Adjustment For Waist-to-hip Ratio Research Articles

The association of waist-to-height ratio and other anthropometric measurements with subclinical atherosclerosis: Results from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

Background and aimsTo compare the performance of waist-to-height ratio (WHtR), waist-to-hip ratio (WHR), waist circumference (WC) and Body-mass index (BMI) with subclinical atherosclerosis. Methods and resultsThe association of quintiles of anthropometric variables (1st as reference) – Odds ratio (OR); 95% Confidence Interval (95% CI) – with Coronary Artery Calcium (CAC: 0 vs. >0; <100 vs. ≥100), Carotid Intima-Media Thickness (CIMT: <75th vs. ≥P75%) and as continuous variables in linear regression models in 4216 participants of ELSA-Brasil baseline. WHtR was associated with CAC >0 (OR, 1.84; 95% CI, 1.16–2.93) and ≥100 after multivariate adjustment including BMI. WHR was associated with CAC >0 OR, 1.81 (95% CI, 1.25–2.82) and ≥100. BMI was not associated with CAC after further adjustment for WHtR, but was associated with CAC >0 after adjustment for WHR (OR, 1.42; 95% CI, 1.02–1.94) or WC (1.63; 95% CI, 1.03–2.59). WHtR was not associated with CIMT after further adjustment for BMI. WHR was associated with CIMT ≥P75% (OR, 1.44; 95% CI, 1.02–2.02) and in linear models (p < 0.0001). WC was associated with CIMT in linear models (p < 0.0001). BMI was associated to CIMT ≥P75% (OR, 2.25; 95% CI, 1.53–2.54); and in linear models (P < 0.0001) after further adjustment for WHtR. After adjustment for WHR and WC the association of BMI with CIMT ≥P75% was respectively (OR 2.31; 95% CI, 1.70–3.13; and OR 2.39; 95% CI, 1.55–3.70); and in both linear models (p < 0.0001). ConclusionsWHtR was a good biomarker for subclinical atherosclerosis measured by CAC while BMI was a good biomarker for CIMT. WHR presented the best performance being associated with both biomarkers of subclinical atherosclerosis.

Metabolic dysfunction in obese Hispanic women with polycystic ovary syndrome.

Are certain ethnic groups with polycystic ovary syndrome (PCOS) at increased risk of metabolic disorders? Obese Hispanic women with PCOS are at increased risk of metabolic disorders compared with age- and BMI-matched obese non-Hispanic white women with PCOS in the USA. Ethnic differences in body composition and metabolic risk are well established. PCOS is a common disorder in women of reproductive age and is associated with high rates of insulin resistance, glucose intolerance and dyslipidemia. A cross-sectional observational study was performed at an Academic Medical Center on 60 women of reproductive age with PCOS. Blood was obtained after fasting from 17 Hispanic, 22 non-Hispanic black and 21 non-Hispanic white women with PCOS who were similar in age and BMI. Anthropometric parameters, insulin, lipid and lipoprotein levels (measured by nuclear magnetic resonance) were compared between the three groups. Age and BMI did not differ between the groups. Hispanic women with PCOS had higher waist-to-hip ratio (WHR) (P = 0.02), homeostasis model assessment of insulin resistance (HOMA-IR) (P = 0.03) and a more atherogenic lipid and lipoprotein profile consisting of lower high-density lipoprotein (HDL) (P = 0.02), higher low-density lipoprotein (LDL) particle number (P = 0.02), higher very low-density lipoprotein particle (VLDL) size (P = 0.03) and lower LDL (P = 0.03) and HDL particle size (P = 0.005) compared with non-Hispanic white women. The differences in HDL, HOMA-IR, VLDL and LDL size did not persist after adjustment for WHR while differences in LDL particle number (P = 0.04) and HDL size (P = 0.01) persisted. The sample size for the three groups was small but the findings were still significant. The women were mostly obese so the ethnic differences in metabolic disorders may not apply to non-obese women with PCOS. Independent of BMI, obese, reproductive age, Hispanic women with PCOS in the USA had a greater degree of abdominal obesity, insulin resistance and dyslipidemia. Hispanic women with PCOS may benefit from more focused management of metabolic parameters. This project was supported by the following National Institutes of Health grants: K23 DK080988-01A1 to S.S. and UL1RR029879 to CTSA at University of Illinois. None of the authors report any conflict of interests.

Associations of Adiponectin Levels With Incident Impaired Glucose Metabolism and Type 2 Diabetes in Older Men and Women

Adiponectin is an adipose tissue-derived protein. Low levels are associated with obesity, insulin resistance, and type 2 diabetes. Our objective was to investigate the prospective association between adiponectin levels and the 6.4-year risk of type 2 diabetes and of impaired glucose metabolism (IGM). The Hoorn Study is a cohort study among Caucasians, aged 50-75 years. BMI, waist-to-hip ratio (WHR), fasting glucose, 2-h glucose, triglycerides, HDL cholesterol, LDL cholesterol, alanine aminotransferase, leptin, and adiponectin were measured at baseline. Lifestyle (alcohol intake, smoking, and physical activity) was assessed by questionnaires. After a mean follow-up of 6.4 years, glucose tolerance was assessed by a 75-g oral glucose tolerance test. Analyses were performed in 1,264 subjects (584 men and 680 women) without type 2 diabetes at baseline. For analyses of incident IGM, 239 subjects with IGM at baseline and/or type 2 diabetes at follow-up were excluded. Age- and lifestyle-adjusted odds ratios and 95% CIs comparing highest with lowest adiponectin quartile were 0.52 (0.23-1.18) in men and 0.15 (0.06-0.39) in women for type 2 diabetes and 0.90 (0.51-1.61) and 0.28 (0.16-0.48) for IGM, respectively. The risks were only slightly reduced after adjustment for WHR and leptin as markers of (abdominal) adiposity. Adjustment for baseline fasting and postload glucose levels (potential mediators) substantially diminished these inverse associations with type 2 diabetes (0.79 [0.32-1.91] and 0.62 [0.21-1.81]) and with IGM (1.20 [0.61-2.35] and 0.48 [0.26-0.90]), respectively. A high adiponectin level was strongly associated with a lower risk of IGM and type 2 diabetes, particularly in women. These results suggest that adiponectin is involved in the pathophysiology linking obesity to type 2 diabetes.

Increased Plasma-Soluble Tumor Necrosis Factor-α Receptor 2 Level in Lean Nondiabetic Offspring of Type 2 Diabetic Subjects

Tumor necrosis factor-alpha (TNF-alpha) is one of the proposed mediators of insulin resistance, upregulated in human obesity. Insulin resistance, however, might precede the development of obesity, especially in subjects with a family history of type 2 diabetes. Therefore, the aim of the present study was to assess plasma levels of TNF-alpha and soluble forms of its receptors (soluble TNF-alpha receptors 1 [sTNFR1] and 2 [sTNFR2]) and to evaluate the relationship of the TNF-alpha system with insulin resistance in lean, nondiabetic offspring of type 2 diabetic patients. We compared 20 lean offspring (BMI <25 kg/m(2), 8 men and 12 women) of type 2 diabetic patients with 20 lean subjects with no family history of diabetes, matched for age, sex, and BMI (control group). Anthropometry and blood biochemical parameters were measured, and insulin sensitivity was evaluated with the euglycemic-hyperinsulinemic clamp technique. Both men and women in the offspring group were markedly more insulin-resistant and had higher plasma levels of sTNFR2 (all P < 0.05). TNF-alpha, sTNFR1, and other examined parameters did not differ between the studied groups. Both TNF-alpha receptors were related to waist-to-hip ratio (WHR), fat-free mass (FFM), plasma total cholesterol, HDL cholesterol, LDL cholesterol, and nonesterified fatty acids (NEFAs). sTNFR2, but not sTNFR1, was also associated with insulin sensitivity (r = -0.49, P = 0.001). This relationship remained significant after adjustment for WHR, FFM, plasma insulin, and NEFA. TNF-alpha system might be involved in modulating insulin action before the onset of obesity in subjects at high risk for type 2 diabetes.

Association between Hyperinsulinemia and Hypertension among White, Black, and Mexican American Adults. Results from the Third National Health and Nutrition Examination Survey, 1988-1994.

P72 Objective: To examine the association between hyperinsulinemia and blood pressure independent of body mass among nondiabetic white non-Hispanic, black non-Hispanic, and Mexican American adults. Methods: We examined this relationship using data from 8004 adults aged ≥20 years from the Third National Health and Nutrition Examination Survey (1988-1994). Univariate differences in body mass index (BMI), waist-to-hip ratio (WHR), glycosylated hemoglobin (HbA 1c ), fasting plasma glucose and C-peptide were examined between normotensives and hypertensives within each racial or ethnic group. Logistic regression was used to obtain the likelihood of being hypertensive across race specific tertiles of C-peptide adjusting for age, sex, education, BMI, and WHR. Results: The prevalence of hypertension was 21.1% among whites, 24.6% among blacks, and 10.9% among Mexican Americans. Hypertensives were older, with higher BMI, WHR, HbA 1c , fasting plasma glucose, and fasting C-peptide levels than normotensives. Also, the prevalence of hypertension increased significantly with C-peptide level for each of the racial or ethnic groups. Persons with a C-peptide in the upper tertile were more likely to be hypertensive than those with a C-peptide level in the lower tertile after adjustment for age, sex, education, and BMI (Mexican Americans OR=3.3, 95% CI=2.2-4.8; whites OR=2.0, 95% CI=1.5-2.7, blacks OR=2.0, 95% CI=1.3-3.0). Adjustment for WHR attenuated the association between C-peptide and hypertension (Mexican Americans OR=3.0, 95% CI=2.0-4.5; whites OR=1.6,95% CI=1.2-2.2; blacks OR=1.7, 95% CI=1.1-2.6). Conclusion: These results suggest that hyperinsulinemia is associated with hypertension independent of BMI and diabetes. Further, WHR was identified as a confounder and should be taken into account in addition to BMI when evaluating the relationship between C-peptide and hypertension.

Sleep-disordered breathing and glucose metabolism in hypertensive men: a population-based study.

Diabetes mellitus and obstructive sleep apnoea (OSA) are two prevalent medical problems. Both are strongly associated with obesity and hypertension. The aim of this study was to investigate whether the association between OSA and diabetes is entirely dependent on obesity in hypertensive men. A population-based study. The municipality of Uppsala, Sweden. Subjects and methods. In 1994, 2668 men aged 40-79 years answered a questionnaire regarding snoring, sleep disturbances and somatic diseases. An age-stratified sample of 116 hypertensive men was selected for a whole-night sleep study. Twenty-five of them had diabetes, defined as reporting regular medical controls for diabetes or having a fasting blood glucose > or =6.1 mmol L(-1). The prevalence of severe OSA, defined as apnoea-hypopnoea index (AHI) > or =20 h(-1) was significantly higher in diabetic patients than in normoglycaemic subjects (36 vs. 14.5%, P < 0.05). The sample was divided into four groups based on the presence or absence of severe OSA and the presence or absence of central obesity, defined as waist-to-hip ratio (WHR) > or =1.0. In a logistic regression model with the non-OSA, WHR <1.0 as the reference group, the adjusted odds ratio (95% confidence interval) for diabetes was 11.8 (2.0-69.8) in the OSA, WHR > or =1.0 group, whilst it was 3.6 (0.9-14.8) in the non-OSA, WHR > or =1.0 group and 5.7 (0.3-112) in the OSA, WHR <1.0 group. In a linear regression model, after adjustment for WHR, there was a significant relationship between variables of sleep-disordered breathing and fasting insulin, glucose and haemoglobin A1c. We conclude that, in hypertensive men, although obesity is the main risk factor for diabetes, coexistent severe OSA may add to this risk. Sleep breathing disorders, independent of central obesity, may influence plasma insulin and glycaemia.