Association between urinary glyphosate metabolites and obesity measures in U.S. adults: The mediating role of oxidative stress biomarkers

O verweight and obesity have become increasingly com- mon; worldwide, at least 1.1 billion adults are overweight and 312 million are obese, when overweight and obesity are defined conventionally as having a body mass index (BMI) of Ͼ25 kg/m 2 and Ͼ30 kg/m 2 , respectively. 1,2In the general population, overweight and obesity are associated with increased risk of developing cardiovascular disease, 3,4 and thus it is not surprising that in cohorts of patients with prevalent ischemic heart disease or acute coronary events, well over 50% are overweight or obese. 5,6Despite the association between obesity and cardiovascular risk in the general population, a multitude of studies have described an inverse correlation between BMI and mortality in patients with coronary artery disease (CAD), including post-coronary revascularization patients and those with acute myocardial infarction (MI); the association between elevated BMI and improved survival has been termed the obesity paradox. 7,8 Article p 482In this issue of Circulation, Zeller et al 9 further investigate the obesity paradox in a cohort of 2229 consecutive patients presenting with acute MI in the Côte d'Or region of France.In assessing the impact of obesity on mortality after MI, the group uses both BMI, a traditional index of obesity, as well as waist circumference, an alternate anthropometric index that is more specific for abdominal obesity.Approximately one-half of the subjects in the study were overweight (BMI 25 to 29.9 kg/m 2 ), one-quarter were obese (BMI Ͼ30 kg/m 2 ) and onehalf had increased waist circumference, which was defined as Ͼ102 cm in men and Ͼ88 cm in women.Left ventricular ejection fraction, type of MI, and acute treatment strategy did not generally differ by BMI or waist circumference values.Of note, BMI was inversely correlated with age and plasma N-terminal pro B-type natriuretic peptide, whereas waist circumference was positively correlated with age and did not correlate with N-terminal pro B-type natriuretic peptide.Consistent with prior studies, survival analysis showed that the risk of death decreased with increasing BMI tertile.In a waist-matched analysis of 832 subjects, BMI was a signifi-

Visceral Adipose Tissue Attacks Beyond the Liver: Esophagogastric Junction as a New Target

No previous study has investigated dietary pattern in association with obesity risk in a middle-aged Chinese population. The purpose of this study was to evaluate the associations between dietary patterns and the risk of obesity in the city of Hangzhou, the capital of Zhejiang Province, east China. In this cross-sectional study of 2560 subjects aged 45–60 years, dietary intakes were evaluated using a semi-quantitative food frequency questionnaire (FFQ). All anthropometric measurements were obtained using standardized procedures. The partial correlation analysis was performed to assess the associations between dietary patterns and body mass index (BMI), waist circumference (WC), and waist to hip ratio (WHR). Multivariate logistic regression analysis was used to examine the associations between dietary patterns and obesity, with adjustment for potential confounders. Four major dietary patterns were extracted by means of factor analysis: animal food, traditional Chinese, western fast-food, and high-salt patterns. The animal food pattern was positively associated with BMI (r = 0.082, 0.144, respectively, p < 0.05) and WC (r = 0.102, 0.132, respectively, p < 0.01), and the traditional Chinese pattern was inversely associated with BMI (r = −0.047, −0.116, respectively, p < 0.05) and WC (r = −0.067, −0.113, respectively, p < 0.05) in both genders. After controlling for potential confounders, subjects in the highest quartile of animal food pattern scores had a greater odds ratio for abdominal obesity (odds ratio (OR) = 1.67; 95% confidence interval (CI): 1.188–2.340; p < 0.01), in comparison to those from the lowest quartile. Compared with the lowest quartile of the traditional Chinese pattern, the highest quartile had a lower odds ratio for abdominal obesity (OR = 0.63; 95% CI: 0.441–0.901, p < 0.05). Conclusions: Our findings indicated that the animal food pattern was associated with a higher risk of abdominal obesity, while the traditional Chinese pattern was associated with a lower risk of abdominal obesity. Further prospective studies are warranted to confirm these findings.

BackgroundChildhood obesity increases the risk of elevated blood pressure (BP) in children. Body mass index (BMI), waist circumference (WC) and waist-to-height ratio (WHtR) are traditional obesity indices, but the extent to which these indices are associated with elevated BP in childhood remains debatable. Moreover, the familial dietary environment plays an important role in obesity, so it is necessary to determine the most relevant dietary factors for childhood obesity to prevent elevated BP. Our study aimed to identify the obesity indices that are most closely associated with elevated BP and then to determine the independent familial dietary factors for those obesity indices.MethodA total of 605 children aged 2 to 6 years, as well as their parents, were involved in this study. The weight, height, WC and BP of the children were measured. Information on familial environments was obtained by questionnaires completed by the parents. BMI, WC and WHtR were standardized into z scores, and categorical variables of these three obesity indices were defined as BMI Category, WC Category and WHtR Category. Logistic regression was used to analyse the associations between all obesity indices and elevated BP. Multivariate linear regression and logistic regression were used to determine the independent factors for obesity indices.ResultsThe obesity indices that were most closely associated with elevated BP were WC and WC Category. Parental BMI, birth weight, eating wheat as a staple food, appetite, eating speed, snacking while watching TV, parental encouragement to eat a diverse assortment of foods and drinking milk were independently associated with WC in both males and females. The risk of abdominal obesity increased 1.375 times in males and 1.631 times in females if appetite increased one level. If eating speed increased one level, the risk of abdominal obesity increased 1.165 times in males and 0.905 times in females. Females who drank milk more than 6 times per week had a 0.546 times lower risk of abdominal obesity.ConclusionWC was an anthropometric parameter more closely associated with elevated BP. In addition to genetics, some familial dietary factors involving eating preference, eating habits and parental feeding practice were independently associated with WC and abdominal obesity in preschool children.

To compare body mass index (BMI), waist circumference and waist-hip ratio (WHR) as indices of obesity and assess the respective associations with type 2 diabetes, hypertension and dyslipidaemia. A national sample of 11 247 Australians aged > or =25 years was examined in 2000 in a cross-sectional survey. The examination included a fasting blood sample, standard 2-h 75-g oral glucose tolerance test, blood pressure measurements and questionnaires to assess treatment for dyslipidaemia and hypertension. BMI, waist circumference and WHR were measured to assess overweight and obesity. The prevalence of obesity amongst Australian adults defined by BMI, waist circumference and WHR was 20.8, 30.5 and 15.8% respectively. The unadjusted odds ratio for the fourth vs. first quartile of each obesity measurement showed that WHR had the strongest relationship with type 2 diabetes, dyslipidaemia (women only) and hypertension. Following adjustment for age, however, there was little difference between the three measures of obesity, with the possible exceptions of hypertension in women, where BMI had a stronger association, and dyslipidaemia in women and type 2 diabetes in men, where WHR was marginally superior. Waist circumference, BMI and WHR identified different proportions of the population, as measured by both prevalence of obesity and cardiovascular disease (CVD) risk factors. Whilst WHR had the strongest correlations with CVD risk factors before adjustment for age, the three obesity measures performed similarly after adjustment for age. Given the difficulty of using age-adjusted associations in the clinical setting, these results suggest that given appropriate cut-off points, WHR is the most useful measure of obesity to use to identify individuals with CVD risk factors.

The proportion of colorectal cancer (CRC) cases attributable to excess weight, known as population attributable fraction (PAF), has been commonly based on measures of body mass index (BMI). Central obesity metrics, such as waist circumference (WC) and waist to hip ratio (WHR), are potentially better indicators of adiposity and have demonstrated stronger associations with CRC incidence. To examine PAFs of CRC cases that are attributable to high WC and WHR and compare them to those attributable to high BMI. This population-based UK Biobank cohort study included 458 543 individuals aged 40 to 69 years at recruitment (March 2006 to July 2010) living within a reasonable distance of the 22 assessment centers across the UK. The analyses were conducted between May and July 2024. Exposures were BMI, as a measure of general obesity, and WC and WHR, as indicators of central obesity. Hazard ratios (HRs) and corresponding 95% CIs were calculated for the associations of BMI, WC, and WHR with CRC incidence. The PAFs and 95% CIs of CRC cases attributable to high BMI, WC, and WHR were also calculated. A total of 458 543 participants (median [IQR] age, 57 [50-63] years; 244 351 [53.3%] female) were included in the study. During a median follow-up of 11.8 (IQR, 10.9-12.5) years, 5944 participants were diagnosed with CRC. The HRs for the association with CRC incidence were notably smaller for BMI (HR for the highest vs lowest BMI quartile, 1.23; 95% CI, 1.14-1.33) than for WC (HR for the highest vs lowest WC quartile, 1.37; 95% CI, 1.27-1.49) and WHR (HR for the highest vs lowest WHR quartile, 1.40; 95% CI, 1.29-1.51); these associations became comparable only after accounting for possible reverse causality by excluding the initial years of follow-up. Similarly, the PAF of CRC for high BMI was 9.9% (95% CI, 5.5%-14.4%), substantially lower than the PAFs for high WC and WHR, which were 17.3% (95% CI, 12.3%-22.1%) and 17.6% (95% CI, 12.9%-22.2%), respectively. After excluding the initial 7 years of follow-up, PAF estimates became analogous across all measures of obesity and were 15.7% (95% CI, 8.9%-22.4%) for BMI, 16.9% (95% CI, 9.8%-23.8%) for WC, and 18.0% (95% CI, 11.5%-24.6%) for WHR. In this cohort study of approximately half a million participants, the PAF of CRC attributable to excess weight, defined as high BMI, was considerably underestimated. The PAFs attributable to WC and WHR were consistent and much higher, underlining the importance of efforts to limit and overcome the obesity epidemic in CRC prevention.

ABSTRACTBackgroundAlthough obesity is a well‐known risk factor for various metabolic disorders, its impact on fracture risk remains uncertain. The inconsistency in findings may be due to the fact that most studies have relied solely on body mass index (BMI) as the measure of obesity. Other indices, such as waist circumference (WC) and the waist‐to‐height ratio (WHtR), have been suggested as better indicators of obesity. This study aimed to evaluate the association between obesity and fracture risk by using multiple obesity measures, including WHtR, WC and BMI, in a longitudinal cohort.MethodsIn this prospective cohort study, we analysed data from 5905 participants in the Korean Genome and Epidemiology Study (KoGES), with a median follow‐up of 16 years. Participants were categorized into tertiles based on WHtR, WC and BMI, and the incidence of overall fractures and site‐specific fractures (vertebral, hip and wrist/humerus) was assessed. Multivariate Cox proportional hazards models were used to examine the association between WHtR, WC, BMI and fracture risk, adjusting for potential confounders.ResultsAmong 5905 participants (54% women; age range, 40–69; median age, 50 years; interquartile range, 44–59), 816 fractures were reported over a median follow‐up period of 16 years. A one‐standard deviation increase in WHtR was associated with a 55% higher risk of overall fractures (adjusted hazard ratio [aHR] 1.55, 95% confidence interval [CI] 1.37–1.75), with similar trends observed for vertebral (aHR 1.60, 95% CI 1.13–2.26), hip (aHR 1.85, 95% CI 1.40–2.43) and wrist/humerus fractures (aHR 1.42, 95% CI 1.16–1.74). A one‐unit increase in WC was linked to a 16% higher risk of overall fractures (aHR 1.16, 95% CI 1.08–1.24). BMI was not significantly associated with the fracture risk. Within the same obesity group defined by BMI, participants in the higher WHtR tertiles had a greater incidence of overall fractures. Specifically, individuals in the third tertile of WHtR with a BMI of ≥ 23 to < 25 kg/m2 or ≥ 25 kg/m2 had a higher risk of overall fractures compared to those in the first tertile of WHtR with a BMI < 23 kg/m2 (aHR 1.88, 95% CI 1.34–2.62, and aHR 1.93, 95% CI 1.30–2.87, respectively).ConclusionAlthough a high BMI has often been considered a protective factor against fractures, this study found that obesity, as measured by WHtR, is a risk factor. Even among individuals with a high BMI, those with elevated WHtR should receive additional medical attention to help prevent fractures.

What is already known about this subject • Recent obesity trends across the world in adults are mixed, varying from showing signs of levelling off to a continuously increasing prevalence. • Secular trends in body mass index (BMI) and waist circumference may vary by sex and age. • Relying exclusively on BMI data may lead to underestimate the obesity epidemic. What this study adds • Adverse trends in obesity indicators have continued in Finland in the 2000s. • In older men, BMI remained quite stable and in older women BMI has decreased since 1997. • Steep upward trends in abdominal obesity (waist circumference and waist-to-height ratio, WHtR) have taken place in both men and women and in all age groups, especially during the past 10 years. • The impact of BMI adjustment on trends in abdominal obesity varied by age such that increases in BMI-adjusted waist circumference and WHtR were more prominent in older age groups. Signs that obesity trends will level off at the turn of the 21st century have been reported. In these studies, however, the definition of obesity has been based only on body mass index (BMI). We investigated obesity trends among Finnish adults over recent years by using BMI, waist circumference and waist-to-height ratio as indicators for obesity. Data were derived from the national FINRISK surveys, which are cross-sectional population surveys conducted at 5-year intervals between 1992 and 2007. Altogether, 20 551 randomly selected men and women aged 25-64 years participated in health examinations, where weight, height, and waist and hip circumferences were measured by trained nurses. Mean BMI increased in younger men and women (aged 25-44 years) between 1992 and 2007, whereas in older men, BMI remained quite stable and in older women BMI has decreased since 1997. Nevertheless, mean waist circumference and waist-to-height ratio increased in both men and women over the 15-year period. The upward trends took place in all age groups, especially during the past 10 years. Adverse trends in obesity indicators have continued in Finland in the 2000s. In particular, concerns are related to steep upward trends in abdominal obesity.

Background Previous research has demonstrated that waist circumference (WC) and hip circumference (HC) are both important predictors of mortality, independent of established risk factors. Their combined influence on risk, and whether they are superior to established obesity measures, has not been thoroughly examined in large cohorts. Purpose We investigated whether WC and HC are better joint predictors of all-cause and cardiovascular disease (CVD) mortality than individual measures of obesity: WC, HC, waist hip ratio (WHR), waist-to-height ratio (WHtR), a body shape index (ABSI), and body mass index (BMI). Methods We used data from 90,487 males and females, 25–74 years of age with no prior history of CVD, from the MOnica Risk, Genetics, Archiving and Monogram (MORGAM) project. Hazard mortality ratios (HR) were estimated using sex-specific Cox models stratified by cohort/country, with age as the time scale. Obesity measures were categorized based on sex specific sample means and standard deviations (SD). All final fully adjusted models included baseline age, total and HDL cholesterol, systolic blood pressure,antihypertensive drugs, current smoker and diabetes. Results During a mean follow-up of 11 years, 9105 all-cause and 2577 CVD deaths were recorded. All obesity measures were found to be associated with all-cause and CVD death after taking account of known CVD risk factors, with the strongest statistical evidence of associations seen for WC and HC combined and ABSI. J- or U-shaped associations with mortality were observed for BMI, WC, HC and WHtR for both males and females, and WHR and ABSI for males. Monotonic associations with mortality were observed for WHR and ABSI for females. For WC and HC combined, HC was an important predictor of death among those with smaller WC (≤1 SD above the mean: below 99cm in women and 106cm in men), with larger HCs associated with reduced risk. No additional increase in mortality risk was found to be associated with HC for those with a WC &gt;1SD above the mean. Of those who would not have been identified as being at higher risk based on their WC alone, 55.7% (n=8350) of females and 30.6% (n=4510) of males are identified as being at higher risk when their smaller HC is taken into consideration. Conclusion The use of single measurements of obesity such as BMI, WC or WHR does not capture the complex relationship between body shape and risk of premature death. Both WC and HC, but not as a ratio, should be used by clinicians to help identify those at increased risk of premature death. Acknowledgement/Funding Individual grants to included cohorts

Simple SummaryRegarding the association between obesity and thyroid cancer, most previous studies have focused only on body mass index (BMI), but other measures of obesity have not been studied much with inconsistent results. This study showed a significant association between increased abdominal obesity indexes, such as waist circumference (WC, ≥85.0 cm) and waist-height ratio (WHTR ≥ 0.5) as well as BMI (≥25.0 Kg/m2), and increased risk of thyroid cancer. In addition, people who had both abnormally obese levels of BMI and other obesity indexes including WC, waist–hip ratio, or WHTR showed an increased risk of thyroid cancer, compared to those with normal levels of BMI and each obesity index. These results provide evidence of the contribution of both total and central adiposity across the lifespan to thyroid cancer incidence. Risk factor modifications must be considered to explain the current thyroid cancer epidemic.Objective: This study aimed to identify the association between various obesity indexes, including waist circumference (WC), waist–hip ratio (WHR), waist–height ratio (WHTR), and BMI, and their combinations with body mass index (BMI) and thyroid cancer risk. Methods: Of the 65,639 participants who completed a follow-up survey of the Health Examinee Study (HEXA), a prospective cohort of the Korean Genome and Epidemiology Study, 412 female incident thyroid cancer cases, and 1648 birth year- and enrollment year-matched female controls were included. Multiple conditional logistic regression was used to estimate the association between obesity indexes and thyroid cancer risk. Results: The risk of developing thyroid cancer was increased by 1.37-fold (95% confidence interval (CI) = 1.03–1.81) higher in the obese BMI group (≥25.0 Kg/m2) compared to that in the normal BMI group (<23.0 Kg/m2). Obesity in terms of WC (≥85.0 cm) and WHTR (≥0.5) was associated with an increased risk of thyroid cancer (OR 1.55, 95% CI = 1.16–2.07; OR 1.37, 95% CI = 1.07–1.75, respectively). However, increased WHR levels did not show any significant association. Women with both obese levels of BMI (≥25.0 Kg/m2) and other obesity indexes (WC ≥ 85.0 cm, WHR ≥ 0.85, or WHTR ≥ 0.5) showed an increased risk of thyroid cancer with OR of 1.63 (95% CI = 1.14–2.31), 1.49 (95% CI = 1.05–2.12), and 1.42 (95% CI = 1.04–1.94), compared to those with normal levels of BMI and each obesity index. Conclusion: These results provide evidence of the contribution of both total and central adiposity across the lifespan of thyroid cancer incidence. Risk factor modifications must be considered to explain the current thyroid cancer epidemic.

Background: ‘A Body Shape Index-Adolescents’ (ABSI-Adolescents) and waist-to-height ratio are recently proposed indices that quantify central obesity in adolescents.Aims: To investigate the scaling exponents to standardise waist circumference (WC) for body mass index (BMI) and height and to investigate the association between BMI, WC-based indices and cardiometabolic outcomes in adolescents of three ethnic groups.Subjects and methods: A cross-sectional study of 1755 adolescents (516 Hans, 565 Uygurs, 674 Kazakhs) was conducted in north-west China. Correlation between indices of obesity and blood pressure (BP) and fasting blood glucose (FBG) were estimated and compared.Results: Two ethnic groups (Han and Kazakh) had WC-BMI-height profiles different from the previously proposed ABSI-Adolescents and, therefore, required different scaling exponents for WC standardization. After adjustment for age and gender, WC and BMI have similar associations with BP and FBG. After further adjustment for BMI, WC remained significantly associated with FBG in all three ethnic groups (each p < 0.01) and with BP in Han and Kazakh adolescents (each p < 0.05).Conclusion: Body proportionality varied between the ethnic groups. WC and WC-based indices were associated with blood pressure and fasting blood glucose in adolescents of three ethnicities. The WC-based indices did not out-perform WC per se.

Endometrial cancer is the most common type of female genital tract malignancies. We intended to assess the relation between different measures of obesity and the risk to develop endometrial cancer in Egyptian females with postmenopausal bleeding (PMB). The study was conducted in Alexandria, Egypt and included all postmenopausal females presenting to the University Hospital of Gynecology and Obstetrics with PMB within the study period (from January 1 to September 30). A questionnaire was completed, and data about anthropometric measurements including weight, height, and waist circumference were collected. Vaginal sonography, dilatation and curettage, and pathological examination were done by experts for all participants. Endometrial cancer was diagnosed in 38% of females presenting with PMB. Using ROC curve analysis, only the measure of abdominal obesity (waist circumference) showed significant accuracy in predicting endometrial cancer (area = 0.63, P < .05). The best cutoff point that maximizes accuracy was 88 cm. Body mass index (≥30 vs. ≤30) showed no significant relation (OR = 1.1, 95%CI 0.5–2.3), and the ratio between upper and lower body obesity (W/H ratio) showed border line significant relation (OR = 2, 95% CI 1–4.1), whereas waist circumference (≥88 vs. ≤88 cm) showed strikingly high OR (OR = 13.6, 95%CI 4–46.6). The risk of abdominal obesity on endometrial cancer remains very high (OR = 15.8, 95%CI 4.1–60.9) even after adjustment, in a logistic model, for other risk factors such as age at presentation, age at menarche, age at menopause, family history of malignancy, and gravidity. Abdominal obesity (waist circumference >88 cm) is the best measure of obesity to be used in predicting the risk of endometrial cancer in Egyptian females with PMB.

Introduction:The COVID-19 pandemic and its prevention measures (e.g., quarantine, social distancing, and shutdown) significantly affected people’s physical activity and lifestyle, potentially increasing Body Mass Index (BMI) and risk of obesity. This study provides a comprehensive analysis to examine changes in BMI and obesity rate across pre-COVID, COVID, and post-COVID periods, and to identify the sociodemographic correlates of BMI and obesity change.Methods:Longitudinal electronic health record data from the All of Us Research Program for adults ≥ 18 years with at least one BMI record in each period (N = 38,632) were analyzed. Periods were defined as pre-COVID (Jan 1, 2018–Mar 12, 2020), COVID (Mar 13, 2020–Dec 31, 2021), and post-COVID (Jan 1, 2022–Oct 31, 2023). We modeled BMI with a linear mixed-effects model and obesity (BMI ≥ 30) with a GEE logit model, adjusting for age, sex, race, ethnicity, income, and employment; time was modeled with linear and quadratic terms, and we tested time × subgroup interactions.Results:Mean BMI increased from 30.05 pre-COVID to 30.14 during COVID, then declined to 29.96 post-COVID; obesity prevalence followed a similar pattern (43.5% → 44.1% → 43.2%). In adjusted models, linear time effects were positive and the quadratic terms negative for both outcomes, indicating non-linear (increase-then-partial-reversal) trends (BMI: β_time = 0.216; β_time2 = −0.018; obesity: aOR_time = 1.052; aOR_time2 = 0.996; all p < 0.001). Female, Black and Hispanic/Latino participants had higher BMI and greater odds of obesity than their counterparts, while higher income showed a protective association. Significant time × subgroup interactions were observed, with age and employment status showed the most consistent effects across both outcomes.Conclusion:BMI and obesity increased during the pandemic and partially reversed afterward, but persistent disparities remained, with higher risk among women, Black and Hispanic/Latino adults, and lower-income groups. Results highlight the impact of COVID-19 on obesity risk and emphasize the need for proactive measures to promote healthier lifestyle and weight management strategies for vulnerable groups in future public health preparedness plans.

018 Waist Circumference and Body Mass Index as Predictors of Health Related Quality of Life

Validity of self-reported abdominal obesity in Thai adults: A comparison of waist circumference, waist-to-hip ratio and waist-to-stature ratio