腹型肥胖个体血浆obestatin水平研究

目的 探讨腹型肥胖患者obestatin的血浆水平及与腰围的相关性.方法 入选腹型肥胖组患者50例（男性腰围≥85cm,女性腰围≥80cm）,及正常对照组20例（男性腰围＜85cm,女性腰围＜80cm,24 kg/m2＞ BMI≥18.5 kg/m2）.应用放射免疫分析法测定血浆obestatin及血清胰岛素水平.血清血脂水平采用自动生化分析仪进行酶法测定.胰岛素抵抗采用胰岛素抵抗指数（HOMA-IR）评定.结果 腹型肥胖个体均表现出高的HOMA-IR、血清胆固醇及甘油三酯水平及低的高密度脂蛋白水平.与正常对照组相比,腹型肥胖组个体的血浆obestatin水平有所下降.在腹型肥胖的个体中,血浆obestatin水平与腰围及体重指数呈负相关.结论 腹型肥胖组的血浆obestatin水平明显降低,而且obestatin水平与腰围呈负相关,提示obestatin与脂肪分布及腹型肥胖的发生有关.     

NPPA Promoter Hypomethylation Predicts Central Obesity Development: A Prospective Longitudinal Study in Chinese Adults

IntroductionAtrial natriuretic peptide plays a potential role in obesity with unclear molecular mechanisms. The objective of this study was to examine the association between its coding gene (natriuretic peptide A [NPPA]) methylation and obesity.MethodsPeripheral blood DNA methylation of NPPA promoter was quantified at baseline by targeted bisulfite sequencing for 2,497 community members (mean aged 53 years, 38% men) in the Gusu cohort. Obesity was repeatedly assessed by body mass index (BMI) and waist circumference (WC) at baseline and follow-up examinations. The cross-sectional, longitudinal, and prospective associations between NPPA promoter methylation and obesity were examined.ResultsOf the 9 CpG loci assayed, DNA methylation levels at 6 CpGs were significantly lower in participants with central obesity than those without (all p < 0.05 for permutation test). These CpG methylation levels at baseline were also inversely associated with dynamic changes in BMI or WC during follow-up (all p < 0.05 for permutation test). After an average 4 years of follow-up, hypermethylation at the 6 CpGs (CpG2 located at Chr1:11908348, CpG3 located at Chr1:11908299, CpG4 located at Chr1:11908200, CpG5 located at Chr1:11908182, CpG6 located at Chr1:11908178, and CpG8 located at Chr1:11908165) was significantly associated with a lower risk of incident central obesity (all p < 0.05 for permutation test).ConclusionsHypomethylation at NPPA promoter was associated with increased future risk of central obesity in Chinese adults. Aberrant DNA methylation of the NPPA gene may participate in the mechanisms of central obesity.     

Meta-Analysis of the Relationship between Abdominal Obesity and Diabetic Kidney Disease in Type 2 Diabetic Patients

Background and ObjectivesThe meta-analysis aimed to investigate the association of visceral fat area (VFA), waist circumference (WC), waist-hip ratio (WHR) and waist-height ratio (WHtR) with diabetic kidney disease (DKD) in type 2 diabetic patients.MethodsIncluded studies were searched from Pubmed, Embase, and the Cochrane Library before July 2020. We synthesized the pooled results of the above relationships by meta-analysis.ResultsFourteen cross-sectional studies were enrolled. The pooled results indicated there was a significant difference in continuous VFA, WC and WHR/WHtR between patients with DKD and those without DKD (standard mean difference, SMD, 0.24, 95% confidence interval, CI, 0.13–0.36, p = 0.000). For VFA, patients with DKD had higher VFA levels than those without DKD (SMD 0.27, 95% CI 0.03–0.50). In the WC subgroup, patients with DKD had higher WC levels than those without DKD (SMD 0.17, 95% CI 0.10–0.24); similarly, abdominal obesity (dichotomized WC) was significantly associated with an increase in the odds of DKD (expected shortfall, ES, 1.57, 95% CI 1.32–1.86). However, the association of continuous WHR/WHtR with DKD was not statistically significant (SMD 0.43, 95% CI −0.12 to 0.97), while we found this relationship was statistically significant when analyzed categorically (ES 1.58, 95% CI 1.22–2.06).ConclusionIn this meta-analysis, we found abdominal obesity parameters (continuous VFA, WC) were associated with increased odds of DKD, and type 2 diabetic patients with DKD were more likely to have abdominal obesity (categorized using WC or WHR/WHtR).     

Prevalence of Thinness,Overweight, Obesity,and Central Obesity in Finnish School-Aged Children: A Comparison of National and International Reference Values

IntroductionThe global epidemic of obesity concerns children, and monitoring the prevalence is of highest priority. Body mass index (BMI) with age- and sex-specific cutoff values determines weight status in children, although multiple reference systems exist. Our aim was to compare the prevalence for thinness, normal weight, overweight, and obesity in Finnish school-aged children according to national and international reference values, as well as to determine which cutoff values for overweight agree with the criteria for central obesity.MethodsThis study includes 10,646 children aged 9–12 years from the Finnish Health in Teens cohort. Height, weight, and waist circumference were measured in 2011–2014. BMI (weight [kg]/height [m]²) and the waist-to-height ratio (WHtR; waist [cm]/height [cm]) were calculated. The WHtR cutoff of >0.5 indicated central obesity. We compared the sex-specific prevalence of thinness, overweight, and obesity using the International Obesity Task Force (IOTF), World Health Organization (WHO) and Finnish (FIN) BMI-for-age reference values, as well as these three against central obesity based on the WHtR.ResultsThe prevalence of thinness, overweight, and obesity were 11.0%, 12.7%, and 2.6%, respectively, using IOTF; 2.6%, 15.9%, and 5.2% using WHO; and 5.1%, 11.4%, and 2.2% using FIN. Overweight and obesity were more common in boys than girls using WHO and FIN, while thinness was more common in girls using IOTF and FIN. IOTF versus WHO exhibited moderate agreement (κ = 0.59), which improved for IOTF versus FIN (κ = 0.74). Of those classified as overweight by WHO, 37% and 47% were regarded as normal weight according to IOTF and FIN, respectively. The prevalence of central obesity was 8.7%, and it was more common in boys than girls. WHO provided the highest sensitivity: 95% of individuals with central obesity were classified with overweight or obesity. Using FIN provided the highest specificity (93%).ConclusionOur findings show that WHO overestimates the prevalence of overweight and obesity, while IOTF overrates thinness. Thus, comparing prevalence rates between studies requires caution. The novelty of this study is the comparison of the cutoff values for overweight with central obesity. The choice of reference system affects the generalizability of the research results.     

Evaluation of some anthropometric indices for the diagnosis of obesity in pregnancy in Nigeria: a cross-sectional study

Background

Obesity in pregnancy is a global health problem which is associated with poor pregnancy outcomes. The use of weight and height, measured at about ten weeks of gestation, to produce pre-gestational body mass index is recommended for the diagnoses of the condition but limitations abound in under resourced settings.

Objectives

To measure anthropometric indices such as mid upper arm circumference, calf circumference, waist circumference and waist to hip ratio, for identification of obesity in pregnancy.

Methods

Anthropometric measurements were carried out on cohorts of pregnant women from 4 hospitals in Enugu, South-eastern Nigeria.

Results

There were no significant difference in the mean mid upper arm circumference (MUAC) and calf circumference (CC) across the trimester groups. The mean values of waist circumferences, hip circumference and waist to hip ratios changed significantly across the trimesters. The 75^th percentile of MUAC (33 cm) and CC (39 cm) in all trimesters, had sensitivity and specificity of more than 70% for identifying obesity in pregnancy.

Conclusion

MUAC and CC values of 33cm and 39cm respectively might be reliable cut off points for diagnoses of obesity throughout pregnancy in Enugu, Nigeria     

Heritability of Phenotypes Associated with Glucose Homeostasis and Adiposity in a Rural Area of Brazil

We aimed to estimate the heritability and genetic correlation between glucose homeostasis and adiposity traits in a population in a rural community in Brazil. The Jequitinhonha Community Family Study cohort consists of subjects aged ≥18 years residing in rural areas in Brazil. The data on the following traits were assembled for 280 individuals (51.7% women): body mass index (BMI), body fat percentage, waist and mid‐upper arm circumferences, triceps skinfold, conicity index, insulin, glucose, high‐density lipoprotein cholesterol (HDLc), triglycerides and C‐reactive protein. Extended pedigrees were constructed up to the third generation of individuals using the data management software PEDSYS. The heritability and genetic correlations were estimated using a variance component method. The age‐ and sex‐adjusted heritability values estimated for insulin (h² = 52%), glucose (h² = 51%), HDLc (h² = 58%), and waist circumference (WC; h² = 49%) were high. Significantly adjusted genetic correlations were observed between insulin paired with each of the following phenotypes; (BMI; ρg = 0.48), WC (ρg = 0.47) and HDLc (ρg = ?0.47). The homeostasis model assessment of insulin resistance (HOMA‐IR) was genetically correlated with BMI (ρg = 0.53) and HDLc (ρg = ?0.58). The adjusted genetic correlations between traits were consistently higher compared with the environmental correlations. In conclusion, glucose metabolism and adiposity traits are highly heritable and share common genetic effects with body adiposity traits.     

Sitting Time and Obesity or Abdominal Obesity in Older South Koreans: Korean National Health and Nutrition Examination Survey 2013

We examined relationships between sitting time and obesity or abdominal obesity according to sex and socioeconomic status in elderly people. We analyzed data from the Korean National Health and Nutrition Examination Survey 2013, and 1565 participants were included in the study. Multivariate logistic regression analysis was used to examine relationships between sitting time and obesity or abdominal obesity according to sex and socioeconomic status. Sitting time was positively correlated with body mass index in men and women and waist circumference in men. When considering socioeconomic factors, men who sat for 5 hours or longer and fell within the lowest income were more likely to have obesity and abdominal obesity relative to men who sat for 5 hours or shorter and earned higher incomes (odds ratio [95% confidence interval] = 1.80 [1.14–2.84] and 1.63 [1.02–2.61] respectively), and women who sat for 5 hours or longer and fell within the lowest educational level were more likely to have obesity relative to women who sat for 5 hours or less and were educated to a higher level (1.24 [1.01–1.85]). Strategies to reduce sedentary behavior would help to prevent obesity in older men who earn low incomes and women with lower levels of educational attainment.     

二甲双胍联合沙格列汀或格列美脲对新诊断合并腹型肥胖的2型糖尿病患者临床疗效对比

目的 比较二甲双胍联合沙格列汀或者格列美脲在新诊断合并腹型肥胖的2型糖尿病患者疗效与安全性。方法 选取2017年4月~11月在我院就诊新诊断合并腹型肥胖的T2DM患者100例,每组50例。采用随机数字表法分为实验组和对照组,实验组给予二甲双胍联合沙格列汀治疗,对照组给予以二甲双胍联合格列美脲治疗。比较两组FPG、2hPPG、HbA1C、FINS、HOMA-β,评估两组患者腰围（WC）、BMI、血压、血脂改善情况及服药期间低血糖发生情况。结果 91例患者完成治疗随访,其中对照组45例,实验组46例。与治疗前相比,两组患者HbA1C、FPG、PPG均降低（P＜0.05）,但两组间比较,差异有统计学意义（P＞0.05）;与治疗前相比,两组FINS、HOMA-β升高（P＜0.05）。与对照组相比,实验组FINS、HOMA-β有改善（P＜0.05）。治疗后,患者BMI、SBP、DBP、TG、LDL-C等指标比较,差异有统计学意义（P＞0.05）。治疗后实验组WC呈现降低趋势,而对照组均有不同程度的升高;与对照组比较,实验组治疗后WC降低（P＜0.05）,治疗期间实验组患者低血糖发生率（4.34%）低于对照组（20.00%）（P＜0.05）。两组均无严重不良事件发生。结论 对新诊断的合并腹型肥胖的T2DM患者,二甲双胍联合沙格列汀与二甲双胍联合格列美脲降糖疗效相当,但沙格列汀在缩小低腰围及改善胰岛功能方面具有优势,同时具有较低的低血糖发生率。     

Depressive symptoms and sub-clinical atherosclerosis in Africans: role of metabolic syndrome, inflammation and sympathoadrenal function

Depressive symptoms have been consistently associated with sub-clinical atherosclerosis and future risk of coronary heart disease events. However, the pathways linking depression and coronary atherosclerosis are poorly understood. These types of data are particularly sparse in sub-Saharan Africa, which is presently experiencing an exponential rise in CVD. We examined the association between depressive symptoms and mean carotid intima media thickness (mCIMT), and the extent to which this association could be explained by sympathoadrenal function, inflammatory, and metabolic pathways. A sample of 186 black (aged 44.0 ± 8.0 years) and 203 Caucasians (aged 44.8 ± 10.8 years) were recruited as part of the Sympathetic Activity and Ambulatory Blood Pressure in Africans (SABPA) study — presently the only study in sub-Saharan Africa focusing on the contribution of the psychosocial risk factors to cardiovascular health. Depressive symptoms were assessed using the self administered 9-item Patient Health Questionnaire. After adjusting for age, sex, ethnicity, and anti-hypertensive drugs use, participants with severe depressive symptoms had higher mCIMT in comparison to participants with no symptoms (β = 0.038 mm, 95% CI, 0.001 to 0.074 mm). Metabolic syndrome was the only significant mediator of the association between depressive symptoms and mCIMT, and accounted for approximately 21% of the effect. In summary, depressive symptoms were associated with an excess burden of sub-clinical vascular disease. Treatment of metabolic syndrome in patients with depression may partly reduce the risk of sub-clinical vascular disease development.     

Association between Central Obesity and Circadian Parameters of Blood Pressure from the Korean Ambulatory Blood Pressure Monitoring Registry: Kor-ABP Registry

Central obesity has been reported as a risk for atherosclerosis and metabolic syndrome. The influence of central obesity on diurnal blood pressure (BP) has not been established. In this study, we investigated the influence of central obesity on the circadian parameters of BP by 24 hr ambulatory BP monitoring. Total 1,290 subjects were enrolled from the Korean Ambulatory BP registry. Central obesity was defined as having a waist circumference≥90 cm in males and ≥85 cm in females. The central-obese group had higher daytime systolic BP (SBP), nighttime SBP and diastolic BP (DBP) than the non-obese group (all, P<0.001). There were no differences in nocturnal dipping (ND) patterns between the groups. Female participants showed a higher BP mean difference (MD) than male participants with concerns of central obesity (daytime SBP MD 5.28 vs 4.27, nighttime SBP MD 6.48 vs 2.72) and wider pulse pressure (PP). Central obesity within the elderly (≥65 yr) also showed a higher BP MD than within the younger group (daytime SBP MD 8.23 vs 3.87, daytime DBP 4.10 vs 1.59). In conclusion, central obesity has no influence on nocturnal dipping patterns. However, higher SBP and wider PP are associated with central obesity, which is accentuated in women.     

Phylogenetic analysis of classical swine fever virus (CSFV) field isolates from outbreaks in South and Central America

To date, there is little information concerning the epidemiological situation of classical swine fever (CSF) in the Americas. Besides summarizing the available data, genotyping of isolates from outbreaks in domestic pigs in several countries of South and Central America was performed. For this, a 190 base fragment of the E2 envelope glycoprotein gene was used. European strains and isolates, and historical isolates from the United States (US) were included for comparison. In contrast to the situation in most parts of Europe, where group 2 isolates predominate, it was found that all the isolates from the American continent analyzed belonged to group 1 and were further resolved into three subgroups. The Cuban isolates clustered in subgroup 1.2, whereas the isolates from Honduras and Guatemala clustered in subgroup 1.3. The remaining isolates from Argentina, Brazil, Colombia and Mexico generated four poorly resolved clusters in subgroup 1.1, together with the vaccine strains, with historical European and US isolates, and with a recent Russian isolate. While the vaccine strains and the historical European isolates formed a relatively distinct cluster, one of the US isolates clustered together with the Mexican, and another one with Colombian isolates. Historically, CSF (hog cholera) was observed almost simultaneously in the US and in Europe in the first half of the 19th century, and its origin remains a matter of discussion. Our results showed that the US isolates are closely related to isolates from South America, while appearance of isolates in Cuba on one hand and in Honduras and Guatemala on the other hand, seems to have been due to unrelated events. This allows to speculate that at least in the American continent, CSF virus may have appeared independently in several regions, and spreading may have been a secondary effect.     

Recent trends in childhood obesity and overweight in the transition countries of Eastern and Central Europe

Objective: Significant political changes—accompanied by economic changes and social restratification—occurred in Eastern and Central European countries in the 1990s. The main purposes of this study were to assess how prevalence of overweight and obese children changed in Hungary during this transitional period; and to compare the prevalence data of childhood overweight in Central and Eastern European countries, where a similar political and socioeconomic environment existed before the transition and similar changes occurred during the transitional period.

Subjects and methods: Representative samples from the first (1983–1986) and second (2003–2006) Hungarian growth studies were used to assess the prevalence of childhood overweight and obesity in Hungary. The most frequently used indicators of social welfare were used to estimate economic and health status as well as nutritional supply in the transition countries, while data on prevalence of childhood overweight in the studied countries were collected by a search of epidemiological surveys from the region.

Results and conclusion: Frequency of overweight and obese children in Hungary increased between the 1980s and the beginning of the 2000s. Prevalence of childhood overweight was very similar in those Central and Eastern European countries where economic, nutritional or health indicators of general welfare were at a similar level.     

The Global Spread of Severe Obesity in Toddlers,Children, and Adolescents: A Systematic Review and Meta-Analysis

IntroductionSevere obesity among children and adolescents has emerged as a public health concern in multiple places around the world.MethodsWe searched the Medline database for articles on severe obesity rates in children published between January 1960 and January 2020. For studies with available prevalence rates for an early and a more recent time period, the relative increase in prevalence was imputed.ResultsIn total, 874 publications were identified, of which 38 contained relevant epidemiological data. Rates of severe obesity varied significantly according to age, gender, geographic area, and the definition of severe obesity. The highest rates of class II and III obesity in the USA according to the Centers of Disease Control cut-off were 9.5% and 4.5%, respectively. Seventeen studies reported prevalence rates in at least two time periods. Data for 9,190,718 individuals showed a 1.71 (95% CI, 1.53–1.90) greater odds for severe obesity in 2006–2017 (N = 5,029,584) versus 1967–2007 (N = 4,161,134). In an analysis limited to studies from 1980s with a minimum follow-up of 20 years, a 9.16 (95% CI, 7.76–10.80) greater odds for severe obesity in recent versus earlier time was found. An analysis limited to studies from 2000, with a follow-up of 5–15 years, a 1.09 (95% CI, 0.99–1.20) greater odds was noted when comparing (2011–2017; N = 4,991,831) versus (2000–2011; N = 4,134,340).ConclusionSevere pediatric obesity is escalating with a marked increase from the 1980s and a slower rate from 2000.     

Predictors and persistence of foot problems in women aged 70 years and over: a prospective study

Objective

To examine the prevalence and correlates of foot problems in older women over a 6-year period.

Study design

Women aged 70–75 years who participated in the Australian Longitudinal Study on Women's Health completed a postal questionnaire incorporating questions relating to demographics, major medical conditions and health status in 1999 (n = 8059) and 2005 (n = 4745).

Main outcome measures

Self-reported foot problems at baseline and at 6 years follow-up, major medical conditions, body mass index (BMI).

Results

At baseline, 26% of the sample reported foot problems. At follow-up, 37% remained free of foot problems, 36% had developed a new foot problem, 13% experienced resolution of their foot problems and 14% experienced persistent foot problems. Increase in BMI was significantly associated with the development of new foot problems and the persistence of existing foot problems.

Conclusions

Foot problems are common in older women and are associated with increased BMI. Maintaining a healthy bodyweight may therefore play a role in the prevention of foot disorders in older women.     

Vigilance Performance and Autonomic Function in Narcolepsy: Effects of Central Stimulants

Twenty female narcoleptic patients treated with central stimulants (CS) were studied during vigilance tests and psychophysiological recordings of autonomic functions, after 3 days off CS, and during CS treatment. Results were compared with healthy female subjects. Narcoleptics were lower in Critical Flicker Fusion (CFF), but did not differ in choice reaction time or continuous vernier visual acuity. CS improved CFF in the narcoleptic group. Narcoleptics had lower skin conductance (SC) level, but did not differ from normals in SC spontaneous fluctuations or heart rate. CS did not affect SC level or heart rate in the narcoleptic group, but counteracted the decrease in SC spontaneous fluctuations normally seen over a monotonous experimental session. CS reduced lowfrequency tremor and increased high-frequency tremor in the narcoleptic group. Comparison with anxiety and psychosomatic patients was also performed. The results of the vigilance tests suggested a specific disturbance of time resolution of stimulus input in narcoleptics, not related to lowered arousal, but alleviated by CS. The psychophysiological findings suggested that narcoleptic patients have a lowered habitual arousal as well as a marked tendency to decreases in phasic arousal. Central stimulants appear to improve only the latter.     

Dilatation of Sinusoidal Capillary and Swelling of Sinusoidal Fenestration in Obesity: An Ultrastructural Study

Obesity, which is one of the causes of the lifestyle-related disease, is a hepatopathic exacerbation factor that causes a chronic hepatic disorder. In this study, we examined the pathological changes in the liver in mice with obesity induced by monosodium glutamate administration. Pathological analysis revealed the deposition of many lipid droplets in hepatocytes and sinusoidal dilatation in obese mice. Scanning electron microscopic analysis revealed the presence of sinusoidal dilatation, and the fenestrations of the sinusoid were significantly swollen in obese mice. These results suggest that a dysfunction of the sinusoidal endothelium occurs in chronic obesity.     

Interactive effects of adiposity and insulin resistance on the impaired lung function in asthmatic adults: cross-sectional analysis of NHANES data

Background: Obesity is considered a risk factor for both asthma and insulin resistance in adults. Insulin resistance (IR) also influences pulmonary function in the non-obese population.

Aim: To investigate the modifying effect of insulin resistance on the predictive role of anthropometric measures in the estimation of impaired lung function among asthmatic adults.

Subjects and methods: A cross-sectional study of 1276 adults extracted from the NHANES 2009–2012 database was performed. Adjusted multiple linear regression was conducted to analyse the contributory role of obesity and IR in predicting lung function among asthmatic adults.

Results: BMI, waist circumference (WC) and waist-to-height ratio (WHtR) showed significantly negative correlations with FVC (r=–0.24, –0.18, –0.39, respectively; p?<?0.001), FEV1(r=–0.24, –0.21, –0.40, respectively; p?<?0.001) and FEF 25–75% (r=–0.15, –0.18, –0.27, respectively; p?<?0.001). Even after adjustment for the covariates (age, gender, smoking history and standing height), BMI and HOMA-IR had significant relationships with FVC (β=??10.3; p?<?0.01 and β=??16.0; p?<?0.05) and FEV1 (β=??8.7; p?<?0.01 and β=??11.7; p?<?0.05). BMI could significantly predict the decreased FVC (β=??13.7; p?<?0.01) and FEV1 (β=??10.7; p?<?0.01) only in the insulin resistant asthmatics.

Conclusion: WHtR and IR predict impaired lung function in overweight/obese asthmatic adults independently. IR also modifies the association between excessive adiposity and respiratory function in asthmatic adults.