Measures Of Abdominal Adiposity Research Articles

Association of a Workplace Sales Ban on Sugar-Sweetened Beverages With Employee Consumption of Sugar-Sweetened Beverages and Health

Reductions in sugar-sweetened beverage (SSB) intake can improve health, but are difficult for individuals to achieve on their own. To evaluate whether a workplace SSB sales ban was associated with SSB intake and cardiometabolic health among employees and whether a brief motivational intervention provides added benefits to the sales ban. This before-after study and additional randomized trial conducted from July 28, 2015, to October 16, 2016, at a Northern California university and hospital assessed SSB intake, anthropometrics, and cardiometabolic biomarkers among 214 full-time English-speaking employees who were frequent SSB consumers (≥360 mL [≥12 fl oz] per day) before and 10 months after implementation of an SSB sales ban in a large workplace, with half the employees randomized to receive a brief motivational intervention targeting SSB reduction. The employer stopped selling SSBs in all workplace venues, and half the sample was randomized to receive a brief motivational intervention and the other half was a control group that did not receive the intervention. This intervention was modeled on standard brief motivational interventions for alcohol used in the workplace that promote health knowledge and goal setting. Outcomes included changes in SSB intake, Homeostatic Model Assessment of Insulin Resistance (HOMA-IR), and measures of abdominal adiposity. The primary associations tested were the correlation between changes in SSB intake and changes in HOMA-IR. Among the 214 study participants, 124 (57.9%) were women, with a mean (SD) age of 41.2 (11.0) years and a baseline mean (SD) body mass index of 29.4 (6.5). They reported a mean daily intake of 1050 mL (35 fl oz) of SSBs at baseline and 540 mL (18 fl oz) at follow-up-a 510-mL (17-fl oz) (48.6%) decrease (P < .001). Reductions in SSB intake correlated with improvements in HOMA-IR (r = 0.16; P = .03). Those not randomized to receive the brief intervention reduced their SSB intake by a mean (SD) of 246.0 (84.0) mL (8.2 [2.8] fl oz), while those also receiving the brief intervention reduced SSB intake by 762.0 (84.0) mL (25.4 [2.8] fl oz). From baseline to follow-up, there were significant reductions in mean (SE) waist circumference (2.1 [2.8] cm; P < .001). This study's findings suggest that the workplace sales ban was associated with a reduction in SSB intake and a significant reduction in waist circumference among employees within 10 months. The randomized clinical trial portion of this study found that targeting those at high risk with a brief motivational intervention led to additional improvements. Workplace sales bans may offer a promising new private-sector strategy for reducing the health harms of SSB intake. ClinicalTrials.gov identifier: NCT02585336.

The association between overall and abdominal adiposity and depressive mood: A cross-sectional analysis in 6459 participants

ObjectiveWe aimed to evaluate the association between measures of adiposity with depressive mood and specific depressive symptoms. MethodsThis study was performed in the Netherlands Epidemiology of Obesity (NEO) study, a population-based study that consists of 6671 middle-aged individuals. We examined the association between measures of overall adiposity (BMI and total body fat), and abdominal adiposity (waist circumference and visceral adipose tissue), with depressive mood severity subgroups and 30 depressive symptoms. Multinomial logistic regression was performed adjusting for potential confounding. ResultsMeasures of adiposity were associated with depressive mood in a graded fashion. Total body fat showed the strongest association with mild (Odds Ratio (OR): 1.59 per standard deviation, 95% Confidence Interval (95% CI): 1.41–1.80) and moderate to very severe (OR: 1.97, 95% CI: 1.59–2.44) depressive mood. Regarding individual symptoms of depressive mood, total body fat was associated with most depressive symptoms (strongest associations for hyperphagia and fatigability). ConclusionsIn the general population, overall and abdominal adiposity measures were associated with depressive mood. This association encompasses most of the depressive symptoms and appeared to be the strongest with specific ‘’atypical’’ neurovegetative symptoms, which may be an indication of an alteration in the energy homeostasis.

The effects of physical exercise on cardiometabolic outcomes in women with polycystic ovary syndrome not taking the oral contraceptive pill: a systematic review and meta-analysis

PurposeWomen with polycystic ovary syndrome (PCOS) exhibit many metabolic abnormalities that are associated with an increased cardiovascular disease risk. Exercise may promote improvements in lipid profile and insulin sensitivity in women with PCOS. There is however, a knowledge gap on the optimal dose of exercise, regarding duration, intensity, type, and frequency of exercise. The aim of this systematic review and meta-analysis was to define effective types of exercise to improve cardiometabolic profile in PCOS.MethodsWe included randomised controlled trials (RCT), quasi-RCT, and controlled clinical trials focusing on reproductive-aged women diagnosed with PCOS. Eligible interventions included those with at least two weeks of supervised exercise sessions. Primary outcomes were blood lipids, blood glucose, blood pressure, measures of abdominal adiposity, and inflammation markers. Secondary outcomes were total and free testosterone, sex hormone binding globulin, and measures of insulin resistance. Nine electronic databases were searched from inception to present for English language publications. The Cochrane Risk Assessment tool was used to assess bias in the included studies. Outcomes were quantitatively synthesised and a meta- analysis was performed. Pooled effect estimates and 95% confidence intervals were presented.ResultsThis systematic review identified three trials, including 231 participants with PCOS, that examined the effect of structured, supervised exercise on cardiometabolic outcomes. Analysis of pooled data indicated statistical favourable effects of exercise on total cholesterol, fasting glucose, waist circumference and waist-to-hip ratio, systolic blood pressure, C-reactive protein, total testosterone, and sex hormone binding globulin using post-intervention scores.ConclusionsModerate aerobic exercise interventions ≥3 months in duration, with a frequency of 3/week for at least 30-min, may have favourable effects on various cardiometabolic risk factors in women with PCOS. However, results should be interpreted with caution. Many of the outcomes were based on studies with serious methodological limitations, and only one “gold-standard” RCT was identified.PROSPERO ID: CRD42018086117.

Effects of Avocado Consumption on Abdominal Adiposity and Glucose Tolerance: Findings from the Persea Americana for Total Health (PATH) Randomized Controlled Trial (P21-005-19)

ObjectivesOver 35% of adults have elevated abdominal obesity. This is concerning because abdominal obesity increases risk for type 2 diabetes. Therefore, dietary interventions with the potential to prevent abdominal obesity and its metabolic consequences have gained increasing importance. Habitual intake of the Hass avocado (Persea Americana) has been cross-sectionally linked to lower abdominal obesity; however, the effects of regular avocado consumption for abdominal adiposity and glycemic measures are unknown. Accordingly, we conducted a single-blind, randomized, controlled trial examining the effects of daily avocado consumption on abdominal adiposity and oral glucose tolerance (OGTT). Methods111 adults (65 females) between 25 and 45y with overweight or obesity (BMI >= 25 kg/m2) were randomized to an intervention group (N = 54) that received a daily meal with one fresh avocado or a control group (N = 57) that received an isocaloric meal without avocado for 3 months. DXA was used to assess abdominal fat distribution changes, calculated as the ratio of visceral adipose tissue to subcutaneous abdominal tissue (VS Ratio) and an OGTT was conducted following an overnight fast. ResultsA group by time effect (P = 0.04) was observed whereby the intervention group exhibited a reduction in the VS Ratio (0.02; 95% CI, 0.0003 to 0.04) whereas there was no change in the control group (0.003; 95% CI, −0.02 to 0.01). Changes in the VS ratio were driven by a reduction in visceral adipose tissue among intervention participants (28.3 g; 95% CI, 3.4 to 53.3). Avocado consumption did not affect the Matsuda Insulin Sensitivity Index (P = 0.28), Glucose AUC (P = 0.37), or Insulin AUC (P = 0.09). However, there was a group by time effect (P = 0.005) whereby the control group exhibited an increase in insulin concentration at 120 m (21.9 μU/ml; 95% CI, 3.3 to 40.5) whereas there was no change in the intervention group (6.1 μU/ml; 95% CI, −4.4 to 16.5). ConclusionsInclusion of one fresh avocado per day over 3 months had abdominal adiposity lowering effects. However, the effects for oral glucose tolerance were limited to insulin secretion 2 h postprandial. Our results demonstrate that avocados have beneficial effects on fat distribution while maintaining insulin sensitivity over time among adults with overweight and obesity. Funding SourcesThis work was supported by funds provided by the Hass Avocado Board. Partial support was also provided by the Department of Kinesiology and Community Health at the University of Illinois and the USDA National Institute of Food and Agriculture, Hatch project 1009249.

Prenatal Cadmium Exposure Is Negatively Associated With Adiposity in Girls Not Boys During Adolescence.

Introduction: Cadmium is a pervasive toxic metal that remains a public health concern and exposure in early life has been associated with growth deficits in infancy and childhood. Growth during adolescence also may be sensitive to effects of cadmium exposure, given the changes in distribution of lean and adipose tissue that vary by sex during puberty. This study examines whether prenatal and concurrent cadmium exposures are associated with adiposity measures at ages 8–15 years in a well-characterized birth cohort.Methods: The sample included 185 participants from the ELEMENT birth cohorts in Mexico City with complete data on urinary cadmium exposures, anthropometry and covariates [child age and sex, household socioeconomic status, and maternal smoking history and body mass index (BMI)]. Maternal third trimester and adolescent urines were analyzed for cadmium using an Inductively Coupled Plasma Mass Spectrometer. Trained personnel obtained anthropometry including height, weight, waist circumference and subscapular, suprailiac, and triceps skinfold thickness. BMI z-scores for age and sex were calculated using the World Health Organization's reference standard. Linear regression models were used to estimate the association of prenatal and concurrent urinary cadmium levels with adolescent anthropometry, adjusting for covariates.Results: Among 87 males and 98 females, median age was 10 years (IQR 9 –11 years). Pregnant women and children had median urinary cadmium concentrations of 0.19 μg/L (IQR 0.12– 0.27 μg/L) and 0.14 μg/L (IQR 0.11– 0.18 μg/L), respectively. Regression models showed inverse relationships between prenatal cadmium exposure and adolescent adiposity. An IQR increase in prenatal cadmium was associated with percent decreases in BMI z-score (−27%, p = 0.01), waist circumference (−3%, p = 0.01), and subscapular (−11%, p = 0.01), suprailiac (−11%, p = 0.02), and triceps (−8%, p < 0.01) skinfold thickness. When stratified by sex, these relationships remained statistically significant in females but not males.Conclusions: Prenatal cadmium exposure was negatively associated with measures of both abdominal and peripheral adiposity in girls, but not in boys. These results emphasize the sex-dependent effects of in utero cadmium exposure on adiposity in adolescence.

Semiautomated Measure of Abdominal Adiposity Using Computed Tomography Scan Analysis

BackgroundThe obesity epidemic has prompted the need to better understand the impact of adipose tissue on human pathophysiology. However, accurate, efficient, and replicable models of quantifying adiposity have yet to be developed and clinically implemented. We propose a novel semiautomated radiologic method of measuring the visceral fat area (VFA) using computed tomography scan analysis. Materials and methodsWe obtained a cohort of 100 patients with rectal adenocarcinoma, with a median age of 60.9 y (age range: 35-87 y) and an average body mass index of 28.8 kg/m2 ± 6.56 kg/m2. The semiautomated quantification method of adiposity was developed using a commercial imaging suite. The method was compared to two manual delineations performed using two different picture archiving communication systems. We quantified VFA, subcutaneous fat area (SFA), total fat area (TFA), and visceral-to-subcutaneous fat ratio (V/S ratio) on computed tomography axial slices that were at the L4-L5 intervertebral level. ResultsThe semiautomated method was comparable to manual measurements for TFA, VFA, and SFA with intraclass correlation (ICC) of 0.99, 0.97, and 0.96, respectively. However, the ICC for the V/S ratio was only 0.44, which led to the identification of technical outliers that were identified using robust regression. After removal of these outliers, the ICC improved to 0.99 for TFA, VFA, and SFA and 0.97 for the V/S ratio. Measurements from the manual methodology highly correlated between the two picture archiving communication system platforms, with ICC of 0.98 for TFA, 0.98 for VFA, 0.96 for SFA, and 0.95 for the V/S ratio. ConclusionsThis semiautomated method is able to generate precise and reproducible results. In the future, this method may be applied on a larger scale to facilitate risk stratification of patients using measures of abdominal adiposity.

The impact of abdominal fat on abdominal aorta calcification measured on non-enhanced CT.

Cardiovascular (CV) morbidity, atherosclerosis, and obesity are all targets of clinical concern and vast research, as is the association between them. Aim of this study is to assess the impact of adipose tissue (including visceral and subcutaneous fat) on abdominal aorta calcification measured on non-enhanced computed tomography (CT). We retrospectively included 492 patients who underwent non-enhanced CT scans during workup for clinically suspected renal colic. All scans were reviewed for abdominal aorta calcification, liver attenuation, and thickness of visceral and subcutaneous fat. Multivariate general linear regression models were used to assess the association between abdominal aorta calcium score and adiposity measures. In the model that included only adiposity measures; visceral fat thickness had statistically significant direct association with abdominal aorta calcium score (B = 67.1, P <.001), whereas subcutaneous pelvic fat thickness had a significant inverse association with abdominal aorta calcium score (B = −22.34, P <.001). Only the association of subcutaneous pelvic fat thickness with abdominal aorta calcium score remained statistically significant when controlling for age, sex, smoking, hypertension, diabetes mellitus, and hyperlipidemia (B = −21.23, P <.001). In this model, the association of visceral fat remained statistically significant in females (B = 84.28, P = .001) but not in males (B = 0.47, P = .973). Visceral fat thickness and subcutaneous pelvic fat thickness were found to have opposing associations with abdominal aorta calcium score. This suggests that while visceral fat may have a lipotoxic effect on aortic atherosclerotic processes, subcutaneous pelvic fat may have a protective role in these processes.

Adult weight change in relation to visceral fat and liver fat at middle age: The Netherlands epidemiology of obesity study.

We aimed to investigate the associations between weight change during adulthood and the amount of abdominal subcutaneous fat, visceral fat, and liver fat at middle age. The Netherlands Epidemiology of Obesity (NEO) study is a population-based cohort of 6671 middle-aged men and women. We calculated the percentage of weight change during adulthood based on body weight at middle age and recalled body weight at age 20. Abdominal subcutaneous and visceral adipose tissue were assessed by magnetic resonance imaging (MRI), in addition to hepatic triglyceride content by 1H-MR spectroscopy in a random subgroup (maximum of n = 2580). With multivariable linear regression analysis, we examined the associations between categories of adult weight change, body mass index (BMI) at age 20 and measures of abdominal adiposity at middle age, adjusted for age, sex, ethnicity, lifestyle factors, menopausal status, parity, use of medication and total body fat at middle age. In 2399 participants (54% women), individuals who gained more than 50% of body weight during adulthood had 1.96 (95% CI: 1.64; 2.33) times more visceral adipose tissue at middle age and 2.39 (95% CI: 1.70, 3.36) times more hepatic triglyceride content than weight maintainers (weight change between -5% and 5%). Associations with abdominal subcutaneous adipose tissue were weaker: participants who gained more than 50% of their body weight had 1.54 (95% CI: 1.38, 1.72) times more abdominal subcutaneous adipose tissue compared with weight maintainers. In this population-based study, adult weight gain was associated with relatively more visceral adipose tissue and hepatic triglyceride content at middle age than abdominal subcutaneous adipose tissue. Overall, our study suggests that weight maintenance during adulthood plays an important role in limiting excess visceral adipose tissue and hepatic triglyceride content at middle age.

Hepatic steatosis is highly prevalent across the paediatric age spectrum, including in pre-school age children.

The prevalence of non-alcoholic fatty liver disease (NAFLD) in children is 8% in the general population, and 34% in the context of obesity. There is a paucity of data on the prevalence of hepatic steatosis in healthy children in Ontario. To determine the prevalence of hepatic steatosis using abdominal computed tomography (CT) scans in a cohort of previously healthy children across the paediatric age spectrum in Ontario, Canada, and to determine any association between measures of abdominal adiposity and hepatic steatosis. Retrospective review of the SickKids Trauma Database from 2004-2015. Previously healthy children ages 1-17years having undergone an abdominal CT scan as a part of routine trauma assessment were included, and those with an intra-abdominal injury excluded. Steatosis was defined as a difference between liver and spleen attenuation ≤-25HU. The percentage of the total area occupied by abdominal subcutaneous adipose and visceral adipose tissue was measured. Anthropometrics and baseline demographics were collected. A total of 503 (51% male) children with mean (±SD) age 9.5±4.5years and weight z-score of 0.37±1.05 were studied. Seventy-seven (15%, 95% CI [12%-18%]) had hepatic steatosis; no differences found between sexes or across age quartiles. The abdominal subcutaneous adipose tissue area was greater in those with hepatic steatosis compared to those without (32% [22-42] vs 24% [17-36], P=0.003). The visceral adipose tissue area was significantly greater in older children ≥9.8years with hepatic steatosis (7.7% [5.1-10] vs 6.6% (4.9-8.5), P=0.04). Hepatic steatosis was highly prevalent in previously healthy children in Ontario, including children of pre-school age. We found an association between hepatic steatosis and abdominal subcutaneous adipose tissue, and in older children with visceral adipose tissue.

Association between abdominal adiposity and subclinical measures of left-ventricular remodeling in diabetics, prediabetics and normal controls without history of cardiovascular disease as measured by magnetic resonance imaging: results from the KORA-FF4 Study

ObjectivesLocal, abdominal fat depots may be related to alterations in cardiac function and morphology due to a metabolic linkage. Thus, we aimed to determine their association with subtle cardiac changes and the potential interaction with hyperglycemic metabolic states.MethodsSubjects from the general population and without history of cardiovascular disease were drawn from the Cooperative Health Research in the Region of Augsburg FF4 cohort and underwent 3 T cardiac and body MRI. Measures of abdominal adiposity such as hepatic proton-density fat fraction [PDFFhepatic], subcutaneous (SAT) and visceral abdominal fat (VAT) as well as established cardiac left-ventricular (LV) measures including LV remodeling index (LVCI) were derived. Associations were determined using linear regression analysis based on standard deviation normalized predictors.ResultsAmong a total of 374 subjects (56.2 ± 9.1 years, 58% males), 49 subjects had diabetes, 99 subjects had prediabetes and 226 represented normal controls. Only subtle cardiac alterations were observed (e.g. LVCI: 1.13 ± 0.30). While SAT was not associated, increasing VAT and increasing PDFFhepatic were independently associated with increasing LVCI (β = 0.11 and 0.06, respectively), decreasing LV end-diastolic volume (β = − 6.70 and 3.23, respectively), and decreasing LV stroke volume (β = − 3.91 and − 2.20, respectively). Hyperglycemic state did not modify the associations between VAT or PDFF and LV measures (interaction term: all p ≥ 0.29).ConclusionIn a healthy population, VAT but also PDFFhepatic were associated with subclinical measures of LV remodeling without evidence for a modifying effect of hyperglycemic state.

The Independent Associations between Walk Score® and Neighborhood Socioeconomic Status, Waist Circumference, Waist-To-Hip Ratio and Body Mass Index Among Urban Adults.

Background: Environmental and policy factors can influence weight status via facilitating or discouraging physical activity and healthy diet. Despite mixed evidence, some findings suggest that the neighborhood built environment, including “walkability”, is associated with overweight and obesity. Most of these findings have measured body mass index (BMI), yet other weight status measures including waist circumference (WC) and waist-to-hip (W-H) ratio are also predictive of health outcomes, independent of BMI. Our study aim was to estimate the associations between walkability, measured using Walk Score®, and each of WC, W-H ratio, and BMI among urban Canadian adults. Methods: In 2014, n = 851 adults recruited from 12 structurally and socioeconomic diverse neighborhoods (Calgary, Alberta, Canada) provided complete data on a physical activity, health and demographic questionnaire and self-reported anthropometric measures (i.e., height and weight, WC and hip circumference). Anthropometric data were used to estimate WC, W-H ratio, and BMI which were categorized into low and high risk in relation to their potential adverse effect on health. WC and BMI were also combined to provide a proxy measure of both overall and abdominal adiposity. Multivariable logistic regression models estimated odds ratios (OR) and 95% confidence intervals (CI) for associations between each weight status outcome and Walk Score®. Results: A one-unit increase in Walk Score® was associated with lower odds of being high-risk based on WC (OR = 0.99; 95%CI 0.97–0.99). Notably, those residing in socioeconomically disadvantage neighborhoods had significantly higher odds of being high risk based on WC, BMI, and WC-BMI combined compared with advantaged neighborhoods. Conclusions: Interventions that promote healthy weight through the design of neighborhoods that support and enhance the effect of physical activity and diet-related interventions could have a significant population health impact.

Quantitative MRI evaluation of whole abdomen adipose tissue volumes in healthy volunteers-validation of technique and implications for clinical studies.

Objective:To explore “whole abdomen” MRI methods for quantifying adipose tissue volumes and to establish associations with body mass index (BMI) and measurement reproducibility—relative to existing “partial abdomen” methods.Methods:15 healthy volunteers were scanned on a 3T MRI scanner using a double-echo three-point-Dixon gradient echo sequence. Whole abdomen volumes were acquired via three separate scans (“supine 1”, “supine 2” and “prone”). Segmentation was applied to derive (i) “whole abdomen” visceral (VAT) and subcutaneous adipose tissue (SCAT) volumes, and (ii) “partial abdomen” volumes at the lumbar spine (L3 to L5). Root-mean-square coefficients of variation (RMS CoV) were calculated to quantify the variability of each measurement.Results:“Whole abdomen” measurements were found to correlate better with BMI (r2max = 0.74) than “partial abdomen” volumes (r2max = 0.66). Total adipose tissue (TAT) measurements correlated better with BMI (r2max = 0.74) than SCAT (r2max = 0.43) or VAT (r2max = 0.33) for both methods. Scan-to-scan RMS CoV’s for “whole abdomen” VAT and SCAT measurements were 4.16 and 3.61% compared to 6.31 and 5.07% for “partial abdomen” measurements.Conclusion:“Whole abdomen” measures of abdominal adiposity are better correlated with BMI and demonstrate better scan-to-scan reproducibility than “partial abdomen” measures. It is recommended that “whole abdomen” measures be used in longitudinal MRI radiology investigations, where small volume changes may occur.Advances in knowledge:Whole abdomen adipose tissue volumes can be measured and quantified using commercial MRI sequences and post-processing software. These methods are better correlated with BMI and are more reproducible than partial abdomen measures.

Body fat distribution and risk of incident ischemic stroke in men and women aged 50 to 74 years from the general population. The KORA Augsburg cohort study.

BackgroundIt remains controversial whether measures of general or abdominal adiposity are better risk predictors for ischemic stroke. Furthermore, so far it is unclear whether body fat mass index (BFMI) and fat free mass index (FFMI) are risk predictors for ischemic stroke. This study examined the sex-specific relevance of body mass index (BMI), BROCA Index, waist circumference (WC), waist-height ratio (WHtR), BFMI and FFMI for the development of ischemic stroke in a Caucasian population.Material and methodsThe prospective population-based cohort study was based on 1917 men and 1832 women (aged 50 to 74 years) who participated in the third (1994/95) or fourth (1999/2001) MONICA/KORA Augsburg survey. Subjects were free of stroke at baseline. Standardized anthropometric and bioelectric impedance measurements were obtained at baseline. Hazard ratios (HR) were estimated from Cox proportional hazard models.ResultsDuring a median follow-up of 9.3 years 128 ischemic strokes occurred in men and 81 in women, respectively. Coded as quartiles WC and WHtR were significantly associated with incident stroke in multivariable analyses in women (comparing the 4th vs. the bottom quartile), but none of the adiposity measures was significantly associated with incident stroke in multivariable adjusted analyses in men. When anthropometric measures were used as continuous variables, these findings were confirmed. After multivariable adjustment the associations between obesity measures and incident ischemic stroke were statistically significant only for WC (HR 1.39, 95%CI 1.12-1.72) and WHtR in women (HR 1.39, 95%CI 1.12-1.73) per increase of 1 standard deviation. In both sexes the measures BFMI and FFMI were no independent predictors for incident ischemic stroke.ConclusionsAbdominal obesity measures are independent predictors of incident ischemic stroke in women but not in men from the general adult population. Thus, it may be of particular importance for women to prevent central obesity in order to reduce their risk of ischemic stroke.

Relation of Overall and Abdominal Adiposity With Electrocardiogram Parameters of Subclinical Cardiovascular Disease in Individuals Aged 45 to 65 Years (from the Netherlands Epidemiology of Obesity Study)

Overall and abdominal obesity are well-established risk factors for cardiometabolic disease. However, associations of overall and abdominal adiposity with electrocardiographic (ECG) markers of subclinical cardiovascular disease (CVD) have not yet been fully elucidated. Therefore, we investigated these associations in a population without preexisting CVD. We performed cross-sectional analyses in the Netherlands Epidemiology of Obesity Study. Body mass index (BMI), total body fat, and waist circumference were assessed in all participants, and abdominal subcutaneous adipose tissue and visceral adipose tissue (by magnetic resonance imaging) were assessed in a random subgroup. ECG parameters were determined using 12-lead electrocardiograms. We performed linear regression analyses, adjusting for potential confounding factors and, when investigating abdominal adiposity, additionally for total body fat. After exclusion of participants with preexisting CVD (n = 654), 5,939 individuals (42% men) were analyzed, with a mean (SD) age of 55 (6) years and BMI of 26.3 (4.4) kg/m2. Measures of both overall and abdominal adiposity were associated with ECG parameters but none of these measures was more strongly associated than the others. For example, heart rate (beats/min) increased per SD higher BMI (2.2; 95% confidence interval 1.9,2.5), total body fat (2.9; 2.4,3.4), subcutaneous adipose tissue (2.3;1.7,2.9), waist circumference (2.1; 1.4,2.8), and visceral adipose tissue (1.7; 0.8,2.5). In subgroup analyses based on gender and cardiovascular risk factors, no consistent interactions were observed. In conclusion, in a middle-aged population without preexisting CVD, measures of both overall and abdominal adiposity were associated with ECG parameters. Future studies should evaluate the added value of adiposity measures in electrocardiography-based diagnoses and the prognostic value of adding adiposity measures to risk prediction tools.

Physical activity and central adiposity in a cohort of African-American adults

BackgroundVisceral adipose tissue (VAT) is known as an independent predictor of cardiometabolic risk and all-cause mortality, while increased physical activity has been shown to improve cardiometabolic risk. The purpose of the present study was to determine whether or not there is an association between objectively-measured physical activity and VAT in a community-based cohort of African-American adults, a population at higher-than-average risk for cardiometabolic diseases.MethodsFree-living physical activity was quantified using accelerometry while VAT and abdominal subcutaneous fat were estimated using dual x-ray absorptiometry in a cohort of African Americans, ages 30–50 years, enrolled in the Modeling the Epidemiologic Transition Study. Univariate and multivariate analyses were used to determine the degree of association comparing moderate-to-vigorous physical activity (MVPA), vigorous activity, and sedentary behavior with measures of central adiposity including VAT, subcutaneous fat, and waist circumference.ResultsA total of 271 individuals with complete data were included in the analyses. Women, on average, had significantly more VAT and abdominal subcutaneous fat than men. There were statistically significant inverse univariate correlations between MVPA and measures of abdominal adiposity (−0.30, p < 0.001) and activity counts and adiposity (−0.31, p < 0.001) among both sexes. These significant associations remained after controlling for age, sex, and smoking status; neither alcohol consumption nor employment status were associated with abdominal adiposity. Time in sedentary behavior was not meaningfully associated with central adiposity in either sex (women: −0.02, p = 0.79; men: −0.21, p = 0.04).ConclusionsTo our knowledge, this study is the first to identify significant inverse associations between MVPA and measures of central adiposity among African American adults from a community-based cohort using an objective measure of physical activity and a validated quantitative imaging technique.

Comparing measures of general and abdominal adiposity as predictors of blood pressure in college students

ABSTRACTObjective: To compare anthropometric measures of body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR), and sagittal abdominal diameter (SAD) as predictors of blood pressure in college students. Participants: Students (N = 116) were recruited from November 2012 to May 2014 at an urban university and rural community colleges. Methods: Students underwent a brief physical examination during which anthropometric measures were obtained and blood pressure was measured. Covariates were measured using self-reported questionnaires. Hierarchical multiple linear regressions were used for the data analysis. Results: All anthropometric measures were predictive of systolic (SBP) and diastolic blood pressure (DBP). WC was the strongest predictor of SBP (β = .582, p < .01) explaining an additional 3–4% of the variance than BMI, WHtR, or SAD. The measures were similar in predicting DBP. WC predicted SBP independent of BMI. Conclusions: Clinicians should consider using WC to assess the risk for hypertension in college students.

The contribution of rising adiposity to the increasing prevalence of diabetes in the United States.

We assessed the contribution of increasing adiposity to the rising prevalence of diabetes in the United States over the period 1988-2014. Data from NHANES III (1988-1994) and continuous waves (1999-2014) were pooled for the current study. Diabetes status was assessed using data on Hemoglobin A1c. We estimated a multivariable logistic regression model that predicted the odds of having diabetes as a function of age, sex, racial/ethnic group, educational attainment, and period of observation. At a second stage, we introduced measures of general and abdominal adiposity into the model. Changes in coefficients pertaining to period of observation between the first and second models were interpreted as indicating the extent to which adiposity can account for trends in the prevalence of diabetes. Sensitivity analyses were conducted to investigate how alternative definitions of adiposity and diabetes status would affect results. The predicted prevalence of diabetes rose by 2.59%/yr between 1988 and 2014 after adjusting for changes in population composition. Increasing adiposity explained 72% of the rise in diabetes. Results were consistent for men and women. Rising levels of adiposity explained the large majority of the rise in diabetes prevalence between 1988 and 2014.

Abdominal obesity and gastroesophageal cancer risk: systematic review and meta-analysis of prospective studies.

To systematically and quantitatively review the relation of abdominal obesity, as measured by waist circumference (WC) and waist to hip ratio (WHR), to total gastroesophageal cancer, gastric cancer (GC), and esophageal cancer. PubMed and Web of Science databases were searched for studies assessing the association between abdominal obesity and gastroesophageal cancer (GC and/or esophageal cancer) up to August 2016. A random-effect model was used to calculate the summary relative risks (RRs) and 95% confidence intervals (CIs). Seven prospective cohort studies – one publication included two separate cohorts – from six publications were included in the final analysis. A total of 2130 gastroesophageal cancer cases diagnosed amongst 913182 participants. Higher WC and WHR were significantly associated with increased risk of total gastroesophageal cancer (WC: RR 1.68, 95% CI: 1.38, 2.04; WHR: RR 1.49, 95% CI: 1.19, 1.88), GC (WC: RR 1.48, 95% CI: 1.24, 1.78; WHR: 1.33, 95% CI: 1.04, 1.70), and esophageal cancer (WC: RR 2.06, 95% CI: 1.30, 3.24; WHR: RR 1.99, 95% CI: 1.05, 3.75).Findings from our subgroup analyses showed non-significant positive associations between gastric non-cardia adenocarcinoma (GNCA) and both measures of abdominal adiposity, while gastric cardia adenocarcinoma (GCA) was positively associated with WC but not with WHR. On analysis restricted to studies that adjusted for body mass index (BMI), WC was positively associated with GC and esophageal cancer, whereas WHR was positively associated with risk of GC only. Although limited, the findings from our meta-analysis suggest the potential role of abdominal obesity in the etiology of gastric and esophageal cancers.

Genetic Association of Waist-to-Hip Ratio With Cardiometabolic Traits, Type 2 Diabetes, and Coronary Heart Disease

In observational studies, abdominal adiposity has been associated with type 2 diabetes and coronary heart disease (CHD). Whether these associations represent causal relationships remains uncertain. To test the association of a polygenic risk score for waist-to-hip ratio (WHR) adjusted for body mass index (BMI), a measure of abdominal adiposity, with type 2 diabetes and CHD through the potential intermediates of blood lipids, blood pressure, and glycemic phenotypes. A polygenic risk score for WHR adjusted for BMI, a measure of genetic predisposition to abdominal adiposity, was constructed with 48 single-nucleotide polymorphisms. The association of this score with cardiometabolic traits, type 2 diabetes, and CHD was tested in a mendelian randomization analysis that combined case-control and cross-sectional data sets. Estimates for cardiometabolic traits were based on a combined data set consisting of summary results from 4 genome-wide association studies conducted from 2007 to 2015, including up to 322 154 participants, as well as individual-level, cross-sectional data from the UK Biobank collected from 2007-2011, including 111 986 individuals. Estimates for type 2 diabetes and CHD were derived from summary statistics of 2 separate genome-wide association studies conducted from 2007 to 2015 and including 149 821 individuals and 184 305 individuals, respectively, combined with individual-level data from the UK Biobank. Genetic predisposition to increased WHR adjusted for BMI. Type 2 diabetes and CHD. Among 111 986 individuals in the UK Biobank, the mean age was 57 (SD, 8) years, 58 845 participants (52.5%) were women, and mean WHR was 0.875. Analysis of summary-level genome-wide association study results and individual-level UK Biobank data demonstrated that a 1-SD increase in WHR adjusted for BMI mediated by the polygenic risk score was associated with 27-mg/dL higher triglyceride levels, 4.1-mg/dL higher 2-hour glucose levels, and 2.1-mm Hg higher systolic blood pressure (each P < .001). A 1-SD genetic increase in WHR adjusted for BMI was also associated with a higher risk of type 2 diabetes (odds ratio, 1.77 [95% CI, 1.57-2.00]; absolute risk increase per 1000 participant-years, 6.0 [95% CI, CI, 4.4-7.8]; number of participants with type 2 diabetes outcome, 40 530) and CHD (odds ratio, 1.46 [95% CI, 1.32-1.62]; absolute risk increase per 1000 participant-years, 1.8 [95% CI, 1.3-2.4]; number of participants with CHD outcome, 66 440). A genetic predisposition to higher waist-to-hip ratio adjusted for body mass index was associated with increased risk of type 2 diabetes and coronary heart disease. These results provide evidence supportive of a causal association between abdominal adiposity and these outcomes.

Associations between circulating levels of adipocytokines and abdominal adiposity in patients after acute pancreatitis.

Adipocytokines are strongly associated with abdominal adiposity during the course of acute pancreatitis (AP). This study investigated associations between a panel of adipocytokines and abdominal adiposity in AP patients after hospital discharge, as well as the effect of several covariates. Fasting venous blood samples were collected to measure adiponectin, interleukin 6, leptin, monocyte chemoattractant protein 1, tumour necrosis factor α (TNFα), resistin, and retinol-binding protein 4. Waist circumference (WC), waist-hip ratio, and waist-height ratio (WheightR) were used as measures of abdominal adiposity. Generalised linear models were built, adjusting for age, sex, ethnicity, diabetes status, aetiology, duration since admission for AP, recurrence, and severity of AP. A total of 93 patients were studied, on average at 22months after AP. Interleukin 6, TNFα, and leptin were significantly associated with WC in both the unadjusted and all the three adjusted models. Also, they were significantly associated with WheightR in both the unadjusted and the three adjusted models. Other studied adipocytokines did not show a consistent association or were not significantly associated with the abdominal adiposity indices. The results suggest that excess abdominal adiposity favours pro-inflammatory milieu in AP patients after hospital discharge, independent of diabetes and effect of other covariates.