Body fat distribution, serum lipoproteins and blood pressure in middle-aged Finnish men and women

The association of body fat distribution as measured by the ratio of waist to hip girth (WHR) to age, to serum total cholesterol and HDL-cholesterol and to blood pressure was studied in a population-based sample of 2461 men and 2768 women aged 25 to 64 years not treated with cardiovascular drugs. In men, the relationships of age with WHR and age with body mass index (BMI) were similar, an increase levelling at the age of about 50 years. In women, BMI increased linearly, but WHR exponentially with age. In both sexes, age-adjusted WHR and BMI associated positively with non-HDL cholesterol, and with systolic and diastolic blood pressure, and inversely with HDL-cholesterol and the HDL/non-HDL cholesterol ratio. WHR and BMI were independently related to several cardiovascular risk factors. HDL-cholesterol concentration was 19% lower in men, and 17% lower in women who belonged to the upper tertile of both WHR and BMI, than in the subjects in the lower tertiles of WHR and BMI. Age-adjusted WHR and BMI also predicted fasting and 2-hour post-challenge blood glucose values in women aged 45 to 64 years, but not in men. The WHR provides additional information on elevated cardiovascular risk factors in cross-sectional analysis among middle-aged men and women independently of BMI. The measurement of WHR in large-scale risk factor surveys should be recommended, in order to assess the independent contribution of WHR to the risk of cardiovascular disease, and to find out the importance of WHR for the prevention of chronic diseases.     

A comparison of serum total cholesterol levels and their determinants between the Federal Republic of Germany and the United States

Mean serum total cholesterol levels appear to be higher in the Federal Republic of Germany (FRG) than in the United States (US) while coronary heart disease death rates are lower. The study examined possible factors for the difference including possible differences in laboratory methodology. Cross-sectional data from the first two waves of the German National Health Surveys (1984–1986 and 1987–1989; n = 9709) and from the Second National Health and Nutrition Examination Survey (1976–1980; n = 7832) were compared for men and women 25–69 years of age. The influence of age, body mass index, diet, cigarette smoking, education, income, use of oral contraceptives or antihypertensive agents, alcohol consumption and potential differences in laboratory measurement were explored using multiple regression techniques separately for men and women for ages 25–39, 40–59 and 60–69 years of age. Overall ages, unadjusted mean total cholesterol levels were higher in German than US men (6.02 vs. 5.64 mmol/l) and in German than US women (6.04 vs. 5.80 mmol/l) as were HDL cholesterol levels (men: 1.30 vs 1.14 mmol/l; women: 1.65 vs. 1.38 mmol/l). Adjusting for lifestyle factors explained, on the average, 40% of the differences in mean total cholesterol of which half or 20% was accounted for by adjusting for alcohol intake. Adjusting for possible laboratory differences explained, on the average, an additional 30% of the differences. Frequency of alcohol intake was the most important factor in explaining differences in mean HDL cholesterol levels. Adjustment for differences in alcohol intake had negligible effects on reducing the differences in mean non-HDL cholesterol.     

Effects of obesity and body fat distribution on lipids and lipoproteins in nondiabetic American Indians: The Strong Heart Study

OBJECTIVES: To examine the relationship between obesity and lipoprotein profiles and compare the effects of total obesity and central adiposity on lipids/lipoproteins in American Indians. RESEARCH METHODS AND PROCEDURES: Participants were 773 nondiabetic American Indian women and 739 men aged 45 to 74 years participating in the Strong Heart Study. Total obesity was estimated using body mass index (BMI). Central obesity was measured as waist circumference. Lipoprotein measures included triglycerides, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, apolipoprotein AI (apoAI), and apolipoprotein B (apoB). Partial and canonical correlation analyses were used to examine the associations between obesity and lipids/ lipoproteins. RESULTS: Women were more obese than men in Arizona (median BMI 32.1 vs. 29.2 kg/m2) and South Dakota and North Dakota (28.3 vs. 28.0 kg/m2), but there was no sex difference in waist circumference. Men had higher apoB and lower apoAI levels than did women. In women, when adjusted for center, gender, and age, BMI was significantly related to HDL cholesterol (r = -0.24, p < 0.001). There was a significant but weak relation with apoAI (r = -0.14, p < 0.001). Waist circumference was positively related to triglycerides (r = 0.14, p < 0.001) and negatively related to HDL cholesterol (r = -0.23, p < 0.001) and apoAI (r = -0.13, p < 0.001). In men, BMI was positively correlated with triglycerides (r = 0.30, p < 0.001) and negatively correlated with HDL cholesterol (r = -0.35, p < 0.001) and apoAI (r = -0.23, p < 0.001). Triglycerides increased with waist circumference (r = 0.30, p < 0.001) and HDL cholesterol decreased with waist circumference (r = -0.36, p < 0.001). In both women and men there was an inverted U-shaped relationship between obesity and waist with LDL cholesterol and apoB. In canonical correlation analysis, waist circumference received a greater weight (0.86) than did BMI (0.17) in women. However, the canonical weights were similar for waist (0.46) and BMI (0.56) in men. Only HDL cholesterol (-1.02) carried greater weight in women, whereas in men, triglycerides (0.50), and HDL cholesterol (-0.64) carried a large amount of weight. All the correlation coefficients between BMI, waist circumference, and the first canonical variable of lipids/lipoproteins or between the individual lipid/lipoprotein variables and the first canonical variable of obesity were smaller in women than in men. Triglycerides and HDL cholesterol showed clinically meaningful changes with BMI and waist circumference in men. All lipid/lipoprotein changes in women in relation to BMI and waist circumference were minimal. DISCUSSION: The main lipoprotein abnormality related to obesity in American Indians was decreased HDL cholesterol, especially in men. Central adiposity was more associated with abnormal lipid/lipoprotein profiles than general obesity in women; both were equally important in men.     

Life course body size and lipid levels at 53 years in a British birth cohort

OBJECTIVES: To investigate the association between growth in height and change in body mass index (BMI) during the life course on lipid levels at 53 years. METHODS: 2311 men and women from a British cohort study were included in analyses. Non-fasting total, high-density lipoprotein (HDL) and low-density lipoprotein (LDL) cholesterol levels were measured at 53 years. Height and BMI at 2, 4, 7, 11, 15 and 36 years in relation to the lipid outcomes at 53 years were assessed using multiple regression models. The effects of z scores of height and BMI at 2 years and yearly rates of change (velocities) in height and BMI between 2-7, 7-15 and 15-36 years were also considered. RESULTS: Total cholesterol level decreased by 0.119 mmol/l (95% CI -0.194 to -0.045) per SD increase in height at 2 years and by 0.073 mmol/l (95% CI -0.145 to -0.001) for every SD increase in height velocity between 15 years and adulthood. Similar, but weaker associations were seen for LDL cholesterol. The relationships between leg length and total and LDL cholesterol were stronger than the relationship with trunk length. Higher BMI at 36 and 53 years and greater BMI increases between 15-36 and 36-53 years were associated with higher total and LDL cholesterol and lower HDL cholesterol levels. The effects of growth could not be explained by birth weight or lifetime socioeconomic status. CONCLUSIONS: Early life exposures, which restrict height growth in infancy, resulting in shorter adult leg length, may influence lipid levels in adult life.     

An independent, inverse association of high-density-lipoprotein-cholesterol concentration with nonadipose body mass

BACKGROUND: Increasing body mass index (BMI) is associated with progressively lower serum HDL-cholesterol concentrations, although the underlying body-composition compartment accounting for this unfavorable lipid change remains uncertain. OBJECTIVE: Because growing evidence favors a role of lean tissue in HDL homeostasis, the hypothesis was tested that non-adipose tissue components of body mass explain the inverse association of HDL cholesterol and BMI. DESIGN: Fasting serum lipid concentrations and body composition [total, subcutaneous, and visceral adipose tissue; adipose tissue-free mass (ATFM); and skeletal muscle by whole-body magnetic resonance imaging and body cell mass by 40K counting) were evaluated in healthy adults. Body-composition compartments were expressed as height2-normalized indexes. RESULTS: An inverse correlation was observed between serum HDL cholesterol and BMI in women (n = 68; R2 = 0.08, P = 0.023) and men (n = 61; R2 = 0.07, P = 0.046). Significant inverse correlations (P = 0.005-0.02) were also observed between HDL cholesterol and nonadipose components (ie, ATFM, skeletal muscle, and body cell mass) but not between HDL cholesterol and any adipose tissue component. The association between HDL cholesterol and ATFM remained significant after serum triacylglycerol was controlled for. When BMI was entered into the HDL cholesterol-ATFM regression model, BMI was not a significant independent variable. The strongest correlate of serum triacylglycerol was visceral adipose tissue (P = 0.002 for both women and men). CONCLUSIONS: Lean tissues and body cell mass appear to account in part for the long-observed inverse association of HDL cholesterol and BMI. These observations suggest a link between nonadipose tissue compartments and the greater cardiovascular risk associated with high BMI.     

Optimal cut-offs of five anthropometric indices and their predictive ability of type 2 diabetes in a nationally representative Kenyan study

BackgroundType 2 diabetes (T2D) is one of the top non-communicable diseases in Kenya and prevention strategies are urgently needed. Intervening to reduce obesity is the most common prevention strategy. However, black populations develop T2D at lower obesity levels and it is unclear which anthropometric cut-offs could provide the best predictive ability for T2D risk. This study, therefore, aimed to determine the optimal anthropometric cut-offs and their predictive ability of T2D in Kenya.MethodsThe study included 2159 participants (59% women) aged 35–70 years from the Kenya STEPwise survey conducted in 2014. Five anthropometric indices were used—body mass index (BMI), waist circumference (WC), waist to hip ratio (WHR), waist to height ratio (WHtR) and waist divided by height^0.5(WHt.5R). Diabetes was defined as a fasting blood glucose of ≥7.0 mmol/l or a previous diagnosis by a health worker. Optimal anthropometric cut-offs and their receiver operating characteristics, such as the area under the curve (AUC), were computed.ResultsOverall, the optimal cut-off for BMI, WC, WHR, WHtR and WHt.5R were 24.8 kg.m⁻², 90 cm, 0.88, 0.54 and 6.9. On disaggregation by sex, the optimal cut-off for BMI, WC, WHR WHtR and WHt.5R was 27.1 kg.m⁻², 87 cm, 0.85, 0.55 and 6.9 in women, and 24.8 kg.m⁻², 91 cm, 0.88, 0.54 and 6.9 in men. Overall, WC (AUC 0.71 (95% confidence interval 0.65, 0.76)) WHtR (AUC 0.71 (0.66, 0.76)) and WHt.5R (AUC 0.70 (0.65,0.75)) had a better predictive ability for T2D than BMI (AUC 0.68 (0.62, 0.73)).ConclusionsWC, WHtR and WHt.5R were better predictors of T2D than BMI and should be used for risk stratification in Kenya. A WC cut-off of 87cm in women and 91cm in men, a WHtR cut-off of 0.54 or a WHt.5R of 6.9 in both men and women should be used to identify individuals at an elevated risk of T2D.     

体脂分布特征与血脂关系及其预测血脂异常的观察

目的 研究体脂分布特征与血脂关系及其预测血脂异常的价值.方法 采用整群抽样方法抽取北京市郊区居民有效样本784名,测量其身高、体重、腰围(WC)、臀围、身体成分与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)、三酰甘油(TG),并计算体重指数(BMI)与腰臀比(WHR).结果 年龄调整偏相关分析显示WC与HDL-C(r=-0.310)、LDL-C(r =0.204),WHR与TC (r=0.151)、TG (r=0.271)的相关性最好.BMI、WC、WHR、躯干脂肪质量(TFM)分组分析显示WC、WHR、TFM能敏感地反应人体血脂水平的变化;BMI、WC、WHR、TFM能敏感地反应低HDL、高TG及血脂异常的风险.ROC曲线分析显示WC、WHR、BMI、TFM预测血脂异常风险的ROC曲线皆在参考线上方,且男女受试者WHR (0.684、0.630)、WC (0.667、0.616)、TFM(0.661、0.604)的ROC曲线下面积有大于BMI (0.629、0.597)的趋势,但差异均无统计学意义(P＞0.05).结论 体脂分布特征指标如WHR、WC、TFM与BMI相比,在预测血脂异常风险中的应用价值更高;以Youden指数最大值为判定依据预测血脂异常风险,男性理想界值点BMI为24 kg/m2,WHR为0.91,WC为85 cm,TFM为7.5 kg;女性BMI为25 kg/m2,WHR为0.91,WC为87 cm,TFM为9.Skg.由于样本量较少,有待进一步扩大范围的研究.     

Use of anthropometric measurements in assessing risk for coronary heart disease: a useful tool in worksite health screening?

The study examined the association between the anthropometric measurements body mass index (BMI), waist/hip ratio (WHR), and waist/thigh ratio (WTR) and cardiovascular risk factors, and assessed whether a combination of BMI and WHR could be used in routine screening of risk for cardiovascular arteriosclerotic disease at worksites. The data were obtained from a cross-sectional survey designed to assess the nutritional situation, with special reference to cardiovascular risk factors. The study population comprised 372 healthy men working on platforms in the North Sea. Serum cholesterol, triglyceride, fibrinogen, and blood pressure were positively related to the anthropometric variables, while high-density lipoprotein (HDL) was inversely related with them. The relations remained after adjusting for possible confounders, such as age, smoking, physical activity, and an indicator of dietary fat intake. In stepwise multiple linear regression models, BMI, WHR, and WTR were positively related to serum cholesterol, triglycerides, fibrinogen, diastolic blood pressure, and systolic blood pressure, and inversely related to HDL. When controlling for the anthropometric variables WHR and WTR, BMI was not independently related to fibrinogen and risk score. WHR and WTR were not independently related to systolic and diastolic blood pressure, and WTR was in addition not related to triglycerides when controlling for BMI. Overall, the anthropometric variables BMI and WHR were considered the best predictors for CAD risk when taking several risk factors into consideration. A joint variable between BMI and WHR, called body score, constituted the four categories lean, lean android, overweight gynoid, and overweight ovoid. This body score was positively associated with levels of serum lipids, fibrinogen, and blood pressure, and inversely associated with HDL. In stepwise multiple linear regression models, controlling for possible confounding variables, body score was positively related to CAD risk. Dividing the risk score into tertiles, about 51% of the lean were in the first, while 46% of the overweight ovoid were in the third tertile. Those classified as lean android or overweight gynoid had about the same distribution, namely between 31% and 39% in each tertile if the two categories were combined. These data support the hypothesis that BMI, WHR, and WTR are independent predictors for risk factors for CAD among oil workers, and that combinations of BMI and WHR are strong enough predictors to be useful in routine screening for CAD risk at worksites. Based on these findings, supported by data from the literature, a matrix aimed at screening for follow-up at worksites is proposed.     

Serum total and high density lipoprotein cholesterol concentrations and body mass index in adult men from 13 countries

In 1980, serum total and high density lipoprotein (HDL) cholesterol concentrations and body mass index (weight/height2) were measured in groups of adult men from 13 countries. A standardized protocol was used for the drawing of blood and the preparation, storage, and transport of serum. Total and HDL cholesterol concentrations were determined in one laboratory to reduce methodological variability as much as possible. Mean serum total cholesterol concentrations were low in the groups from Africa (3.0-4.3 mmol/liter; 1 mmol/liter = 38.7 mg/100 ml), intermediate in the groups from Pakistan, the Philippines, Surinam, Hungary, Poland, and the Mediterranean countries (4.4-5.5 mmol/liter), and high in those from the Netherlands and Finland (5.6- 6.4 mmol/liter). Mean serum HDL cholesterol concentrations tended to be lower in the men from Africa, Asia, and Surinam (0.7-1.3 mmol/liter) than in those from Europe (1.1-1.5 mmol/liter), the highest values for both total and HDL cholesterol being found in the men from eastern Finland. The ratio of HDL cholesterol/total cholesterol varied from 0.15 to 0.32 and was on average slightly higher in the groups from Africa (0.26-0.32) than it was in the groups from Europe (0.20-0.28) and from Asia and Surinam (0.15-0.22). The body mass index was positively related to the concentration of total cholesterol and negatively related to the concentration of HDL cholesterol and the HDL cholesterol/total cholesterol ratio. The relationships between the concentration of HDL cholesterol and mortality from coronary heart disease within and between populations are discussed.     

Association of body fat distribution with plasma lipids, lipoproteins, apolipoproteins AI and B in postmenopausal women

Associations between the distribution of body fat, measured by the waist/hip circumference ratio (WHR), and plasma lipid fractions were examined in 84 postmenopausal women. WHR was correlated r = 0.39 with body mass index (BMI). After adjustment for BMI and other covariates, WHR was positively and significantly associated with concentrations of triglycerides, apolipoprotein B, low-density lipoprotein cholesterol, and the total cholesterol/high density lipoprotein cholesterol ratio. WHR was negatively and significantly associated with concentrations of high density lipoprotein cholesterol and apolipoprotein AI. These results indicate that in postmenopausal women abdominal fat preponderance is associated with an atherogenic plasma lipid profile, independent of its association with BMI.     

Increase in body fatness as a major determinant of changes in serum total cholesterol and high density lipoprotein cholesterol in young men over a 10-year period

Serum cholesterol rises with age in most Western (and Westernized) populations. To identify causes of this rise, the authors studied 315 young Dutch men in 1976 in the district of Utrecht, The Netherlands, when they were aged 18 or 19 years, and again in various towns in the same region 10 years later, in 1986. These men formed the lower and upper quartiles of the distribution of changes in body mass index (weight (kg)/height (m)2) from 1976 to 1986 in a larger cohort of men representative of all Dutch men aged 18 or 19 years in 1976. In 10 years, mean serum total cholesterol (+/- standard deviation) had increased by 1.20 +/- 0.88 mmol/liter (46 +/- 34 mg/100 ml), and high density lipoprotein (HDL) cholesterol had decreased by 0.12 +/- 0.21 mmol/liter (4.6 +/- 8.1 mg/100 ml). The mean increase in body mass index was 2.7 +/- 2.5 kg/m2, and the mean increase in body fat percentage (assessed from skinfolds) was 3.3 +/- 4.6 g/100 g. The mean subscapular:tricipital skinfold thickness ratio--an indicator of body fat distribution--had not changed. In multiple regression analysis, the change in body mass index was the only significant (p less than 0.001) determinant of changes in serum total cholesterol; an increase of 1 kg/m2 in body mass index was associated with an increase of 0.20 mmol/liter (standard error, 0.02) in serum total cholesterol. Changes in body mass index and in smoking habits both contributed significantly toward explanation of changes in HDL cholesterol and in the HDL cholesterol:total cholesterol ratio. If smoking habits were adjusted for, HDL cholesterol decreased by 0.02 mmol/liter and the HDL cholesterol:total cholesterol ratio decreased by 0.012 (standard error, 0.001) for every 1 kg/m2 increase in body mass index. Changes in body fat distribution, as assessed by skinfold ratio, were not associated with changes in lipids. By interpolation, the authors estimated that for the full cohort of men, including the second and third quartile of body mass index changes, the mean rise in cholesterol had been 1.15 mmol/liter (44 mg/100 ml), of which 0.47 mmol/liter could be explained by the estimated rise in body mass index of 2.4 kg/m2. An increase in body fatness between ages 19 and 29 years is a powerful determinant of the rise in total cholesterol and the fall in HDL cholesterol occurring over that period of time.     

Divergent associations of plasma choline and betaine with components of metabolic syndrome in middle age and elderly men and women

Choline is involved in the synthesis of phospholipids, including blood lipids, and is the immediate precursor of betaine, which serves as a methyl group donor in a reaction converting homocysteine to methionine. Several cardiovascular risk factors are associated with plasma homocysteine, whereas little is known about their relationship to choline and betaine. We examined the relation of plasma choline and betaine to smoking, physical activity, BMI, percent body fat, waist circumference, blood pressure, serum lipids, and glucose in a population-based study of 7074 men and women aged 47-49 and 71-74 y. Overall plasma concentrations (means +/- SD) were 9.9 +/- 2.3 micromol/L for choline and 39.5 +/- 12.5 micromol/L for betaine. Choline and betaine were lower in women than in men and in younger subjects compared with older (P < 0.0001). Multivariate analyses showed that choline was positively associated with serum triglycerides, glucose, BMI, percent body fat, waist circumference (P < 0.0001 for all), and physical activity (P < 0.05) and inversely related to HDL cholesterol (P < 0.05) and smoking (P < 0.0001). Betaine was inversely associated with serum non-HDL cholesterol, triglycerides, BMI, percent body fat, waist circumference, systolic and diastolic blood pressure (P < 0.0001 for all), and smoking (P < 0.05) and positively associated with HDL cholesterol (P < 0.01) and physical activity (P < 0.0001). Thus, an unfavorable cardiovascular risk factor profile was associated with high choline and low betaine concentrations. Choline and betaine were associated in opposite directions with key components of metabolic syndrome, suggesting a disruption of mitochondrial choline dehydrogenase pathway.     

Relationships between insulin sensitivity and measures of body fat in asymptomatic men and women

OBJECTIVE: To assess whether measures of body fat by DXA scanning can improve prediction of insulin sensitivity (S(I)) beyond what is possible with traditional measures, such as BMI, waist circumference, and waist-to-hip ratio (WHR). RESEARCH METHODS AND PROCEDURES: Frequently sampled intravenous glucose tolerance tests were performed in 256 asymptomatic non-Hispanic white subjects from Rochester, MN (age 19-60 years; 123 men and 133 women) to determine the S(I) index by Bergman's minimal model technique. Height, weight, and waist and hip circumferences were measured for calculation of BMI and WHR; DXA was used to determine fat in the head, upper body, abdomen, and lower body. Linear regression was used to assess their relationships with S(I) after sex stratification and adjustment for age. RESULTS: After controlling for age, increases in traditional and DXA measures of fat were consistently associated with smaller declines in S(I) among women than among men. In men, after controlling for age, all of the predictive information of S(I) was provided by waist circumference (additional R2 = 0.39, p < 0.001); none of the DXA measures improved the ability to predict S(I). In women, after adjustment for age, BMI, and WHR, the only DXA measure that improved the prediction of S(I) was percentage head fat (additional R2 = 0.03, p < 0.001). DISCUSSION: Equivalent increases in most measures of body fat had lesser impact on S(I) in women than in men. In both sexes, the predictive information provided by DXA measures is approximately equal to, but not additive to, that provided by simpler, traditional measures.     

Serum selenium and precursors of cardiovascular risk factors in adolescents

The aim of this study was to determine, in a population of Italian adolescents, the association of serum selenium levels with precursors of biochemical and anthropometric variables known as being among the major risk factors for cardiovascular diseases in the adult population. The following measurements were taken in a school sample of 627 adolescents (aged 12–13 years): serum selenium, total cholesterol, high density lipoprotein cholesterol, non-HDL cholesterol, height, weight, body mass index, systolic blood pressure and diastolic blood pressure.The serum selenium levels were slightly higher in males (83.1 ± 10.1 g/1) than in females (81.7 ±- 11.0 g/1), but the difference was not statistically significant. Serum selenium was positively correlated with total cholesterol, diastolic blood pressure and HDL cholesterol in both sexes; moreover it was positively correlated with non-HDL cholesterol and negatively correlated with height in males only.Corresponding author.     

Effect of 5-year community intervention Hartslag Limburg on cardiovascular risk factors

BACKGROUND: A widely advocated strategy in public health is community-based health promotion. The aim of this study was to investigate the net effect of a cardiovascular disease prevention program (Hartslag Limburg) on cardiovascular risk factors after 5 years of intervention. DESIGN: Cohort study comparing 5-year mean change in risk factors between the intervention and reference area. The statistical analyses for the study were performed in 2005. SETTING/PARTICIPANTS: In 1998, 3000 subjects (aged 25 to 70) from the intervention area and 895 subjects from a reference area participated in the baseline measurement. Of these, 2414 intervention subjects and 758 reference subjects completed the follow-up measurement in 2003. INTERVENTION: Hartslag Limburg is an integrative community-based cardiovascular disease prevention program promoting a healthy lifestyle. MAIN OUTCOME MEASURES: Body mass index (BMI), waist circumference, blood pressure, serum glucose (nonfasting), and serum total and high-density lipoprotein (HDL) cholesterol. RESULTS: During the 5-year follow-up, risk factors changed unfavorably in the reference group, whereas changes were less pronounced or absent in the intervention group. The adjusted difference in mean change in risk factors between intervention and reference group was significant (p<0.05) for BMI: -0.36 kg/m(2) in men and -0.25 kg/m(2) in women; waist circumference -2.9 cm in men and -2.1 cm in women; systolic blood pressure: -7.8 mmHg in men and -5.5 mmHg in women; total cholesterol 0.11 mmol/L in women and finally serum glucose -0.23 mmol/L in women. CONCLUSIONS: Hartslag Limburg succeeded in reducing-and in some cases, preventing-age- and time-related increase in BMI, waist circumference, blood pressure, and, in women, nonfasting glucose concentration.     

Monozygotic co-twin analyses of body composition measurements and serum lipids

OBJECTIVE: To evaluate BMI and direct measures of body fat (BF) and lean body mass (LBM) in relation to fasting serum lipid profiles in a large Chinese population based twin sample using a monozygotic (MZ) co-twin analysis. METHODS: Adiposity measures collected 1998-2000 on 987 MZ female 20-60 year old twin pairs (n=1974) included BMI, waist circumference (WC), waist/hip ratio (WHR), LBM, trunk fat (TF), %TF, total BF, and % total BF (measured by DEXA). Serum lipids included total cholesterol (TC), triglycerides (TG), LDL, and HDL. Co-twin analyses and conventional regression analyses were used to assess the association between individual adiposity and LBM measures, and serum lipids. RESULTS: In this lean population with a mean BMI 21.8 (2.8), we observed considerable variability in adiposity measures and serum lipids. A positive linear association between all adiposity measures with LDL, TC, and TG, and a negative linear association with HDL was observed. A 1-unit z-score increase of adiposity measures, reflecting fat distribution, was associated with increases in (mmol/L) TC (0.063 to 0.164), LDL (0.064 to 0.131), TG (0.049 to 0.164), and a decrease in HDL (0.021 to 0.038) while controlling for matched factors within twin pairs (i.e., age and unmeasured confounders). However, similar associations were not observed for LBM. CONCLUSION: It is the BF (not LBM) that appears to be associated with serum lipid profiles. This study underscores that in populations where BMI is highly correlated with BF, BMI can be used as a surrogate for BF in evaluating risk of dyslipidemia. Otherwise, direct measures of BF are needed.     

Women and Men with Hypercholesterolemia Respond Similarly to an American Heart Association Step 1 Diet

Objective To compare serum lipid level responses of women and men with hypercholesterolemia to an American Heart Association (AHA) step 1 diet.Design Sixty-three women and 99 men with varying degrees of hypercholesterolemia were instructed on an AHA step 1 diet. Subjects were followed up on a biweekly basis with individual visits and group classes for 8 weeks.Setting Outpatient clinic facility of the Metabolic Research Group, University of Kentucky, Lexington.Subjects/samples Through community cholesterol screenings, we recruited 76 women and 108 men aged 30 to 70 years who were within 80% to 130% of their ideal body weight. Serum cholesterol levels were between 5.17 mmol/L and 8.99 mmol/L and serum triglyceride levels when subjects were fasting were less than 5.08 mmol/L. Sixty-three women and 99 men completed the study.Intervention Subjects followed an AHA step 1 diet (30% of energy from fat, 50 to 60% of energy from carbohydrate, 10 to 20% of energy from protein, and less than 300 mg cholesterol per day) for 8 weeks.Main outcome measures Serum lipid levels, nutrient intake, and body weight.Statistical analyses performed Subjects were divided into three groups according to initial serum cholesterol levels (mild=5.17 to 6.17 mmol/L; MODERATE=6.20 to 6.95 mmol/L; SEVERE = 6.98 mmol/L). Within-individual changes in nutrient intakes, body weights, and serum lipid levels were analyzed using dependent t tests. Between-group comparisons were made using analysis of variance (ANOVA). When significant differences were found using ANOVA, differences between groups were evaluated with the Tukey test.Results All subjects tolerated the diet well and average dietary adherence was good, as assessed by a food frequency questionnaire and analysis of 3-day diet records. Serum total cholesterol levels decreased 9.2% overall for women (P<.001) and 7.2% for men (P<.001); serum low-density lipoprotein cholesterol levels decreased 9.2% for women and 9.8% for men; and serum high-density lipoprotein cholesterol levels decreased 3.6% for women and 2.8% for men. Mean serum triglyceride levels decreased significantly for women but not for men. No significant differences were found in the responses of women and men in the corresponding groups. Women and men with higher initial serum cholesterol values showed significantly greater hypocholesterolemic responses to diet than those with lower initial serum cholesterol values.Applications/conclusions The findings of this study confirm the beneficial role of dietary intervention for reducing atherogenic serum lipid levels in women and men. J Am Diet Assoc. 1995; 95:436–441.     

The Family Risk Score for coronary heart disease: associations with lipids, lipoproteins, and body habitus in a middle-aged bi-racial cohort: The ARIC study

PURPOSE: To examine the association between the Family Risk Score (FRS) for coronary heart disease (CHD) and body mass index (BMI), waist-to-hip ratio (WHR), high density lipoprotein (HDL) and low density lipoprotein (LDL) cholesterol, triglycerides, and lipoprotein(a) protein [Lp(a)]. METHODS: FRS was computed from observed and expected CHD events using family data collected from 11467 black and white adults of the Atherosclerosis Risk in Communities Study (ARIC). BMI, WHR, and lipids adjusted for study center, race, education, BMI (except BMI), WHR (except for BMI and WHR), cigarette smoking, alcohol, and Keys' score were compared among low (FRS < -0.5), average (-0.5 to 0.5), and high (> 0.5) FRS using analysis of covariance. The association between FRS and these risk factors was compared to that for simpler estimates of family risk. RESULTS: Adjusted means of BMI, WHR, LDL, LP(a), and triglycerides were positively associated with FRS, whereas HDL cholesterol was inversely associated with FRS. Of demographic and behavioral factors, cigarette smoking was most strongly associated with FRS. Based on additional comparisons of adjusted means, high vs. low levels of FRS appear to correlate better with CHD risk factors than do the simpler family history assessments. CONCLUSIONS: In situations were genetic or clinical information is not available, FRS may be a favorable measure of familial burden for CHD.     

Inflammatory Markers and Hepcidin are Elevated but Serum Iron is Lower in Obese Women of Reproductive Age

Limited evidence suggests that serum iron and hepcidin concentrations are dysregulated in obesity and inflammation. The objective of the present study was to compare C-reactive protein, interleukin-6, circulating levels of hepcidin, serum lipids, and iron status in obese vs. normal-weight women of childbearing age. Healthy women aged 18–30 years were recruited for the study (n = 47: 25 obese and 22 normal weight). Fasting blood samples were obtained to measure serum lipids (total cholesterol, HDL, LDL cholesterol, triglycerides, non-HDL cholesterol), complete blood count, serum iron, total iron-binding capacity, transferrin saturation, serum ferritin, hepcidin, C-reactive protein, and interleukin-6. Obese women had significantly higher mean serum C-reactive protein (p < 0.001), interleukin-6 (p < 0.001), hepcidin (p = 0.024), triglycerides (p < 0.001) and total cholesterol/HDL ratio (p < 0.001) but lower HDL (p = 0.001) and serum iron/hepcidin ratio (p = 0.011) compared with normal-weight women. BMI correlated positively with inflammatory markers, triglycerides, LDL and total cholesterol/HDL ratio, and negatively with HDL and serum iron/hepcidin ratio. Serum iron correlated negatively with ferritin in the obese group (p = 0.030) but positively in normal weight women (p = 0.002). BMI and ferritin were the only predictors of serum iron/hepcidin ratio accounting for 23% of the variation among subjects. Studies are needed to examine anti-inflammatory dietary approaches that can improve iron biomarkers in obese women.     

A screening procedure detecting high-yield candidates for OGTT. The Women's Health in the Lund Area (WHILA) study: a population based study of middle-aged Swedish women

The objective was to evaluate a screening procedure for detecting high-yield candidates for an OGTT, in a population of middle-aged Swedish women. A two-step screening procedure was performed in 6917 subjects. Women with a positive screening outcome, i.e. increased non-fasting capillary blood glucose, serum triglycerides, BMI, WHR, blood pressure or a family history of diabetes, pharmacological treatment of hypertension or hyperlipidaemia at the primary screening underwent a 75-g OGTT. A control group of women with negative screening outcome (n = 221) also underwent an OGTT. In 2923 women with positive screening outcome, 517 (17.7%) had NFG/IGT (normal fasting venous blood glucose <5.6 mmol/l and 2h-glucose 6.7–9.9 mmol/l), 109 (3.7%) IFG/IGT (fasting 5.6–6.0 and 2h 6.7–9.9 mmol/l) and 223 (7.6%) diabetes (fasting 6.1 or 2h 10.0 mmol/l). These figures were three, five and four times higher, respectively, than in the control group with negative screening outcome (p < 0.001 for all); no differences were found for IFG/NGT (fasting 5.6–6.0 and normal 2h < 6.7 mmol/l) (4.6% vs. 7.2%). For predicting impaired glucose metabolism (IFG/NGT, NFG/IGT, IFG/IGT, diabetes), the screening instrument showed an estimated sensitivity of 70%, specificity of 55%, positive predictive value of 34% and negative predictive value of 85%, based on findings in the control sample. The odds ratio for NFG/IGT increased with the numbers of risk factors from 2.8 to 7.7, for IFG/IGT from 5.7 to 55.0 and for diabetes from 2.5 to 18.1. High B-glucose, WHR and BMI were the three most important factors associated with an increased risk for NFG/IGT, IFG/IGT and diabetes. In subjects with IFG/NGT, none of the screening variables was associated with an increased risk. In summary, the results show a population screening method focused on features of the metabolic syndrome that discloses high-yield candidates for OGTT. A high prevalence of unknown impaired glucose metabolism was found in middle-aged women with a positive screening profile.