Association between simple anthropometric indices and cardiovascular risk factors.

OBJECTIVE: To identify which of the three simple anthropometric indices, body mass index (BMI), waist-to-hip ratio (WHR) and waist circumference (WC), best predicts cardiovascular risk factors, and to determine if the association between the anthropometric indices and cardiovascular risk factors varies with gender. DESIGN AND METHODOLOGY: A cross-sectional population-based survey was carried out during 1995-1996. One thousand and ten Chinese people (500 men and 510 women) aged 25-74 y were recruited as subjects for the study. Metabolic profiles and anthropometric indices were measured. RESULTS: Partial correlation and co-variance analyses showed that WC exhibited the highest degree of association with almost all of the studied metabolic profiles for both men and women. We observed significant gender differences in the association between central or general obesity with cardiovascular risk factors. BMI had an independent and significant association with metabolic risks in men, but not in women, whereas WHR was more strongly correlated with metabolic risks for women than for men. Logistic regression analysis further confirmed the magnitude of the association between the obesity indices and metabolic risks. Among the studied metabolic variables, serum insulin showed the highest degree of association with the obesity indices, followed by plasma glucose, triglyceride, HDL and blood pressure. Total cholesterol and LDL-cholesterol had a small but significant correlation with obesity. No threshold values in the relation between either the anthropometric indices and metabolic values, or with hypertension, diabetes and dislipidemia were observed. CONCLUSION: The association of central or general obesity and metabolic syndrome varied with gender. In addition, the useful anthropometric predictors for cardiovascular risk factors were BMI and WC for men, and WC and WHR for women.     

Visceral obesity and the risk of Barrett's esophagus

It still remains controversial whether simple obesity, as measured by the body mass index (BMI), is an independent risk factor for Barrett's esophagus (BE). Recent studies have shown abdominal obesity, as defined by the waist circumference (WC) and the waist-to-hip ratio (WHR), to be a risk factor for BE, independent of the BMI, with the association between BMI and BE being no longer observed after adjustment for the WC and WHR. Moreover, visceral obesity, as directly measured by the surface area of the visceral adipose tissue (VAT) on abdominal CT images, has also been reported to have an association with the risk of BE. In addition to the mechanical effects of abdominal obesity, that is, increase of the intra- abdominal pressure by the large amount of adipose tissue, circulating factors secreted from the VAT, such as tumor necrosis factor-α, interleukin-6, leptin, and adiponectin, have also been proposed to be pathogenetically linked to BE and esophageal adenocarcinoma. Obesity is associated with the risk of BE, and this risk appeared to be mediated for the most part by abdominal obesity, especially visceral obesity. This raises several questions regarding the pathogenesis of obesity-related BE. Larger studies with prospective enrollment of patients are required for further examination of this issue.     

Comparison of different obesity indices related with hypertension among different sex and age groups in China

Background and aimsTo compare the relationships of five obesity-related routine anthropometric indicators (body mass index (BMI), body adiposity index (BAI), waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR)) for hypertension in both sexes and among different age groups of the Chinese population.Methods and resultsA total of 12,064 adult participants (5638 males and 6426 females) were included. Odds ratios (OR) and 95% confidence intervals were used with binary logistic regression models to estimate the risk of hypertension for each obesity index. For the males, WHtR had the highest OR value in all age groups. The degrees of correlation between hypertension and the obesity indices for different age groups were different among the females. WC, BMI, and WHtR were the highest in the 18–44, 45–59, and ≥60 years age groups, respectively. Furthermore, we compared the area under the ROC curve (AUC) of each obesity index for the criterion of hypertension under the influence of risk factors. For the males, the AUC of WHtR was the largest (0.814, 0.710, and 0.662). WC (AUC = 0.820), BMI (AUC = 0.765), and WHtR (AUC = 0.668) tended to be the best criteria for hypertension among females in the 18–44, 45–59, and ≥60 years age groups respectively. In addition, BAI, as an obesity indicator proposed in recent years, has a positive association with hypertension except in 18–44 years women, which was not stronger than other obesity indicators.ConclusionsFor males, WHtR appears to be the best obesity index related with hypertension. For young, middle-aged, and elderly women, the best obesity indices related with hypertension are WC, BMI, and WHtR, respectively.     

肥胖指标在研究心血管危险因素中的意义

目的探讨体质指数(BMI)和中心性肥胖指标与糖尿病(DM)、高血压患病风险的关系。方法采用横断面研究方法,入选2980名男性和3850名女性(年龄35～74岁)。分别检测受检者的BMI、腰围(WC)、腰臀比(WHR)、腰围与身高的比值(WSR)、空腹血糖(FBG)、餐后2 h血糖(2 hPG)和血压,并分析BMI、WC、WHR和WSR与心血管疾病的危险因素变量(FBG、2 hPG、收缩压或舒张压)的关联。应用受试者工作特征曲线(ROC)下面积,评估检测的各项人体测量指标与DM和高血压关联程度的特异度和敏感度。结果 (1)BMI、WC、WHR和WSR之间相关系数差异有统计学意义(P<0.001),以WC和WSR间相关系数最大(男:0.94,女:0.95)。(2)与BMI相比,男性WSR与DM的关联更强(P=0.081),女性WC和WSR的关联更强(P<0.05)。ROC下面积经年龄调整为男性WSR 0.735和女性WC 0.749,均较BMI 0.725大。(3)与中心性肥胖指标比较,不论男女,BMI与高血压有最强的关联(BMI比WHR,P<0.001;比WSR,P<0.01;比WC,P<0.05)。BMI的ROC曲线下面积经年龄调整分别为男性WSR 0.760和女性WC 0.766,均较相应的中心性肥胖指标高。结论中心性肥胖指标与BMI比较,前者可能与DM患病风险关联更大;而后者可能导致高血压患病风险更大。     

Validity of anthropometric indices in predicting high blood pressure risk factors in Iranian children and adolescents: CASPIAN‐V study

Anthropometric indices have been used as indicators for predicting hypertension (HTN) in children and adolescents but it is not clear which anthropometric measures are a better index for identifying elevated blood pressure (EBP) risk factors in pediatric population. Body mass index (BMI), waist circumference (WC), weight‐height ratio (WHR), a body shape index (ABSI) and blood pressure were measured in 14 008 children and adolescents aged 7‐18 years in a national school‐aged survey CASPIN V. Hypertension (HTN) was defined according to the 2017 American Academy of Pediatrics guidelines, using the 95th percentile. The predictive power of anthropometric indices for HTN risk factors was examined using receiver operating characteristic (ROC) analyses. Multivariate logistic regression analysis was used to compare areas under ROC curves (AUCs) among the four anthropometric indices. BMI, WC, WHR, and ABSI were significantly higher in adolescents than in children. EBP was more prevalent in boys (7.2%) than girls (5.5%), whereas the prevalence of HTN was higher in girls (11.3%) than boys 10.4%. Prevalence odds ratio was around 2 for BMI, WC, and WHR with AUCs scores of nearly 0.6 to predict EBP in both children and adolescents of both sexes. Thus, the ability of BMI z‐score, WC, WHR or ASBI to identify Iranian children and adolescents at higher risk of EBP was week. WC, WHR or ASBI in combination with BMI did not improve predictive power to identify subjects at higher risk of EBP.     

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.     

Nutrient intakes as predictors of body weight in European people with type 1 diabetes.

BACKGROUND: Overweight and obesity are also found among persons with type 1 diabetes. OBJECTIVE: The present study examined which nutrients predict the body mass index (BMI), the waist-to-hip ratio (WHR) and the waist circumference (WC) of European persons with type 1 diabetes. DESIGN: Cross-sectional, clinic-based study (EURODIAB Complications Study). SUBJECTS AND METHODS: Nutrient intakes (assessed by a 3-day dietary record) predicting measures of body weight (BMI, WHR and WC) were determined by stepwise forward regression analysis in 1458 males and 1410 females with type 1 diabetes (P< or =0.05 for inclusion). RESULTS: In men, a higher carbohydrate intake was a significant independent predictor for lower levels of BMI, WHR and WC, an increased saturated fat intake and a lower intake of cereal fibre predicted a higher WHR, a higher monounsaturated fat intake and a lower glycaemic index of the diet determined lower levels of WHR and WC, and a moderate consumption of alcohol determined an increased WC. In women, a higher carbohydrate intake predicted a lower BMI and a thinner WC, no alcohol consumption determined a lower BMI, and an increased intake of saturated fat and a lower consumption of cereal fibre were significant independent predictors for a higher WHR. CONCLUSIONS: A modified fat intake, an increase of carbohydrate and cereal fibre intake and a preferred consumption of low glycaemic index foods are independently related to lower measures of body weight in European persons with type 1 diabetes.     

Comparison of child adiposity indices in prediction of hypertension in early adulthood

We aimed to compare child body mass index (BMI) in prediction of hypertension in early adulthood with 4 other adiposity indices (waist circumference [WC], waist circumference‐to‐height ratio [WHtR], waist‐to‐hip ratio [WHR], and triceps skinfold [TSF]). The cohort from the China Health and Nutrition Survey 1993‐2011 consisted of 1444 adults aged 18‐36 years who were examined in childhood and early adulthood. Child adiposity indices and adult blood pressure (BP) were transformed into age‐, sex‐, and survey year‐specific Z‐scores. Adult hypertension was defined as BP ≥130/80 mm Hg as per the 2017 American College of Cardiology/American Heart Association guidelines. Adult hypertension prevalence was 32.9% during a mean follow‐up of 10.1 years. Childhood BMI showed stronger correlation with adult BP than WHR and TSF (P_S for difference <.05). Child BMI showed the better prediction of adult hypertension compared with WHtR, WHR, and TSF using area under the receiver operating characteristic curves (P_S for difference <.05). Per SD change in the predictor, child BMI (relative risk [95% confidence interval], 1.11 [1.04‐1.18]) and WC (1.12 [1.05‐1.20]) were significantly associated with adult hypertension using covariate‐adjusted Poisson models with robust standard errors. Child BMI performed equally or better compared with 4 other adiposity indices in predicting adult hypertension.     

Prehypertension in young females,where do they stand?

BackgroundTo determine the prevalence of prehypertension in young females and its correlation to various parameters like body mass index (BMI), waist hip ratio (WHR), waist circumference (WC) and family history, and blood pressure (BP) response to exercise stress testing.MethodsOne hundred and fifty apparently healthy females of age group 18–25-years were randomly selected from the student population of Jawaharlal Nehru Medical College, Sawangi (Meghe), Wardha, after satisfying all the inclusion criteria and written informed consent. Along with all the anthropometric parameters BMI, WHR, WC and family history of hypertension (HTN) and/or diabetes, resting BP, and BP response to exercise stress testing were measured in the study.ResultsAmongst 150 subjects, 63 (42%) subjects were normotensive and 87 (58%) were prehypertensive. Body mass index, WHR, WC and family history of HTN were significantly higher in prehypertensive group. Prehypertensive group also had an exaggerated BP response to exercise stress testing and higher BP during recovery.ConclusionPrevalence of prehypertension was found to be high in females, also there was a strong correlation between prehypertension and BMI, WHR and WC suggesting a positive correlation between obesity and prehypertension. Prehypertensive group also showed an exaggerated BP response to exercise stress testing.     

Associations between obesity indices and both type 2 diabetes and impaired fasting glucose among West African adults: Results from WHO STEPS surveys

Background and aimVarious obesity indices such as BMI, waist circumference (WC), waist-hip ratio, (WHR) and waist-to-height ratio (WHtR) are associated with the risk of type 2 Diabetes Mellitus (T2DM). Given few studies examining the strength of the association in this population, we aimed to identify which obesity indices are most strongly associated with T2DM and impaired fasting glucose (IFG) among adults from five West African countries.Methods and resultsData from 15,520 participants from the World Health Organisation (WHO) STEPs surveys in Burkina Faso, Benin, Mali, Liberia, and Ghana were included in analyses. Multinomial logistic regression was used to calculate the relative risk (RR) per standard deviation (SD) of each anthropometric measure, modelled as both continuous variables and as categorical variables based on established cut-points. In the analyses with continuous variables, the unadjusted RRs for T2DM per SD were 1.30 (1.23, 1.37) for body mass index (BMI); 1.56 (1.46, 1.67) for WC; 2.57 (2.15, 3.09) for WHtR and 1.16 (1.03, 1.31) for WHR. WHtR showed the strongest association with T2DM in all adjusted analyses. For models using categorical variables based on established cut-points, obesity defined using waist circumference (OB-WC) and OB-BMI showed the strongest associations with T2DM, and OB-WHR, the weakest association in all adjusted analyses.ConclusionWHtR and WC appear to be the indices most strongly associated with T2DM and IFG respectively. Given its simplicity, WC may be the metric that most usefully conveys risk for T2DM in West African adults.     

Predictive power of novel and established obesity indices for outcome in PAD during a five-year follow-up

Background and aimsPrevious data show contradicting results regarding relevance of obesity on outcome in peripheral arterial disease (PAD). Thus, this study aims to evaluate the predictive power of obesity as measured by established and novel obesity indices (waist circumference WC, waist-hip ratio WHR, body-mass index BMI, body adiposity index BAI, visceral adiposity index VAI, weight-adjusted waist index WWI) in a PAD cohort.Methods and resultsIn 367 patients with diagnosed PAD anthropometric parameters were assessed at study inclusion in an observational study. Mortality data was retrieved from the central death registry after five years. Outcome analyses were performed by multivariable Cox-regression models. 57 PAD patients (15.5%) died during the follow-up, of those 36 were categorized as cardiovascular origin. Patients from the all-cause mortality group were older, more often diabetics with a worse glucose control and had worse renal function. Obesity indices were not significantly different between the event and control group. None of the evaluated risk factors predicted cardiovascular or all-cause death after multivariable adjustment for age, gender, LDL-C, serum creatinine, systolic blood pressure, CRP, smoking habits, diabetes status and previous history of peripheral revascularisation (all-cause WC 1.007 (0.983–1.031), WHR 1.772 (0.106–29.595), BMI 1.006 (0.939–1.078), BAI 1.002 (0.945–1.063), VAI 1.019 (0.895–1.161), WWI 1.085 (0.831–1.416); cv-death WC 1.007 (0.978–1.036), WHR 0.382 (0.006–25.338), BMI 1.004 (0.918–1.098), BAI 1.034 (0.959–1.116), VAI 1.036 (0.885–1.213), WWI 1.061 (0.782–1.441)).ConclusionObesity as risk marker estimated by indices both for general and visceral adiposity, does not predict mortality in a secondary prevention cohort of PAD patients.     

Body mass index,waist circumference and waist–hip ratio: which is the better discriminator of cardiovascular disease mortality risk? Evidence from an individual‐participant meta‐analysis of 82 864 participants from nine cohort studies

Few studies have examined both the relative magnitude of association and the discriminative capability of multiple indicators of obesity with cardiovascular disease (CVD) mortality risk. We conducted an individual‐participant meta‐analysis of nine cohort studies of men and women drawn from the British general population resulting in sample of 82 864 individuals. Body mass index (BMI), waist circumference (WC) and waist‐to‐hip ratio (WHR) were measured directly. There were 6641 deaths (1998 CVD) during a mean of 8.1 years of follow‐up. After adjustment, a one SD higher in WHR and WC was related to a higher risk of CVD mortality (hazard ratio [95% CI]): 1.15 (1.05–1.25) and 1.15 (1.04–1.27), respectively. The risk of CVD mortality also increased linearly across quintiles of both these abdominal obesity markers with a 66% increased risk in the highest quintile of WHR. In age‐ and sex‐adjusted models only, BMI was related to CVD mortality but not in any other analyses. No major differences were revealed in the discrimination capabilities of models with BMI, WC or WHR for cardiovascular or total mortality outcomes. In conclusion, measures of abdominal adiposity, but not BMI, were related to an increased risk of CVD mortality. No difference was observed in discrimination capacities between adiposity markers.     

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.     

Optimal anthropometric factor cutoffs for hyperglycemia, hypertension and dyslipidemia for the Taiwanese population

Background

Optimal cutoffs for obesity indices are rarely studied in Asians. We evaluated these cutoffs for diabetes, hypertension, dyslipidemia and any risk factor for the Taiwanese general population.

Methods

Body mass index (BMI), waist circumference (WC), waist–hip ratio (WHR), waist–height ratio (WHeiR) and other data for 4683 (2280 men and 2403 women) participants of the population-based Taiwanese Survey on Hypertension, Hyperglycemia and Hyperlipidemia were used. Areas under curves (AUCs) were analyzed and optimal cutoffs were estimated by maximizing the sums of sensitivity and specificity. Potential confounders included age, smoking, alcohol, betel nut chewing and exercise.

Results

Optimal cutoffs for men and women, respectively, were 23.7–26.3 and 22.1–23.2 kg/m² for BMI; 85.0–87.0 and 74.0–83.0 cm for WC; 0.87–0.90 and 0.78–0.83 for WHR; and 0.48–0.52 and 0.48–0.52 for WHeiR. AUCs were not significantly different among the indices for diabetes in men and for hypertension in women. In men, WHR was significantly inferior to the other indices for predicting hypertension, dyslipidemia and any risk factor. In women, BMI was significantly inferior to the others for diabetes. For dyslipidemia and any risk factor in women, WHeiR showed the largest AUCs and significant differences were seen in the following pairs: WHeiR vs. BMI and WHeiR vs. WHR for dyslipidemia and WC vs. WHR and WHeiR vs. WHR for any risk factor.

Conclusions

WC and WHeiR have similar efficacy and are superior to BMI and WHR. However, WHeiR has the extra benefit of a unisex cutoff within a narrow range.     

Effectiveness of body roundness index in predicting metabolic syndrome: A systematic review and meta‐analysis

Body roundness index (BRI) is a new anthropometric index developed to predict both body fat and the percentage of visceral adipose tissue. Our aim was to investigate whether BRI is superior to traditional anthropometric indices in predicting metabolic syndrome (MetS). This systematic review and meta‐analysis was conducted using Pubmed, Scopus and Web of Sciences databases. The estimated pooled areas under curve (AUCs) for BRI predicting MetS was higher than body mass index (BMI), waist‐to‐hip ratio (WHR), body shape index (ABSI) and body adiposity index (BAI), similar to waist circumference (WC) and lower than waist‐to‐height ratio (WHtR). However, the difference between BRI and BMI, WC and WHtR predicting MetS was statistically non‐significant. Similar results were found with the summary receiver operating characteristic curve (AUC‐SROC). In addition, the non‐Chinese population had pooled AUCs greater than the Chinese population for all indices. Pooled ORs showed that BRI is associated with an increased MetS risk. In conclusion, BRI had good discriminatory power for MetS in adults of both sexes from diverse populations (AUC > 0.7; AUC‐SROC>0.7). However, WC and WHtR offer the best performance when screening for MetS, and non‐significant differences were found with BRI. In contrast, BRI was superior to BMI, WHR, ABSI and BAI in predicting MetS.     

Body fat distribution and the risk of hypertension and diabetes among Japanese men and women

To identify anthropometrical indices of body fat distribution for predicting the risk of hypertension and diabetes, a population-based prospective study was designed. Subjects in two communities (n = 2,422 and 3,195), who were free of hypertension and diabetes, respectively, were followed-up. The area and gender-specific risk of hypertension and diabetes were compared among tertiles of body mass index (BMI) and body fat distribution, including waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), and subscapular skinfold-thickness (SSF). During the 10-year follow-up for hypertension and diabetes, the incident cases of hypertension were 72 for Yao men, 125 for Kyowa men, 160 for Yao women and 193 for Kyowa women and those of diabetes were 27, 64, 37 and 77, respectively. One SD differences in BMI and WC were associated with 1.2 to 1.6-fold higher risk of hypertension, and that of SSF was associated with 1.4 to 1.6-fold higher risk of diabetes for both men and women in Yao and for women, but not men, in Kyowa. One SD differences of BMI, WC and WHtR were also associated with 1.4 to 2.0-fold higher risk of diabetes for Yao and Kyowa women. In conclusion, the significant predictors for hypertension were BMI and WC and those for diabetes were BMI and SSF in both genders in both communities, except for men in Kyowa. WC and WHtR were also predictors for diabetes in women but not in men.     

Obesity measures at baseline,their trajectories over time,and the incidence of chronic kidney disease: A 14 year cohort study among Korean adults

Background and aimsWe investigated the association of baseline obesity measures, i.e. body mass index (BMI), waist circumference (WC), hip circumference (HC), and waist-hip ratio (WHR), and their trajectories over time with incident chronic kidney disease (CKD).Methods and resultsUtilizing data from 2001 to 2014 for 9796 Korean adults without CKD at baseline, the association of baseline obesity measures with incident CKD was evaluated using logistic regression. Further, among 5605 subjects with repeated measures, the effect of the trajectories in obesity measures on CKD incidence was investigated via Cox regression.Baseline obesity in terms of BMI, WC, and HC increased the odds of incident CKD (odds ratio (OR) 1.19, 95% confidence interval (CI) 1.05–1.33; OR 1.22, 95% CI 1.07–1.38; and OR 1.25, 95% CI 1.11–1.41, respectively), while baseline WHR did not show such an association. A “became non-obese” BMI, WC, or WHR trajectory, and a “constantly not large” HC trajectory decreased the hazard of incident CKD (hazard ratio (HR) 0.70, 95% CI 0.50–0.99; HR 0.61, 95% CI 0.40–0.92; HR 0.55, 95% CI 0.35–0.85; and HR 0.81, 95% CI 0.69–0.95, respectively) when compared with a “constantly obese or became obese” trajectory.ConclusionBoth baseline obesity and obesity trajectories over time were associated with CKD incidence. BMI and WC were equally good measures of CKD risk, while WHR was not. Separately examining WC and HC components of WHR (= WC/HC) may explain WHR's inconsistency, and WHR's usefulness as a measure of CKD risk should be reevaluated.     

Obesity, independent of insulin resistance, is a major determinant of blood pressure in normoglycemic Hong Kong Chinese

Obesity and insulin resistance are considered important links underlying the development of hypertension. In Caucasians, there have been many reports of an association between insulin resistance and hypertension. However, this relationship is not consistently found in other ethnic groups. In this study, we examined the involvement of insulin resistance (assessed as fasting insulin-glucose product, FIGP) and general and central obesity as potential links in the development of hypertension in 413 normoglycemic Hong Kong Chinese (56.9% hypertensive) subjects. Anthropometric parameters (waist circumference [WC], waist-to-hip ratio [WHR], body mass index [BMI]), surrogate measures of insulin resistance (fasting plasma glucose, insulin, FIGP), fasting lipids and systolic (SBP) and diastolic (DBP) blood pressure were measured. Both male and female hypertensives were more obese and dyslipidemic, and the females had higher indices of insulin resistance than the normotensive subjects of the same gender. Before adjustment for age, gender, and adiposity, FIGP correlated with SBP in the total (r = .19, P = .009) and low BMI (r = .23, P < .05) and low WHR (r = .25, P < .01) groups. However, after adjustment, there was no significant relationship between FIGP and blood pressure. In contrast, BMI and WC were strongly associated with blood pressure (r > or = .41, P < .001 for both DBP and SBP in the total population), although in the group with general obesity, the strength of the relationship was weaker (r > or = .13). These relationships persisted after adjustment for age, gender, and FIGP. Obesity, therefore, appears to have a predominant role compared with insulin resistance in determining blood pressure in these normoglycemic Chinese.     

Adiposity parameters and cognitive function in the elderly: Application of “Jolly Fat” hypothesis to cognition

Obesity has a strong association with cardiovascular and metabolic diseases, which have also been linked with dementia. While recent studies have reported an association between mid-life obesity and dementia, the role that later-life obesity may have is less clear. A total of 721 community-dwelling elderly (60–85 years old) were selected. Obesity parameters, like body mass index (BMI), waist-hip ratio (WHR), waist circumference (WC), and percent body fat (PBF), as well as cognitive functions were measured over a period of approximately 2 years, and then the relationships between these variables were assessed. The change in cognitive function in the elderly was associated with the baseline assessment of BMI (linearly, β = 0.092), WC (quadratic, β = 1.333), and PBF (linearly, β = 0.097). Using multiple regression analyses, the differences exist in the change of cognitive function over time according to the sex. For men, increased obesity over time when obese in the baseline assessment (BMI, WHR, WC) were associated with a positive change in cognitive function. For women, a decreased obesity over time when obese in the baseline assessment (WHR) and an increased obesity over time when they had a normal adiposity in the baseline assessment (WC) were both associated with cognitive decline. The relationship between obesity and cognitive decline in the elderly is complex and some differences exist between the sexes. The application of the “Jolly Fat” hypothesis to cognitive function can only be applied to elderly men and not to elderly women.     

Ethnic differences in the relationships between obesity and glucose-metabolic abnormalities: a cross-sectional population-based study

OBJECTIVES: To evaluate whether body mass index (BMI) and other anthropometric indices of visceral obesity vary by ethnic group in their distribution and their relationship to metabolic abnormalities. DESIGN: Cross-sectional study. PARTICIPANTS: Canadian men and women, aged 35-75 years, of South Asian (n=342), Chinese (n=317), European (n=326) and Aboriginal (n=301) descent were recruited using stratified random sampling. PRIMARY MEASURES: Anthropometric indices (BMI, waist to hip ratio (WHR) and waist circumference (WC)), metabolic markers (fasting glucose, HbA1c, the ratio of total cholesterol/HDL) and clinical markers (systolic blood pressure) were assessed. RESULTS: In subjects with BMI<30 kg/m2, the mean marker levels in people with elevated WC (>88 cm in women, >102 cm in men) vs people with normal WC were 6.16 vs 5.34 mmol/l for fasting glucose, 6.05 vs 5.66% for HbA1c and 5.46 vs 4.68 for the ratio of total cholesterol to HDL (P<0.001 in each case). At nearly every given level of BMI, non-European ethnic groups displayed significantly higher marker levels than Europeans. For example, for a given BMI, age and sex, the difference between European and non-European groups in HbA1c levels was 0.53% (95% confidence interval (CI): 0.37-0.69) for South Asians, 0.37% (95% CI: 0.2-0.54) for Chinese and 0.95% (95% CI: 0.78-1.12) for Aboriginal People. CONCLUSIONS: Uniform cut-points for the classification of obesity using BMI, WHR or WC result in marked variation in the levels of glucose-metabolic abnormalities between ethnic groups. Existing action thresholds for these anthropometric indices do not apply to non-European ethnic groups and warrant revision.