Lower Waist Circumference Research Articles

426.5: Regular Physical Activity in the Prevention of Post-transplant Diabetes Mellitus and Associated Metabolic Conditions in Kidney Transplant Recipients

Introduction: Post-transplant diabetes mellitus (PTDM) is significant risk factor for the survival of graft recipients and occurs in 10-30% of patients after kidney transplant (KT). PTDM is associated with premature cardiovascular morbidity and mortality. Insulin resistance (IR) at the time of KT is the most significant risk factor for the development of PTDM in patients after KT, as demonstrated by several analyzes. It is possible to reduce the high incidence of PTDM and affect the long-term survival of patients and grafts by influencing just modifiable risk factors, including obesity and the associated IR. The aim of this work is to determine the effect of regular physical activity on the development of PTDM and its risk factors in patients after KT. Methods: This was a prospective controlled analysis, which included 44 patients after primary KT in the Martin Transplant Center. Half consisted of a study group (n = 22) whose patients were assigned to perform regular physical activity. The primary goal was to complete at least 150 minutes of moderate intensity physical exertion per week. They performed an aerobic or combined (aerobic + strength) type of sports activity. Monitoring was provided by a sports tracker (Xiaomi Mi Band 4 compatible with Mi Fit mobile application). The other half was made up of a control group. The exclusion criterion at that time was already diagnosed with diabetes mellitus or a pre-diabetic condition. IR was assessed using the HOMA-IR (Homeostatic Model Assessment for Insulin Resistance) index from fasting blood glucose and insulinemia values. Each patient underwent an oral glucose tolerance test (oGTT) at the end of follow-up. Patients in both groups have the same immunosuppressive protocol. The duration of follow-up was 6 months. Results: We confirmed a statistically significantly higher IR at 6 months (P = 0.0202) and fasting blood glucose at 3 and 6 months (P = 0.0279) by multivariate analysis in the control group (figure 1, 2). After the end of the follow-up, there were significantly fewer patients with normal oGTT in the control group compared to the study group at 6 months (P < 0.0001), significantly more patients with pre-diabetic condition (impaired plasma glucose, impaired glucose tolerance) (P = 0.0078) and diagnosed with PTDM (P = 0.0212) (figure 3). Significantly lower waist circumference at 3 and 6 months (P = 0.0437, P = 0.0372) and low-density lipoprotein at 6 months (P = 0.0444) were found in the study group compared to the control group. In the study group, the subgroup performing intensive training achieved a significant additional effect on the reduction of waist circumference (P = 0.0173). Patients practicing only aerobic activity achieved significant decrease in triglycerides compared to those practicing combined activity (P = 0.046). Conclusion: In our study, we confirmed a significant effect of regular physical activity in preventing the development of PTDM and associated pre-diabetic conditions.

P06-11 Continuity and changes in commuting mode and influence on physical activity, BMI and waist circumference among Finnish adults

BackgroundRegular physical activity (PA) has been found to be important for cardiovascular health and longevity. However, notable proportion of adult population does not meet the national PA recommendations. Active transport is one domain of physical activity, that could be a time-efficient way to increase PA and reach the national recommendations. Additionally, it could have a positive effect to body composition.MethodsBased on longitudinal cohort study, active commuting modes and objectively measured PA were used to determine the influence of commuting mode to steps, aerobic steps, BMI and waist circumference. Linear regression models were fitted to test the associations between the change groups of commuting mode and the longitudinal changes of the response variables.ResultsWhen compared to passive commuters, participants with public transport (p = 0.09) and walking (p > 0.001-0.021) showed higher amounts of steps and aerobic during summertime and wintertime. Cyclers showed higher amounts of steps and aerobic steps only in wintertime (p = 0.001-0.002). Passive commuters had higher BMI than walkers (p = 0.05) and cyclers (p = 0.023) in summertime. Also, cyclers had lower waist circumference than passive commuters (p = 0.016-0.02). Among those who remained persistently active, number of steps did not change. When compared to persistently active, among those who changed from active to passive commuting, steps (-900 - -885) and aerobic steps (-500) declined (p = 0.010-0.036) while among those who changed from passive to active commuting steps (+900-1000) and aerobic steps (+650-750) increased (p = 0.023-0.011).ConclusionsCommuting actively to work and changing passive mode to active mode has a positive effect to number of daily steps and aerobic steps. Since the active commuting is part of the daily routine, promoting active commuting could be one of the key factors tackling the obesity and insufficient PA among adults. Continuity of active commuting seemed to be effective way to maintain body weight in balance over the years.

The Discovery of Data-Driven Temporal Dietary Patterns and a Validation of Their Description Using Energy and Time Cut-Offs.

Data-driven temporal dietary patterning (TDP) methods were previously developed. The objectives were to create data-driven temporal dietary patterns and assess concurrent validity of energy and time cut-offs describing the data-driven TDPs by determining their relationships to BMI and waist circumference (WC). The first day 24-h dietary recall timing and amounts of energy for 17,915 U.S. adults of the National Health and Nutrition Examination Survey 2007–2016 were used to create clusters representing four TDPs using dynamic time warping and the kernel k-means clustering algorithm. Energy and time cut-offs were extracted from visualization of the data-derived TDPs and then applied to the data to find cut-off-derived TDPs. The strength of TDP relationships with BMI and WC were assessed using adjusted multivariate regression and compared. Both methods showed a cluster, representing a TDP with proportionally equivalent average energy consumed during three eating events/day, associated with significantly lower BMI and WC compared to the other three clusters that had one energy intake peak/day at 13:00, 18:00, and 19:00 (all p < 0.0001). Participant clusters of the methods were highly overlapped (>83%) and showed similar relationships with obesity. Data-driven TDP was validated using descriptive cut-offs and hold promise for obesity interventions and translation to dietary guidance.

Dynapenic-abdominal obesity as an independent risk factor for chronic kidney disease in postmenopausal women: a population-based cohort study.

Low muscle strength and obesity lead to a higher risk of chronic kidney disease (CKD). Perimenopause is associated with a natural decline in muscle strength and an increase in visceral adiposity. Dynapenic obesity, which is the coexistence of low muscle strength and obesity, is expected to synergistically increase the prevalence of CKD in postmenopausal women. The aim of this study was to determine combined associations of dynapenia and obesity with CKD in postmenopausal women. This study used data from the Korean National Health and Nutrition Examination Survey, 2016 to 2019. The study included 4,525 postmenopausal women aged 42 to 80 years that were classified into four groups based on waist circumference (≥85 cm) and hand grip strength (<18 kg): normal, dynapenic, obese, or dynapenic-obese. According to the Kidney Disease: Improving Global Outcomes, we defined CKD as an estimated glomerular filtration rate <60 mL/min per 1.73 m2. Complex sample logistic regression models were conducted to determine the relationships among coexistence of dynapenia, abdominal obesity, and the risk of CKD. Dynapenic-abdominal obese group displayed lower estimated glomerular filtration rate levels than other groups (P < 0.05 for all data). The prevalence rates of CKD were 15.5%, 7.8%, 6.2%, and 2.4% in the dynapenic-abdominal obese, dynapenic, abdominal obese, and normal groups, respectively (P < 0.001). Complex sample logistic regression analyses, after adjusting for age, height, health behaviors, and comorbidities, showed that the odds ratio for CKD with respect to dynapenic-abdominal obesity was 1.82 (95% confidence interval, 1.19-2.79) and to abdominal obesity was 1.54 (95% confidence interval, 1.07-2.22) than in the normal group. This study demonstrated that dynapenic-abdominal obesity, as determined by low handgrip strength and high waist circumference values, was associated with increased risk of CKD in postmenopausal women.

Prevalence and clinical characteristics of metabolically healthy obese versus metabolically unhealthy obese school children.

IntroductionChildren with obesity in the absence of traditional cardiometabolic risk factors (CRF) have been described as metabolically healthy obese (MHO). Children with MHO phenotype has a favorable metabolic profile with normal glucose metabolism, lipids, and blood pressure compared to children with metabolically unhealthy obese (MUO) phenotype. This study aimed to compare several parameters related to obesity between these two groups and to examine the predictors associated with the MHO phenotype.MethodsThis study included a cross-sectional baseline data of 193 children with obesity (BMI z-score > +2 SD) aged 8-16 years enrolled in MyBFF@school program, a school-based intervention study conducted between January and December 2014. Metabolic status was defined based on the 2018 consensus-based criteria with MHO children had no CRF (HDL-cholesterol > 1.03 mmol/L, triglycerides ≤ 1.7 mmol/L, systolic and diastolic blood pressure ≤ 90th percentile, and fasting plasma glucose ≤ 5.6 mmol/L). Those that did not meet one or more of the above criteria were classified as children with MUO phenotype.ResultsThe prevalence of MHO was 30.1% (95% CI 23.7 – 37.1) among schoolchildren with obesity and more common in younger and prepubertal children. Compared to MUO, children with MHO phenotype had significantly lower BMI, lower waist circumference, lower uric acid, higher adiponectin, and higher apolipoprotein A-1 levels (p < 0.01). Multivariate logistic regression showed that adiponectin (OR: 1.33, 95% CI 1.05 – 1.68) and apolipoprotein A-1 (OR: 1.02, 95% CI 1.01 – 1.03) were independent predictors for MHO phenotype in this population.ConclusionsMHO phenotype was more common in younger and prepubertal children with obesity. Higher serum levels of adiponectin and apolipoprotein A-1 increased the possibility of schoolchildren with obesity to be classified into MHO phenotype.

Association between metabolically healthy obesity and non-alcoholic fatty liver disease.

The risks of NAFLD and NAFLD with fibrosis progression among metabolically healthy obesity (MHO) individuals are largely unexplored. This cohort study investigated the association between MHO as well as other metabolic syndrome-obesity combined phenotypes and NAFLD and its fibrosis progression. Participants included 31,010 adults from a health check-up cohort free from NAFLD and intermediate or high probability of advanced fibrosis at baseline. Metabolically healthy was defined as not having any component of metabolic syndrome. Obesity was identified by body mass index (BMI) and waist circumference (WC). Participants were cross-classified by metabolic health and obesity at baseline. The outcomes were NAFLD, and NAFLD with fibrosis progression, as assessed by abdominal B-type ultrasound and noninvasive fibrosis score. During a median follow-up of 2.2 (interquartile range, 1.2-4.9) years, 7,393 participants developed NAFLD. MHO individuals (HR 5.51, 95% CI 4.98, 6.09 for BMI criteria; HR 6.76, 95% CI 6.04, 7.57 for WC criteria) had a significantly higher risk of NAFLD than those with metabolically healthy normal weight or low WC. The corresponding HRs (95% CIs) for metabolically healthy overweight (defined by BMI) and medium WC were 2.74 (2.49-3.02) and 2.93 (2.65-3.24), respectively. Furthermore, 557 participants developed NAFLD with fibrosis progression. The association between different obesity phenotypes and NAFLD with fibrosis progression also showed a similar pattern. MHO was associated with significantly higher risks of NAFLD and its fibrosis progression, suggesting that regarding NAFLD prevention, MHO individuals might still benefit from lifestyle interventions aimed at body weight and WC maintenance.

Baseline Characteristics and Their Associations with Body Composition of Active-Duty Service Members Enrolling in a Randomized Controlled Trial of a Weight Management Program.

Increasing rates of overweight and obesity among military service members (SMs) necessitate the implementation of weight management interventions. Evidence for the effectiveness of military weight management interventions is mixed. Effectiveness may be impacted by individual sociodemographic, psychiatric, psychological, and behavioral factors. Baseline data from SMs who were overweight/obese or at risk of failing body composition or physical fitness tests and enrolling in a weight management randomized controlled trial were used to examine (1) individual characteristics of this sample as a whole and by gender and (2) relationships between those characteristics and body composition metrics that are targeted by military weight management interventions. Understanding these relationships may inform intervention approaches. Active duty SMs (N = 178) who enrolled in a randomized clinical trial of the Navy's weight management program "ShipShape" at a large military hospital provided data at their baseline visit. Because of gender differences in average body fat percentage (BF%) and underrepresentation of women SMs in research, independent samples t-tests and chi-square analyses were used to examine differences between male and female SMs across study variables. Multiple regression analyses were used to examine relationships of sociodemographic, psychiatric, psychological, and behavioral variables with body composition metrics, including weight, body mass index (BMI), BF%, and waist circumference (WC). Participants (61% female; Mage = 29.66 ± 6.92 years; 59.60% White) had an average BMI in the "obese" range (MBMI = 33.1 ± 3.9 kg/m2). Female participants had significantly higher BF% and significantly lower weight and WC than male participants. Compared to male participants, females reported significantly higher rates of pain and headache diagnoses, lifetime diagnosis of an anxiety disorder, lifetime treatment for a mental health concern, lifetime experiences of sexual trauma/harassment and military sexual trauma, and higher current anxiety and post-traumatic stress disorder symptoms. Across all SMs, body composition metrics were significantly associated with several demographic variables, including gender, age, marital status, Asian race, and Black race. Higher weight-related stigma was significantly associated with higher weight, BMI, BF%, and WC. Additionally, more emotional eating was significantly associated with higher BF%, and higher weight-loss confidence was significantly associated with higher BMI. Sociodemographic, psychiatric, psychological, and behavioral variables predicted the greatest variance in BF% compared to other body composition metrics evaluated. Participants in this study were more likely to be female, relatively young members of the Navy with overweight/obesity, who endorsed pain-related medical conditions, probable mental health conditions, and traumatic experiences at relatively high rates. Despite high endorsement of anxiety, depression, and post-traumatic stress disorder symptoms in this group, only weight-related stigma consistently emerged as significantly associated with body composition metrics. Regression results varied by body composition metric, with the most variance explained in BF%, suggesting that BF% may relate most strongly to sociodemographic, psychiatric, psychological, and behavioral variables associated with weight management. These results highlight the need for weight management programs that address weight-related stigma and mental health concerns of SMs to maximize the effectiveness of intervention efforts.

Associations of Body Mass Index and Waist Circumference with the Risk of Head and Neck Cancer: A National Population-Based Study.

Simple SummaryA high body mass index is positively associated with multiple cancer types. However, there are controversies regarding such an association with head and neck cancer. This population-based study is the first report of association of body mass index and waist circumference with the risk of head and neck cancer. Low body mass index and low waist circumference were related to a risk of head and neck cancer. These findings highlight the importance of preventing and reversing body mass index to reduce head and neck cancer incidence.Background: We investigated the association between BMI and HNC subtype incidence in a cohort study of ten million people, adjusting for the effect of smoking and drinking. We also investigated the relationship between waist circumference (WC) and HNC subtype. Methods: All data used in this study originated from the Korean National Health Insurance Service database. We analysed subjects who had undergone health check-ups in 2009 and monitored subjects until 2018 (n = 10,585,852). Finally, 9,598,085 subjects were included after exclusions. We collected variables that could affect the risk of HNC. Cox proportional hazards regression analysis was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Results: The overall incidence of HNC was higher in the low BMI category (BMI < 18.5 according to WHO recommendations for Asian people) (HR: 1.322; 95% CI: 1.195–1.464) compared with the normal BMI category. Among the HNC cases, the incidence rates of laryngeal (HR: 1.3; 95% CI: 1.085–1.558), oral cavity (HR: 1.277; 95% CI: 1.011–1.611), and oropharyngeal (HR: 1.584; 95% CI: 1.25–2.008) cancers were higher in the low BMI category compared with the normal BMI category. No significant association was detected between low BMI and sinus cancer, salivary gland cancer, or nasopharyngeal cancer. The low WC category (<80 cm in men and <75 cm in women) was related to a risk of hypopharyngeal (HR: 1.268; 95% CI: 1.061–1.514) and laryngeal (HR: 1.118; 95% CI: 1.007–1.241) cancers. The HR for occurrence of HNC was high in underweight participants according to smoking status (1.219 for never smoker vs. 1.448 for ever smoker, p for interaction = 0.0015) and drinking status (1.193 for never drinker vs. 1.448 for ever drinker, p for interaction = 0.0044). Conclusions: Low BMI was associated with the risk of some types of HNC. The results of this study could assist etiological investigations and prevention strategies.

Increase in glycemic set point, alongside a decrease in waist circumference, in the non-diabetic population during the Japanese National Intervention Program for metabolic syndrome: A single-center, large-scale, matched-pair analysis.

BackgroundIn 2008, the Japanese government implemented a National Intervention Program for metabolic syndrome. Low-risk individuals were not direct targets of this intervention. Nevertheless, they were indirectly enlightened by this massive campaign. Documentation of the metabolic shifts in low-risk individuals following the program launch may inform public health policy regarding approaches to metabolic risks in the general population.MethodsWe conducted a cross-sectional analysis of data from non-diabetic participants who underwent general health check-ups at the Physical Check-up Center of Sumitomo Hospital. Participants during 2007–2008 were pair-matched with those during 2015–2016 with respect to sex, age, smoking status, hemoglobin level, and red blood cell (RBC) count. Each participant was included only once in the study.ResultsTotals of 3,140 men and 2,048 women were pair-matched. The non-diabetic participants showed lower waist circumference, blood pressure, heart rate, and serum lipid concentrations during the second study period. In contrast, the entire distributions of fasting plasma glucose (FPG) concentration in both sexes and glycated hemoglobin (HbA1c) in women were shifted upwards. In men, Δ FPG was +1.6 mg/dL (P < 0.001) and Δ HbA1c was ±0% (P = 0.6). In women, Δ FPG was +3.0 mg/dL (P < 0.001), and Δ HbA1c was +0.1% (P < 0.001). Δ Homeostasis model assessment of β-cell function was −6.6 in men (P < 0.001) and −10.3 in women (P < 0.001). The homeostasis model assessment of insulin resistance did not change significantly.ConclusionsThe “glycemic set point” has increased in non-diabetic people in Japan during recent years. Lifestyle or environmental changes may have caused this metabolic shift through obesity-independent pathways, possibly through effects on pancreatic β-cell function. The underlying mechanism awaits further investigation.

Effect of the food processing degree on cardiometabolic health outcomes: A prospective approach in childhood

Ultra-processed foods (UPF) consumption has increased greatly over the last decades but its impact on health remains unclear. This study aimed to evaluate the prospective effect of different degrees of food processing on children's cardiometabolic profile. Children from the Portuguese population-based birth cohort Generation XXI evaluated at 7 and 10 years of age (y), with dietary information at 7y and anthropometric measurements at 10y, were included in the present study (n=3034). Dietary data were collected by 3-day food diaries and all reported food items were classified according to the degree of processing using the NOVA classification system. The daily consumption of the NOVA classification groups was calculated (in grams, as a proportion of total grams and total energy intake). The cardiometabolic outcomes included were serum markers [fasting glucose, insulin, blood lipids], anthropometric measurements [body mass index (BMI) and waist circumference (WC)], body composition [fat-free mass (FFM) and fat mass (FM)] and blood pressure (BP). Age- and sex-specific sample z-scores were obtained for all outcomes. Principal Component Analysis was used to identify a potential cluster of cardiovascular risk factors. Generalized linear models were fitted to evaluate the association between the consumption according to the processing degree (as absolute gram intake) and the individual cardiometabolic risk factors and cluster, adjusted for child's sex, maternal age and education and remaining NOVA groups. A mediation role of children's BMI in the previous analysis were tested. At 7y, the daily median consumption of un/minimally processed, processed and UPF was 1210g, 113g and 433g (68%, 6% and 25% of the total grams, as well as 51%, 15% and 31% of the total energy intake, respectively). After adjustment, an increase of 100g in the consumption of un/minimally processed at 7y was associated with a lower BMI (βˆ=-0.028; 95%CI:-0.043;-0.014), WC (βˆ=-0.020; 95%CI:-0.032;-0.008), FM (βˆ=-0.023; 95%CI:-0.035;-0.011), insulin (βˆ=-0.022; 95%CI:-0.036;-0.008) and BP (systolic BP: βˆ=-0.014; 95%CI:-0.025;-0.004; diastolic BP: βˆ=-0.013; 95%CI:-0.020;-0.005), at 10y. BMI was a mediator between the consumption of un/minimally processed foods and BP. Positive associations were found between consumption of processed foods and the cluster 'higher blood pressure', while an inverse association was described between un/minimally processed and the cluster 'higher blood pressure'. No significant associations were found between the UPF consumption and any cardiometabolic outcomes. High consumption of unprocessed or minimally processed foods has a favourable effect on later children's cardiometabolic health, namely lower body weight and body fat, lower waist circumference, blood pressure insulin serum levels.

Black New Yorkers with Type 2 Diabetes: Afro-Caribbean Immigrants Have Lower BMI and Lower Waist Circumference than African Americans.

Using the 2013/2014 New York City (NYC) Health and Nutrition Examination Survey (NYCHANES) data, this exploratory study examined whether (a) type 2 diabetes (diabetes) prevalence differed between NYC Afro-Caribbeans and African Americans; (b) anthropometric, biochemical, and sociodemographic diabetes profiles differed between and within groups; and (c) diabetes odds differed between and within groups. Diabetes was defined as prior diagnosis, HbA1c ≥ 6.5% (7.8mmol/L), or fasting glucose ≥ 126mg/dL. Weighted logistic regression estimated diabetes odds by nativity and either waist circumference (WC) (cm) or BMI (kg/m2). All regression models controlled for age, hypertension, gender, education, income, marital status, physical activity, and smoking. Among Afro-Caribbeans (n = 81, 65% female, age (mean ± SE) 49 ± 2years, BMI 29.2 ± 0.7kg/m2) and African Americans (n = 118, 50% female, age 47 ± 2years, BMI 30.3 ± 0.9kg/m2), Afro-Caribbeans with diabetes had lower BMI (29.9 ± 0.8kg/m2 vs. 34.6 ± 1.7kg/m2, P = 0.01) and lower WC (102 ± 2cm vs. 114 ± 3cm, P = 0.002) than African Americans with diabetes. Afro-Caribbeans with diabetes had lower prevalence of obesity (33.2% vs. 74.7%) and higher prevalence of overweight (57.2% vs. 13.5%) (P = 0.02) than African Americans with diabetes. Odds of diabetes did not differ between Afro-Caribbeans and African Americans. In models predicting the effect of WC, diabetes odds increased with WC (OR = 1.07 (95% CI 1.02, 1.11), P = 0.003) and age (OR = 1.09 (95% CI 1.03-1.15), P = 0.003) for African Americans only. In models predicting the effect of BMI, diabetes odds increased for Afro-Caribbeans with age (OR = 1.06 (1.01, 1.11)*, P = 0.04) and hypertension (OR = 5.62 (95% CI 1.04, 30.42), P = 0.045), whereas for African Americans, only age predicted higher diabetes odds (OR = 1.08 (95% CI 1.03, 1.14), P = 0.003). In NYC, Afro-Caribbeans with diabetes have lower BMI and lower WC than African Americans with diabetes, but odds of diabetes do not differ. Combining African-descent populations into one group obscures clinical differences and generalizes diabetes risk.

Adenovirus 36 Infection in People Living with HIV-An Epidemiological Study of Seroprevalence and Associations with Cardiovascular Risk Factors.

Background. With the life expectancy of people living with HIV (PLHIV) rapidly approaching that of the general population, cardiovascular health in this group is as relevant as ever. Adenovirus 36 (Adv36) is one of the few viruses suspected to be a causative factor in promoting obesity in humans, yet there is a lack of data on this infection in PLHIV. Methods. PLHIV on stable suppressive antiretroviral therapy were included in the study, with assessment of anthropometric measures, blood pressure, serum lipid levels, fasting serum glucose and insulin, non-classical serum cardiovascular risk markers related to inflammation (hsCRP, resistin, calprotectin), and anti-Adv36 antibodies during a routine check-up. Results. 91 participants were recruited, of which 26.4% were Adv36-seropositive (Adv36(+)). Compared to Adv36-seronegative (Adv36(−)) controls, Adv36(+) individuals had a lower waist circumference (Adv36(+) 89.6 ± 7.7 cm, Adv36(−) 95.5 ± 11.7 cm, p = 0.024) and a lower waist-to-hip ratio (Adv36(+) 0.88 ± 0.06, Adv36(−) 0.92 ± 0.09, p = 0.014), but this did not reach statistical significance in the multivariate analysis (p > 0.05). Adv36(+) participants were less likely to be on lipid-lowering treatment (Adv36(+) 12.5%, Adv36(−) 34.3%, p = 0.042), even after adjustment for relevant baseline characteristics (OR = 0.23, 95%CI = 0.04–0.91), but no differences in cholesterol or triglyceride levels were found. No other statistically significant associations were observed. Conclusions. We found no evidence to support the claim that past Adv36-infection is associated with an increased prevalence of cardiovascular risk factors or with elevated inflammatory markers in PLHIV. More research is needed to replicate these findings in other samples of PLHIV and to compare them with the HIV-negative population.

Relation of Change or Substitution of Low- and No-Calorie Sweetened Beverages With Cardiometabolic Outcomes: A Systematic Review and Meta-analysis of Prospective Cohort Studies.

BACKGROUNDAdverse associations of low- and no-calorie sweetened beverages (LNCSB) with cardiometabolic outcomes in observational studies may be explained by reverse causality and residual confounding.PURPOSETo address these limitations we used change analyses of repeated measures of intake and substitution analyses to synthesize the association of LNCSB with cardiometabolic outcomes.DATA SOURCESMEDLINE, Embase, and the Cochrane Library were searched up to 10 June 2021 for prospective cohort studies with ≥1 year of follow-up duration in adults.STUDY SELECTIONOutcomes included changes in clinical measures of adiposity, risk of overweight/obesity, metabolic syndrome, type 2 diabetes (T2D), cardiovascular disease, and total mortality.DATA EXTRACTIONTwo independent reviewers extracted data, assessed study quality, and assessed certainty of evidence using GRADE. Data were pooled with a random-effects model and expressed as mean difference (MD) or risk ratio (RR) and 95% CI.DATA SYNTHESISA total of 14 cohorts (416,830 participants) met the eligibility criteria. Increase in LNCSB intake was associated with lower weight (5 cohorts, 130,020 participants; MD −0.008 kg/year [95% CI −0.014, −0.002]). Substitution of LNCSB for sugar-sweetened beverages (SSB) was associated with lower weight (three cohorts, 165,579 participants; MD, −0.12 [−0.14, −0.10,] kg/y) and lower incidence of obesity (OB) (one cohort, 15,765 participants; RR 0.88 [95% CI 0.88, 0.89]), coronary heart disease (six cohorts, 233,676 participants; 0.89 [0.81, 0.98]), cardiovascular disease mortality (one cohort, 118,363 participants; 0.95 [0.90, 0.99]), and total mortality (one cohort, 118,363 participants; 0.96 [0.94, 0.98]) with no adverse associations across other outcomes. Substitution of water for SSB showed lower weight (three cohorts, 165,579 participants; MD −0.10 kg/year [−0.13, −0.06]), lower waist circumference (one cohort, 173 participants; −2.71 cm/year [−4.27, −1.15]) and percent body fat (one cohort, 173 participants; −1.51% per year [−2.61, −0.42]), and lower incidence of OB (one cohort, 15,765 participants; RR 0.85 [0.75, 0.97]) and T2D (three cohorts, 281,855 participants; 0.96 [0.94, 0.98]). Substitution of LNCSB for water showed no adverse associations.LIMITATIONSThe evidence was low to very low certainty owing to downgrades for imprecision, indirectness, and/or inconsistency.CONCLUSIONSLNCSB were not associated with cardiometabolic harm in analyses that model the exposure as change or substitutions. The available evidence provides some indication that LNCSB in their intended substitution for SSB may be associated with cardiometabolic benefit, comparable with the standard of care, water.

Flavonoid Intake From Cocoa-Based Products and Adiposity Parameters in Adolescents in Spain.

BackgroundCocoa-based products are a good source of flavonoids, which may have beneficial effects on metabolic health.ObjectiveThe aim of this study is to assess the relationship between flavonoids from cocoa-based products and adiposity parameters in adolescents.MethodsA cross-sectional study was conducted involving 944 adolescents aged 11–14 years enrolled in the SI! Program for Secondary Schools trial in Spain with available baseline data from food frequency questionnaires and anthropometric measurements [weight, height, waist circumference (WC), and fat mass percentage (% FM) by bioimpedance analysis]. Fat mass index (FMI) and waist-to-height ratio (WHtR) were obtained by dividing fat mass by height and WC by height, respectively. Body mass index (BMI), WC, and FMI for age and gender z-score were calculated. Overweight/obesity was defined as BMI ≥ 85th percentile and excess adiposity as %FM or FMI ≥ 75th percentile. WC ≥ 90th percentile and WHtR with a 0.5 threshold were considered as criteria of abdominal obesity. Multilevel mixed-effect regressions were used to evaluate the association between flavonoids from cocoa-based products and adiposity parameters. Municipalities and schools were considered random effects.ResultsParticipants with a higher flavonoid intake from cocoa-based products had lower WC z-score [B = −0.04, 95% CI (−0.07; −0.01), P-for trend = 0.045] and WHtR [B = −0.01, 95% CI (−0.02; −0.01), P- for trend < 0.001]. They also had lower probability of having abdominal obesity [OR 0.66, 95% CI (0.52; 0.85), P- for trend = 0.001]. Inverse associations were observed between flavonoids from cocoa powder and BMI z-score [B = −0.08, 95% CI (−0.12; −0.05), P < 0.001], WC z-score [B = −0.06, 95% CI (−0.11; −0.02), P = 0.003], WHtR [B = −0.01, 95% CI (−0.01; −0.00), P < 0.001], %FM [B = −1.11, 95% CI (−1.48; −0.75), P < 0.001], and FMI z-score [B = −0.18, 95% CI (−0.20; −0.17), P < 0.001]. Regarding dark chocolate, an inverse association only with WC z-score [B = −0.06, 95% CI (−0.08; −0.05), P < 0.001] was found. However, no association was observed between flavonoids from milk chocolate intake and anthropometric parameters.ConclusionsA higher intake of flavonoids from cocoa-based products was associated with lower adiposity parameters and a lower probability of presenting abdominal obesity.

AN OBSERVATIONAL ANALYSIS OF CLINICAL PROFILE ASSOCIATED WITH OVULATION INDUCTION USING LETROZOLE AMONG INFERTILE WOMEN WITH POLYCYSTIC OVARIAN SYNDROME

Background- Polycystic ovary syndrome (PCOS) is major endocrine and metabolic disease in reproductive women. As per latest procedures, letrozole should be taken as the rst-line pharmacological treatment for infertile women with PCOS. This study was planned to study the role of clinical prole in ovulation induction after letrozole therapy among infertile women with poly- cystic ovarian syndrome. This was a prospective analytical observational study carried out at the IVF centre, SMS Medical College,Methods- Jaipur. The present study enrolled 100 patients attending the IVF centre for fertility treatment who were diagnosed with PCOS as per Rotterdam criteria. Anthropometric measurements like Body mass index (BMI calculated as weight in kilograms divided by square of height in meters) and waist circumference (the smallest circumference at the level of umbilicus) was taken. A comprehensive physical examination of all patients was done to note signs of clinical hyperandrogenism like acne, alopecia, and hirsutism. Treatment response was dened as ovulation in response to letrozole in doses from 2.5 mg to 7.5 mg. In this study, women from 20 to 25 years of age with shorter duration of infertility, lower BMI,Results- lower waist circumference, absence of hirsutism, or mild hirsutism on clinical examination showed better response to Letrozole. Conclusion- Letrozole can be considered a suitable ovulation induction agent in infertile PCOS patients with lower BMI, lower waist circumference, and absence of hirsutism. A predictive ovulation score can be developed from basic clinical parameters. Identication of various factors affecting response to letrozole may help the clinician to individualize ovulation induction protocols in PCOS women.

Fasting Serum C-Peptide Level May not be Low in Young-Onset Diabetes

Background: Diabetes mellitus (DM) is one of the growing health problems among the young population. Secretory defect of insulin is an important cause, and it can be assessed by measuring fasting serum C-peptide level. Aim: The aim of this article is to assess fasting serum C-peptide in young-onset DM individuals. Materials and Methods: This case–control study was conducted in the Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University (BSMMU) from March 2015 to February 2017. For this purpose, 40 individuals with DM (irrespective of DM type; age range: 11–29 years) were enrolled as case and an equal number of young healthy individuals as control. Demographic profiles, clinical profiles, and serum C-peptide were recorded in a standard and pre-tested structured datasheet. C-peptide was measured by the chemiluminescent immunometric assay. Results: Median fasting C-peptide was 2.67 [interquartile range (IQR) 1.06–4.07, range 0.12–20.0] ng/mL in diabetes individuals, whereas it was 2.19 (IQR 1.36–2.94, range 0.44–9.85) ng/mL in the control group; the difference was insignificant (P = 0.331). Waist circumference (WC) was significantly higher in the young diabetes group in comparison to that of control subjects and so were the plasma glucose values and diastolic blood pressure (P &lt; 0.05 for all). Diabetic participants with low C-peptide group had significantly lower body mass index (BMI) and WC and higher fasting plasma glucose (FPG) and HbA1c in comparison to others (P &lt; 0.05 for all); whereas the high C-peptide group had opposite body indices (higher BMI and WC) and glycemic parameters (lower FPG and HbA1c) (P &lt; 0.05 for all). The classic hyperglycemic symptoms were more common in the low C-peptide group (P = 0.029). In participants with diabetes, C-peptide positively correlated with BMI and WC, whereas it showed a negative correlation with age (P &lt; 0.05 for all). In the control group, C-peptide positively correlated with WC only (P = 0.018). Conclusion: The level of fasting serum C-peptide in diabetic subjects was similar to healthy controls, and it was higher in those subjects who had higher BMI, WC, and lower age.

Associations of plasma betaine, plasma choline, choline intake, and MTHFR polymorphism (rs1801133) with anthropometric parameters of healthy adults are sex-dependent.

Choline and its metabolites apppear to have relationships with body mass index (BMI), body fat, and body weight, but the research results have proved inconsistent. We thus investigated the associations of plasma levels of trimethylamine N-oxide (TMAO), choline, and betaine with anthropometric measurements, including modulatory effects of genetics and diet. The study was performed on a group of 421 adults, aged 20-40 years, who had been recruited in Poland. Plasma concentrations of choline, betaine, and TMAO were determined using reverse-phase ultra-high-performance liquid chromatography electrospray ionisation mass spectrometry. The following polymorphisms were genotyped using TaqMan probes: rs180113 (MTHFR), rs70991108 (DHFR), rs2236225 (MTHFD1), and rs7946 and rs12325817 (PEMT). We employed multivariate linear regression to examine the associations between anthropometric measurements, one-carbon metabolism metabolites, and genotypes. Higher plasma choline was associated with higher BMI (β = 0.17; p < 0.01), body weight (β = 0.11; p < 0.05), body fat mass (FM) (β = 0.10; p < 0.05), and waist circumference (WC) (β = 0.14; p < 0.01), whereas higher choline intake was associated with lower body FM (β = -0.14; p < 0.01) and lower WC (β = -0.12; p < 0.01). After stratification by sex, plasma betaine was found to be associated with lower BMI (β = -0.20; p < 0.05) and body weight (β = -0.16; p < 0.05) in men only, whereas choline intake was associated with lower body FM (β = -0.19; p < 0.05) and waist-to-hip ratio (WHR) (β = -0.19; p < 0.05) and MTHFR CC genotype was associated with WHR (β = 0.15; p < 0.05) in women only. Higher plasma betaine and higher dietary choline are associated with lower FM and body weight, whereas higher plasma choline is positively associated with body weight status and adiposity. Moreover, these associations appear to be sex-specific.

Substituting bouts of sedentary behavior with physical activity: adopting positive lifestyle choices in people with a history of cancer

PurposeTo determine in people with a history of cancer, whether substituting sitting time with other daily activities (i.e., sleeping, walking, moderate and vigorous physical activity) was associated with changes in waist circumference (WC), an important surrogate marker of cardiometabolic risk.MethodsCross-sectional analyses from the Atlantic Partnership for Tomorrow’s Health (Atlantic PATH) cohort was conducted using isotemporal substitution models to explore the associations of substituting sedentary time, physical activity behavior (International Physical Activity Questionnaire), or sleep (Pittsburgh Sleep Quality Index) with changes in WC. Analyses were conducted using sex-specific WC classifications.ResultsIn 3,684 people with a history of cancer [mean age (SD) 58.2 (7.3) years; BMI 28.9 (5.2) kg m−2; 71% female], reallocating 10 min of sleep or sedentary time for 10 min of walking was associated with lower WC in women (p < 0.01). In men, PA intensity appeared to be more strongly associated with a reduced WC. Replacing 10 min of sedentary time with 10 min of moderate or vigorous PA and replacing 10 min of sleep with moderate PA were associated with a significantly reduced WC (p < 0.001). The largest effect was when 10 min of moderate PA was replaced with vigorous PA, a reduction in WC (p < 0.01) was evident.ConclusionFor people with a history of cancer, adopting small but positive changes in lifestyle behaviors could help reduce WC and potentially offset negative health-related outcomes associated with higher WC. Further research is required to examine whether such an intervention may be acceptable and manageable among this population.

Impacts of the Building a Healthy Temple Diabetes Self-Management Education and Support Program (BHT DSMES)

ObjectivesType 2 diabetes disproportionally affects Hispanics, calling for effective diabetes self-management education and support (DSMES) strategies. Churches are promising settings for DSMES delivery in predominately Hispanic communities. Health programs are “faith-placed” (FP) if churches are used as a place for intervention delivery and “faith-based” (FB) if spirituality is incorporated. BHT DSMES integrates spirituality with DSMES in Hispanic churches for diabetic participants in Texas. The study aimed to compare impacts of a FB vs FP approach on diabetes outcomes.MethodsThis cluster-randomized controlled trial, conducted between 2017 and 2020, consisted of 271 participants from 16 churches randomly assigned to the FB Group (church = 9, n = 146) or FP Group (church = 7, n = 125). The FB Group, led by trained church lay leaders, received a Health Sermon, 6-session DSMES, and 7-session Healthy Bible Study. The FP Group, led by outside health professionals, received a 6-session DSMES and 7-session partial attention control curriculum. Key outcome measures included glycated hemoglobin (HbA1c), waist circumference (WC), diabetes self-efficacy, diabetes self-care activities, and diabetes distress. Data were collected at baseline, 6, 9, and 12 months (mo). Following an intent-to-treat principle, linear mixed-effect models were used to determine intervention effect on key outcomes. Models controlled for age, gender, and baseline measure.ResultsThe FB Group had a significantly lower HbA1c at 6 mo (−0.3%, p < 0.05), and a lower WC at 12 mo (−2.9 cm, p = 0.05) than the FP Group. Within-group analysis shows that the FB intervention led to a decreased HbA1c at 6 mo, and WC reductions at 9 and 12 mo. Although no between group differences were observed, compared to baseline, both the FB and FP Groups significantly increased diabetes self-efficacy and diabetes self-care activity score and decreased diabetes distress score post-intervention.ConclusionsBoth the FB and FP interventions had favorable changes in diabetes self-efficacy, diabetes self-care behavior, and diabetes distress. Integrating spirituality with DSMES led to a reduced WC and better blood glucose control among predominately Hispanic churchgoers with diabetes.Funding SourcesThis study is funded by the American Diabetes Association Innovative Clinical or Translational Science Award.

Patterns and Predictors of Elevated Blood Pressure Among Primary School Children in Two Urban Settings in Kenya

ObjectivesWe conducted a cross-sectional study to examine the prevalence of elevated blood pressure (BP) among primary school children of different socio-economic status in two urban settings in Kenya and explored the association between elevated BP and children’s dietary behaviors and overweight/obesity status. MethodsThe research study was conducted in Nairobi and Kisumu cities in Kenya. Three public schools, catering to children from households at low, medium and high socio-economic status were purposively selected to participate in the study in each city. Data was collected among children within the ages of 10–12 years enrolled in grades 4–6 at each school. Certified clinicians read children’s BP readings using an aneroid sphygmomanometer and age-appropriate child BP cuffs. Trained enumerators measured children’s weights, heights, waist circumferences and skinfolds. We calculated children’s BP percentiles, BMI-for-age percentiles, waist circumference-for-height ratio (WHtR) and total skinfold values as recommended. Parents, with the help of their respective children, completed questionnaires on children’s consumption of fruits, vegetables, red meats and processed meats, fries/crisps, fried/baked wheat products, confectioneries and beverages. Complete data were available for 390 children. We utilized prevalence ratio regression analysis to examine the association between children’s BP and dietary practices and obesity. ResultsOver, 20% of the school children had pre-hypertension and 14% had hypertension, giving an overall elevated BP prevalence of 34%. Overweight and obese children were significantly more likely to have elevated BP and hypertension compared to children with healthy BMI-for-age percentiles. Children with WHtR > 0.5 and children with high total skinfold values were significantly more likely to have elevated BP and hypertension compared to children with lower waist circumference and skinfold values. Children who consumed high amounts of fries/crisps were significantly more likely to have elevated BP compared to children who consumed lower amounts. ConclusionsThis study increases our understanding BP patterns and determinants among school children in Kenya, and informs non-communicable disease prevention efforts. Funding SourcesSaff Family.