Predictive Ability of Hypertriglyceridemic Waist,Hypertriglyceridemic Waist-to-Height Ratio,and Waist-to-Hip Ratio for Cardiometabolic Risk Factors Clustering Screening among Chinese Children and Adolescents

Objective Hypertriglyceridemic waist(HW),hypertriglyceridemic waist-to-height ratio(HWHtR),and waist-to-hip ratio(WHR)have been shown to be indicators of cardiometabolic risk factors.However,it is not clear which indicator is more suitable for children and adolescents.We aimed to investigate the relationship between HW,HWHtR,WHR,and cardiovascular risk factors clustering to determine the best screening tools for cardiometabolic risk in children and adolescents.Methods This was a national cross-sectional study.Anthropometric and biochemical variables were assessed in approximately 70,000 participants aged 6–18 years from seven provinces in China.Demographics,physical activity,dietary intake,and family history of chronic diseases were obtained through questionnaires.ANOVA,χ2 and logistic regression analysis was conducted.Results A significant sex difference was observed for HWHtR and WHR,but not for HW phenotype.The risk of cardiometabolic health risk factor clustering with HW phenotype or the HWHtR phenotype was significantly higher than that with the non-HW or non-HWHtR phenotypes among children and adolescents(HW:OR=12.22,95%CI:9.54-15.67;HWHtR:OR=9.70,95%CI:6.93-13.58).Compared with the HW and HWHtR phenotypes,the association between risk of cardiometabolic health risk factors(CHRF)clustering and high WHR was much weaker and not significant(WHR:OR=1.14,95%CI:0.97-1.34).Conclusion Compared with HWHtR and WHR,the HW phenotype is a more convenient indicator with higher applicability to screen children and adolescents for cardiovascular risk factors.

Factors associated with improvement in waist-to-height ratio among newly diagnosed type 2 diabetes patients treated with acarbose or metformin:A randomized clinical trial study

BACKGROUND The waist-to-height ratio(WHtR)is a promising anthropometric measure used to evaluate cardiovascular risk in diabetes and metabolic syndrome patients.The metformin and acarbose in Chinese as the initial hypoglycaemic treatment trial demonstrated that acarbose and metformin reduced the WHtR after 24 wk of treatment.AIM To investigate the factors associated with a decrease in the WHtR in newly diagnosed Chinese type 2 diabetes patients receiving acarbose or metformin monotherapy.METHODS At 24 wk,343 patients in the acarbose treatment and 333 patients in the metformin treatment were included in this analysis.On the basis of the reduction in the WHtR,these participants were divided into the following two groups:LowΔWHtR group and highΔWHtR group.Metabolic and related parameters associated with a highΔWHtR were investigated using univariate and multivariate logistic regression analyses.RESULTS A significant decrease in the WHtR was observed in both treatment groups(acarbose:-0.015,95%confidence interval[CI]:-0.018 to-0.012,P<0.001;metformin:-0.013,95%CI:-0.016 to-0.010,P<0.001).In both the acarbose and metformin groups,the WHtR of the women was more likely to be reduced than that of the men.In the acarbose group,a lower baseline area under the curve of glucagon-like peptide 1(AUCGLP-1)was associated with a highΔWHtR(odds ratio[OR]=0.796,P<0.001),while a higher baseline AUCGLP-1 was associated with a highΔWHtR in the patients treated with metformin(OR=1.133,P=0.025).Regarding the changes from baseline,an increase in AUCGLP-1 was associated with a highΔWHtR in the acarbose(OR=1.121,P=0.016)but not metformin group.A higher reduction in high-density lipoprotein cholesterol/non-highdensity lipoprotein cholesterol was also associated with a highΔWHtR in the acarbose arm(OR=20.735,P=0.001).In the metformin arm,a higher reduction in fasting plasma glucose(OR=0.843,P=0.039)and total cholesterol was associated with a highΔWHtR(OR=0.743,P=0.013).CONCLUSION A lower glucagon-like peptide 1 level and higher increase in glucagon-like peptide 1 are associated with a high reduction in the WHtR in newly diagnosed Chinese diabetes patients receiving treatment with acarbose.

BMI, WC, WHtR, VFI and BFI: Which Indictor is the Most Efficient Screening Index on Type 2 Diabetes in Chinese Community Population

Objective Obesity is a major risk factor for type 2 diabetes, many indexes can be used to describes obesity and predict diabetes. This research attempts to identify the best indicator of obesity to screening diabetes in Chinese population. Methods A cross-sectional data of 8121 subjects aged 35-60 years were included in this research belongs to the Diabetes Appropriate Technology Intervention Study. Anthropometric indicators including body weight, height, waist circumferences （WC）, body fat index （BFI） and visceral fat index （VFI） and blood biochemical indicators after an overnight fast [fasting blood glucose, total cholesterol, high-density lipoprotein （HDL） cholesterol, and triacylglycerol] were measured. BMI （body mass index） and Weight to Height Ratio was calculated. Results Subjects with obesity had a higher risk of physician diagnosed diabetes （0R=2.50, 95% CI 1.83-3.43）, new diagnosed diabetes （0R=4.23, 95% Cl 2.91-6.15） and pre-diabetes （0R=1.75, 95% CI 1.31-2.34） compared to those with normal Body mass index （BMI）. There was a significant trend of increased risk of all diabetes status with increased waist circumference （WC）. The waist-to-height ratio （WHtR） yielded the most significant association with new diagnosed diabetes and physician diagnosed diabetes than other indices. Conclusion Central obesity is significantly correlated with diabetes. VFI was most correlated with pre-diabetes while WHtR is an efficient screening index than BMI and WC in Chinese community diabetes screening.

Prevalence and Correlates of Elevated Blood Pressure in Chinese Children Aged 6-13 Years: a Nationwide School-Based Survey

Objective To estimate the prevalence of elevated blood pressure（EBP） in Chinese children and identify individual and family factors associated with EBP. Methods A nationwide cross-sectional study was conducted in 2010 using stratified cluster sampling. Participants＇ blood pressure was measured, and their parents completed a questionnaire on personal and family characteristics. Prevalence and correlates of EBP were assessed. Results Among a total of 24,333 participants, 20.2% of boys and 16.3% of girls had EBP. The prevalence of EBP increased with the ascending trend of waist circumference, Waist-to-height ratio, and body mass index. The adjusted prevalence ratios（aP Rs） for obese boys and girls were 2.50 and 2.97, respectively. Fewer urban boys（16.2%） had EBP than rural boys（21.7%）. Boys with a family history of hypertension were 12% more likely to have EBP. Children whose mothers received a college education tended to have lower likelihood of EBP; with an aP R was 0.85 among boys and 0.78 among girls. Conclusion EBP is common among obese students and those who have a family history of hypertension. A negative association between mothers＇ education levels and EBP risk in children was found.

Measures of Abdominal Adiposity and Risk of Stroke:A Dose-Response Meta-analysis of Prospective Studies

Objective Waist circumference, waist-to-hip ratio and waist-to-height ratio, which are the indicators or measures of abdominal adiposity, have long been hypothesized to increase the risk of stroke; yet evidence accumulated till date is not conclusive. Here, we conducted a dose-response meta-analysis to summarize evidences of the association between these measures of abdominal adiposity and the risk of stroke. Methods PubMed and Web of Science databases were searched from inception to May 2015. Two investigators independently conducted the study selection and data extraction. Dose-response relationships were assessed by the generalized least squares trend estimation, while the summary effect estimates were evaluated by the use of fixed- or random-effect models. Subgroup and sensitivity analyses were performed to assess the potential sources of heterogeneity and the robustness of the pooled estimation. Publication bias of the literature was evaluated using Begg＇s and Egger＇s test. Results Altogether 15 prospective cohort studies were identified in this study. The summary of relative risks （95% confidence intervals） of stroke for the highest versus the lowest categories was 1.28 （1.18-1.40） for waist circumference, 1.32 （1.21-1.44） for waist-to-hip ratio, and 1.49 （1.24-1.78） for waist-to-height ratio. For a 10-cm increase in waist circumference, the relative risk of stroke increased by 10%; for a 0.1-unit increase in waist-to-hip ratio, the relative risk increased by 16%; and for a 0.05-unit increase in waist-to-height ratio, the relative risk increased by 13%. There was evidence of a nonlinear association between waist-to-hip ratio and stroke risk, Pnonlinearity=0.028, Conclusion Findings from our meta-analysis indicated that waist circumference, waist-to-hip ratio, and waist-to-height ratio were positively associated with the risk of stroke, particularly ischemic stroke.

Relationship between intraocular pressure and parameters of obesity in ocular hypertension

AIM:To evaluate the correlation between intraocular pressure(IOP)and various obesity-related health factors in patients with ocular hypertension in Korea.METHODS:A total of 40850 subjects underwent age,sex,body weight,and height assessments and automated multiphasic tests,including non-contact tonometry,automated perimetry,fundus photography,systolic/diastolic blood pressure measurement,and evaluation of obesity-related health parameters such as obesity index,body mass index(BMI),a body shape index(ABSI),and waist-to-height ratio(WtHR).Subjects were divided into ocular hypertension group and normal IOP group according to IOP after matching of age and sex.RESULTS:Of 40850 participants,1515(3.7%)had ocular hypertension,and 1515 with normal IOP were selected as controls using propensity score matching.The mean IOP of control group was 15.3±2.3 mm Hg,compared with 23.3±1.6 mm Hg in ocular hypertension group.Height,obesity index,BMI,and WtHR in the ocular hypertension group were significantly higher than in the normal IOP group(P<0.001,P<0.001,P=0.009,P=0.002).IOP of ocular hypertension was positively correlated with obesity index(P=0.027)and BMI(P=0.016),whereas IOP of control was positively correlated with blood pressure(P<0.001,P=0.002),obesity index(P<0.001),BMI(P<0.001),and WHtR(P=0.002).Systolic blood pressure(β=0.022,P<0.001)and body weight(β=0.016,P=0.02)were precursors of IOP in normal subjects,but sex(male;β=-0.231,P=0.008)and obesity index(β=-0.007,P=0.017)were precursors of ocular hypertension according to multiple regression analysis.CONCLUSION:Among various obesity-related health parameters,obesity index is the best indicator for further increase in IOP in ocular hypertension group.

Acarbose is again on the stage

Acarbose is an agent that has been used to treat type 2 diabetes for about 30 years;it prevents postprandial hyperglycemia by inhibiting carbohydrate digestion in the small intestine.Since incretin-based treatments have been preferred over the last 10 to 15 years,the use of acarbose is not as common in treating type 2 diabetes as before.Some studies have shown that acarbose also produces a weight-loss effect by increasing glucagon-like peptide 1(GLP-1).The positive effect of acarbose on GLP-1,and increasing evidence that it provides cardiovascular protection,suggests that acarbose may again be considered among the first-choice antidiabetic agents,as it was in the 1990s.

Optimal Cut-off Point of Waist to Height Ratio in Beijing and Its Association with Clusters of Metabolic Risk Factors

A host of studies found waist-to-height ratio(WHtR)having higher diagnostic value than other abdominal obesity anthropometric indicators for metabolic disorders.But the cut-off points are still not consistent.This study was aimed to explore the optimal cut-off point of WHtR in Chinese population and identify the association between WHtR and cluster of metabolic risk factors.In total,13379 Han adults(7553 men and 5726 women)from over 40 institutions who took physical examination in Xuanwu Hospital of Capital Medical University between January 2014 and January 2015 were involved in this cross-sectional study.Subjects with two or more components of metabolic syndrome(MetS)were considered to have multiple risk factors.Optimal cut-off points of WHtR for cluster of metabolic risk factors were analyzed by receiver operating characteristic(ROC)curve analysis.The optimal cut-off points of WHtR were 0.51 for men and 0.49 for women.People with elevated WHtR had higher levels of metabolic risk factors.And the prevalence of individual and clusters of 5 risk factors were all higher among WHtR-defined abdominal obesity people than in normal subjects.The optimal cut-off points of WHtR were 0.51 for men and 0.49 for women.In conclusion,people with elevated WHtR.are susceptible to cluster of metabolic risk factors.

Evaluating Obesity Index among Children with Developmental Disorders

The prevalence of obesity not only among adults but also among children has been increasing globally. Furthermore, obese children reportedly go on to be obese in adulthood. Obesity is likely to cause lifestyle-related diseases not only in able-bodied individuals but also in disabled children. Specific cognitive behavior observed in disabled children often hinders the provision of lifestyle guidance, such as nutritional and physical exercise instructions. To prevent such situations, early identification of obesity is required to improve lifestyle habits through diet and exercise in disabled children. This study included 285 children with developmental disorders. To assess a childhood obesity index, three obesity-related parameters were compared: the degree of obesity in school health, which has been used to evaluate the health of school children in Japan;abdominal circumference, which is useful for predicting visceral fat obesity;and the waist-to-height ratio (WHtR), which reflects visceral fat and physique. The abdominal circumference was significantly dependent on age. The degree of obesity and WHtR did not show a significant association with age. WHtR was significantly associated with the degree of obesity in school health. The WHtR is easily calculated as compared to the degree of index in school health which needs rather complicated calculations depending on age and age-specific coefficients. The study findings suggest that WHtR might be an easy-to-use obesity index comparable to the degree of obesity in school health in children with developmental disorders.

What is the appropriate strategy for diagnosing NAFLD using ultrasonography in obese children?

Background:The aim of this study is to identify obese children who are candidates for a potential diagnosis of non-alcoholic fatty liver disease (NAFLD).Methods:We enrolled 242 obese children (122 boys and 120 girls) aged 7-16 years who were examined with abdominal ultrasonography in our pediatric obesity clinic.We compared patients in the normal group with those in the NAFLD group (mild disease,moderate to severe disease) and identified the optimal anthropometric parameters among height,weight,body mass index (BMI),waist circumference,hip circumference,waist to height ratio (WHtR),and waist to hip ratio to predict NAFLD using a receiver operating characteristic curve analysis.We also investigated risk factors associated with NAFLD for the anthropometric parameters and the biochemical model using logistic regression.Results:The high-and low-risk groups for hepatic steatosis relative to a WHtR of 0.56 as the standard point showed significant differences in hepatic steatosis severity grade (P<0.001),BMI (P=0.004),hip circumference (P=0.090),aspartate aminotransferase (P<0.001),alanine aminotransferase (P<0.001),triglycerides (P=0.001),and the triglyceride to high-density lipoprotein (HDL) cholesterol ratio (P=0.006).Risk factors for hepatic steatosis on logistic regression analysis were male sex (odds ratio:3.68,95% confidence interval:1.76-7.70),WHtR >0.56 (2.25,1.05-4.81),and waist circumference >90th percentile (20.22,9.21-44.36) in the anthropometric parameter model and elevated alanine aminotransferase levels (boys >25.8 U/L,girls >22.1 U/L) (6.93,2.52-19.03),hypertriglyceridemia (>110 mg/dL) (3.80,1.23-11.75),and triglyceride to HDL cholesterol ratio >3 (9.23,2.95-8.83) in the biochemical parameter model.Conclusions:A diagnostic approach to hepatic steatosis is recommended as part of the proper screening and stratification of risk factors in obese children.WHtR is a simple and convenient method of effectively identifying obese children who are candidates for hepatic steatosis screening.