Neck circumference as a potential marker of metabolic syndrome among college students

OBJECTIVE:

to relate neck circumference with metabolic syndrome and its criteria among college students.

METHOD:

cross-sectional study conducted with 702 college students in Fortaleza, CE, Brazil from September 2010 to June 2011. Socio-demographic data, waist circumference and neck circumference were collected together with blood pressure, fasting blood sugar, triglyceride levels, and HDL-C.

RESULTS:

1.7% of the studied sample presented metabolic syndrome. Of these, 58.3% presented altered neck circumference (p<0.006). As neck circumference decreases, pressure levels improve (p<0.001). Additionally, college students with high fasting blood sugar (p=0.003) and high triglyceride levels (p<0.001) presented higher values of neck circumference.

CONCLUSION:

neck circumference is a potential predictive marker in the detection of metabolic syndrome and its components among college students.     

Risk factors for noncommunicable chronic diseases in women in China: surveillance efforts

Objective

To investigate risk factors for chronic noncommunicable diseases (NCDs) and their determinants in Chinese women.

Methods

Data from the 2010 China Chronic Disease and Risk Factor Surveillance survey, comprising a nationally representative sample of women, were obtained to determine the prevalence of eight risk factors for chronic NCDs: current smoking, harmful use of alcohol, insufficient intake of fruit and vegetables, physical inactivity, overweight and obesity, raised blood pressure, raised fasting blood glucose and raised total serum cholesterol. The mean number of risk factors per woman was estimated. Their independent demographic and socioeconomic covariates were also examined with ordinal logistic regression.

Findings

The following prevalences were found: insufficient intake of fruit and vegetables, 51.7%; overweight and obesity, 32.3%; raised blood pressure, 29.7%; physical inactivity, 18.3%; raised total serum cholesterol, 18.1%; raised blood glucose, 7.0%; current smoking, 2.4%; and harmful use of alcohol, 1.3%. The mean number of risk factors per woman was 1.61; 48.0% of the women had at least two risk factors. Women who were older, poorer, from rural areas or from eastern or central China had more risk factors, but only being more than 35 years old, poorly educated and a resident of eastern or central China independently increased the likelihood of having multiple risk factors.

Conclusion

Risk factors for chronic NCDs are common among Chinese women aged 18 or older. Interventions to reduce these factors are needed and should target women who are older, who live in eastern or central China or who are poorly educated.     

Prevalence of Risk Factors for Cardiovascular Disease and Their Associations with Diet and Physical Activity in Suburban Beijing,China

Background

We calculated new prevalences of risk factors for cardiovascular disease (CVD) and examined their associations with dietary habits and physical activity in a suburban area of Beijing—one of the most urbanized cities in China.

Methods

In 2007, a cross-sectional survey of a representative sample of 19 003 suburban residents aged 18 to 76 years was conducted. Dietary and anthropometric data were collected by questionnaire, and blood pressure, fasting blood glucose, and serum lipids were measured.

Results

The age-standardized prevalences of the CVD risk factors overweight/obesity, diabetes, hypertension, dyslipidemia, and metabolic syndrome (MS) were 31.9%, 6.1%, 33.6%, 30.3%, and 11.6%, respectively. The adjusted odd ratios (95% confidence interval [CI]) of overweight/obesity, diabetes, hypertension, dyslipidemia, and MS for participants who were physically active, as compared with those who were not physically active, were 0.67 (0.47 to 0.85), 0.87 (0.80 to 0.95), 0.92 (0.87 to 0.98), 0.89 (0.82 to 0.96), and 0.74 (0.62 to 0.89), respectively. The adjusted odds ratios (95% CI) of hypertension and MS for participants with a high intake of salt, as compared with those without a high intake of salt, were 1.72 (1.29 to 2.03) and 1.48 (1.16 to 1.77), respectively. In addition, participants who consumed a high-fat diet were more likely to be overweight/obese and dyslipidemic, whereas vegetarians had less risk of overweight/obesity, diabetes, hypertension, dyslipidemia, and MS.

Conclusions

In this population of adults living in suburban Beijing, there were relatively high prevalences of the CVD risk factors overweight/obesity, diabetes, hypertension, dyslipidemia, and MS. Healthy dietary habits and physical activity may reduce the risks of these conditions.Key words: cardiovascular disease, risk factors, associations, dietary habits, physical activity     

Peer Reviewed: Effect of Socioeconomic Status on Weight Change Patterns in Adolescents

Introduction

Although socioeconomic differences in prevalence of obesity are well documented, whether patterns of weight gain during key periods of growth and development differ among youth from different socioeconomic backgrounds is unknown. This study examines socioeconomic disparities in overweight status and 5-year weight gain among adolescents.

Methods

Project EAT (Eating Among Teens)-II followed a socioeconomically and ethnically diverse sample of 2,516 adolescents from 1999 through 2004. Mixed-model regression analyses examined longitudinal trends in overweight status as a function of socioeconomic status (SES).

Results

Girls and boys in the low-SES category were more likely to be overweight than were those in the high-SES category. Boys in the high-SES category showed a significant decrease (P = .006) in overweight prevalence between 1999 and 2004, whereas boys in the low- and middle-SES categories showed no significant change. Girls in the low-SES category showed a significant 5-year increase (P = .004) in overweight prevalence compared with a stable prevalence of overweight among girls in the middle- and high-SES categories.

Conclusion

Our data show continued and, in some cases, increasing socioeconomic disparities in risk for overweight. Youth from low-SES backgrounds are at increased risk for overweight and are more likely to remain overweight (boys) or become overweight (girls). Designing obesity prevention and treatment interventions that reach and address the unique needs of youth and families from less-advantaged socioeconomic backgrounds is a public health priority.     

Profile of Non-communicable Disease Risk Factors Among Young People in Palau

Background

Although non-communicable diseases (NCDs) have become the predominant health problems of Palauan society, there have been no comprehensive data on NCD risk factors available to develop effective control strategies. Therefore, the first Palauan national STEPwise approach to risk factor Surveillance (STEPS) was completed in mid-2013 to provide information on its adult population aged 25 to 64 years. This study aims to obtain corresponding data from the younger adults aged 18 to 24 years, who remained to be surveyed.

Methods

We conducted an epidemiological study, targeting the 18- to 24-year-old age group. A survey station and a mobile team were established to recruit voluntary participants dwelling in Koror. A slightly modified WHO STEPS instrument was used, including a structured questionnaire for behavioral risk factors, physical measurements, and blood tests.

Results

A total of 356 young people were recruited during the survey. In both sexes, nearly half of the participants were overweight/obese. The prevalence of hypertension was higher in men than in women (17.6% vs 1.7%). Raised blood glucose and impaired fasting glucose were observed in 3.5% and 5.2% of the total participants, respectively. About 36% of the subjects were observed to have raised levels of total cholesterol. More than 70% of the young people were current tobacco users, in terms of all kinds of tobacco products.

Conclusions

The current survey, for the first time, revealed a high prevalence of NCD risk factors, especially overweight/obesity and tobacco use, among young people in Palau. This indicates that swift measures against NCDs are required even in this young age group.Key words: non-communicable disease, WHO STEPS, obesity, tobacco use, Pacific islanders     

Use of Body Mass Index and Percentage Overweight Cutoffs to Screen Japanese Children and Adolescents for Obesity-Related Risk Factors

Background

Cutoffs based on percentage overweight (POW) are used for screening students in Japan; however, body mass index (BMI) is more common in the rest of the world. To screen for risk factors related to obesity among Japanese primary and secondary school students, we compared fasting and postprandial values, and the receiver operating characteristic (ROC) curves for the POW and BMI criteria.

Methods

The subjects were students aged 10 and 13 years living in Shunan City, Japan between 2006 and 2008 (n = 6566). POW and International Obesity Taskforce (IOTF) BMI criteria were used to screen for obesity-related risk factors. The lower (20%, 18-year-old equivalent: 25 kg/m²) and higher (50%, 18-year-old equivalent: 30 kg/m²) cutoffs were examined, and ROC curves were drawn.

Results

Fasting cholesterol levels were higher than postprandial levels. The prevalences of overweight/obesity were 6.6% to 10.0% using the lower cutoff and 0.6% to 5.0% using the higher cutoff. Among overweight subjects under fasting conditions, dyslipidemia was present in 12% to 52%, hypertriglyceridemia in 29% to 54%, hyperglycemia in 11% to 21%, and hypertension in 15% to 40%. Although the use of the lower and higher POW cutoffs resulted in lower sensitivity and the higher specificity, the POW and BMI ROC curves largely overlapped. However, for girls aged 10 years, the POW curve for ≥3 risks factors was lower than that of the latter (P = 0.013).

Conclusions

For Japanese aged 10 and 13 years, both BMI and POW are useful for risk factor screening. However, subjects may be misclassified with dyscholesterolemia if postprandial blood samples are used.Key words: body mass index, Japanese, risk factors, percentage overweight, ROC curve     

A Tale of Two Countries—the United States and Japan: Are Differences in Health Due to Differences in Overweight?

Background

Despite similar standards of living and health care systems for older persons, there are marked differences in the relative health of the elderly populations in the United States (US) and Japan. We explore the association of overweight and obesity with these health disparities.

Methods

Data on older adults from the US National Health Interview Survey (1994) and the Longitudinal Study of Aging II (1994) were compared to similar data from the 1999-2001 Nihon University Japanese Longitudinal Study of Aging. Regression analyses for the 2 countries were conducted to examine the correlates of being overweight and obese, and the relationships of overweight and obesity with activities of daily living functioning, heart disease, arthritis, and diabetes.

Results

The prevalence of overweight and obesity is higher in the US than in Japan, as is the prevalence of heart disease, diabetes, arthritis, and functioning problems. Education level and marital status are predictors of overweight for older Americans but not for older Japanese people. Health behaviors affect weight in all groups. The prevalence of functioning problems and disease are more likely to be associated with being overweight in US men and women than in Japanese women, and are not associated with being overweight in Japanese men.

Conclusion

Despite similar standards of living and health care systems for older persons, the conditions associated with poor health differ in the US and Japan. Being overweight or obese appears to be related to more functioning problems and arthritis in the US than in Japan.Key words: cross-national studies, obesity, disease, chronic conditions     

Dynapenic Obesity and Prevalence of Type 2 Diabetes in Middle-Aged Japanese Men

Background

The independent and combined associations of muscle strength and obesity on the prevalence of type 2 diabetes in Japanese men remain unclear.

Methods

Hand grip strength was cross-sectionally evaluated between 2011 and 2013 to assess muscle strength in 5039 male workers aged 40 to 64 years. Weight and height were measured, and overweight/obesity was defined as a body mass index ≥25 kg/m². The prevalence of type 2 diabetes, defined as fasting plasma glucose ≥126 mg/dL and/or hemoglobin A1c ≥6.5% and/or self-reported physician-diagnosed diabetes, was evaluated. Odds ratios (OR) and 95% confidence intervals (95% CI) for the prevalence of type 2 diabetes were obtained using a logistic regression model.

Results

In total, 611 participants had type 2 diabetes, and 1763 participants were overweight/obese. After adjustment for covariates, we found an inverse association between muscle strength and the prevalence of type 2 diabetes (P for trend <0.01). In addition, when the analyses were stratified by obesity status, the multivariable-adjusted OR per 2-standard-deviation increase in muscle strength was 0.64 (95% CI, 0.49–0.83) in the overweight/obese group, compared to a weaker relationship in the normal-weight group (OR 0.79 per 2-standard-deviation increase; 95% CI, 0.60–1.06).

Conclusions

Dynapenia, an age-related decrease in muscle strength, is associated with increased prevalence of type 2 diabetes, and this relationship is stronger in overweight/obese middle-aged Japanese men than in normal-weight men.Key words: muscle strength, hand strength, body mass index, hyperglycemia, dynapenia     

Peer Reviewed: Cardiovascular Risk According to Plasma Apolipoprotein and Lipid Profiles in a Canadian First Nation

Introduction

Despite high diabetes rates among Canadian First Nations people, little is known about their cardiovascular disease risk. Our aim was to describe the apolipoprotein profile with respect to cardiovascular risk in a Canadian First Nation community.

Methods

In 2003, a representative sample of adult members of a Manitoba First Nation (N = 483) participated in a screening study for diabetes and diabetes complications. We assessed their cardiovascular risk factors.

Results

Sixty percent of women were at increased cardiovascular risk because of low apolipoprotein A1 (apoA1) levels, compared with 35% of men. The proportion of women with low apoA1 levels decreased with age, but the proportion with low high-density lipoprotein levels remained stable across age groups. Both apoB and apoA1 were significantly associated with obesity when age, sex, diastolic blood pressure, homocysteine, diabetes, and insulin resistance were controlled for.

Conclusion

Apolipoprotein and lipid profiles in this First Nation population suggest high cardiovascular risk. Future research should characterize the lipoprotein particle size in this population.     

Cardiovascular risk profile of mothers of a Portuguese birth cohort: A survey 4 years after delivery

Objectives

The aim of this study is to estimate the prevalence of smoking, low fruit and vegetable intake, sedentariness, overweight/obesity, abdominal obesity, hypertension, dyslipidemia and diabetes mellitus in mothers of a Portuguese birth cohort, 4 years after delivery.

Methods

A birth cohort was assembled at public maternities of Porto (2005–2006). Children and mothers were reevaluated 4 years later. In this analysis, 5435 women were included. Socioeconomic characteristics, smoking, diet and exercise were self-reported. Anthropometrics and blood pressure were measured. A subgroup of 2483 randomly selected women provided a fasting venous blood sample for lipid and glucose measurements.

Results

Overall, 25.3% women smoked, 71.5% consumed < 5 portions of fruit and vegetables per day, 81.3% were sedentary, 31.4% were overweight, 21.3% obese and 31.8% had abdominal obesity. The prevalence of hypertension, dyslipidemia and diabetes mellitus was 8.7%, 18.5% and 0.9%, respectively. At least one risk factor from each of the 3 groups (adverse lifestyles, adiposity and cardiometabolic comorbidities) was observed in 17.4% of women. Except for smoking, all risk factors were associated with unemployment, lower education and lower income.

Conclusions

The high prevalence of unfavorable lifestyles and adiposity, and the aggregation of risk factors emphasize the adverse cardiovascular risk profile at a young age.     

Association between food assistance program participation and overweight

OBJECTIVE

The objective of this study was to investigate the association between food assistance program participation and overweight/obesity according to poverty level.

METHODS

A cross-sectional analysis of data from 46,217 non-pregnant and non-lactating women in Lima, Peru was conducted; these data were obtained from nationally representative surveys from the years 2003, 2004, 2006, and 2008-2010. The dependent variable was overweight/obesity, and the independent variable was food assistance program participation. Poisson regression was used to stratify the data by family socioeconomic level, area of residence (Lima versus the rest of the country; urban versus rural), and survey year (2003-2006 versus 2008-2010). The models were adjusted for age, education level, urbanization, and survey year.

RESULTS

Food assistance program participation was associated with an increased risk of overweight/obesity in women living in homes without poverty indicators [prevalence ratio (PR) = 1.29; 95% confidence interval (CI) 1.06;1.57]. When stratified by area of residence, similar associations were observed for women living in Lima and urban areas; no associations were found between food assistance program participation and overweight/obesity among women living outside of Lima or in rural areas, regardless of the poverty status.

CONCLUSIONS

Food assistance program participation was associated with overweight/obesity in non-poor women. Additional studies are required in countries facing both aspects of malnutrition.     

Weight gain and risk of impaired fasting glucose after smoking cessation

Background

Observation of early changes in fasting plasma glucose level induced by post-smoking cessation weight gain is useful in predicting the risks of diabetes mellitus (DM) and impaired fasting glucose (IFG). We investigated the effect of post-smoking cessation weight gain on early changes in the risk of a high fasting plasma glucose (IFG) level (≥100 mg/dL).

Methods

In 946 subjects who underwent repeated health examinations after smoking cessation, changes in body mass index (BMI) and the odds ratio (OR) for IFG risk (adjusted for sex, age, BMI, fasting plasma glucose at year 1, and alcohol consumption) were calculated every year for 3 years after smoking cessation.

Results

After smoking cessation, the rate of BMI increase significantly increased in quitters: 2.36% at year 2 (never smokers: 0.22%, current smokers: 0.39%) and 0.46% at year 3 (never smokers: 0.14%, current smokers: 0.32%). However, it decreased by 0.15% at year 4 (never smokers: 0.12%, current smokers: 0.26%). The ORs for quitters did not significantly increase at any time during the follow-up period. However, among quitters who had smoked at least 20 cigarettes per day, it was significantly higher (OR 1.51, 95% confidence interval 1.1–2.01 at year 1 and 1.71, 1.23–2.38 at year 2).

Conclusions

The time course of the risk of IFG after smoking cessation was similar to that for the rate of BMI increase. In contrast to the findings of previous reports, the increase in IFG risk after smoking cessation was brief and disappeared in the absence of a significant increase in BMI.Key words: smoking cessation, fasting, glucose tolerance, weight gain     

Prevalence and factors associated with sedentary behavior in adolescents

OBJECTIVE

To analyze the prevalence of sedentary behavior and associated factors in adolescents.

METHODS

A cross-sectional study with adolescents aged 10 to 17 years, of both sexes, belonging to a 1994-1999 birth cohort in the city of Cuiabá, MT, Central Western Brazil. Data were collected using a questionnaire containing sociodemographic, economic, lifestyle and anthropometric variables. Sedentary behavior was determined as using television and/or computer/video games for a time greater than or equal to 4 hours/day. Associations with sedentary behavior were evaluated using body mass index in childhood and adolescence and sociodemographic and behavioral variables using hierarchical logistic regression.

RESULTS

The overall prevalence of sedentary behavior was 58.1%. Of the 1,716 adolescents evaluated, 50.7% (n = 870) were male. In multivariate analysis, after adjustment for confounding factors, the variables that remained associated with sedentary behavior were: age (14 and over) (OR = 3.51, 95%CI 2.19;5.60); higher socioeconomic class (OR = 3.83, 95%CI 2.10;7.01), higher level of maternal education (OR = 1.81, 95%CI 1.09;3.01); living in the country (OR = 0.49, 95%CI 0.30;0.81); insufficient physical activity (OR = 1.25, 95%CI 1.02;1.53); experimentation with alcoholic beverages (OR = 1.34, 95%CI 1.08;1.66) and being overweight in adolescence (OR = 1.33, 95%CI 1.06;1.68).

CONCLUSIONS

The high proportion of adolescents in sedentary activities and the lack of association with being overweight in childhood, indicates the need for educational initiatives to reduce multiple risk behaviors. Encouraging physical activity in young people as a way of reducing sedentary behavior and, consequently, being overweight is fundamental.     

Association between overweight and characteristics of young adult students: support for nursing care

OBJECTIVE:

to verify associations between overweight and the characteristics of young adult students to support nursing care.

METHOD:

case-control study conducted with young adults from public schools. The sample was composed of 441 participants (147 cases and 294 controls, with and without excess weight, respectively). Sociodemographic and clinical characteristics were collected together with exposure factors and anthropometrics. Multiple logistic regression was used. The study received Institutional Review Board approval.

RESULTS:

statistically significant association with overweight: non-Caucasian, having a partner; weight gain during adolescence, mother''s excess weight, the use of obesogenic medication, augmented diastolic blood pressure, of abdominal circumference and waist/hip ratio. In addition to these, schooling and weight gain during childhood were also included in the multivariate analysis. After adjustment, the final model included: having a partner, weight gain during adolescence, augmented diastolic blood pressure and abdominal circumference.

CONCLUSION:

the analysis of predictor variables for excess weight among young adult students supports nurses in planning and developing educational practices aimed to prevent this clinical condition, which is a risk factor for other chronic comorbidities, such as cardiovascular diseases.     

Risk Factors for Community-associated Methicillin-resistant Staphylococcus Aureus Cellulitis - and the Value of Recognition

Objectives

To identify the risk factors for community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) cellulitis.

Methods

A review of risk factors for CA-MRSA skin and soft tissue infection in previously published literature was first performed. A retrospective cohort study was then conducted in a teaching ambulatory-care clinic of a tertiary medical center in Honolulu, Hawai‘i.

Results

Of 137 cases with cellulitis diagnosed from January 2005 to December 2007, MRSA was recovered from 85 (62%) of patients who presented with either abscesses or skin ulcers. The recovery of MRSA was significantly associated with obesity (p=0.01), presence of abscesses (p=0.01), and lesions involving the head and neck (p=0.04). Independent risk factors by multivariate logistic regression analysis included the presence of abscesses [adjusted odds ratio (aOR) 2.72; 95% confidence interval (CI) 1.27–5.83; p=0.01] and obesity (aOR 2.33; 95% CI 1.10–4.97; p =0.03). Patients with CA-MRSA were less likely to receive an appropriate antibiotic (p=0.04) and were more likely to require antibiotic change at evaluation in one week (p=0.04) compared with patients infected with non-MRSA bacteria.

Conclusions

The presence of abscesses and obesity were signifi cantly associated with CA-MRSA cellulitis. Empiric therapy with antibiotics active against MRSA should be guided by these risk factors.