Type 2 diabetes and risk of non-embolic ischaemic stroke in Japanese men and women

Aims/hypothesis The aim of this study was to examine the relationship between type 2 diabetes and risk of ischaemic stroke in Asian populations.Methods We conducted a 17-year prospective cohort study in 10,582 Japanese individuals (4287 men and 6295 women) aged 40–69 years living in five communities in Japan. All subjects were free of stroke and CHD at baseline. Diabetes was defined as a fasting glucose level of 7.0 mmol/l, a non-fasting glucose of 11.1 mmol/l, or receiving medication for diabetes.Results The risk of non-embolic ischaemic stroke was approximately two-fold higher in diabetic subjects than in subjects with normal glucose levels. The multivariate relative risk after adjustment for age, community, hypertensive status, BMI, triceps and subscapular skinfold thickness (TSF and SSF), and other known cardiovascular risk factors was 1.8 (95% CI 1.0–3.2) for men and 2.2 (1.2–4.0) for women. This excess risk was primarily observed among non-hypertensive subjects and individuals with higher values for measures of adiposity (BMI, TSF and SSF values above the median), particularly those with higher values for SSF. The association between non-embolic ischaemic stroke and glucose abnormality was particularly strong among non-hypertensive subjects with higher SSF values: the multivariate relative risk was 1.9 (1.0–3.7) for borderline diabetes and 4.9 (2.5–9.5) for diabetes.Conclusions/interpretation In this cohort, type 2 diabetes was a significant risk factor for non-embolic ischaemic stroke, particularly in non-hypertensive and non-lean individuals. Due to the nationwide decrease in blood pressure and increase in mean BMI among the Japanese population, with current levels approaching those observed in Western countries, the impact of glucose abnormalities on risk of ischaemic stroke represents a forthcoming public health issue in Japan.     

Book review of Human Growth: Assessment and Interpretation. By Alex F. Roche and Shumei S. Sun. (Cambridge University Press,Cambridge, 2003). [pp. 311]. ISBN: 0 521 78245 7. US$95, £53.50.

Background: In many parts of the developing world, modernization has resulted in an increase in the prevalence of overweight and obesity and a subsequent rise in nutrition-related, non-communicable diseases such as cardiovascular disease and Type 2 diabetes.

Aim: The study examined the impact of socio-economic and lifestyle changes associated with modernization on the body size and shape of Balinese women.

Subjects and methods: Anthropometric data including weight, height, body mass index (BMI) and seven skinfolds were collected from 564 Balinese women, aged between 15 and 45 years. The relationship between the degree of ‘modernization’ (using such parameters as household wealth and education level) and body size and shape was analysed using multiple regression analysis, as was the effect of age, family size and breast-feeding.

Results: Using the WHO (WHO ) categories of BMI, 14% of Balinese women displayed Chronic Energy Deficiency (BMI<18.5?kg?m^?2), 7% were overweight (BMI?=?25.0–29.9?kg?m^?2) and less than 1% were obese (BMI?≥?30.0?kg?m^?2). Household wealth (p<0.0001) and education level (p<0.05) were significantly associated with fatness, while breast-feeding (p<0.05) was significantly associated with leanness. Fat distribution was largely independent of biological and socio-economic variables.

Conclusions: The trend toward increasing fatness associated with greater household wealth and higher education has important health implications for Balinese women as they continue their rapid transition from subsistence agriculture towards a more ‘western’ lifestyle.

Résumé. Arrière plan: Dans de nombreuses régions du globe, à la faveur du développement et de la modernisation, est apparue une prévalence du surpoids et de l’obésité ainsi qu’un accroissement corollaire de maladies non infectieuses telles que les maladies cardiovasculaires et le diabète de type 2.

But: L’étude examine l’impact des changements socioéconomiques et de style de vie associés à la modernisation, sur le format et la forme du corps des femmes balinaises.

Sujets et méthodes: Des données anthropométriques comprenant le poids, la stature, l’indice de masse corporelle (IMC) et sept plis cutanés, ont été collectées sur 564 femmes balinaises âgées de 15 à 45 ans. La relation entre le degré de ‘modernisation’ (au moyen de paramètres tels que l’aisance du foyer et le niveau éducatif) et la forme et le format corporel a été analysée, ainsi que les effets de l’âge, de la dimension de la famille et de l’allaitement maternel, au moyen de régressions multiples.

Résultats: Par rapport aux catégories d’IMC de l’OMS (1995), 14% des femmes balinaises présentent une déficience chronique d’énergie (IMC<18,5?kg?m^?2), 7% ont du surpoids (IMC?=?25,0–29,9?kg?m^?2) et moins de 1% sont obèses (IMC≥30,0?kg?m^?2). L’aisance du foyer (p<0,0001) et le niveau éducatif (p<0,05) sont associés significativement à l’adiposité tandis que l’allaitement maternel l’est avec la minceur. La distribution de l’adiposité est largement indépendante des variables biologiques et socioéconomiques.

Conclusion: La tendance en direction d’un accroissement de l’adiposité en association avec meilleure aisance domestique et meilleure éducation présente des implications importantes pour la santé des femmes balinaises, dans la mesure où elles poursuivent une rapide transition d’une agriculture de subsistance à un mode de vie plus ‘occidental’.

Zusammenfassung. Hintergrund: In vielen Entwicklungsländern hat die Modernisierung zu einem Anstieg der Prävalenz von Übergewicht und Adipositas geführt und in der Folge zu einem Anstieg ernährungsabhängiger nicht-übertragbarer Erkrankungen wie kardiovaskulärer Krankheiten und Typ2 Diabetes.

Ziel: Die Studie untersuchte die Bedeutung der mit der Modernisierung einhergehenden, sozio-ökonomischen Veränderungen und der Veränderungen des Lebensstils auf Körpermaße und Körperproportionen Balinesischer Frauen.

Probanden und Methoden: Anthropometrische Daten einschließlich Gewicht, Höhe, Körpermasse-Index (body mass index, BMI) und sieben Hautfettfalten wurden bei 564 Balinesischen Frauen im Alter zwischen 15 und 45 Jahren erhoben. Die Beziehung zwischen dem Grad der ‘Modernisierung’ (unter Verwendung von Begriffen wie verfügbares Haushaltseinkommen und Schulbildung) und Körpermaßen und Körperproportionen wurde mittels multipler Regressionsanalysen hinsichtlich der Effekte von Alter, Familiengröße und Stillen untersucht.

Ergebnisse: Unter Verwendung der WHO-Kategorien () für BMI zeigten 14% der Balinesischen Frauen Zeichen eines chronischen kalorischen Defizits (BMI??2), 7% waren übergewichtig (BMI?=?25,0—29,9?kg?m^?2) und weniger als 1% waren adipös (BMI?≥?30,0?kg?m^?2). Verfügbares Haushaltseinkommen (p<0,0001) und Schulbildung (p<0,05) waren signifikant mit übergewicht, Stillen jedoch (p<0,05) signifikant mit Magerkeit korreliert. Die Fettverteilung war überwiegend unabhängig von den biologischen und sozio-ökonomischen Variablen.

Zusammenfassung: Der Trend zu zunehmendem Übergewicht, der mit größerem verfügbaren Haushaltseinkommen und besserer Schulbildung assoziiert ist, hat große gesundheitliche Bedeutung für Balinesischer Frauen, solange ihr rasanter Übergang von einer landwirtschaftlichen Subsistenzkultur zu einem mehr ‘westlichen’ Lebensstil anhält.

Resumen. Antecedentes: En muchos lugares del mundo en vías de desarrollo, la modernización ha producido un incremento de la prevalencia del sobrepeso y la obesidad así como del riesgo subsecuente de sufrir enfermedades no transmisibles relacionadas con la nutrición, como la enfermedad cardiovascular y la diabetes tipo 2.

Objetivo: El estudio examinó el impacto de los cambios socioeconómicos y del estilo de vida asociados con la modernización sobre el tamaño y la forma corporal de las mujeres balinesas.

Sujetos y Métodos: Se recogieron datos antropométricos que incluían el peso, la estatura y el índice de masa corporal (IMC) de 564 mujeres de Bali, con edades comprendidas entre los 15 y 45 años. La relación entre el grado de ‘modernización’ (utilizando parámetros como la salud familiar y el nivel de educación) y el tamaño y la forma del cuerpo se analizó mediante un análisis de regresión múltiple, que consideraba el efecto de la edad, el tamaño familiar y el amamantamiento.

Resultados: Según las categorías de la WHO () para el IMC, el 14% de las mujeres balinesas mostraron una Deficiencia Energética Crónica (IMC<18,5?kg?m^?2), el 7% presentaba sobrepeso (IMC?=?25,0–29,9?kg?m^?2) y menos del 1% eran obesas (IMC?≥?30,0?kg?m^?2). La salud familiar (p<0,0001) y el nivel de estudios (p<0,05) estaban significativamente asociados con la adiposidad (exceso de peso), mientras que el amamantamiento (p<0,05) estaba significativamente asociado con la delgadez. La distribución de grasa era muy independiente de las variables biológicas y socioeconómicas.

Conclusiones: La tendencia hacia un incremento de la adiposidad cuanto mejor es la salud familiar y mayor el nivel de educación tiene importantes implicaciones sanitarias para las mujeres balinesas, a medida que éstas continúan su rápida transición desde la agricultura de subsistencia hacia un estilo de vida más ‘occidentalizado’.     

A general IGF-I overexpression effectively rescued somatic growth and bone deficiency in mice caused by growth hormone receptor knockout

Both growth hormone and insulin-like growth factor (IGF)-I are essential for postnatal somatic growth, while exerting distinct effects on energy homeostasis. Although growth hormone controls IGF-I production, whether IGF-I was the exclusive mediator of its growth promotion is still debated. In order to further explore their in vivo interactions in somatic growth as well as in energy homeostasis, we have crossed mutant (MT-IGF) transgenic mice onto the GHR ? / ? background. As expected, GHR gene deficiency caused growth retardation, including significant decreases in lumbar, femur and total body lengths, as well as decreased bone area, mineral content and mineral density. IGF-I overexpression alone in MT-IGF mice increased the weight, with no significant change in bone mineralization or longitudinal growth. Compared to GHR ? / ? littermates, overexpressed IGF-I in bitransgenic mice (GHR ? / ? and MT-IGF positive) exhibited fully restored body weight, lumbar (but not femur) and total body lengths, and normalized overall bone area, mineral content and density. On the other hand, there were significant changes in fasting glucose level, glucose tolerance, lean/fat masses and even adipose histology as a result of the transgenic/knockout double-crossing. IGF-I overexpression normalized glucose tolerance in GHR ? / ? mice. Intriguingly, on GHR+/ ? background of partial growth hormone insensitivity, overexpression of IGF-I caused a significant weight gain. Our results thus establish that the growth defect and bone deficiency caused by lack of growth hormone signaling can be effectively restored by increasing IGF-I production in vivo.     

Genetically Predicted Adiposity,Diabetes, and Lifestyle Factors in Relation to Diverticular Disease

Background & AimsAdiposity, type 2 diabetes, alcohol and coffee consumption, and smoking have been examined in relation to diverticular disease in observational studies. We conducted a Mendelian randomization study to assess the causality of these associations.MethodsIndependent genetic instruments associated with the studied exposures at genome-wide significance were obtained from published genome-wide association studies. Summary-level data for the exposure-associated single nucleotide polymorphisms with diverticular disease were available in the FinnGen consortium (10,978 cases and 149,001 noncases) and the UK Biobank study (12,662 cases and 348,532 noncases).ResultsHigher genetically predicted body mass index and genetic liability to type 2 diabetes and smoking initiation were associated with an increased risk of diverticular disease in meta-analyses of results from the two studies. The combined odds ratio of diverticular disease was 1.23 (95% confidence interval [CI], 1.14–1.33; P < .001) for a 1-standard deviation (~4.8 kg/m²) increase in body mass index, 1.04 (95% CI, 1.01–1.07; P = .007) for a 1-unit increase in log-transformed odds ratio of type 2 diabetes, and 1.21 (95% CI, 1.12–1.30; P < .001) for a 1-standard deviation increase in prevalence of smoking initiation. Coffee consumption was not associated with diverticular disease, whereas the association for alcohol consumption largely differed between the 2 studies.ConclusionsThis study strengthens the causal associations of higher body mass index, type 2 diabetes, and smoking with an increased risk of diverticular disease. Coffee consumption is not associated with diverticular disease. Whether alcohol consumption affects the risk of diverticular disease needs further investigation.     

不同肥胖测量指标与成年女性血清C反应蛋白的关联研究

目的 探讨不同的肥胖测量指标对中国成年女性血清C反应蛋白(CRP)的关联。方法 数据来源于成都市双流区城镇乳腺癌筛查项目基线调查及随访调查,共纳入441名成年女性。对研究对象开展问卷调查、体格检查和实验室检测。采用多因素logistic回归模型、两水平线性混合效应模型和限制性立方样条模型探讨不同肥胖测量指标与成年女性血清CRP的线性和非线性关联。结果 BMI、腰围和体脂率每增加1个单位,成年女性血清CRP升高即慢性低度炎症状态加重的风险分别增加16.5%、5.0%和11.1%(P<0.05)。BMI和体脂率与血清CRP之间存在非线性关联,以BMI=24.0 kg/m²为参考点,当BMI>24.0 kg/m²时,血清CRP水平随BMI的增加而增加;以体脂率=30%为参考点,当体脂率>30%时,血清CRP水平随体脂率的增加而增加。结论 BMI反映的整体肥胖与成年女性血清CRP关联最强,体脂率反映的体脂含量与血清CRP关联强度次之,腰围反映的中心性肥胖与血清CRP关联相对最弱。BMI>24.0 kg/m²和体脂率>30%的成年女性是产生肥胖相关炎性表现的高危险人群。     

Predictive performance of obesity indexes for the risk of high blood pressure in an adult population

Background and objectives

Comparisons of predictive performance of various anthropometric measures in high blood pressure have not been investigated. This study aimed at evaluating and comparing the predictive power of Body Mass Index (BMI), Body Adiposity index (BAI) and A Body Shape Index (ABSI) for predicting hypertension in adults.

The Association of Taste with Change in Adiposity-Related Health Measures

The relationship between taste-intensity patterns and 5-year change in adiposity-related health measures was determined. Participants were members of the Beaver Dam Offspring Study, a study of the adult children of participants in the population-based Epidemiology of Hearing Loss Study. There were 1,918 participants (mean baseline age=48.8 years; range=22 to 84 years) with baseline taste (2005 to 2008) and follow-up (2010 to 2013) data. Outcomes included 5-year change in body mass index, waist circumference, blood pressure, non–high-density lipoprotein cholesterol, and glycosylated hemoglobin A1c, and hedonic ratings of specific foods. Cluster analysis with Ward's minimum variance method identified the following 5 patterns of the suprathreshold taste intensities of salt, sweet, sour, and bitter: salt and sweet intensities slightly above population averages, average sour and bitter intensities; salt, sour, and bitter intensities above population average, average sweet intensity; salt, sour, and bitter intensities above population average, sweet intensity substantially above average; all intensities below population averages; and all intensities close to population average. The General Linear Model procedure was used for testing cluster differences in the outcomes. With covariate adjustment, the group with all intensities close to population averages had a significantly lower average increase in body mass index compared with the group with above-average intensities for salt, sour, and bitter (+0.4 vs +0.9), and in glycosylated hemoglobin A1c compared with the group with above-average intensities for all tastes (+0.20% vs +0.34%). Clusters differed in the hedonics of foods representing sweetness and saltiness. The study's findings provide evidence that perceived taste intensity might be related to changes in adiposity-related health.     

Association of MC4R (rs17782313) gene polymorphism with obesity measures in Western India

Background and aimsThe association of melanocortin receptor 4 (MC4R) gene with adiposity measures is widely studied in European populations. Only six studies have investigated the role of MC4R gene with adiposity measures among Indian populations. We have evaluated the role of MC4R (rs17782313) gene polymorphism in influencing adiposity measures in India among children and adults.Materials and methodsThe present population based cross sectional study was conducted among 303 individuals (208 children and 95 adults) of age group 10–30 years, belonging to Rajasthan. Somatometric measurements (standing height, weight, and waist and hip girths) and blood samples were taken after obtaining written informed consent. Genotyping of MC4R rs17782313 single nucleotide polymorphism was done using restriction fragment length polymorphism method for polymerase chain reaction ampli?ed fragments. We examined association between rs17782313 and different adiposity measures (height, weight, BMI, WHR, and waist and hip girths) using linear regression models.ResultsThe MC4R variant (rs17782313) predicted increased body weight (0.15 kg, S.E ± 0.076, P = 0.043) among children. In combined population, the rs17782313 variant was moderately associated with body weight (0.13 kg, S.E ± 0.070, P = 0.057). This variant was not found to be associated with any other adiposity measure.ConclusionFurther studies are needed to evaluate the association of MC4R variants through sequencing and functional genomics with different adiposity measures in Indian populations for understanding the genetic underpinnings of adiposity in India.     

Circunferência do Pescoço e Risco Cardiovascular em 10 Anos na Linha de Base do ELSA-Brasil: Diferenciais por Sexo

Background:Neck circumference (NC), an indirect measure of upper-body subcutaneous adipose tissue, has been pointed out as an independent predictor of cardiometabolic diseases.Objectives:To assess the association between NC and 10-year cardiovascular risk in men and in women.Methods:Cross-sectional analysis of 13,920 participants of the (baseline) Longitudinal Study of Adult Health (ELSA-Brasil). The association between NC (used as continuous variable and grouped into quartiles) and the 10-year cardiovascular risk was estimated by the Framingham Global Risk Score and analyzed by generalized linear models after adjustments for sociodemographic characteristics, health behaviors, body mass index and waist circumference. The significance level adopted was 5%.Results:Mean NC was 39.5 cm (SD± 3.6) in men and 34.0 cm (SD±2.9) in women. After adjustments, a one-centimeter increase in NC was associated with an increment of 3% (95%CI1.02-1.03) and 5% (95% 1.04-1.05) in the arithmetic mean of the 10-year CVD risk in men and women, respectively. Men and women in the last quartile showed an increment of 18% (95%CI 1.13-1.24) and 35% (95%CI 1.28-1.43), respectively in the arithmetic mean of the 10-year CVD risk, after adjustments.Conclusions:We found a positive, independent association between NC and the 10-year cardiovascular disease risk. NC may contribute to the prediction of cardiovascular risk, over and above traditional anthropometric measures.