Comparison of the associations between non-traditional and traditional indices of adiposity and cardiovascular mortality: an observational study of one million person-years of follow-up.

BACKGROUND/OBJECTIVE: The most widely used adiposity index, body mass index (BMI), is not optimal to evaluate cardiovascular (CV) risk associated with overweight and obesity. We aimed to explore the association between traditional and non-traditional adiposity indices and CV mortality, and compare their discriminative ability for CV death. METHODS: We studied participants (age 19-79 years, BMI ≥18.5 kg/m2) from the population-based Norwegian Nord-Trøndelag Health Study 2 (HUNT 2). Traditional indices explored were BMI, waist circumference (WC) and waist- to-hip ratio, whereas non-traditional were estimated total body fat (eTBF), which is a sex-specific fat%-index, index of central obesity (WC/height) and a body shape index (ABSI) [WC/(BMI2/3 × âˆšheight)]. Associations between the traditional and non-traditional indices and CV death, obtained from the Norwegian Cause of Death Registry, were explored by Cox proportional hazard regression, and the indices' discriminative ability by Harrell's C statistics. RESULTS: Baseline assessments were done from 1995 to 1997 and the population (n = 61,016, 52% women) was observed for 17.7 ± 4.2 years (until 2016), yielding 1,080,473.6 person-years of follow-up. Thirteen thousand one hundred and ninety five (21.6%) subjects died, of whom 4908 (37.2%) died from CV causes. Across genders, eTBF had the strongest association to CV death (unadjusted hazard ratios [HRs] 4th vs. 1st quartile in women and men 13.38 [95% confidence interval (CI): 11.05-16.22] and 9.32 [8.03-10.81], respectively), together with index of central obesity in women and ABSI in men. The other indices showed weaker associations, in particular BMI in men: 1.73 [1.56-1.93]. Age adjustment attenuated the associations, but the pattern remained. In concordance with this, C-statistics was C = 0.725 [0.713-0.737] in women and 0.711 [0.701-0.721] in men for eTBF, and C = 0.622 [0.610-0.634] in women and 0.551 [0.541-0.562] in men for BMI. CONCLUSION: eTBF, a sex-specific total body fat index, was more strongly associated with CV death than other adiposity indices and may be a suitable clinical tool for assessment of obesity-associated CV risk.

Exercise Training Normalizes Timing of Left Ventricular Untwist Rate, but Not Peak Untwist Rate, in Individuals with Type 2 Diabetes and Diastolic Dysfunction: A Pilot Study.

BACKGROUND: There is limited information regarding the role of left ventricular (LV) twist and the effect of exercise in type 2 diabetes (T2D). The aim of this study was to compare LV twist parameters in patients with T2D versus healthy control subjects and the effects of high-intensity interval exercise (HIIE) and moderate-intensity exercise (MIE) on LV twist in patients with T2D with diastolic dysfunction. METHODS: This study, which included both prospective and retrospective components, included 47 patients with T2D and diastolic dysfunction and 37 healthy individuals. Patients with T2D were randomized to HIIE (4 × 4 min at 90%-95% of maximal heart rate, three times a week, 120 min/wk; n = 24) or MIE (210 min/wk; n = 23) for 12 weeks and examined with echocardiography (LV twist by speckle-tracking method) at baseline and posttest. The control subjects received no intervention and were matched according to age, gender, and body mass index to those completing the intervention. RESULTS: In total, 37 subjects completed 12 weeks of MIE (n = 17) or HIIE (n = 20). LV peak untwist rate (UTR) was similar in patients with T2D and control subjects (P Ëƒ .05). At baseline, LV peak UTR, relative to total diastolic period, occurred 5.8 percentage points later in patients with T2D compared with control subjects (P = .004). Time to peak UTR was shortened by 6.5 percentage points (P = .002) and 7.7 percentage points (P < .001) after MIE and HIIE, respectively. Time to peak UTR was similar to that in control subjects after exercise interventions. CONCLUSIONS: In patients with T2D and diastolic dysfunction, LV peak UTR was similar, but time to peak LV UTR was delayed compared with control subjects. Twelve weeks of endurance exercise normalized the timing of UTR.

[Declining prevalence of proliferative retinopathy in patients with type 1 diabetes]. / Redusert forekomst av proliferativ retinopati ved type 1-diabetes?

BACKGROUND: It is likely that improved treatment of diabetes during the last decades has led to a declining prevalence of retinopathy. We have assessed whether this is the case for patients with type I diabetes. MATERIAL AND METHODS: Medical records were retrospectively reviewed for all patients who were diagnosed with type 1 diabetes in the periods 1960-1975 (early group) and 1985-1990 (late group) at the diabetes clinic in St. Olavs Hospital (Trondheim). Information on the prevalence of retinopathy ten and 15 years after diabetes onset was obtained from hospital records and private ophthalmologists in Trondheim. RESULTS: 125 patients were identified in the early group and 147 patients in the late group. The prevalence of proliferative retinopathy was higher in the early group than in the late group, both after ten years (4% vs. 0%, p = 0.04) and 15 years (13% vs. 5%, p = 0.04) of diabetes. The prevalence of background retinopathy was not significantly different between the two groups after ten (12% vs. 14%, p = 0.70) or 15 years (29% vs. 24%, p = 0.36) of diabetes. INTERPRETATION: Our results indicate that the prevalence of proliferative retinopathy is decreasing in patients with type 1 diabetes in Norway. Explanations may be improved follow-up and treatment of diabetes and diabetic retinopathy.

[Use of a pedometer in physically inactive persons]. / Bruk av pedometer hos fysisk inaktive personer.

BACKGROUND: Pedometers have been intensively marketed in recent years. This article questions whether there is scientific basis for the claim that use of a pedometer promotes an increase in physical activity or has other beneficial health effects in people who have either type 2 diabetes (T2DM), are physically inactive or overweight. MATERIAL AND METHODS: Publications on the use of a pedometer were retrieved from the PubMed-database with the terms "pedometer AND (diabetes OR physical inactivity)". Only controlled studies have been included. RESULTS: Most studies with a pedometer also include other measures to increase physical activity. Results from such studies cannot be attributed to the use of pedometer per se. Only four studies have been designed to test the effects of a pedometer on increase of physical activity. Two studies with short duration (nine and 12 weeks) and a high dropout rate (53 % and 26 %) showed uncertain effect of pedometer use. In two randomized trials of six months duration, no additional effect of a pedometer was found when the pedometer group and the control group both were coached and counselled to increase physical activity. CONCLUSION: Use of a pedometer is shown to have little additional effect in controlled studies designed to increase physical activity in persons that were physically inactive, obese or had type 2 diabetes. Regular counselling to increase physical activity has moderately beneficial health effects.