Association of waist and hip circumference with 12-year progression of carotid intima-media thickness in elderly women

OBJECTIVE: To test the hypothesis that waist and hip circumferences together provide additional information on the progression of preclinical atherosclerosis beyond either of them alone in elderly women. DESIGN: A 12-year follow-up study. SUBJECTS: A population-based sample of 102 women 60-70 years of age at baseline. MEASUREMENTS: Waist and hip circumferences and body mass index (BMI) were assessed and carotid intima-media thickness (IMT) was quantified noninvasively by ultrasonography. RESULTS: There was a significant increase in the 12-year carotid IMT progression across the thirds of waist circumference (0.080, 0.277, 0.279 mm, P=0.02 for difference) and hip circumference (0.030, 0.342, 0.260 mm, P=0.001 for difference) adjusted for conventional risk factors (age, smoking, systolic blood pressure, serum low-density lipoprotein and high-density lipoprotein cholesterol, blood glucose). The association of waist circumference with IMT progression was not significant after further adjustment for hip circumference or BMI. Further adjustment for waist circumference and BMI did not change the association of hip circumference with IMT progression. The IMT progression was greatest in women with waist circumference >83 cm and hip circumference 相似文献   

Microcirculatory damage of common carotid artery wall in obese and non obese subjects

The objective of the present study was to determine whether the intima-media thickness (IMT) is independently related with obesity, and central fat accumulation in healthy subjects. Common carotid artery IMT, parameters of body fat accumulation and distribution (body mass index, waist circumference, waist-to-hip ratio), blood pressure levels, and circulating fasting insulin, glucose, and lipid (cholesterol, HDL-cholesterol, triglycerides, LDL-cholesterol) levels were determined in a population of non-diabetic normal weight and obese subjects. Smoking habits (packs-years) were also taken into account. 239 healthy subjects (143 women and 96 men), with age ranging between 18 and 45 years, were enrolled into the study. They were divided indo two groups according to the body mass index (BMI), obese (132 subjects, 77 woman and 55 men, with BMI greater than 27.0) and controls (107 subjects: 66 women and 41 men, with BMI lower than 27.0). Common carotid artery intima-media thickness was measured by B-mode ultrasound imaging. Fasting plasma metabolic parameters (glucose and lipids) and insulin levels were determined by enzymatic and radioimmunological assays, respectively. Insulin sensitivity was estimated by insulin tolerance test (ITT) and the rate constant for plasma glucose disappearance (KITT) during the 3- to 15-min period following the regular insulin injection was taken as a measure of in vivo insulin action. Obese patients showed higher IMT than controls, and IMT was significantly associated with BMI in the whole population (r = 0.316, p < 0.001). Age (r = 0.327, p < 0.001), KITT (r = -0.201, p < 0.01), fasting blood glucose (r = 0.187, p < 0.01), LDL-chol (r = 0.201, p < 0.01), smoking (r = 0.147, p < 0.05), MBP levels (r = 0.154, p < 0.05), cholesterol (r = 0.152, p < 0.05) and HDL-chol (r = -0.159, p < 0.05) were also significantly associated with IMT. Age (r = 0.330, p < 0.05), BMI (r = 0.299, p < 0.01), waist (r = 0.312, p < 0.001), WHR (r = 0.266, p < 0.001) and KITT (r = -0.259, p < 0.01) were the parameters most strongly correlated with IMT in women, and age (r = 0.324, p < 0.001), BMI (r = 0.338, p < 0.001) waist (r = 0.325, p < 0.001) and LDL-chol (r = 0.283, p < 0.01) where the parameters most strongly correlated with IMT in men. When a stepwise multiple regression analysis was performed for the whole population, only age (p < 0.001) and BMI (p < 0.001) maintained a significant positive relationship with IMT. When a stepwise multiple regression analysis was performed separately for men and women, BMI or waist circumference or WHR were alternatively entered into the model; interestingly, only age, BMI and waist were still significantly correlated with IMT, whereas WHR did not maintain a significant correlation with IMT. In conclusion, BMI and waist circumference, but not WHR, are strongly and independently associated with the IMT of common carotid artery. These results suggests that central fat accumulation may accelerate the development of earlier clinically silent stages of atherosclerosis, thus possibly explaining the higher prevalence of cardiovascular diseases in patients with abdominal obesity.     

The association of differing measures of overweight and obesity with prevalent atherosclerosis: the Dallas Heart Study.

OBJECTIVES: This study sought to evaluate the associations between different measures of obesity and prevalent atherosclerosis in a large population-based cohort. BACKGROUND: Although obesity is associated with cardiovascular mortality, it is unclear whether this relationship is mediated by increased atherosclerotic burden. METHODS: Using data from the Dallas Heart Study, we assessed the association between gender-specific obesity measures (i.e., body mass index [BMI]; waist circumference [WC]; waist-to-hip ratio [WHR]) and prevalent atherosclerosis defined as coronary artery calcium (CAC) score >10 Agatston units measured by electron-beam computed tomography and detectable aortic plaque measured by magnetic resonance imaging. RESULTS: In univariable analyses (n = 2,744), CAC prevalence was significantly greater only in the fifth versus first quintile of BMI, whereas it increased stepwise across quintiles of WC and WHR (p trend <0.001 for each). After multivariable adjustment for standard risk factors, prevalent CAC was more frequent in the fifth versus first quintile of WHR (odds ratio 1.91, 95% confidence interval 1.30 to 2.80), whereas no independent positive association was observed for BMI or WC. Similar results were observed for aortic plaque in both univariable and multivariable-adjusted analyses. The c-statistic for discrimination of prevalent CAC was greater for WHR compared with BMI and WC in women and men (p < 0.001 vs. BMI; p < 0.01 vs. WC). CONCLUSIONS: We discovered that WHR was independently associated with prevalent atherosclerosis and provided better discrimination than either BMI or WC. The associations between obesity measurements and atherosclerosis mirror those observed between obesity and cardiovascular mortality, suggesting that obesity contributes to cardiovascular mortality via increased atherosclerotic burden.     

Preclinical vascular damage in white postmenopausal women: the relevance of osteoprotegerin

Osteoprotegerin (OPG) has recently been implicated in human atherogenesis. Abdominal obesity represents an established risk factor for the onset and development of atherosclerotic damage. The aim of the present study was to investigate the link between OPG and abdominal fat and the relationship to precocious features of atherosclerotic disease such as brachial flow-mediated vasodilation (FMV) and the intima-media thickening (IMT) in 195 white postmenopausal women (age range, 43-75 years). The study population was divided into 2 groups: group 1-waist circumference <80 cm and group 2-waist circumference > or = 80 cm. Group 2 had higher menopausal years, body mass index, low-density lipoprotein cholesterol, triglycerides, C-reactive protein, and carotid IMT. High-density lipoprotein cholesterol was higher in group 1. Afterward, these groups were divided on the basis of a cutoff value of OPG (6.85 pmol/L) that was the median of its distribution: patients with OPG < or = 6.85 pmol/L were OPG(-), and those with OPG >6.85 pmol/L were OPG(+). The OPG(+) subjects in both had lower brachial FMV and higher carotid IMT in comparison with OPG(-) subjects. At the multivariate regression analysis, waist circumference, high-density lipoprotein cholesterol, C-reactive protein, and OPG were predictors of carotid mean IMT (beta = 0.55, P = .001; beta = -0.14, P = .001; beta = 0.16, P = .001; and beta = 0.14, P = .05, respectively) and age, OPG, low-density lipoprotein cholesterol, and brachial diameter of brachial FMV (beta = -0.13, P = .05; beta = -0.25, P = .001; beta = -0.14, P = .024; and beta = 0.48, P = .001, respectively). The conclusions are as follows: first, OPG levels did not appear to be conditioned by a risk factor such as abdominal obesity; and second, OPG levels are mainly linked to the evidence of vascular damage. On this basis, we could speculate that OPG levels may be considered not a cardiovascular risk condition but a defense against atherosclerotic progression.     

Studies in the distribution of body fat. II. Longitudinal effects of change in weight

Information on the effects of age, sex, obesity and weight change on the fat distribution pattern has not been systematically reported. As an index of body fat distribution, the waist hip circumference ratio (WHR) was computed in 370 men and 177 women aged 22-86 years, participants of the Baltimore Longitudinal Study of Aging. For cross-sectional analysis, initial data on the participants were analyzed; for longitudinal study, the changes in the measurements related to weight change during a 5-year follow-up were analyzed. From cross-sectional analysis: (1) waist circumference is larger in men than in women and increases progressively with age; (2) hip circumference shows no consistent age or sex differences; (3) thus, the well known sex differences in WHR are totally attributable to differences in waist circumference; (4) increases in WHR with age occur in both men and women. From longitudinal analysis of weight change: (1) changes in waist and hip circumferences are correlated directly with changes in weight in both sexes, but there are large differential sex effects; (2) in men, waist changes dominate; (3) in women, waist and hip changes are nearly the same; (4) thus, weight changes in men have large effects on the WHR, while in women changes in WHR are very small. Men, as a group, have a more dangerous fat distribution pattern than women, but men as a group will show a more beneficial pattern of change in WHR with weight control than women.     

Genetic and behavioral influences on body fat distribution

Genetic and environmental influences on four measures of body fat distribution - subscapular/triceps ratio (STR), waist/hip ratio (WHR), and regression-adjusted subscapular skinfold and waist circumference indices - were examined in 265 pairs of white male twins, ages 59 to 70 years, who participated in the third examination of the National Heart, Lung, and Blood Institute's Twin Study. Skinfold indices of fat distribution were not highly correlated with indices based on body circumferences (r = 0.26-0.37 for the four possible correlations). After adjustment for overall obesity, the heritability of the adjusted subscapular skinfold index was substantial (h2 = 0.60, P less than 0.001), as were estimates for both subscapular and tricep skinfolds individually. By contrast, heritability of the STR was low and of borderline statistical significance (h2 = 0.24, P = 0.06). Heritability for the WHR (h2 = 0.31, P = 0.07) was also low. Although higher estimates were observed for the adjusted waist circumference index (h2 = 0.46, P = 0.02) and for the component circumferences, these were not clearly due to genetic influences. Among behavioral influences, cigarette smoking was strongly related to the WHR and adjusted waist circumference index (P less than 0.0001). A crude measure of total physical activity was weakly, inversely related to WHR (P = 0.06), and slightly more strongly related to the adjusted waist circumference index (P = 0.01). Skinfold indices were unrelated to either behavior. We conclude that: (1) skinfold indices measure a different dimension of fat distribution than circumference indices; (2) there is evidence for a genetic influence on subcutaneous fat distribution, but less evidence for such an influence on the WHR; (3) behavioral factors appear to be more important in determining the WHR than subcutaneous fat patterning.     

Mercury accumulation and accelerated progression of carotid atherosclerosis: a population-based prospective 4-year follow-up study in men in eastern Finland

Basic research and our previous studies have suggested that mercury exposure enhances lipid peroxidation and the risk of myocardial infarction, but there are no studies concerning the association between mercury accumulation and atherosclerosis. We therefore investigated whether high hair mercury content is associated with accelerated progression of carotid atherosclerosis, determined by ultrasonographic assessment of common carotid intima-media thickness (IMT), in a prospective study among 1014 men aged 42-60 years. In a linear regression model adjusting for other atherosclerotic risk factors, high hair mercury content was one of the strongest predictors of the 4-year increase in the mean IMT (P2.81 microg/g (fifths) had an IMT increase of 0.105, 0.102, 0.113, 0.107 and 0.140 mm/4 years, respectively (P=0.041 for heterogeneity between groups). The IMT increase was 0.034 mm/4 years (31.9%) greater in the highest fifth than in the other fifths (P<0.05 for the difference). These findings suggest that mercury accumulation in the human body is associated with accelerated progression of carotid atherosclerosis.     

Abdominal obesity is associated with increased risk of acute coronary events in men.

AIMS: The purpose of the study was to investigate the associations of abdominal obesity and overall obesity with the risk of acute coronary events. METHODS AND RESULTS: Body mass index indicating overall obesity and waist-to-hip ratio and waist circumference indicating abdominal obesity were measured for 1346 Finnish men aged 42-60 years who had neither cardiovascular disease nor cancer at baseline. There were 123 acute coronary events during an average follow-up of 10.6 years. In Cox regression analyses adjusted for confounding factors, waist-to-hip ratio (P=0.009), waist circumference (P=0.010) and body mass index (P=0.013) as continuous variables were associated directly with the risk of coronary events. These associations were in part explained by blood pressure, diabetes, fasting serum insulin, serum lipids, plasma fibrinogen, and serum uric acid. Waist-to-hip ratio of > or =0.91 was associated with a nearly threefold risk of coronary events. Waist-to-hip ratio provided additional information beyond body mass index in predicting coronary heart disease, whereas body mass index did not add to the predictive value of waist-to-hip ratio. Abdominal obesity combined with smoking and poor cardiorespiratory fitness increased the risk of coronary events 5.5 and 5.1 times, respectively. CONCLUSIONS: Abdominal obesity is an independent risk factor for coronary heart disease in middle-aged men and even more important than overall obesity. Since the effect of abdominal obesity was strongest in smoking and unfit men, the strategy for lifestyle modification to prevent coronary heart disease should address these issues jointly.     

Characterization of premature atherosclerosis of carotid arteries in acromegalic patients

OBJECTIVE: Acromegalic patients have increased mortality from vascular diseases. Although atherosclerotic risk factors such as hypertension, diabetes mellitus and dyslipoproteinaemia are highly associated with acromegaly, the prevalence of premature atherosclerosis in acromegalic patients and its relationship to these risk factors have not been reported. DESIGN: We measured mean intima-media thickness (IMT) of the carotid arteries in 21 acromegalic patients without symptomatic atherosclerotic vascular disease, by ultrasound high-resolution B-mode imaging. In analysis 1, it was compared with the predicted mean IMT based on data from existing risk factors (age, male sex, dyslipoproteinaemia, hypertension, diabetes mellitus, smoking status) in 282 non-acromegalic subjects. In analysis 2, the mean IMT in the 21 acromegalic patients was compared with that in 42 non-acromegalic subjects matched for age, sex and the other atherosclerotic risk factors. We also analysed clinical characteristics between the acromegalic patients with and without the atherosclerosis. RESULTS: Mean IMT in 21 acromegalic patients was 0.92 +/- 0.21 (mean +/- SD) mm. It was significantly (P < 0.05) lower than the mean IMT (1.03 +/- 0.12 mm) predicted from their existing risk factors (analysis 1). It was also less than that in 42 non-acromegalic subjects matched for atherosclerotic risk factors (1.07 +/- 0.37 mm; P < 0.05) (analysis 2). Among the acromegalic patients, 10 patients (48%) had increased mean IMT (> or = 1.1 mm) and/or plaque lesions whereas the other 11 had no such atherosclerotic changes. In the patients without the atherosclerotic changes, plasma insulin-like growth factor-I (IGF-I) concentration was significantly (P < 0.01) higher, and the prevalence of hypertension was significantly (P < 0.05) lower than in those with the atherosclerotic changes. CONCLUSIONS: The extent of carotid atherosclerosis in the acromegalic patients was not higher than that in non-acromegalic subjects, considering their atherosclerotic risk factors. Increased concentration of IGF-I might be involved in the lack of susceptibility to atherosclerosis in some acromegalic patients.     

Waist measure and waist-to-hip ratio and identification of clinical conditions of cardiovascular risk: multicentric study in type 2 diabetes mellitus patients

Abdominal obesity is associated with cardiovascular disease. This study aims to compare two measures of abdominal obesity [waist and wais-to-hip ratio (WHR)] in patients with DM2 to identify cardiovascular risk factors: ischemic cardiopathy, hypertension, dislipidemia, obesity and diabetic nephropathy. A multicentric study was performed in 820 patients with type 2 DM. Waist circumference strongly correlated with body mass index (BMI), for men (r= 0.814; P< 0.05) and women (r= 0.770; P< 0.05). On the other hand, WRH was weakly correlated (r= 0.263, P< 0.05 for men; r= 0.092, P< 0.05 for women). Only waist circumference correlated with systolic pressure (r= 0.211, P< 0.05 for men; r= 0,224, P< 0.05 for women). ROC curve analysis demonstrated the superiority of waist circumference measurement compared to WHR regarding obesity and hypertension for men and women, and dyslipidemia for men. In conclusion, waist circumference is better correlated with cardiovascular risk factor than WRH.     

Misclassification of high-risk older subjects using waist action levels established for young and middle-aged adults--results from the Rotterdam Study

OBJECTIVES: In the literature, cutoff points based on waist circumference (waist action levels) have been suggested to replace cutoff points based on body mass index (BMI) and waist-hip ratio (WHR) in identifying subjects who are overweight or obese and/or with central fat distribution. These cutoff points have been based on analysis in mainly middle-aged and younger adults. In this article, we examine the applicability of the suggested waist action levels in an older population. PARTICIPANTS: A total of 6,423 men and women aged 55 or over participating in the Rotterdam Study, a population-based cohort study. MEASUREMENTS: Sensitivities and specificities of the proposed waist action levels in relation to the cutoff points for BMI and WHR were calculated. Also, cardiovascular risk factor levels at baseline examination in the different categories defined by high/low waist circumference, BMI and WHR were investigated. RESULTS: At waist action level 1 (waist circumference > or =94 cm in men, > or =80 cm in women), sensitivity was 71% in men and 86% in women for detecting those with high BMI (> or =25 kg/m2) and/or WHR (> or =0.95 in men, > or =0.80 in women). At waist action level 2 (waist circumference > or =102 cm in men, > or =88 cm in women in comparison with BMI > or =30 kg/m2 and/or WHR > or =0.95 in men, > or =0.80 in women), sensitivity was considerably lower: 35% in men and 59% in women. This was mainly due to a large proportion of subjects with low waist and BMI but high WHR. Specificity was high (>90%) at both action levels. Cardiovascular disease risk factors, except smoking, tended to increase with increasing waist circumference, WHR, and BMI. CONCLUSIONS: The suggested cutoff points for waist circumference are only to a limited degree useful in identifying subjects with overweight and obesity and/or central fat distribution in an older population. This concerns especially the upper cutoff point (waist action level 2) and is mainly due to the increased central distribution of fat with advancing age.     

Associations of obesity measures with metabolic risk factors in a community-based population in Japan.

BACKGROUND: The association of obesity measures (ie, body mass index (BMI), waist circumference (WC) and waist-to hip ratio (WHR)) with metabolic risk factors in community-based populations has not been well studied. METHODS AND RESULTS: In the present study 759 men and 1,255 women aged between 30 and 79 years, without histories of stroke or coronary heart diseases, were dichotomized at the medians of BMI-WHR, WC-WHR and BMI-WC. The accumulation of 4 metabolic risk factors (risk _ sum) were examined: high blood pressure (> or =130/85 mmHg or on antihypertensive therapy); high triglycerides (> or =170 mg/dl); low high-density lipoprotein-cholesterol (<40 mg/dl); and impaired glucose tolerance (hemoglobin A1c > or =5.6% or on antidiabetic therapy). BMI and WC correlated well in both men (r=0.871) and women (r=0.874). All 3 obesity measures related with the metabolic risk factors. The area under the receiver-operating characteristic curve for BMI, WC and WHR to predict the risk _ sum > or =2 for men was 0.683, 0.709, and 0.700, respectively, and 0.715, 0.739, and 0.746, respectively, for women. CONCLUSIONS: BMI may be used instead of WC if the latter is not available. When WC is measured, hip circumference also should be measured because the WHR may be the most valuable measure of obesity.     

体重及脂肪分布与高血压病关系的流行病学研究

目的:探讨体重及脂肪分布与高血压病的相关性。方法:采取整群随机抽样的方法选择徐州市大屯社区259位中年居民为调查对象,运用病例对照研究,测量体重指数(BM I)、腰臀比(WHR)、腰围(W C)、臀围(HC)等参数数值,并作统计学处理。结果:(1)高血压组中的体重、体重指数、腰围、臀围、腰臀比高于对照组(P<0.05);高血压合并冠心病组中的腰围、臀围高于对照组(P<0.05);(2)腰臀比与年龄、收缩压、舒张压、尿酸、血糖、甘油三酯、体重呈正相关(r=0.17~0.305,P<0.05);体重指数与收缩压、舒张压、尿酸、甘油三酯、腰围、臀围呈正相关(r=0.299~0.670,P<0.05);(3)腹部肥胖型在各病例组中所占的比例明显高于对照组(P<0.05)。结论:超重、肥胖尤其是腹部肥胖型是高血压病的危险因素。     

Abdominal and total adiposity and risk of coronary heart disease in men.

BACKGROUND: Waist circumference is a simpler measure of abdominal adiposity than waist/hip ratio (WHR), but few studies have directly compared the two measures as predictors of coronary heart disease (CHD) in men. In addition, whether the association of abdominal adiposity is independent of total adiposity as measured by body mass index (BMI) in men remains uncertain. OBJECTIVE: To compare waist circumference and WHR as predictors of CHD in men, and to determine whether the association is independent of BMI. DESIGN: Prospective cohort study. METHODS: We compared WHR, waist circumference and BMI with risk of CHD (myocardial infarction or coronary revascularization) among men in the Physicians' Health Study, a randomized trial of aspirin and beta-carotene among 22 071 apparently healthy US male physicians, aged 40-84 y at baseline in 1982. Men reported height at baseline, and weight, waist and hip measurements on the 9 y follow-up questionnaire. RESULTS: Among the 16 164 men who reported anthropometric measurements and were free from prior CHD, stroke or cancer, a total of 552 subsequent CHD events occurred during an average follow-up of 3.9 y. After adjusting for age, randomized study agent, smoking, physical activity, parental history of myocardial infarction, alcohol intake, multivitamin and aspirin use, men in the highest WHR quintile (>or=0.99) had a relative risk (RR) for CHD of 1.50 (95% CI 1.14-1.98) compared with those in the lowest quintile (<0.90). Men in the highest waist circumference quintile (>or=103.6 cm) had a RR of 1.60 (CI, 1.21-2.11) for CHD compared with men in the lowest quintile (<88.4 cm). Further adjustment for BMI substantially attenuated these associations: men in the highest WHR and waist circumference quintiles had relative risks for CHD of 1.23 (CI, 0.92-1.66) and 1.06 (CI, 0.74-1.53), respectively. Men in the highest BMI quintile (>or=27.6 kg/m(2)) had a multivariate RR of CHD of 1.73 (CI, 1.29-2.32), after adjustment for WHR. No significant effect modification by age of the relationship between either measure of abdominal adiposity and risk of CHD was observed. CONCLUSIONS: These data support a modest relationship between abdominal adiposity, as measured by either WHR or waist circumference, and risk of CHD both in middle-aged and older men. However, abdominal adiposity did not remain an independent predictor of CHD after adjustment for BMI.     

Blood pressure and the progression of carotid atherosclerosis in middle-aged men.

Elevated blood pressure has consistently been associated with increased prevalence of preclinical atherosclerosis and with increased risk of clinical atherosclerotic cardiovascular disease (CVD). However, there is no prospective evidence of the association between blood pressure and the progression of preclinical atherosclerosis. We therefore investigated the relationships of systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse pressure to the 4-year increase in the measures of early carotid atherosclerosis, the mean and maximal common carotid intima-media thickness (IMT), assessed by B-mode ultrasonography, in 1026 men aged 42 to 60 years. Men with the SBP of <120, 120 to 126, 127 to 134, 135 to 143, and >143 mm Hg (fifths) had an increase in the mean IMT of 0.074, 0.090, 0.110, 0.136, and 0.158 mm per 4 years (P<0.001 for difference between groups, P<0.001 for linear trend) and in the maximal IMT of 0.212, 0.221, 0.279, 0.286, and 0.315 mm per 4 years, (P<0.001, P<0.001), respectively, adjusting for other atherosclerotic risk factors, including DBP. Also, pulse pressure, when adjusted for other risk factors including mean arterial pressure, was directly associated with the IMT increase. DBP was not independently related to the IMT increase. This is the first documentation to show that mildly elevated SBP and pulse pressure accelerate the progression of preclinical atherosclerosis. This study provides further evidence for the finding that systolic hypertension is a more important risk factor for atherosclerosis and consequent CVD than diastolic hypertension. Therefore, more attention should be paid to the level of SBP in the evaluation of CVD risk and in the treatment of hypertension.     

Central obesity predicts the worsening of glycemia in southern Chinese.

AIMS: The association between obesity and type 2 diabetes has been found to be consistent across different ethnic populations. Our aim was to study the contribution of obesity to the development of type 2 diabetes in a non-obese Chinese population with a high prevalence of diabetes (9.8% in 1995-1996). METHODS: Six-hundred and forty-four non-diabetic subjects were recruited from the Hong Kong Cardiovascular Risk Factor Prevalence Study (1995-1996). This was a community-based population study which involved the use of a 75 g oral glucose tolerance test and 1985 World Health Organization diagnostic criteria. Their glycemic status was reassessed at 2 y. RESULTS: In subjects with impaired glucose tolerance (n=322), the annual progression rate to diabetes (4.8%; 95% CI 2.5-7.1%), was 8-fold that in control subjects (0.6%; 95% CI 0.0-1.4%; P<0.001). Baseline waist-hip ratio (WHR; OR per unit increase=1.05; 95% CI 1.02-1.07, P=0.0003) and post-load 2 h plasma glucose (OR per unit increase=2.02; 95% CI 1.76-2.34, P<0.0001) were significantly associated with glycemic status at 2 y in stepwise polytomous logistic regression analysis. Subjects with high baseline waist circumference or WHR (> or =median) were more likely to have worsening of glucose tolerance at 2 y than those with low waist circumference (相似文献   

不同肥胖指标对高尿酸血症的影响

目的探讨不同肥胖指标对高尿酸血症(HUA)的影响。方法选取于我院临床营养科就诊的患者279例,收集其一般资料、实验室检查指标及内脏脂肪面积(VFA)。根据血尿酸水平将其分为HUA组和非HUA组,在不同性别中比较两组各指标的差异,并采用logistic回归分析HUA的影响因素。结果279例患者中,73例(26.16%)存在HUA。男性的HUA发生率为30.99%(53/171),女性的HUA发生率为18.52%(20/108)。男性HUA组的经常吸烟、经常饮酒者比例、腰围、腰臀比(WHR)、总胆固醇(TC)、甘油三酯(TG)及VFA均明显高于非HUA组(P<0.05)。女性HUA组的BMI、腰围、WHR、TG及VFA均明显高于非HUA组(P<0.05)。在男性中,经常吸烟(OR=1.423,P=0.027)、经常饮酒(OR=2.074,P=0.004)、TG升高(OR=1.257,P=0.028)及VFA增加(OR=2.140,P=0.007)是HUA的独立危险因素。在女性中,腰围增加(OR=1.256,P=0.041)、WHR增加(OR=1.643,P=0.024)、TG升高(OR=1.370,P=0.033)及VFA增加(OR=2.718,P=0.014)是HUA的独立危险因素。结论肥胖、脂代谢异常与HUA的发生关系密切,除BMI外,临床中更应关注腹型肥胖、内脏肥胖对HUA的影响。男性应积极控制吸烟、饮酒、血脂、内脏肥胖,女性应积极控制血脂、腹型肥胖及内脏肥胖,有利于HUA的早期防治。     

Cardiorespiratory fitness and the progression of carotid atherosclerosis in middle-aged men

BACKGROUND: Good cardiorespiratory fitness has been associated with reduced risk for clinical events of atherosclerotic vascular diseases, but whether it is related to slower progression of early atherosclerosis is unclear. OBJECTIVE: To study the association between cardiorespiratory fitness and the progression of early carotid atherosclerosis. DESIGN: 4-year follow-up study. SETTING: Eastem Finland. PARTICIPANTS: Population-based sample of 854 men 42 to 60 years of age. MEASUREMENTS: Maximal oxygen uptake (VO2max [mL/kg per minute]) was measured directly by using respiratory gas exchange in a cycle ergometer exercise test. Carotid atherosclerosis was assessed by using B-mode ultrasonography. RESULTS: After adjustments for age, technical covariates, and cigarette smoking, VO2max had strong, inverse, and graded associations with 4-year increases in maximal intima-media thickness (IMT) (standardized regression coefficient beta = -0.120; P = 0.002), plaque height (beta = -0.140; P < 0.001), surface roughness (beta = -0.147; P < 0.001), and mean IMT (beta = -0.080; P = 0.035). These associations weakened but remained statistically significant after additional adjustment for systolic blood pressure, serum levels of apolipoprotein B, diabetes, and plasma fibrinogen levels. The increases in maximal IMT, surface roughness, and mean IMT (23%, 31%, and 100%, respectively) were larger among men in the lowest quartile of VO2max (<26.1 mL/kg per minute) than among those in the highest quartile (>36.2 mL/kg per minute). CONCLUSIONS: Good cardiorespiratory fitness is associated with slower progression of early atherosclerosis in middle-aged men. These findings are important because they emphasize that middle-aged men can be evaluated for cardiorespiratory fitness to estimate their future risk for atherosclerotic vascular diseases. Additional research is warranted to investigate a possible causal relationship between cardiorespiratory fitness and atherosclerosis.     

Agrupamentos de Fatores de Risco Cardiometabólicos e sua Associação com Aterosclerose e Inflamação Crônica em Adultos e Idosos em Florianópolis,Sul do Brasil

Background The significant increase in cardiovascular diseases in developing countries alerts about their impact on underprivileged populations.Objective To identify the relationship of clusters of metabolic syndrome (MS) components with atherosclerosis and chronic inflammation among adults and elderly.Methods Cross-sectional analysis using data from two population-based cohort studies in Florianópolis, Southern Brazil (EpiFloripa Adult Cohort Study, n = 862, 39.9±11.5 years; EpiFloripa Aging Cohort Study, n = 1197, 69.7±7.1 years). Blood pressure (BP), waist circumference (WC), and lipid and glucose levels were analyzed as individual factors or as clusters (either as the number of components present in an individual or as combinations of components). Outcomes included carotid intima-media thickness (IMT), atherosclerotic plaques, and C-reactive protein (CRP) levels. Multiple linear and logistic regression analyses adjusted for confounding factors were used. The statistical significance adopted was 5%.Results Individuals with high BP, elevated WC, dyslipidemia and hyperglycemia (6.1% of the sample) showed higher IMT and CRP than those negatives for all MetS components. Elevated WC was a common determinant of systemic inflammation, while the coexistence of high BP and elevated WC (clusters of two or three factors) was associated with higher IMT (β between +3.2 and +6.1 x 10-2 mm; p value < 0.05) and CRP (_EXPβ between 2.18 and 2.77; p value < 0.05).Conclusion The coexistence of high BP and elevated WC was associated with increased IMT and CRP levels, but central obesity affected systemic inflammation either alone or in combination with other risk factors.     

Waist circumference, waist-hip ratio and body mass index and their correlation with cardiovascular disease risk factors in Australian adults

OBJECTIVES: To compare body mass index (BMI), waist circumference and waist-hip ratio (WHR) as indices of obesity and assess the respective associations with type 2 diabetes, hypertension and dyslipidaemia. DESIGN AND SETTING: A national sample of 11 247 Australians aged > or =25 years was examined in 2000 in a cross-sectional survey. MAIN OUTCOME MEASURES: The examination included a fasting blood sample, standard 2-h 75-g oral glucose tolerance test, blood pressure measurements and questionnaires to assess treatment for dyslipidaemia and hypertension. BMI, waist circumference and WHR were measured to assess overweight and obesity. RESULTS: The prevalence of obesity amongst Australian adults defined by BMI, waist circumference and WHR was 20.8, 30.5 and 15.8% respectively. The unadjusted odds ratio for the fourth vs. first quartile of each obesity measurement showed that WHR had the strongest relationship with type 2 diabetes, dyslipidaemia (women only) and hypertension. Following adjustment for age, however, there was little difference between the three measures of obesity, with the possible exceptions of hypertension in women, where BMI had a stronger association, and dyslipidaemia in women and type 2 diabetes in men, where WHR was marginally superior. CONCLUSIONS: Waist circumference, BMI and WHR identified different proportions of the population, as measured by both prevalence of obesity and cardiovascular disease (CVD) risk factors. Whilst WHR had the strongest correlations with CVD risk factors before adjustment for age, the three obesity measures performed similarly after adjustment for age. Given the difficulty of using age-adjusted associations in the clinical setting, these results suggest that given appropriate cut-off points, WHR is the most useful measure of obesity to use to identify individuals with CVD risk factors.