Adiposity indicators exhibit depot- and sex-specific associations with multimorbidity onset: A cohort study of the UK Biobank.

AIM: This study investigated the depot- and sex-specific associations of adiposity indicators with incident multimorbidity and comorbidity pairs. MATERIALS AND METHODS: We selected 382 678 adults without multimorbidity (≥2 chronic diseases) at baseline from the UK Biobank. General obesity, abdominal obesity and body fat percentage indices were measured. RESULTS: Cox proportional hazard regression analyses of general obesity indices revealed that for every one-unit increase in body mass index, the risk of incident multimorbidity increased by 5.2% (95% confidence interval 5.0%-5.4%). A dose-response relationship was observed between general obesity degrees and incident multimorbidity. The analysis of abdominal obesity indices showed that for every 0.1 increment in waist-to-height ratio and waist-to-hip ratio, the risk of incident multimorbidity increased by 42.0% (37.9%-46.2%) and 27.9% (25.7%-30.0%), respectively. Central obesity, as defined by waist circumference, contributed to a 23.2% increased risk of incident multimorbidity. Hip circumference and hip-to-height ratio had protective effects on multimorbidity onset. Consistent findings were observed for males and females. Body fat percentage elevated 3% (0.2%-5.9%) and 5.3% (1.1%-9.7%) risks of incident multimorbidity in all adults and females, respectively. Arm fat percentages elevated 5.3% (0.8%-9.9%) and 19.4% (11.0%-28.5%) risks of incident multimorbidity in all adults and males, respectively. The general obesity indices, waist circumference, waist-to-height ratio, waist-to-hip ratio and central obesity increased the onset of comorbidity pairs, whereas hip circumference and hip-to-height ratio decreased the onset of comorbidity pairs. These adiposity indicators mainly affect diabetes mellitus-related comorbidity onset in males and hypertensive-related comorbidity onset in females. CONCLUSIONS: Adiposity indicators are predictors of multimorbidity and comorbidity pairs and represent a promising approach for intervention.

The interaction between general or abdominal obesity and hypertension on the risk of type 2 diabetes mellitus: a cross-sectional analysis in Iranian adults from the RaNCD cohort study.

BACKGROUND: Interactions between risk factors may influence disease severity. Knowing this relationship is important for preventive interventions and disease control. The purpose of this study was to determine the interactions effects of obesity and hypertension on the risk of type 2 diabetes mellitus (T2DM). METHODS: The data of 9,283 adults 35 to 65 years were examined from the cohort study of Ravansar Non-Communicable Disease (RaNCD). Waist circumference (WC) was used to identify both general and abdominal obesity based on body mass index (BMI). To assess the interaction between hypertension and obesity (general/abdominal) and the risk of T2DM, the additive interaction was calculated. RESULTS: The adjusted odds ratios for T2DM were 2.38 (1.67, 3.41) in men and 4.02 (2.47, 6.47) in women for the combinations of hypertension and abdominal obesity. The adjusted odds ratios for T2DM were 2.53 (1.63, 3.82) in men and 2.66 (1.92, 3.70) in women for the combinations of hypertension and general obesity. The results of the additive interaction indicators were inconsistent with gender. The relative excess risk due to interaction (interaction between hypertension and central obesity) (RERI), attributable proportion due to interaction (AP) and synergy index (SI) were0.27 (-1.01, 1.54), 0.11 (-0.41, 0.63) and 1.23 (0.41, 3.68) in male and were 0.61 (-1.12, 2.33), 0.23 (0.08, 0.37) and 1.26 (0.60, 2.61) in female, respectively. CONCLUSION: General/abdominal obesity and hypertension have a synergistic effect on the risk of T2DM. The recommendation for preventing T2DM is lifestyle modification. Large longitudinal studies are necessary to investigate causal relationships.

Independent and joint associations of general and abdominal obesity with the risk of conventional adenomas and serrated polyps: A large population-based study in East Asia.

Evidence regarding associations of general and abdominal obesity with the risk of conventional adenomas (ADs) and serrated polyps (SPs) from Asian population is scarce. Our study aimed to investigate the independent and joint associations of general obesity assessed by body mass index (BMI) and abdominal obesity assessed by waist circumference (WC) or waist-to-hip ratio (WHR) with the risk of ADs and SPs among 25 222 participants recruited by a population-based screening program. Compared to participants with normal BMI, those with a BMI ≥28 kg/m2 had increased risk of ADs (odds ratio [OR] 1.52, 95% confidence interval [CI]: 1.36-1.70) and SPs (OR 1.69, 95% CI: 1.38-2.07). For participants with a WC ≥102 cm (≥88 cm for females), the risk of ADs (OR 1.37, 95% CI: 1.25-1.51) and SPs (OR 1.81, 95% CI: 1.52-2.16) was higher than that of the reference group. For participants with a WHR ≥0.95 (≥0.90 for females), the risk of ADs (OR 1.26, 95% CI: 1.16-1.36) and SPs (OR 1.46, 95% CI: 1.26-1.69) was higher than that of the reference group. Moreover, participants with both BMI ≥28 kg/m2 and WC ≥102 cm (≥88 cm for females) had 61% and 119% higher risk of ADs (OR 1.61, 95% CI: 1.39-1.85) and SPs (OR 2.19, 95% CI: 1.70-2.82) compared to those with both normal BMI and WC. These findings indicate that both general and abdominal obesity are associated with SPs and ADs, presenting stronger association with SPs than ADs. Moreover, the association is more evident when both obesities exist.

Association of body mass index and waist-to-height ratio with outcomes in ischemic stroke: results from the Third China National Stroke Registry.

BACKGROUND AND PURPOSE: Conflicting reports of obesity paradox have led to confusion about weight management strategies for post-stroke patients. The main purpose of this study is to determine whether the obesity paradox measured by body mass index (BMI) or by waist-to-height ratio (WHtR) is real. METHODS: We evaluated the association of general obesity measured by BMI, and abdominal obesity measured by WHtR with 1-year all-cause mortality, recurrence of stroke and combined vascular events of acute ischemic stroke (AIS) patients in a cohort -- the Third China National Stroke Registry (CNSR-III). Cox proportional hazards models and restricted cubic splines were performed to investigate the association between obesity and clinical outcomes. RESULTS: A total of 14,146 patients with ischemic stroke were included. When BMI was used as a measure of obesity, compared to the normal weight patients, mortality decreased in overweight patients (hazard ratio [HR] 0.74 [95% confidence interval (CI) 0.61-0.91], P = 0.0035) and obese patients (HR 0.54 [0.40-0.73], P < 0.0001); and increased in underweight patients (HR 2.55 [1.75-3.73], P < 0.0001). After adjustment for confounding factors, the protective effect of obesity and overweight disappeared. BMI had no association with recurrence of stroke or combined vascular events. When WHtR was used as a measure of obesity, obese patients had lower 1-year all-cause mortality (HR 0.64 [0.43-0.97], P = 0.0357). After adjustment for confounding factors, this difference disappeared; overweight patients still had lower all-cause mortality (adjusted hazard ratio [aHR] 0.42 [0.26-0.67], P = 0.0003), recurrence of stroke (aHR 0.77 [0.60-0.99], P = 0.0440) and combined vascular events (aHR 0.75 [0.58-0.95], P = 0.0198). CONCLUSIONS: Among Chinese patients with AIS, our study does not support the BMI paradox; overweight patients measured by WHtR had a more favorable prognosis. TOAST subtypes did not modify the association.

The relationship between general and abdominal obesity, nutrition and respiratory functions in adult asthmatics.

OBJECTIVE: Although obesity is known to have adverse effects on asthma, it is not fully known whether general or abdominal obesity affects asthma symptoms more. In this study, the effects of diet and general/abdominal obesity on respiratory functions were evaluated. METHODS: A total of 204 adult asthmatic individuals participated in the study. Anthropometric measurements, respiratory functions, asthma control test (ACT) scores, and 24-hour food consumption were recorded. The results were compared according to body mass index (BMI), waist circumference (WC), and waist-hip ratio (WHR) classification. RESULTS: FEV1, FVC, MEF25-75, MEF50, and MEF25 decreased with the increase in BMI, WC, and WHR. FEV1 showed a negative linear relationship with BMI, WC and WHR and these results were more significant in WC and WHR than BMI. Similarly, the ACT score also showed a negative correlation with BMI (r = -0.372; p = 0.023), WC (r = -0.402; p = 0.001) and WHR (r = -0.387; p = 0.011), and the results were more significant in WC and WHR than BMI. Individuals whose WC (OR: 2.170 CI (1.325-3.182)) and WHR (OR: 2.119 CI (1.246-3.338)) were at risk had higher odds of uncontrolled asthma than those with normal WC and WHR. Each 100-kcal increase in total energy consumption increased the odds of uncontrolled asthma (OR: 1.125 CI (1.086-2.217)) (p < 0.05). CONCLUSIONS: The effects of WC and WHR, which are indicators of abdominal obesity, on respiratory functions and ACT score, were found to be higher than BMI. Obese individuals should be referred to diet clinics to improve their asthma symptoms.

Association of dietary patterns with general and central obesity among Chinese adults: a longitudinal population-based study.

BACKGROUND: Limited evidence exists for the association between dietary patterns and later obesity phenotypes among Chinese adults. This longitudinal study aimed to evaluate associations of dietary patterns with general and central obesity in Chinese adults. METHODS: Based on the China Health and Nutrition Survey (CHNS) waves 2004 and 2015, the study was conducted on 4207 adult men and women (age range: 18-65 years). Dietary intakes were assessed by three consecutive 24-h dietary recalls, and dietary patterns were identified using exploratory factor analysis. Longitudinal associations of dietary patterns with general and central obesity were evaluated using logistic regression analyses. RESULTS: The prevalence rates of general and central obesity were 14.2% and 42.1%, respectively. Factor analysis extracted three major dietary patterns: "traditional southern," "modern," and "traditional northern." After adjustment for potential confounders, adults in the highest quartile of the traditional southern dietary group were less likely to develop over 10 years general (odds ratio [OR] = 0.50, 95% confidence interval [95%CI]: 0.39, 0.65) and central (OR = 0.52, 95%CI: 0.43, 0.63) obesity compared to those in the lowest quartile group. The modern dietary pattern was not significantly associated with general and central obesity. Adherence to the traditional northern dietary pattern increased the chance of both general and central obesity (OR = 1.61, 95%CI: 1.23, 2.10; OR = 1.64, 95%CI: 1.36, 1.98) after 10 years. CONCLUSIONS: Our study provides longitudinal evidence for associations between dietary patterns and later obesity phenotypes among Chinese adults. Our findings may guide the development of evidence-based preventive nutrition interventions to control the obesity epidemic.

Insulin resistance mediates obesity-related risk of cardiovascular disease: a prospective cohort study.

BACKGROUND: The mechanisms linking obesity to cardiovascular disease (CVD) are still not clearly defined. Individuals who are overweight or obese often develop insulin resistance, mediation of the association between obesity and CVD through the insulin resistance seems plausible and has not been investigated. This study aimed to evaluate whether and to what extend the effect of general and central obesity on cardiovascular disease (CVD) is mediated by insulin resistance. METHODS: A total of 94,136 participants without CVD at baseline were recruited from the Kailuan study. Insulin resistance was evaluated by the triglyceride-glucose (TyG) index, calculating as ln [fasting triglyceride (mg/dL) × fasting glucose (mg/dL)/2]. Mediation analysis using a new 2-stage regression method for survival data proposed by Valeri and VanderWeele was to explore the mediating effects of the TyG index on the association between obesity and CVD. RESULTS: During a median follow-up of 13.01 years, we identified 7327 cases of CVD. Mediation analyses showed that 47.81% of the total association (hazard ratio [HR], 1.18; 95% confidence interval [CI], 1.12-1.24) between overweight and CVD was mediated through the TyG index (HR [indirect association], 1.07; 95% CI, 1.07-1.09), and the proportion mediated was 37.94% for general obesity. For central obesity, analysis by waist circumference, waist/hip, and waist/height categories yielded an attenuated proportion mediated of 32.01, 35.02, and 31.06% for obesity, taken normal weight as reference. CONCLUSIONS: The association between obesity and CVD was mediated by TyG index, suggesting proper control of insulin resistance can be effective to reduce the effects of obesity on CVD.

Prevalence and risk factors of general and abdominal obesity and hypertension in rural and urban residents in Bangladesh: a cross-sectional study.

BACKGROUND: Obesity and hypertension are global health concerns. Both are linked with increased risks of all-cause and cardiovascular mortality. Several early studies reported the prevalence of obesity and hypertension in Bangladeshi adults, but the associated factors in this country population are not clear yet. We aimed to estimate the prevalence and related risk factors of general and abdominal obesity and hypertension in rural and urban adults in Bangladesh. METHODS: In this cross-sectional study, data (n = 1410) was collected on rural (n = 626) and urban (n = 784) adults from eight divisional regions of Bangladesh. Both anthropometric and socio-demographic measurements were recorded in a standardized questionnaire form. General and abdominal obesity were defined based on WHO proposed cut-off values and hypertension was defined by SBP ≥ 140 mmHg and/or, DBP ≥ 90 mmHg and/or, intake of anti-hypertensive drugs at the time of data collection. Multivariable logistic regression analyses were performed to assess the relationship of general and abdominal obesity and hypertension with various factors. RESULTS: The overall prevalence of general obesity, abdominal obesity and hypertension was 18.2, 41.9 and 30.9%, respectively. The women had a higher prevalence of general obesity (25.2%), abdominal obesity (56.1%) and hypertension (32.3%) compared to the men (12.2, 29.0, and 29.7%, respectively). The prevalence of both general and abdominal obesity was higher in urban participants (21.7 and 46.6%, respectively) than in the rural participants (13.8 and 35.1%, respectively), whereas, the rural participants had a higher prevalence of hypertension (35.1%) compared to the urban participants (27.5%). In geographical region comparison, the prevalence of general and abdominal obesity and hypertension were higher in participants enrolled from Dhaka (30.8%), Khulna (63.6%) and Mymensingh (43.5%) regions, respectively compared to other regions. In regression analysis, increased age, place of residence and less physical activity were positively associated with the increased risk of both types of obesity and hypertension. The analysis also showed a significant positive association between high BMI and an increased risk of hypertension. CONCLUSION: This study shows a high prevalence of obesity and hypertension in rural and urban adults. Increased age, inadequate physical activity and place of residence were significant determinants of general and abdominal obesity and hypertension. A comprehensive intervention program focusing on modifiable risk factors such as lifestyles and food habits is needed to increase awareness and prevent the burden of obesity and hypertension in the Bangladeshi population.

Tracking and risk of abdominal and general obesity in children between 4 and 9 years of age. The Longitudinal Childhood Obesity Study (ELOIN).

BACKGROUND: Studies have shown that overweight and obesity conditions tend to be stable from childhood and adolescence to adulthood. Unfortunately, little is known about the evolution of abdominal obesity during childhood. The aim of this study was to evaluate the temporal variations and risk of general and abdominal obesity between 4, 6, and 9 years of age. METHODS: Measurements of children in the ELOIN study taken at the three follow-ups of 4, 6, and 9 years of age were included (N = 1,902). Body mass index and waist circumference were recorded via physical examination. General obesity was determined according to the criteria of the World Health Organization (WHO) and abdominal obesity according to the cut-off points proposed by the International Diabetes Federation (IDF). Prevalence ratios (PRs) were estimated by sex and family affluence using generalized estimating equation models and relative risks (RRs) of obesity were obtained via Poisson regression. RESULTS: The prevalence of general obesity was 5.1%, 9.1%, and 15.6% at 4, 6, and 9 years, respectively, yielding a PR of 3.05 (95%CI: 2.55-3.60) (9 years old relative to 4 years). The prevalence of abdominal obesity was 6.8%, 8.4%, 14.5% at 4, 6, and 9 years, respectively, and the PR was 2.14 (95%CI: 1.82-2.51) (9 years old relative to 4 years). An inverse correlation was observed between both general and abdominal obesity and socioeconomic status. Among participants with general or abdominal obesity at 4 years of age, 77.3% and 63.6% remained in their obesity classification at 9 years, respectively, and 3.4% and 3.5% presented general or abdominal obesity also at 6 and 9 years of age, respectively. The RRs of general and abdominal obesity at 9 years were 4.61 (95%CI: 2.76-7.72) and 4.14 (95%CI: 2.65-6.48) for children classified with obesity at 4 years of age, increased to 9.36 (95%CI: 7.72-11.35) and 9.56 (95%CI: 7.79-11.74) for children who had obesity at 6 years, and up to 10.27 (95%CI: 8.52-12.37) and 9.88 (95%CI: 8.07-12.11) for children with obesity at both 4 and 6 years, respectively. CONCLUSIONS: General and abdominal obesity begin at an early age and increase over time, showing an inverse correlation with socioeconomic status. In addition, general and abdominal obesity at 9 years are strongly associated with being classified with obesity at 4 and 6 years, so preventive interventions should be established at very early ages.

Dietary intake of branched-chain amino acids in relation to general and abdominal obesity.

PURPOSE: Despite the huge evidence on the link between dietary protein intake and obesity, limited studies have examined the role of individual amino acids in this regard. This study aimed to investigate the association between dietary total and individual BCAAs intake and odds of general and abdominal obesity in a large group of adults. METHODS: This cross-sectional study was conducted among 8691 adults aged 18-55 years in Isfahan, Iran. Dietary BCAAs were assessed using a validated dish-based 106-item semi-quantitative food frequency questionnaire (DS-FFQ). Information about weight and waist circumference was collected through a self-reported validated questionnaire. General obesity was defined as body mass index (BMI) ≥ 30 kg/m2, and abdominal obesity was defined as waist circumference (WC) ≥ 88 cm for women and ≥ 102 cm for men. RESULTS: Mean age of study participants was 36.8 ± 8.1 years. Prevalence of general obesity was 9.2% in men and 9.7% in women and that of abdominal obesity was 13.3% and 36.2% in men and women, respectively. We found that participants in the top tertile of total BCAAs intake had higher odds of general obesity compared with those in the bottom tertile (OR: 1.42; 95% CI: 1.09-1.84). Such significant association was seen in men (OR: 1.57; 95% CI: 1.05-2.34), but not in women (OR: 1.33; 95% CI: 0.94-1.89) in our stratified analysis. We found no significant association between total BCAAs intake and odds of abdominal obesity. Stratified by sex, no significant association was observed between total BCAAs intake and odds of abdominal obesity [for men: (OR: 1.10; 95% CI: 0.74-1.65) and for women: (OR: 1.08; 95% CI: 0.84-1.38)]. Assessing the association with individual BCAAs, a significant positive association was observed between dietary intake of valine (OR: 1.42; 95% CI: 1.10-1.84), leucine (OR: 1.43; 95% CI: 1.10-1.86), and isoleucine (OR: 1.42; 95% CI: 1.09-1.84) with general obesity. We observed no significant association between dietary intake of individual BCAAs intake and odds of abdominal obesity. CONCLUSION: Dietary BCAAs intake was associated with an increased odds of general obesity, in particular among men. No significant association was observed between dietary BCAAs and abdominal obesity. LEVEL OF EVIDENCE: Level V, descriptive cross-sectional study.

Differences in hypertension and prehypertension among people living with and without HIV in China: role of HIV infection and antiretroviral therapy.

OBJECTIVES: Hypertension is a growing health concern in people living with HIV (PLWH). However, association between HIV infection and hypertension is equivocal. METHODS: In all, 1472 PLWH and 2944 HIV-negative individuals frequency-matched by age and sex were derived from the baseline survey of Comparative HIV and Aging Research in Taizhou (CHART), China. Prehypertension was defined as systolic blood pressure (BP) of 120-139 mmHg and/or diastolic blood pressure of 80-89 mmHg. RESULTS: Despite the fact that prevalence of hypertension was overall lower among PLWH than among HIV-negative people (21.1% vs. 29.1%, P < 0.001), it was similar at ages 18-29 (7.6% vs. 8.5%) and 30-44 years (17.1% vs. 18.5%) but significantly lower in PLWH at ages 45-59 (26.1% vs. 40.7%) and 60-75 years (37.1% vs. 57.3%). Prehypertension prevalence was consistently higher in PLWH across all age groups. In the model adjusting for traditional risk factors, HIV infection was associated with hypertension (adjusted odds ratio [aOR] = 1.27, 95% confidence interval: 1.04-1.55) and prehypertension (aOR = 1.77, 95% CI: 1.51-2.08), and attenuated after additional adjustment for abdominal obesity. Age-stratified analysis showed that these associations of HIV with hypertension were observed at ages 18-29 and 30-44 years and associations with prehypertension were observed at ages 18-29, 30-44 and 45-59 years only. Years since HIV diagnosis and stavudine use were the HIV-specific factors independently associated with hypertension or/and prehypertension. CONCLUSIONS: HIV infection is independently associated with prehypertension and hypertension especially at younger ages, and this risk may increase as treatment becomes prolonged. Our findings reinforce the urgent necessity for active BP screening and control strategies be adopted for PLWH in China.

General and abdominal obesity and incident hypertension among people living with HIV on antiretroviral therapy.

Hypertension is highly prevalent among people living with HIV (PLWH). We sought to characterize the hypertension incidence among PLWH on antiretroviral therapy, focusing on the effect of change in general and abdominal obesity on hypertension during follow-up. This was a prospective analysis of 229 treated PLWH aged over 40 years without hypertension at baseline. Overall a median follow-up of 2.9 years, 26.2% PLWH developed hypertension. In multivariable models, compared to those without obesity measures at both baseline and follow-up visit, PLWH with general obesity at both occasions (adjusted odds ratio [aOR] = 3.83, P = 0.006) or at baseline only (aOR = 5.45, P = 0.003), abdominal obesity (measured as waist circumference) at both occasions (aOR = 3.87, P = 0.001) or at follow-up only (aOR = 2.27; 9P = 0.060), abdominal obesity (measured as waist-to-hip ratio) at both occasions (aOR = 2.27, P = 0.077) were at increased risk of incident hypertension. Our data show that both general and abdominal obesity especially in the persistent status increase the hypertension risk in treated PLWH.

General and central obesity operate differently as predictors of falls requiring medical care in older women: a population-based cohort study in Spain.

OBJECTIVES: to examine the association of general and abdominal obesity with falls, falls requiring medical care and falls with fractures in older women. DESIGN: a population-based prospective cohort of 1,185 women aged ≥60 in Spain, followed up from 2008 to 2010 through 2012. MEASURES: weight, height and waist circumference were measured at baseline using standardised techniques. Participants were classified according to body mass index as normal weight (<25), overweight (25-29.9) and general obesity (≥30). Abdominal obesity was defined as waist circumference >88 cm. In 2012, participants reported the falls experienced in the previous year. Logistic regression models were mutually adjusted for general and abdominal obesity and for main confounders. RESULTS: in this cohort of older women, a total of 336 women experienced falls, 168 of them had falls requiring medical care and 64 falls with fractures. For falls, no association was found with general obesity nor abdominal obesity. However, compared with normal weight, overweight women had a decreased risk for falls requiring medical care [odds ratio (OR) 0.57; 95% confidence interval (CI) 0.34-0.94] and for falls with fractures (OR 0.27; 95% CI 0.12-0.63). The corresponding values for general obesity were 0.44 (0.24-0.81) and 0.30 (0.11-0.82). Abdominal obesity was positively associated with falls requiring medical care (OR 1.82; 95% CI 1.12-2.94) and falls with fractures (OR 2.75; 95% CI 1.18-6.44). CONCLUSIONS: in older women, general obesity may protect from falls requiring medical care and falls with fractures. On the contrary, abdominal obesity increased the risk of suffering from types of falls.

Association of general and abdominal obesity and their changes with stroke in Chinese adults: Results from an 11.8-year follow-up study.

BACKGROUND AND AIMS: Obesity-related diseases play a significant role in the epidemiology of stroke; however, the exact effects of obesity and transitions in obesity status on stroke risk are still unclear. This study was performed to investigate the association of general and abdominal obesity and their changes with stroke in Chinese adults. METHODS AND RESULTS: A total of 26,815 subjects (13,684 men and 13,131 women) aged ≥35 years participated in the study. The association of general and abdominal obesity and their changes with stroke was estimated by Cox proportional hazards models. During a median follow-up period of 11.8 years, 1507 people developed an incident stroke event. The multivariable-adjusted hazard ratios (HRs) (95% CIs) for stroke comparing the highest vs. lowest quartiles of these measurements were 1.276 (1.068-1.524) for BMI, 1.245 (1.035-1.499) for WC, 0.940 (0.786-1.125) for WHR, and 1.221 (1.019-1.464) for WHtR in men. For women, the corresponding values were 1.368 (1.089-1.718), 1.424 (1.119-1.813), 0.971 (0.765-1.232), and 1.341 (1.059-1.699), respectively. C- statistics showed no difference in the predictive value for stroke among various measures of adiposity. Compared with participants who maintained a normal BMI, the HRs for reversed general obesity was 1.272 (95% CI: 1.044-1.550) among men and 1.240 (95% CI: 0.948-1.623) among women. CONCLUSION: Increasing levels of general or abdominal adiposity consistently predict increased risk of stroke, and maintenance of a normal BMI or WC may aid in stroke prevention.

Water intake and intra-meal fluid consumption in relation to general and abdominal obesity of Iranian adults.

OBJECTIVE: The aim of this study was to examine the association between whole-day water intake and intra-meal fluid consumption and odds of general and abdominal obesity among adults. METHODS: This cross-sectional study was conducted among 7958 adults in Isfahan, Iran. Daily water consumption was assessed through the use of a pre-tested questionnaire by asking questions about the average number of glasses of water consumed in a day. Intra-meal fluid consumption was also analysed. Data regarding height, weight and waist circumference were collected using a validated self-administered questionnaire. Obesity was defined as body mass index ≥30 kg/m2, and abdominal obesity was defined as waist circumference >88 cm for women and >102 cm for men. RESULTS: After taking potential confounders into account, individuals who were taking more than eight glasses of water in a day had 78% greater odds of general obesity (OR: 1.78; 95% CI: 1.08-2.94) compared with those who were taking less than two glasses of water. Individuals with much water intake had no significant greater odds of abdominal obesity. Compared with those who were consuming less than a glass of intra-meal fluids, subjects with 1-2 glasses of fluids between meals had 34% greater odds of general obesity (OR: 1.34; 95% CI: 1.04-1.59). Although subjects with greater intra-meal fluid intake had greater odds of abdominal obesity in crude model, this association became non-significant after adjustment for potential confounders (comparing > 4 glasses vs. ≤1 glass: OR: 1.65; 95% CI: 0.81-3.34). CONCLUSIONS: We observed that taking more than eight glasses of water in a day and consuming 1-2 glasses of fluids between meals was associated with greater odds of general obesity.

Association between adherence to MIND diet and general and abdominal obesity: a cross-sectional study.

BACKGROUND: Recently, a new eating pattern called as "Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND)" has been coined. Emerging studies are examining this dietary pattern with chronic conditions. We aimed to investigate the association between the MIND diet score and general and central obesity among adults. METHODS: This cross-sectional study was conducted in a framework of the Study on the Epidemiology of Psychological Alimentary Health and Nutrition (SEPAHAN). Dietary information was collected using a validated self-administered 106-item Willett-format dish-based semi-quantitative food frequency questionnaire (DS-FFQ) in 6724 adults. Adherence to the MIND diet was examined based on components suggested in this eating pattern. Anthropometrics data were collected using a validated self-reported questionnaire. General obesity was defined as body mass index ≥30 kg/m2, and abdominal obesity as waist circumference > 102 cm for men and > 88 cm for women. RESULTS: Mean age, BMI and WC in the study population was 36.8 ± 8.08 y, 24.9 ± 3.8 kg/m2 and 83.7 ± 16.02 cm, respectively. Overall, 9.5% of subjects were generally obese and 24.4 were abdominally obese. Examining the whole study population, we found no significant association between the MIND diet score and odds of general obesity, either before (ORs for comparing T3 vs. T1: 1.03; 95% CI: 0.83, 1.27; P-trend = 0.74) or after controlling for potential confounders (ORs for T3 vs. T1: 0.91; 95% CI: 0.67, 1.25; P-trend = 0.58). This was also the case for men and women when analyzed separately. We also failed to find any significant association between the MIND diet score and odds of abdominal obesity after controlling for potential confounders in the whole study population (ORs for T3 vs. T1: 1.00, 95% CI: 0.79, 1.27; P-trend = 0.87). However, women with the greatest adherence to the MIND diet were 19% less likely to be abdominally obese than those with the lowest adherence in crude model (OR = 0.81; 95% CIs: 0.67, 0.98; P-trend = 0.03). This association disappeared after controlling for potential confounders (OR = 0.87; 95% CIs: 0.66, 1.14; P-trend = 0.55). CONCLUSION: No significant association was observed between adherence to the MIND diet and odds of general and central obesity.

Body size and obesity during adulthood, and risk of lympho-haematopoietic cancers: an update of the WCRF-AICR systematic review of published prospective studies.

BACKGROUND: To summarise the evidence on the associations between body mass index (BMI) and BMI in early adulthood, height, waist circumference (WC) and waist-to-hip ratio (WHR), and risk of lympho-haematopoietic cancers. METHOD: We conducted a meta-analysis of prospective studies and identified relevant studies published up to December 2017 by searching PubMed. A random-effects model was used to calculate dose-response summary relative risks (RRs). RESULTS: Our findings showed BMI, and BMI in early adulthood (aged 18-21 years) is associated with the risk of Hodgkin's and non-Hodgkin's lymphoma (HL and NHL), diffuse large beta-cell lymphoma (DLBCL), Leukaemia including acute and chronic myeloid lymphoma (AML and CML), and chronic lymphocytic leukaemia (CLL) and multiple myeloma (MM). The summary RR per 5 kg/m2 increase in BMI were 1.12 [95% confidence interval (CI): 1.05-1.20] for HL, 1.05 (95% CI: 1.03-1.08) for NHL, 1.11 (95% CI: 1.05-1.16) for DLBCL, 1.06 (95% CI: 1.03-1.09) for ML, 1.09 (95% CI: 1.03-1.15) for leukaemia, 1.13 (95% CI: 1.04-1.24) for AML, 1.13 (95% CI: 1.05-1.22) for CML and 1.04 (95% CI: 1.00-1.09) for CLL, and were1.12 (95% CI: 1.05-1.19) for NHL, 1.22 (95% CI: 1.09-1.37) for DLBCL, and 1.19 (95% CI: 1.03-1.38) for FL for BMI in early adulthood analysis. Results on mortality showed a 15%, 16% and 17% increased risk of NHL, MM and leukaemia, respectively. Greater height increased the risk of NHL by 7%, DLBCL by 10%, FL by 9%, MM by 5% and Leukaemia by 7%. WHR was associated with increased risk of DLBCL by 12%. No association was found between higher WC and risk of MM. CONCLUSION: Our results revealed that general adiposity in adulthood and early adulthood, and greater height may increase the risk of almost all types of lympho-haematopoietic cancers and this adds to a growing body of evidence linking body fatness to several types of cancers.

The independent role of deprivation in abdominal obesity beyond income poverty. A population-based household survey in Chinese adults.

BACKGROUND: Individual-level deprivation takes into account the non-monetary aspects of poverty that neither income poverty nor socio-economic factors could fully capture; however, it has rarely been considered in existing studies on social inequality in obesity. Therefore, we examined the associations of deprivation, beyond income poverty, with both general and abdominal obesity. METHODS: A territory-wide two-stage stratified random sample of 2282 community-dwelling Hong Kong adults was surveyed via face-to-face household interviews between 2014 and 2015. Deprivation was assessed by a Deprivation Index specific to the Hong Kong population. General obesity was defined as body mass index (BMI) ≥ 25 kg/m2, while abdominal obesity was defined as waist circumference (WC) ≥ 90 cm/80 cm for male/female. Multivariable binary logistic regressions were performed. RESULTS: Deprivation was independently associated with abdominal obesity (odds ratios (OR) = 1.68; 95% confidence intervals (CI): 1.27-2.22); however, no significant association was found with general obesity (OR=1.03; CI: 0.77-1.38). After additional adjustment for BMI, deprivation remained strongly associated with abdominal obesity (OR=2.00; CI: 1.41-2.83); and after further adjustment for WC, deprivation had a marginal inverse association with general obesity (OR=0.72; CI: 0.51-1.01). CONCLUSIONS: Deprivation is an important risk factor of abdominal obesity and plays a critical role in capturing the preferential abdominal fat deposition beyond income poverty.

Urban-rural-specific trend in prevalence of general and central obesity, and association with hypertension in Chinese adults, aged 18-65 years.

BACKGROUND: China has the largest obese population in the world, and the prevalence of central obesity is increasing dramatically in China. Moreover, the rapid economic growth of China in recent decades has led to rapid urbanization in rural China. However, studies comparing the prevalence trends of different types of obesity and the association of obesity with hypertension between urban and rural areas in China are very scarce, and most studies have focused only on the difference in the prevalence of overweight and general obesity or hypertension among rural and urban populations. Therefore, the focus of this study was to examine the shifts in the overall distribution of the prevalence of different types of obesity and to estimate the risk of hypertension in different types of obesity among urban and rural adults aged 18-65 years. METHODS: Seven iterations of the China Health and Nutrition Survey (CHNS), conducted in 1993, 1997, 2000, 2004, 2006, 2009 and 2011, were used in this study. A total of 53,636 participants aged 18-65 years were included. Obesity was classified into three types based on body mass index (BMI) and waist circumference (WC). A log-binomial model was constructed to estimate the prevalence ratio (PR) of hypertension with three types of obesity. RESULTS: The age-standardized prevalence of central obesity only, general obesity only, and both central and general obesity increased from 15.8, 0.2 and 2.9% in 1993 to 30.3, 0.9 and 10.3% in 2011, respectively. The prevalence of central obesity only (urban vs. rural: 20.8% vs. 13.4% in 1993, 29.6% vs. 30.6% in 2011) and both central and general obesity (urban vs. rural: 3.5% vs. 2.5% in 1993, 10.0% vs. 10.6% in 2011) in rural adults exceeded that in urban adults in 2011. Participants with both central and general obesity had the highest risk for incident hypertension compared with those with normal body measurements (adjusted PR, urban: 2.30 (95% CI, 2.01-2.63), rural: 2.50 (95% CI, 2.25-2.77)). CONCLUSIONS: Both WC and BMI should be considered measures of obesity and targeted in hypertension prevention. More attention should be paid to the incidence of central obesity in adults in rural China.

The prevalence and increasing trends of overweight, general obesity, and abdominal obesity among Chinese adults: a repeated cross-sectional study.

BACKGROUND: The prevalence of general and abdominal obesity has increased rapidly in China. The aims of this study were to estimate the dynamic prevalence of overweight, general obesity, and abdominal obesity and the distribution of body mass index (BMI) and waist circumference (WC) among Chinese adults. METHODS: Data were obtained from the China Health and Nutrition Survey (CHNS). According to the suggestions of the WHO for Chinese populations, overweight was defined as a 23 kg/m2 ≤ BMI < 27.5 kg/m2 and general obesity as a BMI ≥ 27.5 kg/m2. Abdominal obesity was defined as a WC ≥ 90 cm for males and ≥ 80 cm for females. Grade 1, grade 2, and grade 3 obesity were defined as 27.5 kg/m2 ≤ BMI < 32.5 kg/m2, 32.5 kg/m2 ≤ BMI < 37.5 kg/m2, and BMI ≥ 37.5 kg/m2, respectively. Generalized estimation equations were used to estimate the prevalence and trends of overweight, general and abdominal obesity. RESULTS: This study included 12,543 participant. From 1989 to 2011, the median BMI of males and females increased by 2.65 kg/m2 and 1.90 kg/m2, respectively; and WC increased by 8.50 cm and 7.00 cm, respectively. In 2011, the age-adjusted prevalence of overweight, general obesity, and abdominal obesity were 38.80% (95% CI: 37.95-39.65%), 13.99% (95% CI: 13.38-14.59%), and 43.15% (95% CI: 42.28-44.01%), respectively, and significantly increased across all cycles of the survey among all subgroups (all P < 0.0001). The age-adjusted prevalence of grade 1-3 obesity significantly increased in total sample and sex subgroups (all P < 0.0001). For all indicators, there were significant increases in annual ORs among all subgroups (all P < 0.0001), with the exception of grade 2 obesity. Significant differences were observed in ORs across the three age groups in males. And ORs significantly decreased with age. CONCLUSIONS: The age-adjusted prevalence of overweight, general obesity, and abdominal obesity significantly increased among Chinese adults from 1989 to 2011. The obesity population is trending toward an increased proportion of males and younger individuals in China.