Physical activity and changes in weight and waist circumference in midlife women: findings from the Study of Women's Health Across the Nation

Controversy exists regarding the extent to which age, menopausal status, and/or lifestyle behaviors account for the increased weight, fat mass, and central adiposity experienced by midlife women. To address this question, the authors longitudinally examined the relations of aging, menopausal status, and physical activity to weight and waist circumference in 3,064 racially/ethnically diverse women aged 42-52 years at baseline who were participating in the Study of Women's Health Across the Nation (SWAN), an observational study of the menopausal transition. Over 3 years of follow-up (1996-1997 to 1999-2000), mean weight increased by 2.1 kg (standard deviation (SD), 4.8) or 3.0% (SD, 6.5) and mean waist circumference increased by 2.2 cm (SD, 5.4) or 2.8% (SD, 6.3). Change in menopausal status was not associated with weight gain or significantly associated with increases in waist circumference. A one-unit increase in reported level of sports/exercise (on a scale of 1-5) was longitudinally related to decreases of 0.32 kg in weight (p < 0.0001) and 0.10 cm in waist circumference (not significant). Similar inverse relations were observed for daily routine physical activity (biking and walking for transportation and less television viewing). These findings suggest that, although midlife women tend to experience increases in weight and waist circumference over time, maintaining or increasing participation in regular physical activity contributes to prevention or attenuation of those gains.     

Five-year exposure to PM2.5 and ozone and subclinical atherosclerosis in late midlife women: The Study of Women's Health Across the Nation

Introduction

Effects of more than one-year exposure to air pollution on atherosclerosis is seldom studied. This paper aims to examine the association between five-year exposure to particulate matter ≤2.5?μm (PM_2.5), ozone (O₃) and atherosclerosis observed about seven years later in late midlife women.

Racial/ethnic differences in the prevalence of depressive symptoms among middle-aged women: The Study of Women's Health Across the Nation (SWAN)

OBJECTIVES: We examined racial/ethnic differences in significant depressive symptoms among middle-aged women before and after adjustment for socioeconomic, health-related, and psychosocial characteristics. METHODS: Racial/ethnic differences in unadjusted and adjusted prevalence of significant depressive symptoms (score >/= 16 on the Center for Epidemiologic Studies Depression [CES-D] Scale) were assessed with univariate and multiple logistic regressions. RESULTS: Twenty-four percent of the sample had a CES-D score of 16 or higher. Unadjusted prevalence varied by race/ethnicity (P <.0001). After adjustment for covariates, racial/ethnic differences overall were no longer significant. CONCLUSIONS: Hispanic and African American women had the highest odds, and Chinese and Japanese women had the lowest odds, for a CES-D score of 16 or higher. This variation is in part because of health-related and psychosocial factors that are linked to socioeconomic status.     

腰围动态变化与高血压发病关系的前瞻陛研究

目的 探讨腰围(WC)在随访过程中的动态变化对队列人群高血压发病率的影响.方法 采用前瞻性研究方法,以江苏省多代谢异常和代谢综合征综合防治研究队列满足2次随访的人群为研究对象.第一次随访时WC与基线WC之间的差值来衡量WC的动态变化量,并按照基线和第一次随访是否为腹型肥胖分为控制组和非控制组;以第二次随访是否为高血压作为结局变量(高血压=1,正常血压=0).运用Cox比例风险模型分析WC的变化量以及WC控制与否与随访新发高血压关系.结果 2778名研究对象中,660例为新发高血压患者.不论基线WC正常与否,WC水平在后两组的人群随访中发生高血压的RR值均高于第一组人群.基线WC正常组和腹型肥胖组中,非控制组的高血压累积发病率均高于控制组(基线WC正常组:35.0％vs.18.4％;基线腹型肥胖组:34.7％vs..21.4％).在基线腹型肥胖组中,其随访时仍为腹型肥胖的人群相比WC转为正常的人群发生高血压的RR值(95％CI)为1.95(1.19 ～ 3.19);基线WC正常组中,随访时转为腹型肥胖人群相比WC仍保持正常的人群发生高血压的RR值(95％CI)为2.38(1.89～2.99).调整基线性别、年龄和高血压一般危险因素后,基线腹型肥胖和WC正常组中,非控制组人群相比于控制组人群发生高血压的RR值(95％CI)分别为4.36( 1.69～9.74)和1.44( 1.03～2.35).结论 WC动态变化与高血压发病密切相关,控制WC的增长或降低WC是高血压早期预防的有效措施之一.     

Urinary metals and metal mixtures in midlife women: The Study of Women's Health Across the Nation (SWAN)

BackgroundLittle is known about the extent of exposure to metals and metal mixtures among midlife women.ObjectivesWe assessed exposure to multiple metals in the Study of Women's Health Across the Nation (SWAN), a multi-site, multi-racial/ethnic cohort of women at midlife.MethodsWe measured urinary concentrations of 21 metals (arsenic, barium, beryllium, cadmium, cobalt, chromium, cesium, copper, mercury, manganese, molybdenum, nickel, lead, platinum, antimony, tin, thallium, uranium, vanadium, tungsten and zinc) using high-resolution inductively coupled plasma-mass spectrometry among 1335 white, black, Chinese and Japanese women aged 45–56 years at the third SWAN annual visit (1999–2000). Least squared geometric mean concentrations were compared across race/ethnicity, education, financial hardship, smoking, secondhand smoking, seafood intake and rice intake groups. Overall exposure patterns of multiple metals were derived using k-means clustering method.ResultsThe percentage of women with detectable concentrations of metals ranged from 100% for arsenic, cesium, molybdenum and zinc, to less than 5% for platinum; 15 metals had detection rates of 70% or more. Asian women, both Chinese and Japanese, had higher urinary concentrations of arsenic, cadmium, copper, mercury, molybdenum, lead and thallium, compared with other race/ethnic groups, independent of sociodemographic, lifestyle, dietary, and geographic characteristics. Seafood and rice intake were important determinants of urinary arsenic, cesium, mercury, molybdenum and lead levels. Two distinct overall exposure patterns- “high” vs. “low” -- were identified. Women in the “high” overall exposure pattern were more likely to be Asians, current smokers, and to report high consumption of seafood and rice. Black women were less likely to have the high exposure pattern.ConclusionsMetal exposure of midlife women differs by racial/ethnic, sociodemographic, lifestyle, dietary, and geographic characteristics. Asian women may be experiencing the highest exposures to multiple metals compared with other racial/ethnic groups in the United States.     

天津市宝坻区老年人体质指数、腰围以及腰围身高比与高血压患病率的关联

  目的   探讨天津市宝坻区60岁及以上老年居民的体质指数(body mass index, BMI)、腰围(waist circumference, WC)以及腰围身高比(waist-to-height ratio, WHtR)与高血压患病率的关联。   方法   本研究对2018年4-5月参加天津市宝坻区口东卫生院体检的老年人(≥60岁)进行问卷调查和体格检查。采用分层分析和logistic回归分析BMI与WC(或WHtR)对高血压的联合作用和交互作用。   结果   共邀请1 692人, 1 417人(83.75%)参与本研究。老年人群的高血压患病率为46.36%、BMI超重和肥胖者占66.50%、WC中心型肥胖者占74.66%、WHtR超重和肥胖者占75.38%。与BMI或WC正常相比, BMI超重(OR=1.65, 95% CI:1.19~2.30)和肥胖(OR=3.41, 95% CI:2.23~5.20)及WC中心型肥胖(OR=1.49, 95% CI:1.00~2.23)均增加高血压的患病风险。BMI联合WC超重/肥胖(OR=2.49, 95% CI:1.78~3.46), 或BMI联合WHtR超重/肥胖(WHtR超重: OR=2.05, 95% CI:1.41~2.99;WHtR肥胖: OR=2.37, 95% CI:1.50~3.76)的患病风险高于后者单独作用的风险(WC超重/肥胖: OR=1.39, 95% CI:0.90~2.15;WHtR超重: OR=1.02, 95% CI:0.62~1.66;WHtR肥胖: OR=1.44, 95% CI:0.55~3.81)。   结论   三项指标中, BMI与高血压患病的关联性最强, 且BMI超重/肥胖增强WC(或WHtR)与高血压的关联, 提示控制BMI相关体重指标在正常范围内有助于预防和控制高血压。     

珠海市斗门区居民体重指数、腹围与血压关系的研究

目的研究珠海市斗门区居民体重指数（BMI）、腹围与血压的关系,为控制体重及向心性肥胖从而降低高血压发病率提供参考。方法按照分层、整群、随机相结合的方法,抽取斗门区两镇,对其农村居民进行面对面调查和体检。结果体重指数为〈24、24～28、≥28时,血压均值分别为125．49／79．81、135．62／85．42、／44．63／93．77mmHg,高血压患病率分别为27．5％、47．6％、71．0％;腹围从正常到腹部肥胖,血压均值从124．67／79．65mmHg上升到135．50／85．09mmHg,高血压患病率从25．5％上升到48．5％。体重指数对血压、高血压患病率的预测效果高于腹围;超重、肥胖与正常组相比,发生高血压的危险性分别增加3．0和5．2倍。结论珠海市斗门区居民血压值和高血压患病率随着体重指数、腹围的增加而上升,体重指数是预测高血压的重要指标,应采取有针对性的措施,控制体重指数在正常范围内。     

北京市小学生BMI、腰围与代谢综合征的关系研究

目的 探讨儿童肥胖与代谢综合征(MS)的关系,分析体重指数(BMI)和腰围与MS组分的关系.方法 在北京市海淀区的8所学校选取1 928名7～14岁小学生,测量其身高、体重和各MS组分,分析不同营养状况小学生MS组分的差异.采用多元线性回归和Logistic回归模型,分析BMI、腰围与MS组分的关系.结果 除空腹血糖外,血压、血脂、腰围在不同营养状况小学生之间差异有统计学意义(P＜0.05),表现为肥胖组＞超重组＞体重正常组.不同营养状况小学生高SBP、高TG、低HDL-C、中心性肥胖的检出率差异均有统计学意义(P＜0.01),随BMI增加异常率增高.多元线性回归发现BMI和腰围均与除中心性肥胖外的其他MS组分有独立的相关性;除TC外, “腰围”对于其他MS组分的标化回归系数绝对值略大于“BMI”.除DBP外,对于其他MS组分,BMI与腰围同时升高(超重/肥胖且腰围≥P90)的OR值＞BMI和腰围有且仅有一项偏高(超重/肥胖或腰围≥P90)＞体重正常且腰围正常.结论 儿童肥胖与代谢综合征关系密切,联合应用腰围和BMI有利于评估MS风险.     

BMI、腰围与睡眠质量对成年人高血压患病风险的联合作用

目的  探讨成年人BMI、腰围与睡眠质量的联合作用对高血压患病风险的影响。方法  采用便利抽样法,于2020年10月12日―2020年12月18日对十堰市3 195名成年居民进行问卷调查。采用Logistic回归分析模型分析BMI、腰围与睡眠质量对高血压患病的联合作用。结果  高血压患病率为18.22%。多因素Logistic回归分析模型分析显示,以BMI正常且睡眠质量好的组为对照组,体重过轻且睡眠质量好的组、超重且睡眠质量好的组、全身型肥胖且睡眠质量好的组、体重过轻且睡眠质量差的组、BMI正常且睡眠质量差的组、超重且睡眠质量差的组、全身型肥胖且睡眠质量差的组高血压患病风险分别是对照组的4.049倍、1.172倍、4.625倍、4.581倍、1.166倍、5.476倍和8.230倍。以腰围正常且睡眠质量好的组为对照组,腹型肥胖且睡眠质量好的组、腰围正常且睡眠质量差的组、腹型肥胖且睡眠质量差的组高血压患病风险分别是对照组的4.017倍、3.074倍和7.495倍。结论  睡眠质量差和全身型肥胖或腹型肥胖共存会增加高血压的患病风险,提示睡眠质量差的人群控制BMI和腰围有利于高血压的预防。     

糖调节受损人群胰岛素早期分泌相与腰围的研究

目的探讨糖调节受损(IGR)人群胰岛素早期分泌相的变化及胰岛素早期分泌相与腰围的相关性。方法选取包钢糖尿病流行病学调查人群1 024例作为研究对象。所有研究对象均测量腰围、行口服葡萄糖耐量试验(OGTT)。根据OGTT结果划分糖耐量状态:糖耐量正常、空腹血糖受损、糖耐量低减、空腹血糖受损伴糖耐量低减、糖尿病(DM)。计算早期胰岛素分泌指数(△I30/△G30)。结果腹型肥胖组与非腹型肥胖组对比,IGR、DM的患病率明显增加。随着糖耐量恶化,△I30/△G30逐渐减少。胰岛素早期分泌相与腰围呈负相关,相关系数r=-0.716,p<0.01。结论胰岛素早期分泌相与腰围间有相关性。腰围可作为评估早期胰岛素分泌指数的指标。     

空腹血糖受损人群腰围变化对新发糖尿病的影响

目的 探讨空腹血糖受损人群腰围变化与新发糖尿病发病风险之间的关系.方法 采用前瞻性队列研究法,以参加2006-2007、2010-2011年开滦集团健康体检的在职及离退休职工为研究对象,以符合入选标准的12 657名职工作为观察队列,依据基线腰围四分位水平将观察对象分为4组,比较4组间糖尿病的发病率.用多因素logistic回归分析腰围与糖尿病发病风险的关系.结果 在12 657名的糖尿病前期空腹血糖受损人群观察队列中,男性为10 697名,女性为1960名,年龄为(49.9±11.3)岁.至2010-2011年度健康体检时,调查对象糖尿病的年发病率为4.27％(1884/12 657),男性人群年发病率为4.25％(1581/10 697),女性为4.44％(303/1960),差异有统计学意义(P＜0.05).随着腰围的增加,糖尿病的发病率逐渐升高,第一分位组、第二分位组、第三分位组、第四分位组的糖尿病的年发病率分别为2.19％(235/3083)、3.07％(333/3114)、4.47％(473/3037)、7.08％(843/3423);按性别分层后,男性4组糖尿病的年发病率分别为2.34％(213/2626)、3.06％(282/2645)、4.37％(393/2582)、7.00％(693/2844),女性4组的年发病率分别为1.38％ (22/457)、3.12％ (51/469)、5.05％(80/455)、7.45％(150/579).相同腰围分组间女性糖尿病年发病率均高于男性,差异均有统计学意义(P＜0.05).影响糖尿病的多因素logistic回归分析显示,校正年龄、性别等因素后,与第一分位组比较,第二、三、四分位组均增加糖尿病的发病风险[OR(95％ CI)值分别为1.38(1.13 ～1.68)、1.79(1.47～2.09)和3.10(2.57 ～3.75)].结论 随着腰围的增加,糖尿病前期空腹血糖受损人群糖尿病发病风险增加.     

北京市朝阳区成年人体质指数和腰围与高血压的关系

目的 探讨北京市朝阳区成人体质指数（body mass index, BMI）、腰围（waist circumference,WC）与高血压的关系。方法 采用多阶段分层随机抽样方法,抽取北京市朝阳区18～79岁32668名成年居民作为研究对象。调查内容包括一般人口学特征、生活方式、行为习惯、慢性疾病病史资料等,也进行体格测量。通过方差分析、偏相关分析和非条件logistic回归模型研究BMI、WC与高血压的关系。结果 调查人群新检出高血压患病率为19.80%（标化率为16.30%）;不同性别人群BMI、WC组间血压水平差异均有统计学意义（P＜0.050）;不同性别人群BMI、WC与收缩压和舒张压呈正相关（P＜0.050）;随着BMI、WC增加,男女人群的高血压患病危险性均上升,且BMI和WC每增加一个标准差,男性人群高血压患病危险性分别增加0.66（OR=1.66,95% CI:1.57～1.75）和0.56（OR=1.56,95% CI:1.48～1.65）,女性人群分别增加0.50 （OR=1.50,95% CI:1.42～1.57）和0.57（OR=1.57,95% CI:1.49～1.66）。结论 BMI、WC与高血压患病危险性密切相关,且BMI对男性人群患病危险性影响更大,WC对女性的影响更大。     

BMI,waist circumference,and clustering of cardiovascular risk factors in Japanese adults

Objective  

To examine whether the association between waist circumference (WC) and clustering of cardiovascular risk factors varies with obesity (BMI) status.     

体质指数和腰围对浙江地区成年人糖尿病发生影响的前瞻性研究

目的 探讨BMI和腰围对成年人糖尿病发病的影响。方法 使用"中国慢性病前瞻性研究"（CKB）浙江省桐乡市数据,剔除基线时自报患有恶性肿瘤、心脏病、脑卒中和糖尿病患者后,纳入分析30~79岁53 916人。采用Cox比例风险模型计算糖尿病发病风险比（HR）。结果 调查对象累计随访391 512人年（平均随访7.26年）。随访期间,男性944人和女性1 643人被新诊断为糖尿病。多因素调整后,与BMI正常组的人群相比,男性超重和肥胖组糖尿病发病的HR值（95%CI）分别为2.72（95%CI：2.47~2.99）和6.27（95%CI：5.33~7.36）。女性超重和肥胖组HR值（95%CI）分别为2.19（95%CI：2.04~2.36）和3.78（95%CI：3.36~4.26）;与腰围正常组的人群相比,男性Ⅰ级（85.0~89.9）和Ⅱ级中心性肥胖（≥ 90.0）组糖尿病发病的HR值（95%CI）分别为2.56（2.22~2.95）和4.66（4.14~5.24）。女性Ⅰ级（80.0~84.9）和Ⅱ级中心性肥胖（≥ 85.0）组HR值（95%CI）分别为1.99（1.80~2.21）和3.16（2.90~3.44）。结论 超重/肥胖以及中心性肥胖人群糖尿病发病风险均会升高。在开展控制体重预防糖尿病的同时,更应控制腰围。     

Multiple imputation for body mass index: lessons from the Australian Longitudinal Study on Women's Health

In large epidemiological studies missing data can be a problem, especially if information is sought on a sensitive topic or when a composite measure is calculated from several variables each affected by missing values. Multiple imputation is the method of choice for 'filling in' missing data based on associations among variables. Using an example about body mass index from the Australian Longitudinal Study on Women's Health, we identify a subset of variables that are particularly useful for imputing values for the target variables. Then we illustrate two uses of multiple imputation. The first is to examine and correct for bias when data are not missing completely at random. The second is to impute missing values for an important covariate; in this case omission from the imputation process of variables to be used in the analysis may introduce bias. We conclude with several recommendations for handling issues of missing data.     

中国中老年人群和高个成年人中心型肥胖的腰围界值点验证

目的 探讨中国中老年人群和高个成年人的适宜腰围界值点及其对糖尿病患病危险的预测价值.方法 利用2002年中国居民营养与健康状况调查数据,分析≥45岁人群和身高在全人群第85百分位数(P85)以上成年人的腰围分布特征,分析不同的腰同界值点与体重指数(BMI:kg/m2)≥24的诊断一致性,采用多元logistic回归分析不同腰围水平的调查对象患糖尿病和空腹血糖受损的相对风险,并以ROC曲线最短距离确定上述人群的适宜腰围界值点.结果 中国中老年人腰围男性均值为80.8 cm,女性均值为79.4 cm;高个男性腰围均值为84.1 cm,女性为77.9 cm.中老年人腰围以男性85 cm、女性80 cm作为界值点,与BMI≥24的诊断一致性最好,预测糖尿病的ROC曲线距离最短.与腰围<85 cm组相比,85 cm～组、90 cm～组和95 cm～组的中老年男性患糖尿病[OR值分别为2.1(95%CI:1.6～2.8)、3.0(95%CI:2.3～4.0)和4.5(95%CI:3.4～5.8)]和空腹血糖受损[OR值分别为1.6(95%CI:1.2～2.2)、2.6(95%CI:1.9～3.5)和3.5(95%CI:2.6～4.6)]的相对风险明显增加.与腰围<80 cm组相比,80 cm～组、85 cm～组和90 cm～组中老年女性患糖尿病[OR值分别为1.9(95% CI:1.4-2.6)、3.2(95%CI:2.4～4.3)和4.8(95%CI:3.7～6.1)]和空腹血糖受损[OR值分别为2.5(95%CI:1.8～3.4)、3.2(95%CI:2.4～4.4)和4.2(95%CI:3.2～5.6)]的相对风险明显增高.高个成年人腰围以男性90 cm、女性85 cm作为界值点,预测糖尿病患病的ROC曲线距离最短.与腰围<85 cm组相比,95cm～组高个男性患糖尿病和空腹血糖受损的相对风险明显增高[OR值分别为3.6(95%CI:2.1～6.4)和5.5(95%CI:3.0～10.1)].与腰围<80cm组相比,85 cm～、90 cm～组高个女性患糖尿病的相对风险明显升高[OR值分别为5.0(95%CI:2.7～9.4)和8.0(95%CI:4.6～14.1)],90 cm～组患空腹血糖受损的相对风险OR=3.7(95%CI:2.0～6.9).结论 男性85 cm和女性80 cm是中老年人群的适宜腰围界值点;对于高个成年人,此腰围界值点对于空腹血糖受损有预测价值;人群中心型肥胖预防指标建议使用男性85 cm和女性80 cm作为腰围界值点.     

A five year longitudinal study investigating the prevalence of childhood obesity: comparison of BMI and waist circumference

Objective

The purpose of this study was to examine the prevalence of obesity over time in the same individuals comparing body mass index (BMI), waist circumference (WC) and waist to height ratio (WHtR).

Study design

Five year longitudinal repeated measures study (2005–2010). Children were aged 11–12 (Y7) years at baseline and measurements were repeated at age 13–14 (Y9) years and 15–16 (Y11) years.

Methods

WC and BMI measurements were carried out by the same person over the five years and raw values were expressed as standard deviation scores (sBMI and sWC) against the growth reference used for British children.

Results

Mean sWC measurements were higher than mean sBMI measurements for both sexes and at all assessment occasions and sWC measurements were consistently high in girls compared to boys. Y7 sWC = 0.792 [95% confidence interval (CI) 0.675–0.908], Y9 sWC = 0.818 (95%CI 0.709–0.928), Y11 sWC = 0.943 (95%CI 0.827–1.06) for boys; Y7 sWC = 0.843 (0.697–0.989), Y9 sWC = 1.52 (95%CI 1.38–0.67), Y11 sWC = 1.89 (95%CI 1.79–2.04) for girls. Y7 sBMI = 0.445 (95%CI 0.315–0.575), Y9 sBMI = 0.314 (95%CI 0.189–0.438), Y11 sBMI = 0.196 (95%CI 0.054–0.337) for boys; Y7 sBMI = 0.353 (0.227–0.479), Y9 sBMI = 0.343 (95%CI 0.208–0.478), Y11 sBMI = 0.256 (95%CI 0.102–0.409) for girls. The estimated prevalence of obesity defined by BMI decreased in boys (18%, 12% and 10% in Y 7, 9 and 11 respectively) and girls (14%, 15% and 11% in Y 7, 9 and 11). In contrast, the prevalence estimated by WC increased sharply (boys; 13%, 19% and 23%; girls, 20%, 46% and 60%).

Conclusion

Central adiposity, measured by WC is increasing alongside a stabilization in BMI. Children appear to be getting fatter and the additional adiposity is being stored centrally which is not detected by BMI. These substantial increases in WC are a serious concern, especially in girls.