中老年2型糖尿病患者骨密度水平与代谢指标及并发症相关性分析

目的探讨中老年2型糖尿病(type 2 diabetic mellitus,T2DM)患者腰椎骨密度(bone mineral density,BMD)与代谢指标及糖尿病并发症的关系。方法回顾性分析228例中老年T2DM患者的住院资料,按腰椎1～4(L1-L4)BMD的水平分为骨量正常组(T-1.0SD)、骨量减少组(-2.5 SDT≤-1.0 SD)及骨质疏松组(T≤-2.5 SD),比较各组临床资料、血糖控制、代谢指标、糖尿病并发症情况,并分析腰椎BMD与各指标的相关性。结果 (1)随骨密度下降,体质量指数(body mass index,BMI)下降,女性比例、感觉阈值(vibration perception threshold,VPT)增加,差异有统计学意义(P0.01);骨质疏松组年龄、糖化血清白蛋白(glycated albumin,GA)大于骨量正常及骨量减少组(P0.01),且发生糖尿病足病明显增加(P0.05);骨质疏松组病程、空腹及餐后2 h血糖大于骨量减少组(P0.05),腰围、尿酸、甘油三酯低于骨量正常组(P0.01),高密度脂蛋白胆固醇(HDL-C)、血镁高于骨量正常组(P0.05);骨量减少组碱性磷酸酶高于骨量正常组(P0.05),腰围(P0.05)、尿酸(P0.01)、总胆固醇(P0.05)低于骨量正常组。(2)相关分析提示,腰椎BMD与年龄、性别(女)、GA、HDL-C、血镁、VPT(异常)呈负相关(P0.05);与腰围、BMI、尿酸、甘油三酯呈正相关(P0.01)。(3)以腰椎骨密度为因变量,进一步行多重线性回归分析,结果显示BMI、性别(女)、VPT(异常)、尿酸差异有统计学意义。结论女性患者和感觉阈值异常是T2DM患者骨密度降低的独立危险因素,而适当高BMI及高尿酸则是骨密度降低的保护因素。     

肥胖与慢性肾脏病患者冠状动脉疾病的关系

目的：了解肥胖对慢性肾脏病（CKD）患者发生冠状动脉疾病（CAD）的影响,并探索体重指数（BMI）、腰围、腰臀比对CAD的预测价值。方法：选取102例非透析CKD患者,分别以BMI、腰围、腰臀比作为肥胖的判定指标,将患者分为肥胖组与非肥胖组,比较各组CAD的患病率。以多因素Logistic回归分析各项肥胖评价指标与CAD的关系。结果：（1）CKD患者的肥胖以中心性肥胖较多见。（2）腰围超标组患者CAD的患病率为39.5%,高于腰围正常组的15.3%,差异具有统计学意义（P〈0.01）。以BMI、腰臀比为标准划分的肥胖组与非肥胖组患者CAD患病率差异无统计学意义。（3）多因素Logistic回归分析显示,腰围是CKD患者发生冠状动脉疾病的危险因素,OR值为2.643。结论：肥胖是非透析CKD患者发生CAD的危险因素,腰围可以作为CKD患者冠状动脉疾病的直接预测因素。     

住院2型糖尿病男性患者骨质疏松相关危险因素分析

目的分析住院2型糖尿病男性患者发生骨量减少及骨质疏松的相关危险因素。方法选取2018年1月至2020年1月在天津医科大学代谢病医院内分泌科住院的年龄≥50岁的2型糖尿病男性患者370名,排除继发性骨质疏松以及其他影响骨代谢的疾病。应用美国GE公司的LUNAR双能X线骨密度仪测定患者腰椎L_1～L_4、股骨颈、全髋部位的骨密度,根据骨密度结果分为骨量正常组,骨量减少组与骨质疏松组,比较3组患者的年龄、病程、生化指标、糖尿病并发症等情况,分析引起骨量减少以及骨质疏松的危险因素。应用SPSS 24.0进行统计学分析,P0.05为差异有统计学意义。结果 2型糖尿病合并骨质疏松组男性患者年龄、病程、糖化血红蛋白、TC、LDL-C以及糖尿病微血管及大血管患病率均高于正常骨量与骨量减少组(P0.05)。而HOMA-β低于骨量正常与骨量减少组(P0.05),将上述结果进行Logistic回归分析,结果显示,年龄与糖尿病病程的增加、糖化血红蛋白的升高是住院男性2型糖尿病患者发生骨量减少的危险因素。而年龄的增长、糖尿病病程的增加,糖化血红蛋白、低密度脂蛋白的升高、合并微血管与大血管并发症是这些患者发生骨质疏松的危险因素。结论年龄、病程、Hb A1c、LDL-C,合并微血管与大血管并发症可以预测住院2型糖尿病男性患者骨质疏松发生风险。     

不同类型肥胖与骨质疏松症的研究

目的旨在分析肥胖与骨质疏松症的关系,为肥胖与骨质疏松症的防治提供切实可信的数据。方法选取2014年1月至2015年1月在哈尔滨医科大学附属第二医院体检中心进行体检人员1192例,测定甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白(LDL-C)、高密度脂蛋白(HDL-C)、空腹血糖(FBG)的值。采用双能X线骨密度扫描双侧股骨及腰椎进行骨密度检测,根据骨密度T值分为骨量正常组、骨量减少组和骨质疏松组并结合身高、体重、血压、腰围等分为全身性肥胖、复合型肥胖、中心性肥胖,使用t检验和χ~2检验各组间有无统计学差异,对检测结果进行分析。结果在男性群体中50~59岁年龄组骨质疏松检出率明显升高(12.06%),80~89岁组达到最高(16.67%);女性群体中随年龄增长骨质疏松检出率有所增加,而70~79岁组骨质疏松的检出率最高为54.55%。在骨量正常组、骨量减少组及骨质疏松组3组中空腹血糖、甘油三酯和低密度脂蛋白胆固醇组间比较有差异,且具有统计学意义(P0.05)。合并一种代谢异常与骨质疏松的研究中,高血糖、血脂异常合并骨质疏松组间比较差异显著,有统计学意义;两种代谢异常合并骨质疏松组间比较差异显著,有统计学意义(P0.05)。复合型肥胖、中心性肥胖合并骨质疏松组间比较差异显著,有统计学意义(P0.05)。结论不同类型的肥胖与骨质疏松的关系并不一致。     

男性类风湿关节炎患者骨量减低的相关研究

目的探讨男性类风湿关节炎(rheumatoid arthriti,RA)患者骨量减低的相关情况及合并骨质疏松的危险因素。方法收集2013年8月至2019年5月在苏州大学附属常州市肿瘤医院诊治的男性类风湿关节炎患者38例,年龄(64. 39±9. 44)岁,对照组为40例健康正常人群,年龄(63. 53±8. 14)岁。通过双光能X线骨密度仪测定正位腰椎(L1～4)及左侧股骨近端(包括FN、Troch、Ward、Total)骨密度;运用电化学发光免疫分析法检测BAP、BGP、CTX;记录RA患者的ESR、CRP、关节肿胀及压痛数、RF以及CCP等情况。分析比较两组骨密度及骨生化指标的差异,并采用单因素分析和多因素Logistic回归分析调查类风湿关节炎患者合并骨质疏松的危险因素。结果两组间年龄、体质量指数(body mass index,BMI)差异无统计学意义(P0. 05)。类风湿关节炎组左侧股骨颈、整体髋骨BMD测量值较对照组减低(P0. 05);且类风湿关节炎组骨量减少、骨质疏松发生率较对照组显著增高(P0. 05);在骨生化指标方面,类风湿关节炎组CTX水平高于对照组(P0. 05)。单因素分析显示BMI、CRP、DAS28-ESR及CTX与男性类风湿关节炎患者继发骨质疏松相关(P0. 05);多因素Logistic回归分析显示,BMI 18. 5 kg/m2(OR=0. 014),DAS28-ESR5. 1(OR=21. 433)及CTX0. 7 ng/m L(OR=25. 875)是男性类风湿关节炎继发骨质疏松的独立危险因素(P0. 05)。结论男性类风湿关节炎患者同样易合并骨质疏松的发生,BMI、DAS28及CTX等危险因素应高度重视。     

中老年2型糖尿病患者血清FGF21、FGF23水平与骨量异常关系的研究

目的 探讨中老年2型糖尿病（type 2 diabetes mellitus,T2DM）患者血清成纤维细胞生长因子21（FGF21）、23（FGF23）水平与骨量异常的关系。方法 随机纳入中老年T2DM患者250例,根据骨密度结果将研究对象分为骨量正常组和骨量异常组（骨量减少、骨质疏松）,收集患者的性别、年龄、糖尿病病程等资料,测定空腹血糖、糖化血红蛋白、血钙、血磷、25羟维生素D、肝肾功、血脂、血清FGF21及FGF23水平,分析T2DM患者血清FGF21、FGF23水平与骨量异常的关系。结果 与骨量正常组相比,骨量异常组患者血清FGF21（P＜0.05）、FGF23水平均降低,但后者比较差异不具有统计学意义（P＞0.05）。排除年龄、收缩期血压（SBP）、体质量指数（body mass index, BMI）、评估的肾小球滤过率（eGFR）及甘油三酯（TG）影响后,协方差分析显示骨量异常组血清FGF21水平（pg/mL）仍低于骨量正常组（P＜0.05）。以T2DM是否合并骨量异常为因变量,年龄、BMI、eGFR、TG、FGF21、FGF23、SBP为自变量,Logistic回归分析显示,年龄、SBP是骨量异常的独立危险因素,BMI、FGF21是骨量异常的保护因素。结论 中老年T2DM合并骨量异常患者血清FGF21、FGF23水平较骨量正常者降低,低血清FGF21水平可能是中老年T2DM患者骨量减少的危险因素。     

包头地区人群骨密度影响因素研究

目的 研究影响包头地区人群骨密度的相关因素。方法 采用病例-对照研究方法。收集来自包头医学院第一附属医院进行健康体检的596例女性和230例男性流行病学资料，用双能X线吸收仪对研究对象进行骨扫描，按骨密度检测值分为正常对照组和骨质疏松及骨量流失组。采用 Logistic回归法分析影响骨密度的相关因素。结果 经Logistic回归分析，饮酒是女性发生骨质疏松的危险因素，吸烟、饮酒是男性发生骨质疏松的危险因素。补钙是人群保护因素。结论 包头地区 男、女性通过补钙均可预防骨质疏松；饮酒与女性骨量流失及骨质疏松显著相关，吸烟、饮酒与男性骨量流失及骨质疏松显著相关。     

大连地区中老年人25-羟维生素D和同型半胱氨酸与骨质疏松症相关性研究

目的探讨大连地区中老年人25-羟维生素D[25-hydroxyvitamin D,25(OH)D]、血清同型半胱氨酸(Homocysteine,Hcy)水平与骨密度(Bone mineral density,BMD)及骨质疏松性骨折(Osteoportic fracture,OPF)的相关性。方法本研究为横断面研究。210例(男85例,女125例)研究对象均来自我院门诊及体检中心,年龄46-90岁。所有研究对象均检测腰椎1-4(Total)(BMD-L)、髋部(Total)(BMD-H)、股骨颈(BMD-N)骨密度和血清25(OH)D、Hcy、钙、磷、镁、碱性磷酸酶。210例分为骨质疏松组,骨量减少组和骨量正常组。应用方差分析和回归分析分别对男性和女性血清25(OH)D、Hcy与BMD及OPF的相关性进行分析。结果男性和女性骨质疏松组25(OH)D均低于骨量减少组和骨量正常组,差异有统计学意义(P0.05)。多元线性回归分析校正年龄等潜在混杂因素后,25(OH)D与男性BMD-L(P=0.064)、BMD-H(P=0.073)和女性BMD-H(P=0.072)近似正相关;25(OH)D20 ng/m L时,男性25(OH)D与BMD-N呈显著正相关;25(OH)D15 ng/m L时,女性25(OH)D与BMD-L和BMD-N呈显著正相关。Logistic回归分析显示,女性骨质疏松症患者血清中25(OH)D每增加1 ng/m L骨折风险降低12.8%。女性Ln Hcy在骨质疏松组与骨量正常组和骨量减少组比较差异有统计学意义(P=0.040和P=0.020)。女性Ln Hcy与BMD-N呈负相关,校正年龄后不相关。男性和女性Ln Hcy和25(OH)D均不相关。结论 25(OH)D在不同范围时,大连地区中老年男性和女性25(OH)D与各部位BMD不同程度正相关。维生素D缺乏可能是中老年女性OPF发生的独立危险因素。Hcy不是女性发生OPF的危险因素(女性Hcy和OPF不相关),女性高Hcy与低BMD有一定相关关系,这种相关可能与增龄有关。男性Hcy与BMD不相关。     

北京地区中老年男性骨硬化蛋白与心血管危险因素的关系

目的 在北京地区中老年男性正常血糖人群中,分析骨硬化蛋白与心血管危险因素之间的关系.方法 从北京某社区中老年人群横断面调查中筛查出糖代谢正常男性共105例(40～69岁)进行问卷调查.收集年龄、吸烟饮酒史、既往史等信息.测量体质量指数(BMI)、腰围、血压等.化验血糖、血脂,酶联免疫吸附法(ELISA)测定血清骨硬化蛋...     

某高校4056例教职工骨密度流行病学调查分析

目的调查某高校教职工的骨质状况及其相关因素的分析,为教职工的骨质疏松防治提供参考依据。方法采用美国通用公司Achilles EXPΙΙDocument Kit骨质测量仪测量4056名教职工右脚跟骨骨质状况,并记录教职工的年龄、性别、体质量、腰围,采用卡方检验和Pearson相关性分析探讨骨质状况与以上因素的关系。结果 (1)随着年龄的增长,骨量正常百分比逐渐下降,骨量减少和骨质疏松百分比逐渐上升,其结果具有统计学意义(χ_(趋势)~2=745.103,P0.01)。(2)在男性受检人员中,随着年龄的增长,骨量正常百分比逐渐下降,骨量减少和骨质疏松百分比逐渐上升,结果具有统计学意义(χ_(趋势)~2=153.129,P0.01)。在女性受检人员中,随着年龄的增长,骨量正常百分比逐渐下降,骨量减少和骨质疏松百分比逐渐上升,其结果具有统计学意义(χ_(趋势)~2=720.801,P0.01)。(3)低体质量组以骨量减少为主,正常体质量组及超重组以骨量正常为主,差异具有统计学意义(χ2=23.759,P0.01),随着体质量的增加,骨量正常百分比逐渐上升,骨量减少和骨质疏松百分比逐渐下降,结果具有统计学意义(χ_(趋势)~2=11.861,P0.01)。(4)进一步对高体质指数(body mass index,BMI)分层,肥胖组骨质正常率低于偏胖组,骨质疏松率高于偏胖组,其结果具有统计学意义(χ_(趋势)~2=17.434,P0.01)。(5)腰围越大,骨质状况越差(r=-0.072,P0.01),差异具有统计学意义。结论 (1)骨质状况随着年龄的增长越来越差,即使是年轻人,如果不注意生活方式,也可能会增加骨量减少的发生。(2)体质量过高或过低都是骨量减少的危险因素,将体质量控制在一个合理的范围内更有助于健康。(3)绝经期妇女或许可以通过运动或改善饮食来降低雌激素水平下降对骨质状况带来的不利影响。     

Do current body mass index criteria for obesity surgery reflect cardiovascular risk?

BACKGROUND: Obesity is an underlying cause of the development of cardiovascular disease (CVD). Obesity itself does not result in CVD, rather, it acts through intermediate-risk factors. Most, but not all, studies examining the obesity-CVD relationship have found them to be correlated. We hypothesized that the inconsistencies among the studies of the obesity-cardiovascular relationship were attributable to an irregular relationship between obesity and the presence of risk factors for CVD. METHODS: The Third National Health and Nutrition Examination Surgery database was queried regarding the presence of known cardiovascular risk factors as a function of obesity. These were further related to anthropomorphic measurements and analyzed by regression and contour mapping techniques. RESULTS: Of the conventional CVD risk factors, blood pressure, serum glucose, and waist circumference increased linearly with adiposity. The reverse was observed for high-density lipoprotein. Insulin, C-peptide, apolipoprotein B, non-high-density lipoprotein cholesterol, low-density lipoprotein, and serum triglycerides all peaked in the body mass index range of 30-40 kg/m(2) and then decreased with increasing degrees of obesity. CONCLUSION: Cardiovascular risk factors are markedly increased for many individuals with a body mass index >30 kg/m(2). Massively obese individuals might have better CVD risk profiles than less obese individuals. The discrepancy is related, in part, to body conformation. The criteria for obesity surgery should be changed to lower BMIs than are currently used if patients have risk factors for CVD.     

不同糖耐量人群骨密度变化及与血清护骨素水平的相关性研究

目的研究不同糖耐量人群骨密度的变化及与血清护骨素水平的关系。方法 2013年1月至12月期间收集社区绝经后女性共271人,根据不同的糖耐量水平分为3组,其中2型糖尿病组93人、糖调节受损组90人、正常糖调节组88人。所有研究对象测量身高、体重、腰围、臀围,采用全自动生化分析仪检测血生化指标,酶联免疫法检测血清OPG水平,双能X线骨密度仪检测腰椎(L_2-L_4)及股骨颈骨密度。结果正常糖调节组人群腰椎及股骨颈骨密度明显低于2型糖尿病组,差异有显著性(P=0.004,P=0.008)。血清OPG水平、年龄、碱性磷酸酶、血肌酐、高密度脂蛋白与腰椎及股骨颈骨密度呈负相关(P0.05),身高、体重、体质指数、臀围、腰围、血尿酸与腰椎及股骨颈骨密度呈正相关(P0.05)。进行多因素回归分析发现,年龄、体质指数、体脂含量、碱性磷酸酶、血尿酸、血肌酐等与腰椎骨密度相关(P0.05),年龄、体质指数、碱性磷酸酶、血尿酸与股骨颈骨密度相关(P0.05)。结论不同糖耐量人群骨密度存在差异,并且受多种因素影响,血清OPG水平可能与糖尿病患者骨密度变化相关。     

南昌市部分社区40岁以上人群骨质疏松症流行现状调查及影响因素分析

目的 明确南昌市部分社区40岁以上人群骨质疏松症(Osteoporosis,OP)的患病状况及其影响因素,为OP的社区干预提供基础信息和依据.方法 应用HOLOGIC公司生产的Sahara定量超声骨密度检测仪测量南昌部分社区10071名40岁以上人群跟骨骨密度.对所有受试者进行问卷调查,检测其肝肾功能、血糖、糖化血红蛋白(HbA1C)、甘油三脂(TG)、高密度脂蛋白胆固醇(HDL-c)、低密度脂蛋白胆固醇(LDL-c)、总胆固醇(TC);测量血压、身高、体重、腰围、臀围,计算其腰臀比(WHR)、体质指数(BMI).首先行单因素Logistic分析,有统计学意义者(P＜0.1)进一步行二分类Logistic回归分析,计算OR值及其95％置信区间.结果 (1)OP的总患病率为9.3％,男性7.1％,女性10.8％;年龄、性别标化后的总患病率为11.3％,男性7.9％,女性11.7％;(2)在男性,单因素分析显示年龄、文化程度、饮酒、饮牛奶、舒张压、HDL-c、BMI、体力劳动、OP家族史等与OP患病可能相关(P＜0.1).二分类Logistic回归分析显示增龄、OP家族史为OP可能危险因素;高文化程度、饮酒、饮牛奶、大BMI为OP的可能保护性因素;(3)在女性,单因素分析显示年龄、婚姻状况、文化程度、吸烟、饮牛奶、收缩压、HDL-c、LDL-c、TG、TC、HbA1c、BMI、WHR、体力劳动、孕次、产次、初潮年龄、绝经状态、绝经年龄、绝经年限、哺乳是OP的可能影响因子(P＜0.1);二分类Logistic回归分析显示增龄、无配偶、多产次、已绝经、长绝经年限和大WHR是OP的可能危险因素;经常饮用牛奶、晚绝经年龄、高BMI为其可能保护性因素.结论 南昌市部分社区OP骨质疏松症的主要危险因素在男性是OP家族史和增龄;在女性是增龄、绝经、无配偶、多产次以及中心性肥胖.饮牛奶和合适的体质指数是男女共同的OP保护因素,在男性良好的教育和适量饮酒,女性晚的绝经年龄可能有助于减少OP的患病风险.应要采取相应的干预措施,控制OP的可控因素,预防和延缓骨质疏松症的发生.     

女性正常范围促甲状腺激素水平与骨代谢的相关性研究

目的探讨正常范围内促甲状腺激素(Thyroid Stimulating Hormone,TSH)水平对女性骨代谢指标的影响。方法选取896名甲状腺功能正常的女性,根据TSH水平进行三分位数法分组,未绝经组:T1组(0.27-2.00 mIU/L)、T2组(2.01-2.8mIU/L)及T3组(2.81-4.2 mIU/L);绝经组:T1组(0.27-2.01 mIU/L)、T2组(2.02-3.23 mIU/L)及T3组(3.24-4.2mIU/L)。比较各组间血钙、血磷、25(OH)vitD、腰围、BMI、BMD水平之间差异。spearman相关性分析TSH水平与骨量等级之间的相关性。以BMD作为因变量,对其分层后进行二元Logistic回归分析不同TSH水平对女性骨质疏松发生的影响。结果 (1)绝经期组T1组和T2组的左前臂BMD均明显低于T3组(P0.05),T1组和T2组右跟骨BMD均明显低于T3组(均P0.05);未绝经组3组间各指标无明显差异。(2)绝经组分层后的TSH水平与右跟骨、左前臂骨量等级呈负相关(r=-0.228,P0.05;r=-0.145,P0.05)。未绝经组分层后的TSH水平与右跟骨、左前臂骨量等级无相关性。(3)二元Logistic回归分析:以分组后的右跟骨BMD作为因变量,校正性别、年龄、BMI、腰围、血钙、血磷、25(OH)vitD后,绝经后女性T1组能够增加骨质疏松的风险(OR=2.278,95%CI 1.011～5.132,P0.05)。结论绝经后女性正常范围低水平TSH的骨密度更低,患骨质疏松的风险增高。     

Positive associations of bone mineral density with body mass index,physical activity,and blood triglyceride level in men over 70 years old: a TCVGHAGE study

It is known that osteoporosis decreases physical function in older males. However, the role of metabolic parameters and physical activity influencing older men's bone status remains unclear. Thus, this study was designed to evaluate calcaneus bone mass by ultrasonic screening and the associated physical and metabolic functions in older men. This was a cross-sectional study. Three hundred sixty-eight older men (average age, 78.8 years) living in a veterans' home were enrolled. We measured body height and weight, waist and hip circumference, body fat, lean body mass, blood pressure, 6-min walking distance, complete blood count, and blood biochemical profile. Broadband ultrasound attenuation (BUA) and T-score were recorded using Soundscan quantitative ultrasound over the right calcaneus. The range of calcaneus BUA was 27.3–134.0; T-score was from −4.78 to 3.43. Of the total participants, 36.4% were osteopenic (−2.5 < T-score < −1.0) and 16.3% were osteoporotic (T-score ≦ −2.5). BUA correlated with weight, body mass index (BMI), waist circumference, hip circumference, body fat, lean body mass, serum triglycerides, high-density lipoprotein-cholesterol, albumin, prealbumin, fasting and PC-2h blood insulin, red blood cell count, hemoglobin concentration, and 6-min walking distance. Multiple regression stepwise analysis revealed that only BMI, distance of 6-min walking, and blood triglyceride level were independently and positively associated with the values of BUA. Calcaneus bone mass is significantly and positively associated with BMI, blood triglycerides, and 6-min walking distance in older men.     

Prevalence of risk factors for cardiovascular disease in Brazilian renal transplant recipients

OBJECTIVE: Cardiovascular disease (CVD) is the major cause of death in renal transplant recipients. The aim of this study was to assess the prevalence of CVD risk factors among Brazilian adult renal transplant recipients. METHODS: This cross-sectional study included 192 cases in which the evaluated CVD risk factors were hypertension, diabetes mellitus, impaired fasting glucose, obesity, overweight, abdominal obesity, metabolic syndrome, and dyslipidemia. RESULTS: Hypertension, abdominal obesity, and hypercholesterolemia were the highest prevalent risk factors among the total population with prevalences of approximately 60%. The prevalence of obesity was significantly higher (P < .001) in recipients with normal graft function (28%) than in those with impaired graft function (7%). Abdominal obesity was also higher (P = .02) in the normal graft function group (77%) than in recipients with creatinine clearance (CrCl) values <60 mL/min (61%). There were positive, significant correlations between CrCl and body mass index (BMI) (r = 0.47; P < .001) and between CrCl and waist circumference (WC) (r = 0.44; P < .001). BMI (r = 0.31; P < .001) and WC (r = 0.27; P < .001) were also positively associated with triglyceride levels. There were negative associations of high-density lipoprotein (HDL)-cholesterol (HDL-c) with BMI (r = -0.28; P < .01) and WC (r = -0.32; P < .01). CONCLUSIONS: The high prevalence of CVD risk factors among renal transplant recipients emphasizes the importance of taking appropriate therapeutic measures to reduce modifiable risk factors, reducing CVD and its consequences.     

Is the negative relationship between obesity and bone mineral content greater for older women?

Obesity and osteoporosis are two important body composition problems with increasing prevalences in aged populations. Traditionally, obesity has been regarded as being beneficial to bone health. However, the protective effect of obesity on osteoporosis has been questioned. In some recent studies, obesity, as defined by percentage body fat, was regarded as a risk factor for osteoporosis. The purpose of this study was to (1) evaluate the effect of waist circumference, a surrogate measure for abdominal obesity, on bone mineral content (BMC) and (2) examine whether the effect of waist circumference increases with advancing age. The study population is made up of women aged over 45 years who completed the body composition and bone mineral density examinations in the fifth Korea National Health and Nutrition Examination Survey in 2010. Subjects who take estrogen or are under medical treatment for osteoporosis were excluded. Stroke patients are also excluded. Femoral neck, total-hip, and whole-body BMC were measured by dual-energy X-ray absorptiometry. A total of 1,434 subjects were included in the analysis. Waist circumference was negatively associated with BMC in all tested regions after correction for weight, menopausal status, smoking, drinking, and exercise. In addition, the negative association between waist circumference and BMC in the femoral neck and total hip increases with age, after correction for confounding factors, showing an interaction effect between waist circumference and age on BMC. In conclusion, this study shows that the negative relationship between waist circumference and BMC in the femoral neck and total hip is greater for older women.     

A review of body mass index and waist circumference as markers of obesity and coronary heart disease risk in persons with chronic spinal cord injury

STUDY DESIGN: Literature review. BACKGROUND: Increased fat mass and coronary heart disease (CHD) are secondary complications of chronic spinal cord injury (SCI). In able-bodied populations, body mass index (BMI, body weight (kg)/height (m(2))) is a widely used surrogate marker of obesity and predictor of CHD risk. Waist circumference, an accurate and reproducible surrogate measure of abdominal visceral adipose tissue, is also associated with CHD risk (more so than BMI) in able-bodied populations. OBJECTIVE: To review the literature on the accuracy of BMI and waist circumference as surrogate measures of obesity and CHD risk in persons with chronic SCI. SETTING: Ontario, Canada. METHODS: Literature review. RESULTS: In the SCI population, BMI is an insensitive marker of obesity, explains less of the variance in measured percent fat mass than in the able-bodied, and is inconsistently related to CHD risk factors. This may be due to potential measurement error, and to the inability of BMI to distinguish between fat and fat-free mass and to measure body fat distribution. Waist circumference has not been validated as a surrogate measure of visceral adipose tissue, however preliminary evidence supports a relationship between waist circumference and CHD risk in the SCI population. CONCLUSIONS: We recommend that SCI-specific BMI classifications be determined. We also recommend that accuracy and reliability of waist circumference as a surrogate measure of visceral adipose tissue and CHD risk be determined in men and women with long-standing paraplegia and tetraplegia.     

Divergent Effects of Obesity on Bone Health

Historically, obesity was thought to be advantageous for maintaining healthy bones due to the greater bone mineral density observed in overweight individuals. However, recent observations of increased fracture in some obese individuals have led to concern that common metabolic complications of obesity, such as type 2 diabetes, metabolic syndrome, impaired glucose tolerance, insulin resistance, hyperglycemia, and inflammation may be associated with poor bone health. In support of this hypothesis, greater visceral fat, a hallmark of insulin resistance and metabolic syndrome, is associated with lower bone mineral density. Research is needed to determine if and how visceral fat and/or poor metabolic health are causally associated with bone health. Clinicians should consider adding a marker metabolic health, such as waist circumference or fasting plasma glucose concentration, to other known risk factors for osteoporosis and fracture.     

Abdominal obesity: a health threat

Abdominal obesity is often associated with a constellation of comorbidities that include central adiposity, insulin resistance, dyslipidemia, and hypertension. Clinical evaluations should include a measurement of waist circumference, which is a good marker of abdominal obesity. Abdominal obesity is closely associated with an elevated outflow of free fatty acids from the visceral fat compartment and dysregulation of adipokine expression, accompanied by increased inflammation. The most serious consequences of abdominal obesity are coronary heart disease and stroke. It is also associated, however, with polycystic ovary syndrome and hepatic steatosis. Weight reduction and increased physical activity should be recommended to patients with a high waist circumference. Patients with abdominal obesity and other classic risk factors are at high cardiovascular risk and require strict monitoring of their blood pressure, LDL-c, and blood glucose. New pharmacological strategies might help manage both abdominal obesity and its metabolic consequences.