Central Obesity and Metabolic Risk Factors in Middle-aged Chinese

Objective Central obesity is considered to be a central component of metabolic syndrome. Waist circumference （WC） has been widely used as a simple indicator of central obesity. This study is aimed to evaluate the sensitivity of WC cut-off values for predicting metabolic risk factors in middle-aged Chinese. Methods The study involved 923 subjects aged according to the Chinese Joint Committee for 40-65 years. The metabolic risk factors were defined Developing Chinese Guidelines on Prevention and Treatment of Dyslipidemia in Adults. WC cut-off 85-90 cm and 〉90 cm were used as cut-off values of central pre-obesity and central obesity in males, respectively, while WC 80-85 cm and 〉85 cm were used as cut-off values of central pre-obesity and central obesity in females. Results First, WC values corresponding to body mass index （BMI） 24 kg/m2 and visceral fat area （VFA） 80 cm2 were 88.55 cm and 88.51 cm in males, and 82.46 cm and 82.52 cm in females respectively. Second, receiver operating characteristic curves showed that the optimal WC cut-off of value was 88.75 cm in males, higher than that in females （81.75 cm）. Third, the subjects with higher WC values were more likely to have accumulating metabolic risk factors. The prevalence of metabolic risk factors increased linearly and significantly in relation to WC levels. Conclusion WC cut-off values of central pre-/central obesity are optimal to predict multiple metabolic risk factors.

Association between central obesity and executive function as assessed by stroop task performance:A functional near-infrared spectroscopy study

Recent studies have suggested a link between executive function(EF)and obesity.Studies oftenadopt body mass index(BM),which reflects the distribution of subcutaneous fat,as the solemarker of obesity;however,BMI is inappropriate to distinguish central obesity,which indicatesthe centralized distribution of visceral fat.Visceral fat compared with subcutaneous fat repre-sents greater relative lipid turnover and may increase the risk of cognitive decline in older adults.However,the relationship between EF and central obesity is largely unknown,particularly inyoung adults.Therefore,we used waist circumference(WC)as a marker of central obesity andinvestigated diferent sensitivities between BMI and WC in the brain function.A total of 26healthy young adults(aged 18-25 years;42%female)underwent functional near-infrared spec-troscopy assessments.EF was assessed using the Stroop task,which is a classical measurementof EF.A significant Stroop effect was observed in the behavioral and hemodynamic data.Inaddition,we observed that behavioral interference on the Stroop task varied much more insubjects with higher BMI and WC than those subjects with lower.Elevated BMI and WC wereassociated with a decreased hemodynamic response during the Stroop task specifically in the pre-frontal cortex(PFC).Compared to BMI,WC was more closely connected with inhibitory controland revealed right lateralized PFC activation.Our findings suggest that WC is a reliable indicatorof brain function in young adults and propose a relationship bet ween EF and central obesity.

Zhang Xijian, a famous Chinese medicine practitioner in China, discusses the pathogenesis characteristics of adolescent central obesity based on "qi change theory"

Obesity[1]is a group of common and ancient metabolic diseases.Central obesity is common in clinical practice.Due to the simple constitution of adolescents,their pathogenesis is simple and changeable,or there is a mixture of cold and heat,or a mixture of cold and heat,or the same disease on the surface,and the pathogenesis of traditional Chinese medicine is complex and changeable.The pathogenesis of TCM pathogenesis of adolescent central obesity is analyzed with examples to provide new theoretical ideas for the treatment of obesity by Chinese medicine.

The Relationship Between Multiple Obesity Indices and Long-Term Prognosis in STEMI Patients:An Observational Cohort Study of 220 Cases

Objective:To investigate the association of body mass index(BMI),waist circumference(WC),and waist-to-height ratio(WHtR)with the long-term prognosis of ST-elevation myocardial infarction(STEMI)patients and to determine whether the combination of obesity indices can be used for risk stratification.Method:A multifactorial Cox regression analysis was performed using 3-year follow-up data from 220 STEMI patients to explore the relationship between obesity indicators and major adverse cardiovascular events(MACEs).The incidence of MACEs was also compared by combining BMI and WHtR.Results:WC was found to reduce the risk of MACEs within 25 months after myocardial infarction[hazard ratio(HR)=0.95,95%confidence interval(CI)=0.92-0.98,P<0.001].However,this effect was not significant beyond 25 months(HR=0.98,95%CI=0.97-1.07,P=0.49).Neither BMI nor WHtR were significantly associated with the risk of MACEs.The incidence of MACEs was highest in patients with low body weight(BMI<18.5 kg/m^(2))and WHtR>0.5,and lowest in obese patients(BMI≥28 kg/m^(2))with WHtR>0.5.Conclusions:BMI,WC,and WHtR were not significantly associated with the long-term prognosis of STEMI patients.However,the combination of BMI and WHtR can be useful for further stratifying patient risk.

Effects of obesity on lower urinary tract symptoms in Korean BPH patients

We analyzed the effects of obesity on lower urinary tract symptoms （LUTSs） in Korean benign prostatic hyperplasia （BPH） patients. This is a multicenter, cross-sectional, prospective study conducted in four centers in Korea. A total of 602 men with LUTSs secondary to BPH were included. BPH/LUTSs cases were men aged ≥ 40 years with intemational prostate symptom scores （IPSS） ≥ 8 points. Height, weight and waist circumference were measured. Among the 602 patients, 156 patients had a waist circumference above 90 cm, representing central obesity, and 215 patients had a body mass index above 25 kg m2. Waist circumference was positively correlated with prostate volume （P = 0.034）. Men with waist circumference 〉 90 cm experienced a 1.36-fold increased risk of severe LUTSs （95% CI 0.82-2.41） compared with men with waist circumference ≤ 90 cm. Prostate volume was positively correlated with urgency and nocturia in men with central obesity. In this population of Korean men diagnosed with BPH, central obesity rather than overall obesity seems to be the more important predictor of LUTSs correlated with BPH.

Waist Circumference Distribution of Chinese School-age Children and Adolescents

Background Waist circumference （WC）, a proxy measure of central body fat, is a better predictor than overall body fat for cardiovascular risk factors in both adults and children. WC cutoffs have been established in many countries, but the national WC reference has not been developed in China. Objective To study the distribution of WC in a representative group of Chinese children for establishing Chinese WC cutoff points. Methods Cross-sectional data obtained from 15 mainland provinces and Hong Kong were collected. There were 160 225 children and adolescents aged 7-18 years old in total. The subjects were divided into five regional groups namely costal city, other city, noah rural, south rural, and Hong Kong, for analyzing the distribution of WC. Results A large variation in WC distribution was found among the five groups for both sexes. Coastal city group had the highest P85 WC values consistently from the early school ages to 18-year-old compared with other groups. In contrast, south rural group had P85 values consistently lagged behind not only the city groups but also the north rural group. Hong Kong group had a high P85 WC at early ages, but because of the smaller increments of WC during adolescence, the P85 curve was gradually exceeded by the north rural groups. Catch-up trend was found in the two rural groups since the peak of puberty. These disparities were caused by not only socioeconomic and urban-rural factors but also north-south differences. Because of the regional variation of WC, a ＂gradient＂ prevalence of central obesity was prospected among these groups. Comparisons of WC distributions between the Chinese and the U.S.A or Netherlands demonstrated the necessary of setting up China＇s own WC cutoffs. Sex and age-specific percentiles were obtained and smoothed by using LMS method. Conclusion The data obtained from this study could be used to develop national WC cutoff points for Chinese children and adolescents.

Relationship of Body Mass Index, Waist Circumference and Cardiovascular Risk Factors in Chinese Adult

Objective To compare the relative risk of waist circumference （WC） and/or BMI on cardiovascular risk factors. Methods A cross-sectional data of 41 087 adults （19 567 male and 21 520 female） from the 2002 China National Nutrition and Health Survey were examined. According to the obesity definition of WGOC （BMI, 24 kg/m^2 and 28 kg/m^2; WC, male 85 cm and 95 cm for male, 80 cm and 90 cm for female）, the study population were divided into 9 groups. The prevalence and odds ratio （ORs） of cardiovascular disease （CVD） risk factors （hypertension, high fasting plasma glucose and dyslipidemia） were compared among these 9 groups. Stepwise linear regression analyses were used to compare the likelihood of BMI and/or WC on CVD risk factors. Results Both the indexes levels and the odds ratios of CVD risk factors were significantly increased （decreased for HDL-C levels） along with the increase of WC and/or BMI, even when the effect of age, sex, income, education, sedentary activity and dietary factors were adjusted. The variances （R2） in CVD risk factors explained by WC only and BMI only were quite similar, but a little bit larger when WC and BMI were combined. The standard fl was higher of BMI when predicting systolic BP and was higher of WC when predicting TG, TC and HDL. Conclusions BMI and WC had independent effects on CVD risk factors and combination of BMI and WC would be more predictive. Findings from the present study provided substantive evidence for the WGOC recommendation of a combined use of BMI and WC classifications.

Effectiveness of Different Waist Circumference Cut-off Values in Predicting Metabolic Syndrome Prevalence and Risk Factors in Adults in China

Objective To study the effectiveness of waist circumference cut-off values in predicting the prevalence of metabolic syndrome （MetS） and risk factors in adults in China. Methods A cross-sectional survey was condcuted in 14 provinces （autonomous region, municipality） in China. A total of 47 325 adults aged 〉20 years were selected by multistage stratified sampling, and questionnaire survey and physical and clinical examination were conducted among them. MetS was defined according to the International Diabetes Federation （IDF） criteria and modified IDF criteria.Results The age-standardized prevalence of MetS was 24.2% （22.1% in men and 25.8% in women） and 19.5% （22.1% in men and 18.0% in women} according to the IDF criteria and modified IDF criteria respectively. The age-standardized prevalence of pre-MetS was 8.1% （8.6% in men and 7.8% in women） according to the modified IDF criteria. The prevalence of MetS was higher in urban residents than rural residents and in northern China residents than in southern China residents. The prevalence of central obesity was about 30% in both men and women according to the ethnicity-specific cut-off values of waist circumference for central obesity （90 cm for men and 85 cm for women）. Multivariate regression analysis revealed no significant difference in risk factors between the two MetS definitions. Conclusion Using both the modified IDF criteria and ethnicity-specific cut-off values of waist circumference can provide more useful information about the prevalence of MetS in China.

Optimal Waist Circumference Cut-off values for Identifying Metabolic Risk Factors in Middle-aged and Elderly Subjects in Shandong Province of China

Objective To study the optimal waist circumference （WC） cut-off values for identifying metabolic risk factors in middle-aged and elderly subjects in Shandong Province of China. Methods A total of 2 873 men and 5 559 women were included in this cross-sectional study. Metabolic syndrome （MetS） was diagnosed according to the definition of Chinese Diabetes Society in 2004. The relation between WC and MetS was analyzed by multivariate logistic regression analysis. The optimal WC cut-off values were identified using the area under the ROC curve and the different diagnostic criteria for central obesity were compared. Results The WC was the risk factor for MetS independent of BMI, blood glucose, blood lipid, and blood pressure. The optimal WC cut-off value was 83.8 cm and 91.1 cm for identifying MetS in women and men, respectively. Compared with 80 cm and 85 cm for women and men, 85 cm and 90 cm had a higher Youden index for identifying all metabolic risk factors and MetS in women and men. Conclusion The appropriate WC cut-off value is 85 cm and 90 cm for identifying central obesity and MetS in women and men in Shandong Province of China.

Nonalcoholic fatty liver disease in asymptomatic Brazilian adolescents

AIM： To evaluate the prevalence and clinical characteristics of Nonalcoholic fatty liver disease （NAFLD） among asymptomatic Brazilian adolescents. METHODS： Transversal observational study included asymptomatic adolescents with central obesity from private and public schools in Salvador-Bahia, northeastern Brazil. The children answered a questionnaire that in- cluded age, gender, race, and medical history, and were submitted to a complete physical exam and abdominal ultrasound. Biochemical exams included： ALT, AST, GGT, C reactive protein （CRP）, fasting glucose, insulin, cholesterol and triglycerides. Criteria for NAFLD included： the presence of steatosis in ultrasound and/or high level of ALT, negative or occasional historic of intake of alcohol （4 140 g/wk）, negative investigation for hepatitis A, B, C, auto-immune hepatitis, Wilson disease and hemochro-matosis.RESULTS： From October, 2005 to October, 2006, the study included 1801 subjects between 11 and 18 years of age and a mean age of 13.7± 2.0 years. One hun- dred ninety-nine had central obesity. The prevalence of NAFLD was 2.3%, most of whom were male and white. Insulin resistance （IR） was observed in 22.9% of them and had positive correlations with ALT and GGT （P 〈 0.05）. Elevated CRP was observed in 6.9% of the cases; however, it was not associated with WC, IR or liver enzymes. CONCLUSION： The prevalence of NAFLD in Brazilian adolescents was low. The ethnicity may have influence this frequency in the population studied, which had a large proportion of African descendents.

Elevated thyroid stimulating hormone levels are associated with metabolic syndrome in a Chinese community-based population of euthyroid people aged 40 years and older

This study investigated whether high-normal thyrotropin（TSH） levels are associated with metabolic syndrome in euthyroid Chinese people≥40 years old.Clinical and metabolic factors were assessed in 2,356 subjects（40-77 years old） with TSH levels in the normal range（0.35-5.00 mU/L）.Using 2.50 mU/L as the cut-off point of TSH level within the normal range,we divided subjects into the high-TSH（2.50-5.00 mU/L;n= 1,064） and low-TSH（0.35-2.50mU/L;n= 1,292） group.The results showed that the mean levels of body mass index（BMI）,total cholesterol（TC）,low density lipoprotein cholesterol（LDL-C）,and fasting plasma glucose（FPG） were higher in the high-TSH group and TSH levels were significantly positively con-elated with BMI,LDL-C,TC,and FPG.The prevalence of central obesity,hypertriglyceridemia,low high density lipoprotein cholesterol（HDL-C）,and high FPG（〉5.60 mmol/L） was significantly higher in females and subjects with high-TSH levels.Metabolic syndrome was also more prevalent in the high-TSH group.People over the age of 40 years with high-normal TSH levels had a 1.2-fold increased risk of metabolic syndrome,compared with those with low-normal TSII levels,after adjusting for age and gender.In conclusion,high normal TSH is a risk factor for metabolic syndrome in people ≥40 years old.

Waist circumference cutoff points for Chinese adults with metabolic syndrome defined by the International Diabetes Federation

Objective To investigate the appropriate waist circumference(WC)cutoff points for central obesity in the middle-aged and elderly Beijing residents by the metabolic syndrome definition of the International Diabetes Federation(IDF).Methods A total of 2,344 Beijing residents aged≥40 years were investigated.They answered questionnaires,received physical examinations,and underwent plasma glucose and lipid profile measurement.Those non-diabetic subjects underwent a 75g oral glucose tolerance test.All data were analyzed to calculate the appropriate WC cutoff points for central obesity reaching the diagonsis of MS.Results 1)Both in males and females,the triglyceride(TG),systolic blood pressure,diastolic blood pressure and fasting plasma glucose(FPG)increased linearly with WC,and the high density lipoprotein cholesterol(HDL-C)decreased linearly with WC(P<0.05).2)The prevalence of elevated TG,reduced HDL-C,elevated blood pressure,elevated FBG,or≥2 of these factors increased with WC(P<0.05).3)Based on the receiver operating characteristic(ROC)curve analysis and Youden index,the WC values for central obesity and for detecting BMI≥25 kg/m^(2) were about 90 cm for men and 80 cm for women.4)The odds ratio for the presence of two or more metabolic risk factors increased abruptly in men with WC≥90 cm and in women with WC≥80 cm.Conclusions The appropriate WC cutoff point for central obesity was determined to be 90 cm for men and 80 cm for women in the middle-aged and elderly Beijing residents by the metabolic syndrome definition of IDF.

Metabolic-associated fatty liver disease is associated with low muscle mass and strength in patients with chronic hepatitis B

BACKGROUND Although the prognostic relevance of sarcopenia has been increasingly recognised in the context of liver disease,there is a paucity of data evaluating body composition in patients with chronic hepatitis B(CHB).Beyond virus-related factors,nutritional and metabolic aspects can be associated with skeletal muscle abnormalities in these patients and should not be disregarded.AIM To evaluate the association between components of sarcopenia and demographic,clinical,lifestyle,nutritional,and biochemical variables in CHB patients.METHODS Dual-energy X-ray absorptiometry(DXA)was used to assess muscle mass by quantifying appendicular lean mass(ALM)adjusted for body mass index(ALMBMI).Muscle function was evaluated by hand grip strength(HGS)and the timed up and go test.Metabolic-associated fatty liver disease(MAFLD)was defined according to the criteria proposed by an international expert panel.A body shape index and the International Physical Activity Questionnaire were used to assess central obesity and physical activity level,respectively.RESULTS This cross-sectional study included 105 CHB outpatients followed at the tertiary care ambulatory centre(mean age,48.5±12.0 years;58.1%males;76.2%without cirrhosis;23.8%with compensated cirrhosis).The DXA-derived fat mass percentage was inversely correlated with the ALMBMI(r=-0.87)and HGS(r=-0.63).In the multivariable analysis,MAFLD,sedentarism and central obesity were positively and independently associated with low ALMBMI.MAFLD and central obesity were independently associated with low HGS.CONCLUSION MAFLD and central obesity were associated with low muscle mass and strength in patients with chronic hepatitis B,independent of the liver disease stage.

Type 2 Diabetes Phenotype in a Small Isolated Zapotec-Speaking Community in the Valley of Oaxaca, Southern Mexico

Objective: To test the hypothesis that the type 2 diabetes mellitus (T2DM) phenotype in an indigenous population is characterized by proportionally short legs and obesity. Methods: Anthropometric characteristics were compared in females and males with T2DM (n = 20, n = 8, respectively) and without T2DM (n = 117, n = 93, respectively). Factor analysis derived dimensions were regressed on T2DM in logistic regression. Results: Weight, sitting height ratio and hip circumference were significantly lower (p < 0.0001) in females, while waist: hip ratio was significantly higher among women and men with T2DM (p < 0.0001 and p < 0.008, respectively). Arm circumference, triceps skinfold, arm muscle circumference, and right and left grip strength were significantly lower among T2DM women (p < 0.0001 for each). Five rotated principal components accounted for 86.7% of the variance: muscular (grip) strength (29.6%), body mass (27.9%), central adiposity (10.7%), body height (9.3%), and trunk length (9.2%). Regression of factors on T2DM status among females indicated muscle strength (OR = 0.16, 95% CI: 0.04 - 0.71) and central adiposity (OR = 13.76, 95% CI: 3.80 - 49.83) were predictors of T2DM. In males, muscle strength (OR = 0.28, 95% CI: 0.07 - 1.08, p < 0.06) and central adiposity significantly predicted T2DM (OR = 3.17, 95% CI: 95% 1.11 - 9.04, p < 0.008). Conclusion: Reduced muscle strength/mass and increased central adiposity characterize the T2DM phenotype.

Independent Relationship between Body Mass Index and LH Peak Value of GnRH Stimulation Test in ICPP Girls: A Cross-sectional Study

The effect of obesity on idiopathic central precocious puberty（ICPP） girls is still under discussion. The relationship between body mass index（BMI） and sexual hormone levels of gonadotropin-releasing hormone（GnRH） stimulation test in ICPP girls is controversial and the underlying mechanism is unclear. This study aims to further explore the independent effect of excess adiposity on peak luteinizing hormone（LH） level of stimulation test in ICPP girls and the role of other related factors. A retrospective cross-sectional study was performed on 618 girls diagnosed as having ICPP, including 355 cases of normal weight, 99 cases of overweight and 164 cases of obese. The results showed that obese group had more progressed Tanner stage and no significant difference（P=0.28） in LH peak was found as basal LH value was used as a covariate. The obese group had higher total testosterone（TT）, adrenocorticotrophic hormone（ACTH）, 17-α hydroxyprogesterone（17-αOHP） and androstendione（AN）, with significantly increased fasting insulin（FIN） and homeostasis model of assessment for insulin resistance index（HOMA-IR）. Stratified analysis showed inconsistency of the relationship between BMI-standard deviation score（BMI-SDS） and LH peak in different Tanner stages（P for interaction=0.017）. Further smoothing plot showed linear and non-linear relationship between BMI-SDS and LH peak in three Tanner stages. Then linear regression model was used to analyze the relationship between BMI-SDS and LH peak in different Tanner stages, with and without different confounding factors being adjusted. In B2 stage, BMI-SDS was negatively associated with LH peak. In B3 stage, when BMI-SDS 〈1.5, as BMI-SDS increased, the level of LH peak decreased（model Ⅰ： β=–1.8, 95% CI=–4.7 to 1.1, P=0.214）. When BMI-SDS ≥1.5, BMI-SDS was significantly positively associated with LH peak（model Ⅰ： β=4.5, 95% CI=1.7 to 7.4, P=0.002）. In B4 stage, when BMI-SDS 〈1.5, BMI-SDS was negatively associated with LH peak（model Ⅰ： β=–11.6, 95% CI=–22.7 to –0.5, P=0.049）. When BMI-SDS ≥1.5, BMI-SDS was positively associated with LH peak（model Ⅰ： β=–4.2, 95% CI=–3.3 to 11.7, P=0.28）. It is concluded that there is an independent correlation between BMI-SDS and LH peak of stimulation test in ICPP girls, their relationships are different in different Tanner stages, and the effect of BMI-SDS can be affected by adrenal androgens, estradiol and glucose metabolism parameters.