Screening for type 2 diabetes in a high-risk population: study design and feasibility of a population-based randomized controlled trial

ABSTRACT: BACKGROUND: We describe the design and present the results of the first year of a population-based study of screening for type 2 diabetes in individuals at high risk of developing the disease. High risk is defined as having abdominal obesity. METHODS: Between 2006 and 2007, 79,142 inhabitants of two Dutch municipalities aged 40--74 years were approached to participate in screening. Eligible participants had a self-reported waist circumference of [GREATER-THAN OR EQUAL TO]80 cm for women and [GREATER-THAN OR EQUAL TO]94 cm for men, and no known pre-existing diabetes. Of the respondents (n = 20,578; response rate 26%), 16,135 were abdominally obese. In total, 10,609 individuals gave written informed consent for participation and were randomized into either the screening (n = 5305) or the control arm (n = 5304). Participants in the screening arm were invited to have their fasting plasma glucose (FPG) measured and were referred to their general practitioner (GP) if it was [GREATER-THAN OR EQUAL TO]6.1 mmol/L. In addition, blood lipids were determined in the screening arm, because abdominal obesity is often associated with cardiovascular risk factors. Participants in both arms received written healthy lifestyle information. Between-group differences were analyzed with Chi-square tests (categorical variables) and unpaired t-tests (continuous variables). RESULTS: The screening attendance rate was 84.1%. Attending screening was associated with age at randomization (OR = 1.03, 95% CI 1.02-1.04), being married (OR = 1.57, 95%CI 1.33-1.83) and not-smoking currently (OR = 0.52, 95%CI 0.44-0.62). Of the individuals screened, 5.6% had hyperglycemia, and a further 11.6% had an estimated absolute cardiovascular disease risk of 5% or higher, according to the Systematic Coronary Risk Evaluation risk model. These participants were referred to their GP. CONCLUSIONS: Self-reported home-assessed waist circumference could feasibly detect persons at high risk of hyperglycemia or cardiovascular disease. Continuation of the large-scale RCT is warranted to test the hypothesis that targeted population-based screening for type 2 diabetes leads to a significant reduction in cardiovascular morbidity and mortality.Trial registrationISRCTN75983009.     

Measures of adiposity in the identification of metabolic abnormalities in elderly men

BACKGROUND: Body mass index (BMI; in kg/m(2)) is considered a poor indicator of overall and abdominal obesity in the elderly. OBJECTIVES: Our goal was to determine which simple anthropometric measurements [BMI, waist-to-hip ratio (WHR), waist circumference (WC), percentage body fat (%BF), or fat mass (FM)] are most closely associated with metabolic risk factors and insulin resistance in elderly men. DESIGN: This was a cross-sectional study of 2924 men aged 60-79 y with no history of coronary heart disease, stroke, or diabetes who were drawn from general practices in 24 British towns. RESULTS: BMI and WC were the measures most strongly associated with the metabolic syndrome (>/=3 of the following: hypertension, low HDL cholesterol, high triacylglycerols, or high blood glucose) and insulin resistance. For a 1-SD increase in BMI, WC, WHR, %BF, and FM, the odds ratios (95% CIs) of having the metabolic syndrome after adjustment for age, socioeconomic status, smoking status, and physical activity were as follows: BMI, 1.61 (1.44, 1.79); WC, 1.65 (1.48, 1.81); WHR, 1.49 (1.34, 1.66); %BF, 1.41 (1.25, 1.59); and FM, 1.53 (1.38, 1.70). For insulin resistance, the odds ratios (95% CIs) were as follows: 2.48 (2.22, 2.77), 2.46 (2.19, 2.65), 1.75 (1.59, 1.93), 1.79 (1.60, 2.00), and 2.10 (1.88, 2.34), respectively. In normal-weight (BMI < 25) and overweight (BMI 25-29.9) men, the presence of the metabolic syndrome and insulin resistance increased with increasing WC; this did not occur in obese men. CONCLUSIONS: BMI and WC are the simple measures of adiposity most strongly associated with metabolic abnormalities in elderly men. Our findings suggest that WC can be used as a complementary measurement to identify health risks in normal-weight and overweight elderly persons.     

我国成年人体质指数和腰围与缺血性卒中发病风险的前瞻性研究

目的 分析我国成年人BMI和腰围与缺血性卒中发病风险的关联。方法 从2010年中国慢性病监测项目选取60个监测点人群（城市监测点25个、农村监测点35个）作为本次研究对象,共计36 632人。将2010年中国慢性病监测项目数据作为基线数据。2016-2017年对该60个监测点人群进行随访,实际完成者27 762人。采用Cox比例风险回归模型分析不同人群BMI和腰围与缺血性卒中发病风险比,敏感性分析将死亡者和高胆固醇血症者剔除。结果 共纳入26 907人进入分析,随访期间观察到缺血性卒中事件1 128例（男性491例,女性637例）。调整相关混杂因素后,以BMI正常/腰围正常者为参照,全人群和男性具有CVD危险因素人群,BMI正常/腹型肥胖组、超重/腹型肥胖组和肥胖/腹型肥胖组缺血性卒中发病风险分别增加50%（HR=1.50,95% CI：1.07~2.08）、51%（HR=1.51,95% CI：1.20~1.91）、46%（HR=1.46,95% CI：1.09~1.96）和63%（HR=1.63,95% CI：1.12~2.38）、56%（HR=1.56,95% CI：1.20~2.03）、45%（HR=1.45,95% CI：1.05~2.01）,超重/腰围正常组未见发病风险增加;女性全人群和女性CVD危险因素人群,超重/腹型肥胖组和肥胖/腹型肥胖组发病风险分别增加40%（HR=1.40,95% CI：1.15~1.72）、46%（HR=1.46,95% CI：1.16~1.83）和35%（HR=1.35,95% CI：1.08~1.69）、30%（HR=1.30,95% CI：1.01~1.67）,超重/腰围正常组和BMI正常/腹型肥胖组未见发病风险增加。敏感性分析结果未见变化。结论 在男性人群中,超重/肥胖且腹型肥胖或单纯腹型肥胖缺血性卒中发病风险增加;在女性人群中,超重/肥胖且腹型肥胖发病风险增加;提示在控制体重预防缺血性卒中,应将BMI和腰围进行结合来评价人群肥胖情况。     

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。     

青岛成年双生子不同肥胖指标与高血压的关联与遗传度研究

目的 探讨青岛地区成年双生子整体性肥胖、腹型肥胖与高血压患病风险之间的关联,并分析遗传因素对肥胖、血压的影响。方法 以青岛市自愿参加调查的225对成年双生子人群为研究对象,于2019年8—9月进行问卷调查和体格检测。采用多因素条件logistic回归分析肥胖与高血压患病的关系,并用组内相关系数法计算肥胖、血压的遗传度。敏感性分析以卵型鉴定者为研究对象进行多因素条件logistic回归。结果 多因素条件logistic回归分析显示,男性整体性超重、肥胖（依据BMI划分）和腹型肥胖（依据WC、WHR、WHtR划分）人群高血压患病风险是正常人群的2.45、4.86倍和2.77、1.99、3.04倍（P＜0.001）。男女同卵双生子组内相关系数均高于异卵双生子。男性双生子BMI、WC、WHR、SBP、DBP的遗传度分别为0.31、0.39、0.13、0.50、0.57,女性的遗传度为0.30、0.64、0.44、0.40、0.53。敏感性分析显示男性整体性超重、肥胖（依据BMI划分）和腹型肥胖（依据WC、WHR、WHtR划分）人群高血压患病风险是正常人群的2.39、5.50倍和2.56、1.86、1.67倍。结论 男性整体性肥胖、腹型肥胖者高血压患病风险增加;且不同性别WC、WHR及SBP、DBP的遗传度不同。     

中国成年人体质指数和腰围与高血压关系的四年随访研究

目的探讨中国成年人体质指数(BMI)和腰围(WC)的增加与高血压发病危险的关系。方法利用“中国居民健康与营养调查”资料,以4552例18~60岁参加2000年调查、当时无高血压等慢性病并且2004年调查被随访到者为研究对象,考察基线BMI和WC对高血压的预测作用,以及BMI和WC4年间的变化与高血压发病之间的关系。结果男性和女性随访4年高血压发病率分别为20.01%和13.52%。随着基线肥胖程度的增加,高血压的发病危险增加。与BMI和WC均不肥胖者相比,BMI超重/肥胖并且WC肥胖者发生高血压的危险最高(男性,RR=2.840,95%CI:2.139~3.771;女性,RR=2.734,95%CI:2.050~3.647)。调整了其它协变量后,4年中BMI每增加一个单位,男性和女性患高血压的危险分别增加0.141和0.109倍;WC每增加1cm,男性和女性患高血压的危险分别增加0.038和0.035倍。结论体质指数和腰围的增加均能增加高血压发病的危险,体质指数和腰围联合使用可增强对高血压发病的预测作用。     

体重指数、腰围与代谢性健康风险的关系

目的比较体重指数（BMI）、腰围（WC）与代谢性健康风险的大小。方法对苏州市和常熟市两个社区的江苏省多代谢异常和代谢综合征（MS）防治研究中，经济发达地区基线资料的1604例对象按BMI和WC分组，在正常体重（BMI：18～23．9）、超重（BMI：24～27．9）、肥胖（BMI≥28）类别中，计算高血压、高血糖、血脂异常的相对危险度（RR），并对WC类别中腹型肥胖（男≥85cm，女≥80cm）和WC正常个体进行比较。结果无论是男性还是女性，其高血压、糖脂代谢各项指标以及MS的罹患率均与BMI和WC相关，控制混杂因素后，这样的相关性依然存在；但仅BMI超重时，各项表示代谢性健康风险的aRR值基本上都低于BMI超重合并腹型肥胖的aRR值；男、女性BMI正常但有腹型肥胖时，均较BMI超重而WC正常者的健康风险高。结论WC在表示代谢性健康风险方面比BMI更为有效。     

Caregiving associated with selected cancer risk behaviors and screening utilization among women: cross-sectional results of the 2009 BRFSS

ABSTRACT: BACKGROUND: Informal caregiving is increasingly common as the U.S. population ages, and there is concern that caregivers are less likely than non-caregivers to practice health-promoting behaviors, including cancer screening. We examined caregiving effects on cancer risk behaviors and breast and cervical cancer screening in the 2009 Behavioral Risk Factor Surveillance System. METHODS: Women age [GREATER-THAN OR EQUAL TO]41 with data on breast and cervical cancer screening were included (weighted frequency 3,478,000 women). Cancer screening was classified according to American Cancer Society guidelines. We evaluated the association of caregiving with cancer risk behaviors (obesity, physical activity, alcohol intake, smoking status, and fruit/vegetable consumption) and cancer screening (mammography, clinical breast exam [CBE], and Pap test) using logistic regression overall and with stratification on age (<65, [GREATER-THAN OR EQUAL TO]65) or race (white, non-white). RESULTS: Caregivers had greater odds of being obese, physically active, and current smokers. Subgroup analyses revealed that caregiving was associated with obesity in younger women and whites, and with less obesity in older women. Also, caregiving was associated with smoking only among younger women and non-whites. Caregivers had greater odds of ever having had a mammogram or CBE, yet there was no association with mammogram, CBE, or Pap test within guidelines. CONCLUSIONS: Caregiving was associated with some health behaviors that increase cancer risk, yet not with cancer screening within guidelines. Effects of caregiving by age and race require confirmation by additional studies.     

上海18739名职业人员不同类型肥胖特征及其与慢性病指标的关系

目的研究上海市职业人群不同类型肥胖流行特征,分析其与血糖、血脂、肝肾功能等慢性病指标间的关系,为职业人群的健康管理提供依据。方法选取2020年在华东疗养院诊疗中心参加健康体检的18739名上海市职业人员为研究对象,收集一般基础资料、健康体检资料,按照全身型肥胖和中心型肥胖的判断标准对研究对象的肥胖类型进行区分,采用二元logistic回归分析验证超重、肥胖的影响因素及其与慢性病指标的相关性。结果18739名职业人群中,根据体质量指数(BMI),超重(含肥胖)检出率为51.25%,其中肥胖检出率为13.27%;中心型肥胖检出率为42.70%。随着BMI的增加,中心型肥胖占比也升高。随着年龄的增大,超重肥胖的风险也随之增大,其中50~60岁年龄组风险最大(OR=2.031,P<0.01);女性发生超重肥胖的风险较男性低(OR=0.216,P<0.01);吸烟(OR=1.128,P<0.01)、饮酒(OR=1.300,P<0.01)者发生超重、肥胖的风险高于不吸烟、饮酒者;分别相比公务员、脑力劳动者、每天静坐<2 h者,农民(OR=3.424,P<0.01)、轻体力劳动者(OR=1.149,P<0.01)、每天静坐时间4~6 h(OR=1.114,P<0.01)和>6 h者(OR=1.158,P<0.01)发生超重肥胖的风险增加,而每天睡眠时长7~9 h者较睡眠时长<5 h者发生超重肥胖风险显著降低(OR=0.799,P<0.01)。各类慢性病指标异常的检出率随着BMI的增加而升高(P<0.01);中心型肥胖组的各指标异常检出率均高于正常组(P<0.01);相比正常人群,合并两种类型肥胖的人群发生高血压、高血糖、高总胆固醇、高甘油三酯、高低密度脂蛋白胆固醇、高尿酸的风险最高(OR=1.422~5.885,P<0.01)。结论上海市职业人群中超重、肥胖情况比较严峻,肥胖人群尤其是中心型肥胖人群面临较严重的健康风险,降低超重、肥胖率迫在眉睫。     

Evaluation of waist circumference to predict general obesity and arterial hypertension in women in Greater Metropolitan Belo Horizonte,Brazil

This study examined the capacity of waist circumference (WC) to identify subjects with overweight (BMI >/=25) and obesity (BMI >/=30), in agreement with internationally recommended levels of action. Data were obtained from 791 women, 15-59 years old. After identifying overweight and obesity according to WC values, sensitivity and specificity were calculated to verify whether WC could be a good risk predictor for hypertension. Associations were tested by linear regression and logistic regression, controlling for confounding. WC cut-off points of 80cm and 88cm correctly identified 89.8% and 88.5% of women with overweight and obesity, respectively. Abdominal obesity (WC >/=88cm) was statistically associated with hypertension in the multivariate analysis (OR = 2.88; 95% CI: 1.77-4.67). Hypertension was identified with a sensitivity of 63.8% and 42.8%, and with a specificity of 68.0% and 83.3%, for WC >/=80 and >/=88, respectively. The proposed cut-off points for abdominal obesity can potentially distinguish individuals at risk for future obesity, but has only moderate power to predict individuals with high blood pressure.     

不同肥胖指标与MS其他组分患病风险研究

目的分析体质指数(BMI)、腰围(WC)、腰围/身高比值(WHtR)3个肥胖指标与MS及其他组分的相关性。方法选取2008年参加健康体检的延吉市某社区居民,进行问卷调查、血压测量、体格检查及生化指标检测。对资料完整的886例对象按照不同的BMI、WC水平进行分层,比较分析代谢异常组分患病情况。对WHtR指标与MS其他组分异常数量的相关性进行分析,并寻找适合的切点,分析其对MS的患病风险。结果调查对象中肥胖程度比较严重,且各项指标存在性别差异;各项代谢异常患病率均与BMI和WC有关,两者均异常时,各项表示代谢性健康风险的OR值明显高于BMI与WC各单项异常组(P﹤0.01),但仅有腹型肥胖时,其OR值均高于BMI超重而WC正常者;WHtR与代谢异常数量之间存在正相关(r=0.479,P﹤0.01),当WHtR超过0.50时,个体MS患病危险度显著增加(OR:1.564,95%CI:1.046～1.896,P﹤0.01)。结论 BMI和WC异常可增加代谢异常疾病的患病风险,WHtR是较好代表中心性肥胖的指标,在防治MS其他组分时应将体脂增多同时伴有脂肪分布异常者列为重点高危人群。     

Discrimination of health risk by combined body mass index and waist circumference

OBJECTIVE: NIH Clinical Guidelines (1998) recommend the measurement of waist circumference (WC, centimeters) within body mass index (BMI, kilograms per square meter) categories as a screening tool for increased health risk. RESEARCH METHODS AND PROCEDURES: The Canada Heart Health Surveys (1986 through 1992) were used to describe the prevalence of the metabolic syndrome in Canada and to test the use of the NIH guidelines for predicting metabolic risk factors. The sample included 7981 participants ages 20 to 74 years who had complete data for WC, BMI, high-density lipoprotein-cholesterol, triglycerides, diabetic status, and systolic and diastolic blood pressures. National Cholesterol Education Program Adult Treatment Panel III risk categories were used to identify the metabolic syndrome and associated risk factors. Logistic regression was used to test the hypothesis that WC improves the prediction of the metabolic syndrome, within overweight (25 to 29.9 kg/m(2)) and obese I (30 to 34.9 kg/m(2)) BMI categories. RESULTS: The prevalence of the metabolic syndrome was 17.0% in men and 13.2% in women. The odds ratios (OR) for the prediction of the metabolic syndrome were elevated in overweight [OR, 1.85; 95% confidence interval (95%CI), 1.02 to 3.35] and obese (OR, 2.35; 95%CI, 1.25 to 4.42) women with a high WC compared with overweight and obese women with a low WC, respectively. On the other hand, WC was not predictive of the metabolic syndrome or component risk factors in men, within BMI categories. DISCUSSION: In women already at increased health risk because of an elevated BMI, the additional measurement of WC may help identify cardiovascular risk.     

Relationship of BMI, waist circumference, and weight change with use of health services by older adults

OBJECTIVE: To examine the relationship of BMI, waist circumference (WC), and weight change with use of health care services by older adults. RESEARCH METHODS AND PROCEDURES: This was a prospective cohort study conducted from 2001 to 2003 among 2919 persons representative of the non-institutionalized Spanish population > or =60 years of age. Analyses were performed using logistic regression, with adjustment for age, educational level, size of place of residence, tobacco use, alcohol consumption, and presence of chronic disease. RESULTS: Obesity (BMI > or = 30 kg/m(2)) and abdominal obesity (WC >102 cm in men and >88 cm in women) in 2001 were associated with greater use of certain health care services among men and women in the period 2001-2003. Compared with women with WC < or = 88 cm, women with abdominal obesity were more likely to visit primary care physicians [odds ratio (OR): 1.36; 95% confidence limit (CL): 1.06-1.73] and receive influenza vaccination (OR: 1.30; 95% CL: 1.03-1.63). Weight gain was not associated with greater health service use by either sex, regardless of baseline BMI. Weight loss was associated with greater health service use by obese and non-obese subjects of both sexes. In comparison with those who reported no important weight change, non-obese women who lost weight were more likely to visit hospital specialists (OR: 1.45; 95% CL: 1.02-2.06), receive home medical visits (OR: 1.61; 95% CL: 1.06-2.45), be hospitalized (OR: 1.88; 95% CL: 1.29-2.74), and have more than one hospital admission (OR: 2.31; 95% CL: 1.19-4.47). DISCUSSION: Obesity and weight loss are associated with greater health service use among the elderly.     

Frailty status is related to general and abdominal obesity in older adults

The association between frailty and obesity may differ according to the heterogeneity of body mass index (BMI) and waist circumference (WC) phenotypes in older adults. We hypothesized that the use of simple indicators of general and abdominal obesity combined, may more accurately represent obesity and allow to further elucidate on how frailty status and its criteria are related to obesity. A sample of 1444 older adults, aged ≥65 years (Nutrition UP 65 study) was included in a cross-sectional analysis. General and abdominal obesity were defined according to World Health Organization BMI and WC cut-offs, and frailty by Fried et al. phenotype. A cluster analysis defined groups according to BMI and WC levels. Overweight (BMI between 25.0 and 29.9 kg/m²; 44.6%), general obesity (BMI ≥30.0 kg/m²; 39.0%), and abdominal obesity (WC >102 cm for men and >88 cm for women) were highly frequent (66.5%). Prefrailty (odds ratio [OR]: 2.33; 95% confidence interval [CI]: 1.52-3.57) and frailty (OR: 2.87; 95% CI: 1.58-5.22) were directly associated with the “general and abdominal obesity” cluster. Regarding frailty criteria, low handgrip strength (OR: 2.29; 95% CI: 1.55-3.38) and weight loss (OR: 0.27; 95% CI: 0.14-0.52) were also associated with this cluster. In this sample of older adults presenting a high frequency of overweight and obesity, prefrailty and frailty are linked to higher levels of adiposity, but only when both general and abdominal obesity are present. Present results emphasize the importance of the evaluation of both BMI and WC in the geriatric clinical practice and suggest that older adults presenting both general and abdominal obesity should be routinely screened for frailty.     

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。     

Variation by body mass index and age in waist-to-hip ratio associations with glycemic status in an aboriginal population at risk for type 2 diabetes in British Columbia, Canada

BACKGROUND: It is unclear whether obesity and age modify or confound relations between abdominal adiposity and metabolic risk factors for type 2 diabetes. OBJECTIVE: Our objective was assess the consistency of relations between abdominal adiposity and glycemic variables across discrete categories of obesity and age. DESIGN: We performed a stratified analysis of prevalence data from a rural screening initiative in British Columbia, Canada. Subjects were Salishan Indians, all healthy relatives of individuals with type 2 diabetes [n = 151; age: 18-80 y; body mass index (BMI, in kg/m2): 17.0-48.2]. We measured waist-to-hip ratio (WHR) (2 categories); insulin, glycated hemoglobin (Hb A1c), and 2-h glucose concentrations (2 categories); and BMI (4 categories). BMI and age-specific odds ratios (ORs) and 95% CIs were calculated. RESULTS: WHR-glycemic variable relations were not consistent across BMI and age strata. Risks associated with high WHR were: for persons with BMIs from 25 to 29, elevated insulin (OR: 6.71; 95% CI: 1.41, 34.11) and Hb A1c (OR: 16.23; 95% CI: 2.04, 101.73) concentrations; for persons aged 18-34 y, elevated insulin concentrations [OR: indeterminate (+infinity); 95% CI: 1.89, +infinity]; and, for persons aged 35-49 y, elevated Hb A1c (OR: +infinity; 95% CI: 3.17, +infinity) and 2-h glucose (OR: 9.15; 95% CI: 1.74, 59.91) concentrations. CONCLUSIONS: WHR discriminates risk of type 2 diabetes in overweight but not obese individuals. Abdominal adiposity is associated with elevated insulin concentrations in younger age groups and with impaired glucose control in middle-aged groups, suggesting metabolic staging by age on a continuum from insulin resistance to impaired glucose tolerance.     

儿童肥胖对高血压发病率影响的随访研究

目的 探讨儿童肥胖状态及肥胖状态的改变对其高血压发病率的影响.方法 采取前瞻队列研究的方法,抽取2004年北京市儿童青少年代谢综合征队列人群中2189名6～16岁血压正常儿童,于2010年12月对其随访,进行身高、腰围(WC)、体重和血压的测量.分别以体质指数(BMI)和WC作为评价超重、肥胖、腹型肥胖的指标.以不同肥胖状态组设置哑变量,以随访时点是否高血压作为结局变量,进行非条件logistic回归分析,分析基线肥胖状态及肥胖状态的改变与高血压发病率之间的关系,并计算相应的OR值及95%CI值.结果 共完成了1184名在校学生的随访,6年间高血压累积发病率为19.9%(236/1184).男性高血压发病率(23.2%,149/643)高于女性(16.1%,87/541) (χ2=9.257,P=0.002).基线非超重组、超重组、肥胖组随访期间高血压累积发病率分别为8.7%(45/519)、19.3%(35/181)、32.4%(156/484)(χ2=9.332,P<0.001),基线非肥胖组与腹型肥胖组随访期间高血压累积发病率分别为10.3%(63/613)、30.7%(173/567) (χ2=77.753,P<0.001).基线肥胖组的高血压发病危险高于基线非超重组(BMI:OR=4.9,95%CI:3.4～7.0)和基线非肥胖组(WC:OR=3.9,95%CI:2.8～5.3);基线时BMI、WC水平相同时,随访时BMI、WC水平增加,高血压发病危险增加.控制年龄、性别,基线BMI和WC每增加1 kg/m2和1 cm,高血压发病风险分别增加0.21和0.07倍,OR(95%CI)值分别为1.21(1.16～1.26)和1.07(1.05～1.09);随访时BMI和WC改变量每增加1 kg/m2和1 cm,高血压发病风险分别增加0.16和0.05倍,OR(95%CI)值分别为1.16(1.11～1.22) 和1.05(1.03～1.07).结论 儿童肥胖及肥胖水平升高的改变会增加其高血压发病风险.

Abstract：

Objective To explore the impact of obesity level and the level change in childhood on hypertension incidence.Methods A perspective cohort study was conducted.As part of Beijing Child and Adolescent Metabolic Syndrome Study,2189 aged 6-16 year non-hypertensive children was followed up in December,2010.In this study,height,weight,waist circumference (WC) and blood pressure was measured at follow-up,and body mass index (BMI) and WC was respectively used to assess overweight,obesity and abdominal obesity.Non-conditional logistic regression was used to evaluate the association between baseline obesity status, change of obesity status and hypertension incidence. OR and 95%CI were computed in the model using obese status as dummy variable and hypertension at follow up visit as dependent variable.Results The total hypertension incidence of 1184 subjects during 6 years follow-up was 19.9%(236/1184).The hypertension incidence in male (23.2%,149/643) was higher than that in female (16.1%,87/541) (χ2=9.257,P=0.002).The hypertension incidence of non-overweight,overweight and obese children at baseline was 8.7%(45/519),19.3%(35/181) and 32.4%(156/484)respectively (χ2=9.332,P<0.001),and the incidence of non-obese and abdominal obese children at baseline was respectively 10.3%(63/613) and 30.7%(173/567) (χ2=77.753,P<0.001).Hypertension incidence in the baseline obesity group was higher than the non-overweight (BMI:OR=4.9,95%CI:3.4-7.0) and non-obese group (WC:OR=3.9,95%CI: 2.8-5.3).The hypertension incidence increased with the follow-up BMI/WC level,based on the same baseline level of BMI and WC.The hypertension risk increased to 0.21 and 0.07 times respectively with elevation of baseline BMI level by 1 kg/m2 and WC level by 1 cm,and OR(95%CI) were 1.21(1.16-1.26) and 1.07(1.05-1.09),respectively.Similarly,the hypertension risk increased 0.16 and 0.05 times respectively with the elevation of BMI level change by 1 kg/m2 and 1 cm,and OR (95%CI) were 1.16(1.11-1.22) and 1.05(1.03-1.07),respectively.Conclusion Obesity and increased obesity level change in childhood can increase the risk of incident hypertension.     

Obesity, abdominal obesity, and clustering of cardiovascular risk factors in South Korea

The aim of this study was first, to investigate the prevalence of obesity, abdominal obesity, and clustering of cardiovascular (CVD) risk factors, and secondly, to identify the BMI or waist circumference (WC) level at which clustering increases in South Koreans. A population-based, cross-sectional National Health Examination Survey was carried out in 1998. A total of 8,816 subjects (4,029 men and 4,787 women) aged 15-79 y were selected by stratified multistage probability sampling design. The measurements taken of the subjects included: height, weight, waist and hip circumference, blood pressure, fasting glucose, and lipids. The prevalence of BMI > or = 25 kg/m2 was 25.3% for men and 28.3% for women. The prevalence of WC >90 cm in men, and >80 cm in women was 18.5%, and 38.5%, respectively. Clustering of 3 or more CVD risk factors was 22.7% in men ad 21.7% in women. Using <21 kg/m2; as a referent, subjects with BMI of 23 kg/m2; and 27 kg/m2; had an odds ratio of 3.5 and 10.2 in men, and 3.1 and 6.7 in women, respectively for clustering of CVD risk factors. Using <65 cm as a referent, subjects with a WC of > or = 90 cm in men and > or = 85 cm in women had an odds ratio of 13.4, and 13.6, respectively for clustering of CVD risk factors. Considering the significant associations between clustering of CVD risk factors and BMI or WC, the present study suggests that high prevalence of overweight may have important implications for the health care system, even at a lower level of BMI or WC.     

Prospective study of optimal obesity index cutoffs for predicting development of multiple metabolic risk factors: the korean genome and epidemiology study

Background: In this prospective cohort study, we estimated the risk of developing more than 1 metabolic risk factor, using different obesity indices. In addition, we investigated the relative usefulness of the obesity indices for predicting development of such risk factors and calculated optimal cutoffs for the obesity indices.Methods: The cohort comprised 10 038 representative residents of a small city and a rural county who were recruited in 2001-2002. Follow-up examinations were conducted every 2 years. Among the 3857 participants without metabolic syndrome at baseline, 1102 new cases occurred during the 6-year follow-up. Receiver operating characteristic (ROC) curves for the obesity indices were plotted to compare the usefulness of the obesity indices.Results: The numbers of new cases of multiple metabolic risk factors among people in the highest quintiles of body mass index (BMI), waist circumference (WC), waist-hip ratio (WHR), and waist-height ratio at the baseline examination were 2 to 3 times those in the lowest quintiles. The area under the ROC curve for WHR was significantly higher than that for BMI. The optimal BMI cutoff was 24 kg/m(2) in men and women, and the optimal WC cutoffs were 80 cm and 78 cm in men and women, respectively.Conclusions: Both overall obesity and central obesity predicted risk of developing multiple metabolic risk factors, and WHR appeared to be a better discriminator than BMI. To prevent development of metabolic diseases among Koreans, it might be useful to lower the cutoff for abdominal obesity, as defined by WC.     

Race-ethnicity-specific waist circumference cutoffs for identifying cardiovascular disease risk factors

BACKGROUND: Waist circumferences (WCs) in white men and women that represent a risk of cardiovascular disease (CVD) equivalent to that of body mass indexes (BMIs; in kg/m2) of 25 and 30 have been identified. However, WC cutoffs for other race-ethnicity groups remain unknown. OBJECTIVE: The objective was to determine WC cutoffs for CVD risk in non-Hispanic blacks (blacks), Mexican Americans (MA), and non-Hispanic whites (whites). DESIGN: Data from 10,969 participants in the third National Health and Nutrition Examination Survey (1988-1994) were analyzed. The presence of CVD risk factors was the main outcome. Sex- and race-ethnicity-specific WC cutoffs were determined with logistic regression models by linking WC cutoffs with equivalent CVD risk based on BMI cutoffs for overweight and obesity. WC cutoffs for metabolic syndrome risk factors were similarly calculated. RESULTS: Correlations between WC and lipid profiles, blood pressure, and glucose were significantly higher than those between BMI and these same variables in all groups. The WC cutoffs were approximately 5-6 cm greater for white than for black men at BMIs between 25 and 40, and those for MA were intermediate. In women, few differences in WC cutoffs were observed between the groups. Simplified WC cutoffs corresponding to BMIs of 25 and 30, largely independent of age, for the 3 race-ethnicity groups were 89 and 101 cm for men and 83 and 94 cm for women. Minimal distances in receiver operating characteristic curves tended to be shorter when WC cutoffs rather than BMI cutoffs were used. CONCLUSIONS: WC is a better indicator of CVD risk than is BMI in the 3 race-ethnicity groups studied. The proposed WC cutoffs are more sensitive than are BMI cutoffs in predicting CVD risk.