Larger thigh and hip circumferences are associated with better glucose tolerance: the Hoorn study

OBJECTIVE: A higher waist-to-hip ratio, which can be due to a higher waist circumference, a lower hip circumference, or both, is associated with higher glucose levels and incident diabetes. A lower hip circumference could reflect either lower fat mass or lower muscle mass. Muscle mass might be better reflected by thigh circumference. The aim of this study was to investigate the contributions of thigh and hip circumferences, independent of waist circumference, to measures of glucose metabolism. RESEARCH METHODS AND PROCEDURES: For this cross-sectional study we used baseline data from the Hoorn Study, a population-based cohort study of glucose tolerance among 2484 men and women aged 50 to 75. Glucose tolerance was assessed by a 75-g oral glucose tolerance test; hemoglobin A(1c) and fasting insulin were also measured. Anthropometric measurements included body mass index (BMI) and waist, hip, and thigh circumferences. RESULTS: Stratified analyses and multiple linear regression showed that after adjustment for age, BMI, and waist circumference, thigh circumference was negatively associated with markers of glucose metabolism in women, but not in men. Standardized beta values in women were -0.164 for fasting, -0.206 for post-load glucose, -0.190 for hemoglobin A(1c) (all p < 0.001), and -0.065 for natural log insulin levels (p = 0.061). Hip circumference was negatively associated with markers of glucose metabolism in both sexes (standardized betas ranging from -0.093 to -0.296, p < 0.05) except for insulin in men. Waist circumference was positively associated with glucose metabolism. DISCUSSION: Thigh circumference in women and hip circumference in both sexes are negatively associated with markers of glucose metabolism independently of the waist circumference, BMI, and age. Both fat and muscle tissues may contribute to these associations.     

Body mass index and hip and thigh circumferences are negatively associated with visceral adipose tissue after control for waist circumference

BACKGROUND: Waist circumference (WC) is positively associated with morbidity and mortality with or without control for hip circumference (HC) or body mass index (BMI; in kg/m(2)). This association is thought to be explained by an expanded visceral adipose tissue (VAT) depot. Conversely, HC and BMI are negatively associated with morbidity and mortality after control for WC. Whether this inverse association is explained in part by the ability of HC and BMI to identify subjects with increased subcutaneous adipose tissue (SAT), increased skeletal muscle (SM) mass, or decreased VAT after control for WC is unclear. OBJECTIVE: We examined the independent associations between WC, HC, thigh circumference (ThC), and BMI with VAT and total, lower-body, and abdominal SAT and SM. DESIGN: Total and regional body composition were measured in 256 white men and women with magnetic resonance imaging. RESULTS: WC, HC, ThC, and BMI were all positively correlated with total, lower-body, and abdominal SAT and SM and with VAT. After statistical control for WC, HC, ThC, and BMI remained positively associated with total, lower-body, and abdominal SAT and SM (men only) but were negatively associated with VAT (P < 0.05). HC (P < 0.05) but not BMI (P > 0.10) or ThC (P = 0.06) remained negatively associated with VAT after further control for age. CONCLUSIONS: HC, ThC, and BMI are positively associated with total, lower-body, and abdominal SAT and SM but negatively associated with VAT after control for WC. However, only HC remained negatively associated with VAT after control for age and WC.     

Accuracy of self-measurement of body fat distribution by waist, hip, and thigh circumferences

There are indications that body fat distribution, independent of obesity, may be a disease risk factor. The accuracy of self-measurement of waist, hip, and thigh circumferences, indicators of fat distribution, were examined for 227 women (aged 19-45) who were sent either a calibrated or uncalibrated tape measure and subsequently remeasured by a trained technician. Subjects tended to underestimate all circumferences somewhat. Spearman correlations between self-measurement and technician measurement were 0.88, 0.89, and 0.86 for the waist, hip, and thigh, respectively, and 0.65 and 0.77 for the waist-to-hip waist-to-thigh ratios. Correlations for waist, but not other measures, were better with the uncalibrated than with the calibrated tape. Accuracy did not vary within strata of education, body mass index, or waist-to-hip ratio. Subjects were able to measure their circumferences with reasonable accuracy. Circumference measures were more accurate than were computed ratios of circumferences; waist-to-thigh ratios were more accurate than were waist-to-hip ratios.     

Associations of waist-to-height ratio with the incidence of type 2 diabetes and mediation analysis: Two independent cohort studies

AimTo assess the relationship between waist-to-height ratio (WHtR) and the incidence of type 2 diabetes (T2D)/impaired fasting glucose (IFG) and to explore to what extent these associations are mediated by blood pressure, lipids and other indicators related to liver and kidney metabolism.Materials and methodsThis study was based on a functional community cohort included 6109 participants which were divided into two sub-cohorts. One sub-cohort included participants with normal fasting glucose (n = 5563), another included IFG individuals at baseline (n = 546). Cox regression models were used to evaluate the relationships of WHtR with T2D/IFG. Four-year time-dependent receiver operating characteristic (ROC) curve and area under curve (AUC) were calculated to estimate the discriminatory power of WhtR and other anthropometric indices on T2D. Mediation analysis was performed to estimate which risk factors mediate the association between WHtR and T2D.ResultsSignificant positive associations were found between WHtR and the incidence of T2D/IFG in both sub-cohort. WhtR was a useful predictor of T2D (P < 0.05). Mediation analysis showed that HOMA-IR (0.45 %), SBP (5.10 %), triglycerides (11.02 %), creatinine (9.36 %) and combined kidney indicators (17.48 %) partly mediated the effect of WHtR on T2D in men. For women, this association was partly mediated by SBP (13.86 %), HDL (24.54 %), ALT (6.29 %), UA (22.58 %) and combined kidney indicators (39.51 %).ConclusionsWHtR was an independent risk factor for the development of T2D and IFG. This association was partly mediated by HOMA-IR, SBP, lipids and other liver and kidney metabolism indicators.     

成年人体质指数及相关指标与2型糖尿病关系

目的探讨江苏省南京市35岁～人群体质指数(BMI)、腰围(WC)、腰臀比(WHR)和腰身比(WHtR)与2型糖尿病(T2DM)关系。方法 2004年7月对南京市的3个城区和1个郊县的35岁～居民进行横断面调查;对无T2DM的研究对象于2007年7月进行随访;采用多因素Logistic回归和受试者工作特征曲线(ROC)评估基线4个肥胖指标对T2DM发生的预测作用。结果基线调查中无T2DM共4 058人,3年后共随访3 031人,随访率为74.7%;3年后新发生的T2DM患者共计72例,累计发病率为2.4%;其中男性33例,女性39例。随着基线肥胖程度的增加,T2DM的发病危险增加;WC超标和WHtR≥0.5者发生T2DM的风险无论男女性均较高。4个肥胖指标中,ROC曲线下面积WHtR最大。结论 BMI、WC、WHR和WHtR的增加均能提升T2DM发病的危险;WHtR可能是最重要的肥胖与T2DM相关预测指标。     

Validity of self-reported waist and hip circumferences in men and women

Recent epidemiologic evidence indicates an association between fat distribution and many diseases. To assess the validity of circumference measurements obtained by self-report, the authors analyzed data from 123 men aged 40-75 years and 140 women aged 41-65 years, drawn from two large ongoing prospective studies. On mailed questionnaires, subjects were asked to measure and record their weight and waist and hip circumferences. These data were compared with standardized measurements taken approximately six months apart by technicians who visited participants at their homes. Crude Pearson correlations between self-reported waist circumferences and the average of two technician-measured waist circumferences were 0.95 for men and 0.89 for women. Similar correlations for hip measurements were 0.88 for men and 0.84 for women, and for waist-to-hip ratios, 0.69 for men and 0.70 for women. After adjusting for age and body mass index (kg/m2), correlations for waist-to-hip ratios were 0.55 for men and 0.58 for women. Correlations became stronger after correcting for random within-person variability from daily or seasonal fluctuations. Self-reported and measured weights were highly correlated: 0.97 for men and 0.97 for women. Self-reported waist, hip, and weight measurements appear reasonably valid. The moderate degree of measurement error for the ratio of self-reported waist and hip circumferences, however, implies that previously reported associations based on self-report of these measures may have been appreciably underestimated.     

Intake of brown rice lees reduces waist circumference and improves metabolic parameters in type 2 diabetes

Intake of whole grains has been associated with lower risks of type 2 diabetes and cardiovascular disease. Brown rice is unrefined whole grain and is produced by removing the outermost layers containing the germ and bran, which are rich in nutrients including dietary fiber, vitamins, minerals, and other unmeasured dietary constituents. The lees of brown rice (LB) are by-products of its fermentation in the process of manufacturing takju, a Korean turbid rice wine. In this study, we hypothesized that intake of LB would reduce waist circumference, a strong risk factor for cardiovascular disease in type 2 diabetic patients. A randomized, double-blind, placebo-controlled study was scheduled for 12 weeks. Thirty subjects were randomly assigned to receive a supplement prepared from the LB or from a mixed-grain dietary product (MG). Body weight, waist circumference, body composition, lipid profiles, and other laboratory parameters were measured. The LB group showed greater reduction in waist circumference (LB: 87.9 ± 8.8 to 85.1 ± 9.0 cm; MG: 86.9 ± 8.8 to 86.0 ± 9.3 cm; P = .032). In addition, the consumption of LB resulted in a significantly greater decrease in the level of aspartate transaminase (LB: 25.4 ± 8.5 to 21.0 ± 5.1 IU/mL; MG: 22.5 ± 5.3 to 22.4 ± 5.7 IU/mL; P = .044) and alanine transaminase (LB: 28.6 ± 11.3 to 21.9 ± 8.2 IU/mL; MG: 24.4 ± 7.5 to 24.5 ± 9.9 IU/mL; P = .038). Consumption of the LB was associated with a decreased waist circumference in type 2 diabetic patients. Further study is required to evaluate the metabolic effect of the extract of the LB in type 2 diabetes.     

基于孟德尔随机化探索臀围与2型糖尿病的因果关系

  目的   采用孟德尔随机化分析方法, 探讨臀围与2型糖尿病的因果关联。   方法   将分别来自人体测量特征遗传研究(genetic investigation of anthropometric traits, GIANT)和糖尿病遗传学验证和荟萃分析(diabetes genetics replication and Meta-analysis, DIAGRAM)数据库的臀围和2型糖尿病遗传位点数据, 据单核苷酸多态性(single nucleotide polymorphism, SNP)编号匹配合并, 以与臀围密切相关的SNP为工具变量, 运用逆方差加权法、MR-Egger回归模型和加权中位数法分析臀围对2型糖尿病的因果效应。   结果   不分性别队列、女性队列和男性队列中分别匹配到52、9和15个SNP。异质性检验结果提示SNP间同质。三个队列的OR值及其95%的置信区间分别为1.065(1.030~1.100)、1.103(1.057~1.150)和1.583(1.273~1.968), 均有统计学意义(均有P < 0.05)。敏感性分析结果显示三个队列逐一移除SNP, 其因果效应不受影响, 结果稳健。   结论   人体臀围与2型糖尿病之间均存在因果关联, 臀围可能为2型糖尿病的危险因素。     

山东省2010年7～18岁中小学生腰围和臀围发育状况调查

目的了解山东省儿童少年腰围(WC)和臀围(HC)发育水平,为建立中心性肥胖筛查标准提供参考。方法以2010年山东省学生体质健康调查研究中42275名7～18岁中小学生为研究对象,测量身高、WC和HC,分析WC、HC、腰臀比(腰围/臀围,WHR)和腰围身高比(腰围/身高,WHtR)的发育状况,并与国内文献资料比较。结果山东省7～18岁中小学生WC随年龄的增长而增加,各年龄组男生显著高于女生(P<0．01)。男女生HC的发育曲线存在两次交叉：在11岁前男生大于女生,进入青春发育突增期后(12～14岁)女生超过男生,15岁后男生再次超过女生。山东省7～18岁中小学生WC第50百分位数(P₅₀)比2008年国内15省调查数据高1_3～3．1 cm(男)、1．2～2．0 cm(女),比2005年香港调查数据高1．9-5．4 cm(男)、2．0-6．5 cm(女)。以2008年国内15省调查WC P₉₀为界值,山东省7～18岁中小学生中心性肥胖总检出率男生为20．20%,女生为16．57%,男生显著高于女生(P<0.01);以WHtR≥0．5为界值,中心性肥胖总检出率男生为15．73%,女生为7．38%,男生同样显著高于女生(P<0．01)。结论山东省7～18岁中小学生WC发育水平较高。     

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。     

BMI与腰围对阻塞性睡眠呼吸暂停与2型糖尿病的中介效应

目的  探究BMI和腰围(waist circumference, WC)对阻塞性睡眠呼吸暂停(obstructive sleep apnea, OSA)与2型糖尿病、糖代谢连续测量指标之间的中介效应。方法  纳入分析的1 615名研究对象来自动脉粥样硬化多民族研究(Multi-Ethnic Study of Atherosclerosis, MESA)。OSA评价指标为呼吸暂停低通气指数(apnea-hypopnea index,AHI),由多导睡眠图测定。糖代谢连续测量指标包括FPG和糖化血红蛋白(glycated hemoglobin,HbA1c)。肥胖指标包括全身肥胖指标BMI和腹型肥胖指标WC。结果  OSA与2型糖尿病显著相关,后者的患病风险随OSA严重程度增加而升高(P < 0.001)。BMI和WC均介导重度OSA与2型糖尿病之间的关联,其中腹型肥胖指标WC的中介效应为1.296(95% CI: 1.182~1.466),中介效应比例为56.397%;BMI的中介效应为1.291(95% CI: 1.173~1.479),中介效应比例为55.400%。BMI和WC同样介导重度OSA与FPG、HbA1c之间的关联。结论  OSA与2型糖尿病、FPG和HbA1c的关系,与肥胖程度增加有关。提示OSA患者通过早期的体重干预,特别是控制腹型肥胖对降低糖尿病和心血管并发症的患病率具有重要意义。     

Waist circumference, waist:hip ratio, and risk of breast cancer in the Nurses' Health Study

This study examined prospectively the associations of waist circumference and waist:hip circumference ratio with risk of breast cancer. A total of 47,382 US registered nurses who reported their waist and hip circumferences in 1986 were followed up through May 1994 for identification of incident cases of breast cancer. During 333,097 person-years of follow-up, 1,037 invasive breast cancers were diagnosed. In proportional hazards analyses, waist circumference was nonsignificantly related to risk of premenopausal breast cancer but was significantly associated with postmenopausal breast cancer after adjustment for established breast cancer risk factors (for the highest quintile of waist circumference vs. the lowest, relative risk (RR) = 1.34; 95% confidence interval (CI): 1.05, 1.72). When the analysis was limited to postmenopausal women who had never received hormone replacement therapy, a stronger positive association was found (RR = 1.88; 95% CI: 1.25, 2.85). After the data were further controlled for body mass index, the positive association was only slightly attenuated (RR = 1.83; 95% CI: 1.12, 2.99). Among past and current postmenopausal hormone users, no significant associations were found. Similar but slightly weaker associations were observed between waist:hip ratio and breast cancer risk. These data suggest that greater waist circumference increases risk of breast cancer, especially among postmenopausal women who are otherwise at lower risk because of never having used estrogen replacement hormones.     

Waist and hip circumferences have independent and opposite effects on cardiovascular disease risk factors: the Quebec Family Study

BACKGROUND: A high waist-to-hip ratio is associated with unfavorable cardiovascular disease risk factors. This could be due to either a relatively large waist or a small hip girth. OBJECTIVE: We sought to define the separate contributions of waist girth, hip girth, and body mass index (BMI) to measures of body composition, fat distribution, and cardiovascular disease risk factors. DESIGN: Three-hundred thirteen men and 382 women living in the greater Quebec City area were involved in this cross-sectional study. Percentage body fat, anthropometric measurements, and abdominal fat distribution were obtained and BMI (in kg/m2) and waist-to-hip ratio were calculated. Serum blood lipids were determined from blood samples collected after subjects had fasted overnight RESULTS: A large waist circumference in men and women (adjusted for age, BMI, and hip circumference) was associated significantly with low HDL-cholesterol concentrations (P < 0.05) and high fasting triacylglycerol, insulin, and glucose concentrations (P < 0.01). In women alone, a large waist circumference was also associated with high LDL-cholesterol concentrations and blood pressure. A narrow hip circumference (adjusted for age, BMI, and waist circumference) was associated with low HDL-cholesterol and high glucose concentrations in men (P < 0.05) and high triacylglycerol and insulin concentrations in men and women (P < 0.05). Waist and hip girths showed different relations to body fat, fat-free mass, and visceral fat accumulation. CONCLUSIONS: Waist and hip circumferences measure different aspects of body composition and fat distribution and have independent and often opposite effects on cardiovascular disease risk factors. A narrow waist and large hips may both protect against cardiovascular disease. These specific effects of each girth measure are poorly captured in the waist-to-hip ratio.     

男性下尿路症状与腰围及腰臀比相关性分析

目的 采用国际前列腺症状评分量表(IPSS)对≥55岁临床术后良性前列腺增生(BPH)的男性进行调查,探讨下尿路症状(LUTS)程度与腰围(WC)及腰臀比(WHR)的关系.方法 2005年7月～2007年6月,收集280例55～85岁临床术后BPH男性的LUTS资料,同时测量腰围和臀围.采用多元Logistic回归模型对中～重度LUTS(梗阻性和刺激性症状)进行分析.结果 LULS的严重程度随年龄的增长呈显著性升高.在调整了多因素之后,WC>85cm和WHR≥0.9者发生中～重度LUTS(刺激性症状)的危险增加.WC与中～重度LUTS和刺激性症状的OR值分别为2.807和1.105(95%=2.506～15.587和1.023～2.892);WHR与发生LUTS(OR=3.635,95%CI=3.432～10.624)和刺激性症状(OR=1.195,95%CI=1.135～3.286)的危险性呈正相关.结论 向心性肥胖可能是LUTS的重要危险因素,不良生活行为方式可能是促使LUTS恶化的因素.     

BMI is strongly associated with hypertension, and waist circumference is strongly associated with type 2 diabetes and dyslipidemia, in northern Chinese adults

Background

Obesity is closely associated with chronic diseases such as hypertension, type 2 diabetes mellitus (T2DM), and dyslipidemia. We analyzed the optimal obesity index cut-off values for metabolic syndrome (MetS), and identified the obesity index that is more closely associated with these chronic diseases, in a population of northern Chinese.

Methods

We surveyed 8940 adults (age, 20–74 years) living in northern China for chronic diseases. Receiver operating characteristics (ROC) analysis, relative risk, and multivariate regression were used to develop an appropriate index and optimal cut-off values for MetS and obesity-related chronic diseases.

Results

Waist circumference (WC) and body mass index (BMI) were good markers for MetS, WC was a good marker for T2DM and dyslipidemia, and BMI was a good marker for hypertension. The optimal BMI cut-off value of MetS was 24 kg/m², and the optimal WC cut-offs were 86 cm and 78 cm in men and women, respectively. Relative risk regression models showed that BMI was associated with hypertension, T2DM, and hypertriglyceridemia and a higher prevalence ratio (PR) for hypertension: 2.35 (95% CI, 2.18–2.50). WC was associated with T2DM, hypertension, and hypertriglyceridemia, with PRs of 2.05 (1.63–2.55) for T2DM and 2.47 (2.04–2.85) for hypertriglyceridemia. In multivariate regression models, the standardized regression coefficients (SRCs) of BMI were greater for SBP and DBP, and the SRC of WC was greater for fasting blood glucose, 2-hour postload blood glucose, triglyceride, and total cholesterol.

Conclusions

Our analysis of a population of northern Chinese indicates that the optimal cut-off values for MetS are WCs of 86 cm in men and 78 cm in women and a BMI of 24 kg/m² in both sexes. BMI was strongly associated with hypertension, while WC was strongly associated with T2DM and dyslipidemia.Key words: obesity, chronic disease, cut-off value     

中国成年人体质指数和腰围与肾结石住院风险的关联研究

目的分析中国成年人体质指数(BMI)和腰围与肾结石住院风险的关联。方法本研究利用中国慢性病前瞻性研究的长期随访数据, 剔除基线自报患有慢性肾病、恶性肿瘤、BMI和腰围为极端值的研究对象, 最终纳入502 096人。采用Cox比例风险回归模型分析BMI和腰围与肾结石住院风险之间的关联。结果研究对象随访(10.7±2.2)年, 随访期间记录肾结石导致的首次住院共12 396例。调整潜在混杂因素后, 以BMI(kg/m2)20.5～22.4者为参照组, <18.5、18.5～20.4、22.5～23.9、24.0～25.9、26.0～27.9、28.0～29.9、≥30.0者的风险比(HR)(95%CI)依次为:0.96(0.87～1.05)、0.94(0.88～1.00)、1.11(1.05～1.17)、1.25(1.18～1.32)、1.29(1.21～1.37)、1.39(1.28～1.50)、1.54(1.40～1.71);BMI每增加1 kg/m2, 肾结石住院风险的HR值增加4%(HR=1.04, 95%CI:1.04～1.05)。与腰围(cm)75.0～79.9者相比, ...