Increased Waist Circumference Research Articles

Correlation of obstructive sleep apnea with components of metabolic syndrome and implications for long-term adverse cardiovascular risk in elderly patients

To investigate the relationship between obstructive sleep apnea (OSA) and components of metabolic syndrome (MetS) in the elderly and the implications for long-term risk for major adverse cardiovascular events (MACE). This multicenter prospective cohort study was conducted among 1157 consecutive patients with OSA [defined as an apnea-hypopnea index (AHI) ≥5 times/h recorded by overnight polysomnography] aged ≥60 years enrolled from January, 2015 to October, 2017. All the patients did not have a history of MACE at baseline and had complete documentations of MetS indicators. The baseline demographic data, clinical characteristics, biochemical markers, and sleep parameters were collected from all the patients, who were divided into 4 groups according to the quartile level of AHI and followed up for a median of 42 months for MACE and its component events (cardiovascular death, myocardial infarction, and hospitalization for unstable angina or heart failure). Multivariate linear regression and Cox proportional risk regression models were used to analyze the correlation of MetS components with major objective predictors of OSA, AHI and LSpO2 and the long- term risk of MACE. AHI and LSpO2 quartiles group showed a positive dose-response relationship with MetS components [fasting blood glucose, waist circumference, systolic blood pressure, and triglycerides] and a negative dose-response relationship with high-density lipoprotein level. MACE occurred in 119 (10.3%) patients with OSA during the follow-up. Multivariate Cox regression analysis showed that a high triglycerides, a high systolic blood pressure, and an increased waist circumference were independent risk factors for MACE and its component events (P < 0.05 or 0.01); a high HDL was a protective factor against MACE and myocardial infarction (P < 0.05 or 0.01) independent of the AHI. MetS components independent of LSpO2 showed no significant correlations with the risk of MACE or its component events. The major diagnostic indexes AHI and LSPO2 in elderly patients with OSA have a dose-response relationship with MetS components, and the interaction between the components of MetS and AHI can increase the risk of MACE and its component events.

Correlation between Neck Circumference and Other Anthropometric Measurements in Eight Latin American Countries. Results from ELANS Study.

Neck circumference (NC) is being used to identify the risk of chronic diseases. There is a high prevalence of overweight and obesity in Latin America, and neck circumference is a simple and practical measurement to assess this, especially in primary health centers. We analyzed the correlation between the NC anthropometric indicator and other anthropometric measurements such as BMI and waist circumference (WC) in eight Latin American cities. We applied Pearson’s correlation to identify the correlate NC with the other anthropometric variables stratified by sex; the sensitivity (Se) and specificity (Sp) by sex were evaluated according to the cut-off established with the Youden Index. The strongest correlations between NC and WC were found when stratified by sex (women: r = 0.71; men: r = 0.69, respectively) followed by the correlation between NC and BMI (r = 0.65, both sex). NC cut-off points of 39.0 cm in men and 32.9 cm in women identified those individuals with an increased WC and 39.8 and 33.7 cm, respectively, for a substantial increase in WC. For BMI ≥ 25.0 kg/m2 for men, the cut-off point was 37.5 cm, and for women, it was 33.1 cm, and for BMI ≥ 30 kg/m2, the cut-off points were 39.2 and 34.2 cm, for men and women, respectively. Conclusion: NC proved to be a useful, practical, and inexpensive tool that can be used to identify, evaluate, and monitor overweight and obese individuals.

Obesity in young South African women living with HIV: A cross-sectional analysis of risk factors for cardiovascular disease.

Young South African women are faced with a dual epidemic of HIV and obesity, placing them at a high risk of developing atherosclerotic cardiovascular disease (CVD). We sought to determine the prevalence of CVD risk factors in a cohort of reproductive-aged South African women living with HIV (WLHIV). While the main purpose of an ongoing intervention study is the reduction of cardiovascular disease through the integration of CVD screening and prevention in the HIV management plan for women of reproductive age (ISCHeMiA trial), we present the prevalence of risk factors for CVD in this cohort of young women at baseline. Sociodemographic, conventional CVD risk factors, HIV-related factors and self body image perception were assessed through study questionnaires and standardized clinical and laboratory procedures. Of the 372 WLHIV enrolled from November 2018 to May 2019, 97% had received efavirenz-based antiretroviral treatment (ART) for at least 1 year and 67.5% (248/367) of women were overweight or obese at the time of enrolment. The prevalence of metabolic syndrome was 17.6% (95%CI 11.6-22.8) at a median age of 35 years (IQR 30.5-40.5). A significant proportion of women had abnormally low levels of high-density lipoprotein (43.2%, 80/185) and elevated levels of high sensitivity C-reactive protein (59.5%, 110/185). Seventy five percent of overweight women with an increased waist circumference reported to be satisfied with their body image. The high prevalence of metabolic syndrome, obesity and elevated markers of inflammation in young South African WLHIV, underscores the need for a proactive integrated management approach to prevent atherosclerotic cardiovascular disease in low and middle income settings.

Fluctuations in waist circumference increase diabetes risk: a 4-year cohort study in 61,587 older adults

PurposeTo evaluate the effect of fluctuations in waist circumference (WC), weight, and body mass index (BMI) on the incidence of diabetes in older adults.Patients and methodsA prospective cohort of 61,587 older adults (age, 60–96 years) who did not have diabetes at study initiation was examined. Data on weight, BMI, and WC were collected, and participants were followed up until 31 December 2018. The main end point was new-onset diabetes. A Cox regression model was used to estimate the risk of diabetes (hazard ratios [HRs] and confidence intervals [CI]) in these participants.ResultsDuring a mean follow-up of 3.6 years, being overweight (HR [95% CI] 1.87 [1.62–2.17]), obesity (1.41 [1.26–1.59]), abdominal obesity (1.42 [1.28–1.58]), and obesity plus abdominal obesity at baseline (1.93 [1.66–2.25]) increased the risk of diabetes onset. Compared with older adults who “maintained normal WC”, those who “remained abdominally obese” (HR = 1.66), “became abdominally obese” (HR = 1.58), or “achieved normal WC” (HR = 1.36) were at a higher risk of diabetes onset, as well as those with an increase in WC > 3 cm or > 5% compared with the baseline level. Weight gain or loss > 6 kg or weight gain > 5%, increase or decrease in BMI > 2 kg/m2, or an increase in BMI > 10% were associated with a higher diabetes risk. The diabetes risk was reduced by 19% in overweight older adults who exercised daily.ConclusionFor older adults, WC, BMI, and healthy weight maintenance reduce the diabetes risk. The findings may provide evidence for developing guidelines of proper weight and WC control for older adults.

Effect of numbers of metabolic syndrome components on mortality in patients with antineutrophil cytoplasmic antibody-associated vasculitis with metabolic syndrome.

This study investigated the effect of the number of metabolic syndrome (MetS) components on all-cause mortality in patients with antineutrophil cytoplasmic antibody-associated vasculitis (AAV) with MetS. The medical records of 93 AAV patients with MetS were retrospectively reviewed. MetS was diagnosed when three or more the following MetS components for Asians were met: (i) increased waist circumference; ii) high blood pressure; (iii) hypertriglyceridaemia; (iv) low level of high-density lipoprotein (HDL)-cholesterol; and (v) impaired fasting glucose (IFG) or type 2 diabetes mellitus (T2DM). All-cause mortality was defined as death owing to any aetiology. The median age was 61.4 years and 33 patients were men. Among 93 AAV patients with MetS, as the number of MetS components increased, the cumulative patient survival rate significantly decreased (p = 0.024). Compared to surviving AAV patients with MetS, deceased AAV patients with MetS were older, had higher Birmingham vasculitis activity score (BVAS) and Five-factor score (FFS), a lower frequency of IFG or T2DM, and a higher number of MetS components. In the multivariable Cox analysis, AAV patients with MetS who had all five MetS components were approximately 62 times more susceptible to all-cause mortality than those who had only three components. In terms of IFG or T2DM, patients with only IFG exhibited a significantly lower cumulative patients' survival rate than those without. The presence of many MetS components at the initial diagnosis of AAV was an independent and significant predictor of all-cause mortality in AAV patients with MetS.

PHYSICAL INACTIVITY AND HIGH SEDENTARY BEHAVIOR ARE ASSOCIATED WITH HYPERTRIGLYCERIDEMIC WAIST IN ELDERLY

During aging, an increase in sedentary behaviour and a decrease in physical activity levels are observed. These factors may increase abdominal adiposity and triglyceride levels, which characterizes the hypertriglyceridemic waist (HW) phenotype, providing a high risk for cardiometabolic diseases. This study aimed to analyze the association between hypertriglyceridemic waist, physical activity level and sedentary behaviour in community-dwelling elderly. A population-based cross-sectional study was carried out, involving 316 elderlies (≥ 60 years) of both genders. The hypertriglyceridemic waist was diagnosed using high triglycerides (≥ 150 mg/dl) and increased waist circumference ≥ 88 and ≥ 102 cm values for women and men, respectively. The physical activity level and sedentary behaviour were evaluated using the IPAQ. The study included 173 women (54.7%) and 143 men (45.3%), with a mean age of 74.2 ± 9.8 years. The prevalence of HW was 27.1%, 47.7% insufficiently active and 24.1% high sedentary behaviour. The insufficiently active elderly (OR= 2.48; 95% CI: 1.31 - 4.71; p= 0.005) and with high sedentary behaviour (OR= 2.21; 95% CI: 1.04 - 4.32; p= 0.038) were associated positively with HW, indicating that elderly with insufficient physical activity levels and high sedentary behaviour showed themselves to approximately 2.5 and 2.2 times more likely to develop HW, respectively. Low physical activity level and high sedentary behaviour are associated with hypertriglyceridemic waist in community-dwelling elderly.

Prospective associations between leukocyte telomere length and adiposity in childhood.

Leukocyte telomere length (LTL) is associated with obesity and may be involved in its aetiology, but few studies have focused on children and most have been cross-sectional. We assessed the relation of LTL with adiposity development in a prospective study of Colombian children. We quantified LTL at enrollment in 722 children aged 5-12 years and measured anthropometry annually for a median 6 years. Using mixed effects models, we estimated changes in adiposity measures including BMI and waist circumference (WC)-for-age z-scores in relation to baseline LTL z-score. In girls, longer LTL was linearly related to a lower increase in WC z-score from age 6 to 16 years. Every 1 SD LTL was associated with an adjusted 0.13 units lower increase in WC (95% CI: -0.23, -0.03; p=0.01). In conclusion, longer LTL among girls in middle childhood is associated with smaller increases in WC, an indicator of abdominal adiposity.

Positive Association of Serum Adiponectin Level With the Vascular Reactivity Index in Kidney Transplant Patients.

Adiponectin has an important role in obesity, insulin resistance, and cardiovascular disease. We investigated the association between serum adiponectin levels and endothelial function in kidney transplant patients. Fasting blood samples were obtained from 70 kidney transplant patients. The vascular reactivity index was measured with a digital thermal monitoring test. Serum adiponectin levels were measured with a commercially available enzyme immunoassay kit. A vascular reactivity index <1.0 was defined as poor, 1.0 or greater but less than 2.0 was intermediate, and 2.0 or greater was good. The results showed that 10 kidney transplant patients (13.3%) were categorized with a vascular reactivity index of poor, 25 (35.7%) were intermediate, and 35 (50%) were good. Increased waist circumference (P = .037), increased serum alkaline phosphatase (P = .026), and lower serum adiponectin (P = .001) were associated with poor vascular reactivity index. Advanced age (r = -0.300; P = .012), waist circumference (r = -0.372; P = .002), serum alkaline phosphatase (r = -0.323; P = .006), and logarithmically transformed serum triglycerides (r = -0.317; P = .007) were negatively correlated with the vascular reactivity index, whereas serum adiponectin (r = 0.332; P = .005) was positively correlated with the vascular reactivity index. Multi variable forward stepwise linear regression analysis showed that waist circumference, serum alkaline phosphatase, and serum adiponectin were significantly and independently associated with the vascular reactivity index. Fasting serum adiponectin levels were positively associated with the vascular reactivity index and negatively associated with endothelial function in kidney transplant patients.

Highly Active Antiretroviral Therapy in Adult HIV-Infected Patients with Diabetes Mellitus: A 5-year Prospective Cohort Study

Adverse effects following long-term use of highly active antiretroviral therapy (HAART), such as metabolic syndromes (MetS) and cardiovascular diseases (CVDs), have been reported. We determined whether patients with controlled pre-existing diabetes mellitus (DM) undergoing HAART are at high risk of long-term adverse effects, compared with HIV-infected patients without DM. In this prospective cohort study that recruited 172 HIV-infected patients, patients were followed up every six months for five years. Data Collection on Adverse Effects of Anti-HIV Drugs (D:A:D), a CVD risk score for HAART, and lab data, were compared between patients with controlled DM and non-DM patients matched on age and gender. HAART was less effective for HIV-infected patients with DM, with a higher plasma HIV RNA load in plasma viral load (PVL) testing (r=0.4868, P=0.0216) since the third year of follow-up. HAART increased the risk of CVDs for DM patients, with higher D:A:D (R) (r=0.1636, P=0.0336) and D:A:D (F) (r=0.1883, P=0.0142) scores at fifth year. DM patients presented with higher risk of advanced stages CKD (GFR<30 mL/min) (r=0.3226, P< 0.0001), with increased creatinine (r=0.5669, P<0.0001) and BUN (r=0.2832, P=0.0009). As of MetS, DM patients had increased waist circumference (r=0.2601, P=0.0006), total cholesterol (CHO) (r=0.2745, P=0.0309), LDL (r=0.1925, P=0.0402), compared to baseline. Even though under controlled status at baseline, DM patients still had higher fasting blood sugar since the third year (r=0.3129, P=0.0002). In conclusion, HAART was less effective in DM patients, and resulted in more subsequent CVDs and renal toxicities; other signs of metabolic syndromes were as well observed.

Prevalence of cardiometabolic risk factors in patients with hypertension and subclinical hypothyroidism

It is known that the presence of overt hypothyroidism carries additional risks of developing cardiovascular diseases due to impaired lipid and carbohydrate metabolism. But whether subclinical hypothyroidism (SH) has the same negative impact is still controversial. The assessment of its role is especially important in patients with existing arterial hypertension (AH) in the early stages of the disease in order to prevent future complications. The aim of this work is to identify and assess the prevalence of early cardiometabolic risk factors in patients with AH combined with SH. Materials and methods. 66 patients (55.4 % women) aged from 25 to 59 years with a median age of 51.1 years were included in the study during 2019–2020 years. All the patients were divided into 3 groups, randomized by age and sex: group 1 (n = 21) – vo­lunteers without AH and SH; group 2 (n = 25) – euthyroid patients with stage 1–2 grade 1–2 AH and low-to-moderate cardiovascular risk (CVR); group 3 (n = 20) – patients with stage 1–2 grade 1–2 AH and low-to-moderate CVR in combination with SH. Blood pressure was measured, anthropometric data were assessed, glucose levels and lipid profile indicators were determined in all patients. Results. Comparative characteristics of the groups showed a rise in the frequency of detecting increased waist circumference and the waist-to-hip ratio, obesity, metabolic syndrome, its individual components and lipid profile disorders, especially the levels of total cholesterol and high-density lipoprotein cholesterol in patients with SH even in the early stages of AH and CVR of low gradations. However, dyslipidemias in general and hypertriglyceridemia in particular were more common in euthyroid hypertensive patients compared to patients with AH and concomitant SH. There was also a tendency towards an increase in gynoid obesity and a worsening of the lipid and carbohydrate profile disorders in SH patients in comparison to euthyroid patients with AH, although the differences were not statistically significant. Conclusions. Evaluation of cardiometabolic risk factors revealed the increase in severity of female obesity and worsening of abnormalities in lipid and carbohydrate profiles with the SH development in patients even in the early stages of AH and low-CVR, that additionally increases the risk of cardiovascular complications.

MRI assessment of the abdominal adipose tissue and the state of the abdominal aorta in patients with coronary artery disease: association with metabolic disorders

Aim. To evaluate potential associations between quantitative features of visceral and subcutaneous adipose tissue (AT) and anthropometric characteristics of obesity, metabolic disorders, and the state of the abdominal aorta in patients with chronic coronary artery disease (CAD).Materials and methods. The study included 55 patients (average age 61.2 ± 7.2 years) with chronic CAD. Magnetic resonance imaging (MRI) was performed on a 1.5 T MRI scanner using T2-weighted spin-echo modes. The area and volume of abdominal subcutaneous (SAT) and visceral adipose tissue (VAT) were calculated at the L4–L5 level; the total volumes of abdominal SAT and VAT were determined. Parameters of lipid and carbohydrate metabolism, as well as adipokine profile were studied in the blood serum.Results. In the course of a multiple linear regression analysis, we detected the independent determinants, which described 95% of the total VAT volume variability and were represented by waist circumference (WC) and serum levels of high-density lipoprotein (HDL) cholesterol and adiponectin. The model was characterized by the significance level p &lt; 0.000001, the residuals of the model were normal. We calculated the coefficients in the model: 1.39 for WC, –0.26 for HDL cholesterol, and –0.19 for adiponectin. We detected a positive correlation between the abdominal aorta (AA) diameter and SAT area at the L4–L5 level (rs = 0.48; p = 0.0014), which does not depend on gender, and reverse correlations between the aorta diameter and glycated hemoglobin (HbA1c) level (rs = –0.40; p = 0.0359) and postprandial glycemia (rs = –0.40; p = 0.0273). The patients with a dilated aorta (group 2), when compared with the patients with a normal aorta diameter (group 1), did not differ in the AT accumulation, but demonstrated decreased levels of HbA1c and postprandial glycemia, which resulted in a smaller number of patients with type 2 diabetes mellitus.Conclusion. We identified independent determinants of an increase in the total volume of abdominal visceral AT, such as an increase in WC and a decrease in serum adiponectin and HDL cholesterol levels. Results of the study indicate the presence of a link between the AA remodeling, accumulation of subcutaneous AT, and impaired glucose metabolism.

Association of Periaortic Fat and Abdominal Visceral Fat with Coronary Artery Atherosclerosis in Chinese Middle Aged and Elderly Patients Undergoing Computed Tomography Coronary Angiography.

Background and Aims:Coronary artery disease (CAD) is usually caused by atherosclerosis, which is associated with general obesity and stronger associations with localized ectopic fat depots have been reported. We measured body ectopic fat distribution in Chinese patients to determine the association with coronary artery atherosclerosis (CA).Methods:Patients undergoing coronary computed tomography angiography (CCTA) who agreed to participate in the study (n = 750, 50.4% men, mean age 64.8 years) had cardiovascular disease and risk assessment. Body ectopic fat depots were measured from CT and their association with CA, determined from CCTA, was evaluated by univariate and multivariate logistic regression models.Results:CAD with CA (CAD-CA) was present in 57.2% of participants with CAD of moderate/severe CA (CAD-msCA) present in 23.5% and both were significantly more frequent in men than in women. Overall, men had greater body mass index (BMI) but there was no difference in waist circumference (WC) between genders. However, significantly higher visceral adipose tissue (VAT) and periaortic fat volume (PAFV) were observed in men, whereas women had significantly higher abdominal subcutaneous adipose tissue (SAT). With increasing age, there was a significant decline in BMI, WC and SAT in men, but a significant increase of WC and VAT, PAFV and epicardial fat volume (EFV) in women. A high proportion of non-calcified plaques was observed in CAD-CA, 55.3% in CAD of minimal/mild CA (CAD-mmCA) with 38.7% exclusively non-calcified plaques, and 59.7% in CAD-msCA with multiple type plaques containing non-calcified ones. Multivariate logistic regression showed a significant association of PAFV with CAD-CA and CAD-msCA that was independent of general obesity and clinical risk factors, and independent of abdominal obesity in the highest PAFV quartile patients. VATA was associated with an increased prevalence of CAD-msCA in the patients in the upper 2 VATA quartiles that was independent of clinical risk factors and both general and abdominal obesity.Conclusions:We found age and gender differences of body ectopic fat distribution in Chinese patients with higher VAT and PAFV in men and higher SAT in women. With increased age, there was a decline of WC and SAT in men but not in women and an increase in WC, VAT and PAFV in women but not in men. PAFV was significantly associated with overall CAD-CA and CAD-msCA, while VAT was associated with CAD-msCA.

Insulin resistance and associated factors in female adolescents from two capital cities in the north and south of Brazil

BackgroundIt has been described that physiological changes in glucose metabolism, represented by insulin resistance (IR), are predicted during pubertal evolution, and obesity may be associated with its persistence even at the end of puberty. The aim of this study was to investigate the prevalence of IR in female adolescents with possible associated factors and evaluate the relationship of time since menarche (< 2 vs. ≥ 2 years) in the occurrence of IR in two Brazilian capital cities: Porto Velho (RO) and Porto Alegre (RS).MethodsThis is a cross-sectional school-based study, using information from the Study of Cardiovascular Risks (ERICA) database for adolescents aged 12–17 years, enrolled in public and private schools, in municipalities with more than 100,000 inhabitants in Brazil, between 2013 and 2014. The present study included 889 adolescents, 382 in Porto Velho (PVh) and 507 in Porto Alegre (PoA). The homeostasis model assessment for insulin resistance (HOMA-IR) ≥ 3.16 and fasting insulin ≥ 15 mU/L was used to determine the outcome variable of IR. Estimates of crude and adjusted prevalence ratios with confidence intervals of 95% were calculated using Poisson regression with robust variance. Sociodemographic, behavioral, reproductive and nutritional characteristics were considered as potential confounding factors in multivariable models based on a conceptual framework of IR determination.ResultsIn the total sample, the prevalence of IR was 22.03% (95% CI 17.84–26.89). After adjusting the models, age 15–17 years and time since menarche ≥ 2 years were found to act as protective factors for IR; in contrast, the highest probability of IR was observed in black adolescents, with increased waist circumference (WC) and overweight/obesity (Ow/Ob). The protective effect of two or more years since menarche (post-menarche) was observed for both higher HOMA-IR and fasting insulin in PVh; in PoA, such protection was maintained only for fasting insulin ≥ 15 mU/L after adjustments in the multivariate models.ConclusionsIR is more prevalent during the peri-menarche period, especially in younger and black adolescents, compared to their white and post-menarche counterparts. The association between Ow/Ob and high WC with the occurrence of IR was independent of age and ethnicity variables.

Retracted: Cardiovascular risk profile of a young adult population with high risk for obstructive sleep apnea screened by Stop-Bang and Epworth sleepiness scale in a primary health care unit

Abstract Objective To establish the relationship between cardiovascular (CV) risk profile and detected risk of Obstructive Sleep Apnea (OSA) in two questionnaires - STOP-BANG (SB) and Epworth Sleepiness Scale (ESS), in a young population of adults registered in a Primary Health Care unit in Brazil. Design and methods This cross-sectional population study enrolled adults between 20–50 years old, registered in a primary healthcare unit in Brazil. A database is being developed including sociodemographic and anthropometric data, and CV risk factors. Office blood pressure (BP) and Home Blood Pressure Monitoring (HBPM) (7-day protocol) (Omron-705CP). Moreover, OSA was investigated by SB and ESS. Patients with a high risk for OSA in either of these two questionnaires were subsequently assigned for polysomnography (PSG). Results A total of 562 subjects were evaluated [40% males, 38.9±8.8 years], where 151 (26.9%) were identified as high risk for OSA by the SB questionnaire and 210 (37.4%) by ESS. The most common CV risk factor was physical inactivity (43%), followed by dyslipidemia (38%) and obesity (28%). By OBP, the prevalence of hypertension was 13.4% while by HBPM was 18.6%, with a low concordance between them (kappa=0.472). Subjects with a high risk at SB are older, with a higher prevalence of obesity, hypertension and higher office BP and HBPM. On the other hand, individuals with high-risk by ESS were more obese, with increased waist circumference, higher prevalence of dyslipidemia and metabolic syndrome. Nevertheless, there was no difference in BP levels. Among the subjects submitted to PSG, 46% had a diagnosis of OSA (AHI ≥5/hour) and 23% of moderate/severe OSA (AHI&amp;gt;15/hour). The best predictor of AOS was SB, positive in 100% of subjects with moderate/severe OSA, while ESS was positive in only 20% of them. Conclusion This young and apparently healthy population presented a high prevalence and risk for OSA. The SB had a higher association with higher BP levels, while ESE was associated with a worse metabolic profile. SB questionnaire seems to be the best predictor for moderate/severe OSA in this young adult population. Funding Acknowledgement Type of funding sources: None.

Metabolically healthy obesity in a young population assisted by the Family Health Strategy in Brazil. LapARC study

Abstract Background Obesity is increasing in younger populations, and is associated with a high cardiovascular (CV) risk, however, it is not clear whether metabolically healthy obesity (MHO) may have a lower CV risk or if it is just an earlier stage of the disease. Objective To evaluate the prevalence and CV risk factors associated with MHO in a young population assisted by a Family Health Care unit in a large urban center in Brazil. Methods A cross-sectional population study for CV risk assessment in adults aged 20–50 years old from a FHC unit in Brazil. Demographic, anthropometric data and CV risk factors were recorded. All underwent office blood pressure (OBP) measurements, laboratory evaluation (lipid and glycidic profile). Obesity was defined as a BMI ≥30 kg/m2 and MHO are those who have less than 3 of the following criteria: hypertension, diabetes, total cholesterol ≥200 mg/dL, HDL&amp;lt;40 mg/dL (men) and 50 mg/dL (women), triglycerides&amp;gt;150 mg/dL and increased waist circumference. Results A total of 632 individuals were evaluated (60% female; mean age 37±9 years). The prevalence of obesity was 26%, of which 73% were classified as MHO. Obeses are older, with a higher prevalence of physical inactivity (51% vs 41%, p=0.03), hypertension (44% vs 19%, p&amp;lt;0.001), dyslipidemia (50% vs 36%, p=0.002) and diabetes (7% vs 2%, p=0.001) with higher systolic OBP. MHO compared to unhealthy ones are significantly younger and smoke less. Despite being obese, they have lower BMI (33.6 vs 35.2 kg/m2, p=0.02) and abdominal circumference (102 vs 110 cm, p=0.03), with lower diastolic BP. Conclusion MHO was more prevalent in this young population and seems to have a lower CV risk, however it is not clear whether these younger and less obese individuals are only at an earlier stage of the disease. Perhaps the CV diseases onset is postponed for a few years. Even so, these individuals should not be excluded from public health policies as a form of primary prevention Funding Acknowledgement Type of funding sources: None.

High within-visit systolic blood pressure variability is associated with stroke and diabetes

Abstract Background Within-visit systolic blood pressure variability (SBPV) has been inconsistently, positively associated with cardiovascular (CVD) outcomes. Purpose We sought to determine whether SBPV was cross-sectionally associated with CVD and CVD risk factors in a nationally representative study population of United States adults. Methods Using the 2011–2018 National Health and Nutrition Examination Surveys, a total of 10,879 adults ≥20 years not taking antihypertensive medications were included. After an initial five-minute rest, participants had three, sitting, consecutive BP readings (30 sec. rest in between) taken by protocol-trained physicians using a mercury sphygmomanometer. SBPV was calculated as 1) the standard deviation (SD) of the three BP readings and categorized into less than, and greater than or equal to the 75th percentile (SD≥4.2 mmHg). We also calculated the maximum minus minimum SBP difference (MMD), categorized into less than 10, and greater than or equal to 10 mmHg. The primary outcomes were self-reported history of CVD outcomes, including stroke, myocardial infarction, coronary heart disease, and heart failure. Secondary outcomes included increased waist circumference, impaired glucose tolerance, diabetes, hypertriglyceridemia, and low HDL. We used one-way ANOVA, chi-square tests, and multivariable logistic regression to determine association between SBPV and CVD outcomes. All analyses accounted for the complex survey design and had a significance level of 0.05. Results Among the 10,879 participants, 2,386 (20%) had high SBPV. Those with high SBPV were older (mean [SD]; 47.0 [0.6] vs. 41.8 [0.3], p&amp;lt;0.0001), had higher mean SBP (mean [SD] mmHg; 121 [0.4] vs. 118 [0.2], p&amp;lt;0.0001), higher max SBP (127 [0.4] vs. 120 [0.2], p&amp;lt;0.0001), higher HbA1c % (5.54 [0.02] vs. 5.48 [0.01]) but similar lipid profiles. Accordingly, high SBPV participants were more likely to have diabetes, but had no difference in other metabolic syndrome criteria (Figure 1). High SBPV participants were more likely to have a history of stroke (1.7% vs. 0.8%, p&amp;lt;0.0001), but less likely to have myocardial infarction (p=0.028; Figure 2). After adjustment for covariates, those with high SBPV had 50% higher odds of stroke compared to those without high SBPV (OR [95% CI]; 1.50 [1.11, 2.03]). This association persisted when using MMD (1.48 [1.04, 2.11]). However, the adjusted associations were attenuated when treating SBPV as a continuous variable (SD, unadjusted OR [95% CI]: 1.14 [1.07, 1.21], adjusted OR: 1.06 [0.99, 1.13]). Conclusion Participants with high SBPV were more likely to have diabetes and history of stroke. SBPV greater than or equal to 4.2 mmHg or maximum-minus-minimum SBP difference greater than or equal to 10 mmHg both were associated with nearly 50% higher odds of stroke. This suggests that stroke survivors may benefit from interventions to decrease within-visit BP variability to improve BP measurement accuracy and potentially prognosis. Funding Acknowledgement Type of funding sources: None. Figure 1. Cardiometabolic Factors &amp; BPVFigure 2. Cardiovascular Disease &amp; BPV

Comparative Utility of Transient and 2D Shear Wave Elastography for the Assessment of Liver Fibrosis in Clinical Practice.

The aim of the study was to investigate the feasibility and correlation of liver stiffness measurements (LSM) between 2D-shear wave elastography (2D-SWE) and transient elastography (TE) in patients with chronic liver disease. Over 4months, 421 patients with chronic liver disease of any cause underwent LSM by 2D-SWE and TE (M and/or XL probe) and controlled attenuation parameter at the same visit. LSM was not feasible by TE in 16 (3.8%) and by 2D-SWE in 17 (4.0%) patients. Median LSM were 8.9 and 8.7kPa with TE and 2D-SWE, respectively, having a strong correlation (r = 0.774, p < 0.001) in the total cohort and in any cause of liver disease (r = 0.747-0.806, p < 0.001). There was a strong agreement on diagnosis of severe fibrosis (k-statistic: 0.841, p < 0.001) or cirrhosis (k-statistic: 0.823, p < 0.001). Both methods had increased failure rates in patients with obesity and/or increased waist circumference. Among 104 obese patients, TE was more feasible than 2D-SWE (92.3% vs 85.6%, p < 0.001]. LSM by 2D-SWE are strongly correlated to LSM by TE independently of the etiology of chronic liver disease, stage of fibrosis, degree of liver steatosis, and patients' characteristics. TE with the XL probe may be superior in a minority of obese patients.

The Relation between Waist Circumference and Hypertension

Background: Prior studies have supported that waist circumference correlates with abdominal (central) obesity, and values higher than normal are associated with increased prevalence of hypertension. . Objective: To evaluate the association of waist circumference with increased prevalence of hypertension among population in Kirkuk city. Materials and Methods: Across-sectional study was conducted comprising 300 male and female, their ages ranged from 20-72 years with an average mean of 53 year from Kirkuk city. The waist circumference was measured in centimeters, together with other data designed in the data sheet for this study, hypertensive people were identified and recorded. Patients who had coexisted Diabetes Mellitus and hypertension were excluded from the study. Results: The total number of females was 218, out of them, 176(80.7%) had increased waist circumference, this included 74(42%) hypertensive, compared with 42(19.2%) women with normal waist circumference and included 6(14.2%) hypertensive. (P < 0.05). Out of 82 males, 46(56%) had increased waist circumference (>102cm), this included 17(37%) hypertensive; compared with 36(44%) with normal waist circumference, which included 7(19.4%) hypertensive. P. value ˂0.001 Waist circumference was positively correlated with hypertension Conclusions: Increasing waist circumference was significantly associated with increased prevalence of hypertension, reduction in the occurrence of hypertension in male and female can be achieved if the waist circumference is decreased in these populations.

Hair cortisol, obesity and the immune system: Results from a 3 year longitudinal study

ObjectivesHigher long-term glucocorticoid levels, measured in scalp hair (HairGC), are associated with obesity. This may represent the state of obesity (perhaps interrelated with chronic immune activation), but could also promote further weight gain. We studied whether hair cortisol (HairF) and hair cortisone (HairE) predict changes in body mass index (BMI) and waist circumference (WC) over time, and assessed the association between HairGC and common immune parameters. MethodsWe measured HairGC in 1604 participants of the Netherlands Study of Depression and Anxiety (NESDA), and investigated their associations to BMI, WC, and immune parameters (interleukin-6 (IL-6), C-reactive protein (CRP), and leukocyte subsets). Also, we assessed whether baseline HairGC predict changes in BMI and WC at follow-up (three years later). ResultsIn cross-sectional analyses, HairF and HairE were positively associated to BMI (β = 2.06 kg/m2, 95% confidence interval (CI)= 1.22–2.90 kg/m2) and β = 2.84 kg/m2 (95%CI 1.75–3.93 kg/m2) respectively) and WC (β = 5.36 cm (95%CI 3.09–7.62 cm) and β = 8.54 cm (95%CI 5.60–11.48 cm) respectively, all p < 0.001). HairF was also positively associated to IL-6 (β = 0.15 (95%CI 0.003–0.292) p < 0.05) and leukocyte count (β = 0.57 (95%CI 0.234–0.909), p < 0.01), and HairE to IL-6 (β = 0.21 (95%CI 0.016–0.399), p < 0.05).In the longitudinal analyses, higher HairF was associated with yearly increases in BMI (β = 0.58% BMI change per year (95%CI 0.14–1.01%), p = 0.009) and higher HairE with increases in WC (β = 0.84% WC change per year (95%CI 0.02–1.69%), p = 0.049). Adjusting for baseline IL-6 or leukocytes did not change the found associations between HairGC and WC or BMI change. ConclusionsHairGC levels are positively associated to BMI, WC, IL-6 and leukocyte numbers in cross-sectional analyses, and to increases in BMI and WC in longitudinal analyses. Although causality is yet to be proven, higher long-term glucocorticoid levels could represent a relevant risk factor for the development of obesity.

Lipidomic Signatures of Changes in Adiposity: A Large Prospective Study of 5849 Adults from the Australian Diabetes, Obesity and Lifestyle Study.

Lipid metabolism is tightly linked to adiposity. Comprehensive lipidomic profiling offers new insights into the dysregulation of lipid metabolism in relation to weight gain. Here, we investigated the relationship of the human plasma lipidome and changes in waist circumference (WC) and body mass index (BMI). Adults (2653 men and 3196 women), 25–95 years old who attended the baseline survey of the Australian Diabetes, Obesity and Lifestyle Study (AusDiab) and the 5-year follow-up were enrolled. A targeted lipidomic approach was used to quantify 706 distinct molecular lipid species in the plasma samples. Multiple linear regression models were used to examine the relationship between the baseline lipidomic profile and changes in WC and BMI. Metabolic scores for change in WC were generated using a ridge regression model. Alkyl-diacylglycerol such as TG(O-50:2) [NL-18:1] displayed the strongest association with change in WC (β-coefficient = 0.125 cm increment per SD increment in baseline lipid level, p = 2.78 × 10−11. Many lipid species containing linoleate (18:2) fatty acids were negatively associated with both WC and BMI gain. Compared to traditional models, multivariate models containing lipid species identify individuals at a greater risk of gaining WC: top quintile relative to bottom quintile (odds ratio, 95% CI = 5.4, 3.8–6.6 for women and 2.3, 1.7–3.0 for men). Our findings define metabolic profiles that characterize individuals at risk of weight gain or WC increase and provide important insight into the biological role of lipids in obesity.