prevalence of subCVD after 18 years’ follow up.

Results

The high frequency of religious participation was associated with a significantly greater incidence of obesity in unadjusted models (RR 1.57, 95% CI 1.14-1.73) and demographic-adjusted models (RR 1.34, 95% CI 1.09-1.65) but not after additional adjustment for baseline RFs (RR 1.17, 95% CI .97-1.41). When religious participation was treated dichotomously, any religious participation, compared with none, was associated with significantly lower subCVD.

Conclusions

Frequent religious participants are more likely to become obese between young adulthood and middle age; this association is confounded by demographic and other factors. Nonetheless, young adults with frequent participation may represent an opportunity for obesity prevention.     

肥胖儿童心血管疾病的危险因素

营养过剩所致的儿童肥胖症已成为十分常见的营养问题。本文对上海市五角场地区８８０２名４－１２岁儿童进行了单纯性肥胖症的筛查及有关调查。     

超重、肥胖和腹型肥胖与心血管代谢性疾病的关联研究

目的 了解超重、肥胖和腹型肥胖对心血管代谢性疾病的影响。方法 采用整群抽样方法,选取河南省开封市通许县673名15岁以上居民为调查对象进行横断面调查,并对研究对象进行问卷调查和体格检查,留取空腹和餐后2h静脉血进行血糖检测。结果 开封地区居民标化超重患病率为35.52%;标化肥胖患病率为14.18%;标化腹型肥胖患病率为42.62%。单因素logistic回归分析显示,超重、肥胖和腹型肥胖是高血压、2型糖尿病、高血脂的危险因素;腹型肥胖是冠心病和脑卒中的危险因素(P<0.05)。腹型肥胖的人群归因危险度(PAR)在高血压、2型糖尿病、高血脂和心脑血管疾病中均高于70%。结论 在对高危人群进行筛查时,腰围比体质指数更为重要。减少腹型肥胖人群比例对预防心血管代谢性疾病的意义更为重大。     

Socio-economic status and risk factors for cardiovascular disease: A multicentre collaborative study in the international clinical epidemiology network (INCLEN)

As part of a multicentre collaborative study of risk factors for cardiovascular disease (CVD) in the International Clinical Epidemiology Network (INCLEN), each of 12 Centres in 7 countries examined the relationship between CVD risk factors and socio-economic variables.

Each Centre (three in Thailand, two each in China, Chile and Brazil and one each in the Philippines, Indonesia and Colombia) examined approx. 200 men aged 35–65 drawn at random from a population within their locality (not designed to be necessarily representative of the general population). Standardized measures of CVD risk factors included body mass index (BMI), blood pressure, blood cholesterol and cigarette smoking habits. Education, occupation and current income were grouped into ordinal categories of socio-economic status according to standard protocol guidelines, and comparisons were made between risk factor levels within each of these categories. Many of these populations had higher levels of education (as a marker of socio-economic status) than would the general population of their country.

For both BMI and blood cholesterol there were a number of centres which showed positive associations with socio-economic status. These were predominately in China or urban or rural South East Asia. For blood pressure and cigarette smoking the associations with socio-economic status tended to be negative, more in line with the direction of association seen in the “Developed” World.

The high risk factor levels found in these populations, particularly the alarming prevalence of cigarette smoking in Asia and the high cholesterol levels in Latin America and Urban S.E. Asia suggest that CVD will emerge as a major public health problem in the Developing World. As this happens, knowledge of the patterns of association between risk and socio-economic status is likely to be important in both understanding the reasons for the patterns of disease and directing efforts at prevention.     

The impact of obesity on cardiovascular disease mortality in the District Sumperk,Czech Republic

Summary Objective: The impact of obesity on cardiovascular mortality in the District Sumperk (C2) is assessed. Methods: A case-control design was selected to study the impact of obesity on cardiovascular mortality among the population of the District Sumperk, Czech Republic. Exposure to obesity was defined as body-mass index (BMI) higher or equal 30. Men and women with BMI lower than 30 were considered nonexposed. Odds ratios were calculated, comparing the probability of exposure among cases and controls. Cases were defined as persons from the studied population who died between 1987–2004, the cause of death being circulatory system diseases. Controls were persons from the studied population who had not died as to December 31, 2004. Results: Cases were more likely to be obese than controls (OR = 1.68; 95 % CI 1.56–1.80). In men OR was 1.56 (95 % CI 1.40–1.74), in women OR was 1.89 (95 % CI 1.72–2.06). The impact of obesity was decreasing with increasing age. Conclusions: An increased risk of cardiovascular mortality following exposure to obesity was observed. Younger age groups seem to be the important target population for preventive programmes focusing on treatment of obesity. Submitted: 6 June 2006; Revised: 9 March 2007; Accepted: 29 March 2007     

Vitamin D, obesity, and obesity-related chronic disease among ethnic minorities: a systematic review

Objective

To assess the association between 25-hydroxyvitamin D (25[OH]D) status and obesity, cardiovascular diseases (CVDs), the metabolic syndrome, and type 2 diabetes mellitus (T2DM) in ethnic minorities.

Methods

Databases searched were CINHAL with full text, Global Health, MEDLINE with full text, and PsycINFO from 1980 through 2010 (February). Studies were included if they 1) targeted immigrants from low- to high-income countries or ethnic minorities, 2) focused primarily on 25(OH)D and its relation to obesity, T2DM, and/or CVDs, and 3) were published in peer-reviewed journals. The influences of key confounders such as age, gender, and ethnicity on any observed relations were also assessed. Due to the heterogeneity of study characteristics, only a narrative synthesis was undertaken.

Results

Ethnic minorities had significantly higher rates of vitamin D insufficiency (25[OH]D <50 nmol/L; children 43.6-48.7% versus 10%; adults 30.3-53% versus 13.7-26%) than their white counterparts. None of the studies reported a prevalence of obesity stratified by ethnicity. There was evidence supporting links between vitamin D deficiency and obesity-related chronic diseases, with 14 of 14 studies reporting a statistically significant result with a measurement of obesity, four of five for T2DM, four of five for CVDs, and one of one for the metabolic syndrome. However, the strength of the association varied across ethnic groups depending on the index used to measure adiposity, T2DM, and CVDs. Because most of the included studies were cross-sectional and there were variations in outcome measurements, it was not possible to determine the relative contributions of obesity or vitamin D insufficiency to CVD risk and risk of T2DM or which is the initial driver It is possible both have a role to play.

Conclusion

Further research specific to migrant populations using randomized controlled trials are required to establish whether causal links between 25(OH)D and obesity-related chronic disease exist, and whether vitamin D supplementation could be valuable in the prevention or treatment of obesity-related diseases.     

The effect of metformin on cardiovascular markers in female mice consuming a high fat diet

BackgroundMetformin, widely used to treat diabetes, is now considered a candidate therapeutic for treatment of cardiovascular disease. This study aimed to assess whether metformin’s non-glycaemic effects could mitigate cardiovascular disease indices in female mice consuming a high fat diet (HFD).MethodsFour-week old female Arc:Arc(S) mice were placed on a standard (std) chow diet or Western-style HFD (22% fat, 0.15% cholesterol). At ～8 months, the mice were administered 150 mg/kg metformin or vehicle (control) via intraperitoneal injection for 11 days. Blood pressure was measured (tail cuff plethysmography) at Day 9 and 11 of treatment. On Day 11, mice were weighed and culled. The mesenteric arcade and kidneys were collected for assessment of vascular reactivity (wire myography), and assessment of expression of cardiometabolic markers (qPCR), respectively.ResultsThe HFD fed female mice were significantly heavier than those receiving the std diet at 1–12 weeks on diet, and at cull. Mice on a std diet with metformin treatment were significantly heavier at cull than the mice on a std diet administered the control treatment. Metformin treatment did not alter the weight of the mice receiving the HFD. Neither the HFD (compared to the std diet), nor metformin treatment (compared to control treatment) altered blood pressure, vascular reactivity, or expression of cardiometabolic markers in the kidney.ConclusionConsumption of a Western-style HFD (without high salt/sugar levels) did not alter the cardiovascular markers measured. Further studies are required to establish the non-glycaemic, cardio-protective effects of metformin in high-risk cohorts.     

不同类型肥胖与心血管疾病危险因素关联的比较

目的 比较不同类型肥胖与心血管疾病(CVD)危险因素的关联,为预防和控制心血管疾病提供科学依据.方法 利用"2002年中国居民营养与健康状况调查"资料,按照<中国成人超重和肥胖症预防控制指南>中判定肥胖的界值点[体重指数(BMI):24kg/m2和28 kg/m2;腰围:男性85 cm和95 cm,女性80 cm和90 cm]判定肥胖类型,比较不同类型肥胖人群与罹患CVD危险因素的关联;用logistic回归和多元线性回归分析BMI和腰围与CVD危险因素的关系.结果 与体重和腰围均在正常范围的人群(OR=1)相比,正常体重并高腰围Ⅰ(男性85～95 cm,女性80～90 cm)的人群、超重但腰围正常的人群罹患CVD危险因素的风险为1～2倍,超重并高腰围Ⅰ、肥胖但腰围正常的人群为2～3倍,超重并高腰围Ⅱ(男性≥95 cm,女性≥90 cm)、肥胖并高腰围Ⅰ或Ⅱ(男性≥85 cm,女性≥80 cm)的人群为≥3倍;同一腰围组中,随着BMI增加罹患CVD危险因素的风险也呈逐渐增加趋势;BMI和腰围同时解释CVD危险因素变异的1.7%～9.4%,大于BMI或腰围单独解释的比例(1.5%～9.0%);BMI对于收缩压的标化回归系数为0.129,略大于腰围(0.123),腰围对甘油三酯、总胆固醇和高密度脂蛋白胆同醇标化回归系数的绝对值大于BMI.结论 BMI和腰围与CVD危险因素独立相关,建议评估疾病危险时同时使用BMI和腰围两项指标.     

社区居民肥胖、中心性肥胖与冠心病发病风险的前瞻性队列研究

目的探索肥胖、中心性肥胖与冠心病发病风险的关系。方法 2013年在上海市浦东新区社区居民中采用多阶段分层随机抽样选取人群开展基线调查,收集6 685名队列研究对象的人口学特征、暴露因素、身体测量指标等信息。随访观察中位时间3.00年,记录队列人群的冠心病发病情况。单因素分析采用t检验、Kruskal-Wallis检验和卡方检验,多因素分析采用COX比例风险模型。结果队列总计观察人年数为19 759.93人年,共有260人发生冠心病,男性101例,女性159例。队列人群总体发病率3.89%,发病密度13.16/千人年。冠心病发病率随BMI升高呈上升趋势(χ²_趋势=6.761,P=0.009)。中心性肥胖人群发病风险是正常人群的1.39倍(P=0.019, 95%CI:1.06-1.82),中心性肥胖合并高血压患者发生冠心病的风险是正常人群的1.77倍(P=0.001, 95%CI:1.26-2.49)。结论中心性肥胖是冠心病发病的重要危险因素。     

Healthy Alberta Communities: Impact of a three-year community-based obesity and chronic disease prevention intervention

Objective

To assess the impact of a 3 year (2006–2009) community-based intervention for obesity and chronic disease prevention in four diverse “Healthy Alberta Communities” (HAC).

Methods

Targeted intervention development incorporated the ANGELO conceptual framework to help community stakeholders identify environmental determinants of obesity amenable to intervention. Several inter-related initiatives were implemented. To evaluate, we surveyed separate samples of adults in HAC communities before and after the interventions and compared responses to identical survey questions asked of adults living in Alberta in two waves of the Canadian Community Health Survey (CCHS).

Results

The HAC sample included 4761 (2006) and 4733 (2009) people. The comparison sample included 9775 and 9784 respondents in 2005 and 2009–10 respectively. Self-reported body mass index showed no change, and neither were there significant changes in behaviors relative to secular trends. Most significant outcomes were relevant to social conditions, specifically sense of belonging to community in the intervention communities.

Conclusion

Health outcome indicators at the community level may not be sufficiently sensitive to capture changes which, over a relatively short term, would only be expected to be incremental, given that interventions were directed primarily to creating environmental conditions supportive of changes in behavioral outcomes rather than toward health outcome change directly.     

某校大学生不同肥胖类型与心血管疾病代谢指标的关系

目的  获得大学生不同肥胖类型与心血管疾病代谢指标之间的关联性,为有效控制青少年肥胖、预防心血管疾病提供科学依据。 方法  本次研究以芜湖市某高校2018级3 450名新生为研究对象,采用整群抽样的方法对其进行问卷调查和体格检测。使用BMI及腰围身高比(waist height ratio, WHtR)作为判断肥胖的指标。 结果  符合条件的3 349名调查对象中复合型肥胖、中心型肥胖和外周型肥胖的患病率分别为6.51%、4.93%、0.53%。除了载脂蛋白A(apolipoprotein A, APOA)外,各心血管疾病代谢异常检出率在不同肥胖类型之间差异均有统计学意义(均有P＜0.05)。除APOA外,复合型肥胖发生心血管疾病代谢异常的风险较非肥胖人群均有增加(均有P＜0.05)。与非肥胖人群相比,复合型肥胖的青少年出现指标异常数≥2的可能性是6.86倍(OR=6.86, 95% CI: 4.54~10.39)。 结论  复合型肥胖青少年发生心血管疾病代谢异常的风险较高,联合使用BMI和WHtR可提高对青少年心血管疾病的预测效应。     

Prevention and treatment of obesity with lifestyle interventions: review and meta-analysis

Summary Objective: To assess the mid- to long-term effectiveness of lifestyle interventions in the prevention and treatment of obesity. Methods: A systematic literature review with meta-analysis was performed. Electronic databases, reference lists, books and reports covering topic of obesity were searched. The included studies were randomized clinical trials of lifestyle interventions in overweight and obese subjects that had a minimum observation period of one year. Outcomes evaluated were measurements of body weight, body mass index, waist circumference, systolic and diastolic blood pressure, blood lipids: total cholesterol, low density lipoprotein, high density lipoprotein, triglyceride, blood glucose control: two-hour plasma glucose, fasting plasma glucose, and glycosylated haemoglobin. Results: Thirteen studies have been selected in the prevention and seventeen in the treatment of obesity. Compared with standard care, lifestyle intervention reduced significantly body weight, body mass index, waist circumference, blood pressure, blood lipids and blood glucose in overweight and obese people. The favorable effects were maintained up to three years. Conclusions: Lifestyle interventions were efficacious in the mid- to long-term prevention and treatment of obesity leading to a significant reduction in body weight and cardiovascular risk factors. Submitted: 18 October 2006; Revised: 6 June 2007; Accepted: 28 August 2007     

Cardiovascular Health Outcomes of Latinos in the Affordable Housing as an Obesity Mediating Environment (AHOME) Study: A Study of Rental Assistance Use

Studies have shown that households subsidized with vouchers live in higher quality units and exhibit fewer physical, mental, and social problems than do their peers living in public housing. However, none of these studies have included cardiovascular outcomes. The objective of this study was to assess if use/type of rental assistance is independently associated with poor cardiovascular health among Latino adults (ages ≥18) who are eligible for federal low-income rental assistance and living in the Bronx, NY. Data from the cross-sectional, Affordable Housing as an Obesity Mediating Environment study, collected over 18 months (January 2011 to August 2012) were used. The prevalence of cardiovascular disease (CVD) outcomes was determined by measured high blood pressure and self-reported heart attack and/or stroke. Type of housing status was defined as: public housing units, units subsidized by section 8 vouchers, and units unassisted by either federal program. Statistical techniques used were analysis of variance and multivariate logistic regression. The prevalence of CVD was significantly higher among public housing residents than unassisted participants even in the presence of all individual level covariates. Public housing residents also have higher levels of CVD than do section 8 participants. The prevalence of CVD was similar for unassisted and section 8 participants. These findings point to the potential for health benefits arising from housing voucher use even within a fairly delimited geographic area.     

汉族和朝鲜族居民不同类型肥胖与心血管代谢危险因素的关系

目的 分析延边地区朝鲜族和汉族居民不同类型肥胖与心血管代谢危险因素的关系.方法 于2006年8月～2008年8月在吉林省延边农村地区随机抽取30～70岁朝鲜族和汉族人群5842人,测其身高、体重、腰围( waist circumference,WC)等指标,同时采集清晨空腹(禁食12h)静脉血,并准确测定生化指标.结果 1)30～70岁人群肥胖粗患率汉族和朝鲜族分别为12.2％和8.7％,年龄调整患病率分别为11.2％和9.8％,汉族均高于朝鲜族(x2=18.09,P＜0.001; U=39.43,P＜0.001);汉族和朝鲜族腹型肥胖粗患病率分别为46.4％和44.8％,年龄调整患病率分别为41.8％和40.9％,调整患病率汉族高于朝鲜族(U=17.64,P＜0.001).2)不同性别及民族心血管代谢危险因素及其聚集性与体质指数(body mass index,BMI)水平、WC关联与否及其程度有所不同.3)Logistic分析结果表明,高血压、高血糖(朝鲜族)、高胆同醇(total cholesterol,TC)(汉族)、低高密度脂蛋白胆固醇(high density lipoprotein cholesterol,HDL-C)(汉族)、非HDL-C、高甘油三酯(triglyceride,TG)和代谢综合征(metabolic syndrome,MS)在BMI和WC均异常组的aRR值最大;单纯BMI异常组的aRR值大于单纯WC异常组的心血管代谢危险因素为高血压(朝鲜族)、低HDL-C(汉族)和非HDL-C(朝鲜族);而单纯WC异常组的aRR值大于单纯BMI异常组的心血管代谢危险因素则为高血压(汉族)、高血糖、高TC(朝鲜族)、高TG和MS.结论 吉林省延边地区一般人群肥胖患病水平较高,而且不同民族人群不同类型肥胖患病率存在明显的差异.BMI、WC及其合并组表现出不同的心血管代谢风险.     

UCP1基因单核苷酸多态性位点与成人超重肥胖的关系

目的 研究解偶联蛋白1（uncoupling protein 1,UCP1）基因SNPs位点与超重肥胖的关系。方法 采用连接酶检测技术对SNPs进行基因分型,检测275例超重肥胖者与253例正常体重者UCP1基因4个SNP位点的基因型,利用SNP Stats在线软件构建单倍体型,并分析单倍体型与性别及非遗传因素的交互作用。结果 两组间体重、体质指数、总胆固醇、甘油三酯、高密度脂蛋白、低密度脂蛋白差异有统计学意义（均有P<0.05）;隐性遗传模式下,rs1800592位点基因型（AA+AG）与GG在两组间差异有统计学意义（P=0.048,OR=1.154,95% CI：1.002~2.286））;与单倍体型CTAA相比,CTCA、CTAG、TACG在两组间分布差异有统计学意义（CTCA：P=0.043,OR=0.658,95% CI：0.439~0.988;CTAG：P=0.043,OR=0.658,95% CI：0.439~0.988;TACG：P=0.004,OR=0.449,95% CI：0.257~0.786）;单倍体型与血清总胆固醇之间存在交互作用（χ²=15.955,P=0.014）;与血清总胆固醇正常组单倍体型CTAA相比,在血清总胆固醇异常组,单倍体型CTAA、CTCG、CTCA、CTAG在两组间的分布差异有统计学意义（CTAA：P<0.001,OR= 2.731,95% CI：1.550~4.752;CTCG：P<0.001,OR=9.768,95% CI：3.403~28.042;CTCA：P=0.037,OR=2.713,95% CI：1.082~7.159;CTAG：P=0.037,OR=2.713,95% CI：1.028~7.159）。结论 隐性遗传模式下,基因型（AA+AG）可能是超重肥胖的危险因素;单倍体型CTCG、CTCA、TACG可能是超重肥胖的保护因素;血清总胆固醇异常时,单倍体型CTAA、CTCG、CTCA、CTAG 可能是超重肥胖的危险因素。     

老年人肥胖与主要慢性病的关系

目的 分析南京市老年人肥胖与高血压、糖尿病、冠心病、高血脂的关系。方法 2013年4月~12月利用整群随机抽样法抽取南京市某区1 927名60岁及以上的老年人;对其进行问卷调查、体格检查和实验室检测,获取信息,得到完整有效资料1 808份;肥胖用体质指数（body mass index,BMI）和腰围（waist circumference,WC）诊断,采用SPSS 19.0软件进行方差分析、χ²检验、非条件Logistic回归分析,探讨肥胖与血压、血糖、血脂以及主要慢性病的关系。结果 1 808名老年人中慢性病患病人数为1 276（70.6%）人,主要慢性病为高血压、糖尿病、冠心病、高血脂;超重人数为668人,占36.9%,肥胖人数为150人,占8.2%。中心肥胖人数为406人,占比22.5%;肥胖与收缩压、舒张压、空腹血糖、总胆固醇、甘油三脂、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇密切相关（均有P<0.05）;BMI和WC对高血压患病情况有影响（均有P<0.05）。结论 老年人肥胖增加主要慢性病患病风险,肥胖与血压、血糖、血脂密切相关,控制体重是提高老年人健康水平的有效方法。