National trends in type 2 diabetes mellitus stratified by central adiposity using waist-to-height ratio in South Korea, 2005-2022.

Studies investigating the association between type 2 diabetes mellitus and central adiposity are lacking. Therefore, this study aimed to investigate trends in type 2 diabetes mellitus stratified by central adiposity using waist-to-height ratio (WHtR). Trends in type 2 diabetes mellitus were examined by central adiposity, using WHtR, with data from the Korea National Health and Nutrition Examination Survey (2005-2022). Individuals aged 30 years and over who participated in the survey were selected. Type 2 diabetes mellitus was identified based on serum glucose or HbA1c levels, the use of diabetes medications, or a prior diagnosis by a physician. Weighted ß-coefficients or odd ratios (ORs) with 95% confidence intervals (CIs) were calculated to assess changes in disease prevalence. A total of 79,368 participants were included in the database (female: 45,163 [56.9%]). from 2005 to 2022, the prevalence of type 2 diabetes mellitus increased from 3.3 to 5.8% in the healthy central adiposity group, from 11.2 to 17.1% in the increased central adiposity group, and from 18.0 to 26.7% in the high central adiposity group. Males, older population, lower education level, lower household income, and smoking are associated with a higher risk of type 2 diabetes. In the high central adiposity group, overweight and obese individuals had higher susceptibility than underweight or normal-weight individuals, with ORs of 5.85 (95% CI, 2.54-13.47) and 8.24 (3.79-17.94), respectively. The prevalence of type 2 diabetes mellitus has increased in all central adiposity groups in the past decade. This underscores the need for tailored interventions to address disparities and improve diabetes management in at-risk populations.

Association between Adiposity and Iron Status in Women of Reproductive Age: Data from the UK National Diet and Nutrition Survey (NDNS) 2008-2019.

BACKGROUND: Overweight/obesity and iron deficiency (ID) are highly prevalent in women of reproductive age (WRA), impacting on women's health. Obesity is a risk factor for nutritional deficiencies but its association with ID is unclear. OBJECTIVES: To determine the association between adiposity and markers of iron status and ID prevalence in WRA. METHODS: This cross-sectional study analyzed the National Diet and Nutrition Survey (2008-2019) data, focusing on women aged 18-49 y with body mass index (BMI) ≥18.5 kg/m2. Prevalence of anemia, iron deficiency anemia (IDA), and ID were analyzed. Ferritin was adjusted for C-reactive protein. Iron status was assessed across high and low BMI, waist circumference (WC), waist-to-height ratio (WHtR), and waist-to-hip ratio (WHR). χ2, linear and logistic regressions were performed adjusting for covariates. RESULTS: Among 1098 WRA, 496 normal weight and 602 overweight/obesity, prevalence rates were: anemia 9.2% and IDA 6.8%. Anemia was more prevalent in those with higher WHtR and WHR (11.9% compared with 5.9% and 16.7% compared with 6.5%, both P < 0.001). WRA with increased WC, WHtR, and WHR had higher IDA prevalence than those with lower adiposity (8.5% compared with 4.3%, P = 0.005; 9.4% compared with 3.3%, P < 0.001; 12.1% compared with 4.9%, P < 0.001). ID prevalence was 49.7% (ferritin cutoff 30 µg/L) and 19.6% (ferritin cutoff 15 µg/L), showing similar rates across adiposity groups. ID prevalence defined by soluble transferrin receptor (sTfR) was higher in women with increased WHR (P = 0.001). Higher WHR predicted ID categorized by sTfR (adjusted odds ratio [aOR]: 2.104, P = 0.004), and WHtR and WHR predicted anemia and IDA (anemia: WHtR aOR: 2.006, P = 0.036; WHR aOR: 4.489, P < 0.001 and IDA: WHtR aOR: 2.942, P = 0.012; WHR aOR: 4.142, P < 0.001). CONCLUSIONS: At least 1 in 5 WRA in the UK are iron deficient, highlighting the need to revise current policies. Greater central adiposity was strongly associated with impaired iron status and the development of anemia, IDA, and ID.

Waist-based anthropometric measures and central adiposity-related comorbidities in children.

BACKGROUND:  Waist-related measures are commonly used to classify central adiposity and related comorbidities. This classification may be essential among children, as it may identify the risk of future non-communicable diseases. METHODS:  A cross-sectional study was conducted in the Eastern Cape province, South Africa, among 459 primary school learners aged 9-14 years. Height, weight and waist circumference (WC) were measured using standardised techniques recommended by World Health Organization (WHO). The anthropometric measurements, including body mass index (BMI), WC, waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR) were computed and evaluated. RESULTS:  Most participants were girls (57.70%) with an average age of 11.20 ± 1.60 years. The average weight was 38.81 kg ± 10.49 kg with an average height of 144.16 (standard deviation [s.d.] = 10.37) cm. The sample had a BMI of 18.41 kg/m2 (s.d. = 3.19). The results showed, on average, WC of 62.10 cm ± 8.12 cm, WHR of 0.82 ± 0.15 and WHtR of 0.44 ± 0.05. Girls reported significantly higher BMI, WC and WHtR. Based on WHtR, the results showed the acceptable ability to classify children according to abdominal obesity, thus identifying their risk for comorbidities. CONCLUSION:  Overall body fat indicated by BMI and central obesity shown by waist-related anthropometric measures can play a significant role in classifying children in terms of their risk of comorbidities.Contribution: To prevent the risks of metabolic diseases in childhood, it is necessary to detect abdominal obesity early using WC-based anthropometric measurements, especially WHtR, to identify those at risk.

Adiposity and cardiac autonomic function in children with a family history of obesity.

PURPOSE: Data on associations between adiposity and heart rate variability (HRV) in prepubertal children are limited. We examined the associations between adiposity indices and HRV, independent of lifestyle behaviors, comparing multiple indicators of adiposity, and explored differences between boys and girls. METHODS: Data stem from 469 participants of the QUALITY cohort (630 children aged 8-10 years with a parental history of obesity). Adiposity indices included waist-to-height ratio, body mass index (BMI) percentiles and categories (overweight, obesity), dual-energy x-ray absorptiometry (DEXA) defined fat mass percentage and android/gynoid ratio. HRV indices in the frequency and the spectral domain were derived from a daytime 3-h Holter recording. Multivariable linear regression models were adjusted for age, sex, Tanner stage, physical activity, screen time, and fitness. Interactions between sex and adiposity were tested. RESULTS: Greater adiposity was associated with decreased parasympathetic modulation and increased sympathetic dominance. Waist-to-height ratio was associated with lower parasympathetic activity: root mean square of the successive differences (RMSSD) [B = -23.32, 95% confidence interval (CI) -42.42, -4.22], pNN50 (B = -16.93, 95% CI - 28.58, - 5.27), LF/HF ratio (B = 1.83, 95% CI 0.97-2.70). Patterns of association were similar for android/gynoid ratio. Overweight was not associated with altered HRV. Obesity was negatively associated with RMSSD and pNN50 and positively with LF/HF ratio. Greater fat mass percentage was associated with lower RMSSD, pNN50, and HF, and increased LF/HF ratio. There were no differences between boys and girls. CONCLUSIONS: Specific markers of adiposity relate to altered HRV in childhood, with waist-to-height ratio being potentially a more relevant marker of HRV than BMI and more pragmatic than percent body fat. TRIAL REGISTRATION: NCT03356262, 11 November 2017.

Centrally Distributed Adiposity as a Modifiable Risk Factor for Fecal Incontinence: United States Population-based Analysis.

BACKGROUND AND AIMS: Fecal incontinence (FI) is highly prevalent with substantial impacts on quality of life and health care utilization. The impact of obesity on FI remains unclear, with differing conclusions using body mass index (BMI) as a risk factor. We aimed to determine the association between obesity and FI, and whether this relationship is dependent on the distribution of adiposity (waist circumference-to-height ratio [WHtR]). METHODS: This was a population-based analysis of the National Health and Nutrition Examination Survey, including participants who responded to the bowel health survey in 2005 to 2010. FI was defined by the accidental bowel leakage of solid stool, liquid, or mucus at least once in the past month. Stepwise multivariable logistic regression models were constructed to assess risk factors for FI. RESULTS: A total of 7606 participants were included, with an overall FI prevalence of 9.2%. When stratified by quartiles of body measurements, FI was increasingly prevalent from the 1st to the 4th quartile for both WHtR (range, 5.3%-12.5%) and BMI (range, 7.1%-10.5%). WHtR was associated with FI and was a stronger predictor than BMI in all quartiles of body measurement. On multivariable analysis, WHtR remained a significant predictor of FI comparing the 4th with the 1st quartile of body measurements (odds ratio [OR], 1.77; 95% confidence interval [CI], 1.11-2.80; P = .017), whereas BMI was not. A WHtR cutoff of >0.592 optimized the Youden index in prediction of FI in the overall sample. CONCLUSION: WHtR was independently associated with increased odds of FI in this nationally representative sample of United States adults, whereas BMI was not consistently correlated. This suggests bowel continence may depend more on how body mass is distributed.

Ultrasound-based measurement of central adiposity: Key considerations and guidelines.

Central adiposity, which is visceral and subcutaneous adiposity in the abdominal region, is a known risk factor for developing chronic cardiometabolic diseases. Central adiposity can be measured relatively inexpensively using ultrasound. Ultrasound has been shown to be precise and reliable, with measurement accuracy comparable to computed tomography and magnetic resonance. Despite the advantages conferred by ultrasound, widespread adoption has been hindered by lack of reliable standard operating procedures. To consolidate the literature and bring clarity to the use of ultrasound-derived measures of central adiposity, this review outlines (i) the [patho]physiological importance of central adiposity to cardiometabolic disease risk; (ii) an overview of the history and main technical aspects of ultrasound methodology; (iii) key measurement considerations, including transducer selection, subject preparation, image acquisition, image analysis, and operator training; and (iv) guidelines for standardized ultrasound protocols for measuring central adiposity.

Glycoprotein Acetyls Associate With Intraglomerular Hemodynamic Dysfunction, Albuminuria, Central Adiposity, and Insulin Resistance in Youth With Type 1 Diabetes.

OBJECTIVES: Glycoprotein acetyls (GlycA's) are biomarkers of systemic inflammation and cardiovascular disease, yet little is known about their role in type 1 diabetes (T1D). In this study we examined the associations among GlycA's, central adiposity, insulin resistance, and early kidney injury in youth with T1D. METHODS: Glomerular filtration rate and renal plasma flow by iohexol and p-aminohippurate clearance, urine albumin-to-creatinine ratio (UACR), central adiposity by dual-energy x-ray absorptiometry, and estimated insulin sensitivity were assessed in 50 youth with T1D (16±3.0 years of age, 50% female, glycated hemoglobin 8.7%±1.3%, T1D duration 5.7±2.6 years). Concentrations of GlycA were quantified by targeted nuclear magnetic resonance spectroscopy. Correlation and multivariable linear regression analyses were performed. RESULTS: GlycA's were higher in girls vs boys (1.05±0.26 vs 0.84±0.15 mmol/L, p=0.001) and in participants living with overweight/obesity vs normal weight (1.12±0.23 vs 0.87±0.20 mmol/L, p=0.0004). GlycA's correlated positively with estimated intraglomerular pressure (r=0.52, p=0.001), UACR (r=0.53, p<0.0001), and trunk mass (r=0.45, p=0.001), and inversely with estimated insulin sensitivity (r=-0.36, p=0.01). All relationships remained significant after adjustment for age, sex, and glycated hemoglobin. CONCLUSIONS: As biomarkers of inflammation, GlycA's were higher in girls and those with overweight or obese body habitus in T1D. GlycA's associated with parameters of early kidney dysfunction, central adiposity, and insulin resistance.

Rest-Activity Rhythms Are Associated With Prevalent Cardiovascular Disease, Hypertension, Obesity, and Central Adiposity in a Nationally Representative Sample of US Adults.

BACKGROUND: Rest-activity rhythms (RARs), a measure of circadian rhythmicity in the free-living setting, are related to mortality risk, but evidence is limited on associations with cardiovascular disease (CVD) and its risk factors. METHODS AND RESULTS: Participants included 4521 adults from the 2013 to 2014 National Health and Nutrition Examination Survey physical activity monitoring examination. Wrist-worn ActiGraph GT3X+ data were used to estimate RARs. Multivariable logistic models evaluated associations of RARs with prevalent CVD, hypertension, obesity, and central adiposity. Participants (mean age, 49 years) in the highest versus lowest tertile of relative amplitude (greater circadian rhythmicity) had 39% to 62% lower odds of prevalent CVD, hypertension, obesity, and central adiposity. A more active wake period was associated with 19% to 72% lower CVD, hypertension, obesity, and central adiposity odds. Higher interdaily stability (regular sleep-wake and rest-activity patterns) was related to 52% and 23% lower CVD and obesity odds, respectively. In contrast, participants in the highest versus lowest tertile of intradaily variability (fragmented RAR and inefficient sleep) had >3-fold and 24% higher CVD and obesity odds, respectively. A later and less restful sleep period was associated with 36% to 2-fold higher CVD, hypertension, obesity, and central adiposity odds. A statistically significant linear trend was observed for all associations (P-trend<0.05). CONCLUSIONS: A robust, stable, and less fragmented RAR, an active wake period, and an earlier and more restful sleep period are associated with lower prevalent CVD, hypertension, obesity, and central adiposity, with evidence of a dose-response relationship. The magnitude, timing, and regularity of sleep-wake and rest-activity patterns may be important targets for reducing cardiovascular risk.

Prevalence of Polycystic Ovarian Syndrome and Its Link to Obesity in Adolescent Girls.

Polycystic ovarian syndrome (PCOS), also referred to as Stein-Leventhal syndrome, happens to be one of most common hormonal disorders found in females, causing large-sized ovaries with small cysts of non-ovulated oocytes in the outer medulla part of the ovary. Women suffering from PCOS often exhibit symptoms like oligomenorrhoea, elevated testosterone levels, acne, alopecia, hirsutism, sudden weight gain and many more. It can predispose a woman to developing infertility in future, and thus, difficulties in conceiving; due to the cystic changes in the ovaries, it results in anovulation and amenorrhea. The early symptoms of PCOS are being commonly observed nowadays in young women who are in their early 20s and those who are overweight or obese. The metabolic expression of PCOS increases with obesity. Obesity is a factor that is considered to contribute the most in the occurrence of various long-standing and non-transmissible illnesses apart from PCOS such as atherosclerosis, hypertension, diabetes, high blood cholesterol and even certain types of cancers. In obesity, there is an increase in the size and number of fat cells in the body. Obese and overweight young girls have a heightened likelihood of developing PCOS and its corresponding metabolic and reproductive health complications.

Cardiometabolic Risk Markers for Aboriginal and Torres Strait Islander Children and Youths: A Systematic Review of Data Quality and Population Prevalence.

Cardiovascular disease and type 2 diabetes mellitus are leading contributors to the health inequity experienced by Aboriginal and Torres Strait Islander peoples, and their antecedents can be identified from early childhood. We aimed to establish the quality of available data and the prevalence of cardiometabolic risk markers among Aboriginal and Torres Strait Islander children and youths (0-24-year-olds) to inform public health approaches. A systematic review of the peer-reviewed and grey literature was conducted between 1 January 2000-28 February 2021. Included studies reported population prevalence of cardiometabolic risks, including elevated blood pressure, obesity, central adiposity, dyslipidaemia, hyperglycaemia, and 'metabolic syndrome' for Aboriginal and Torres Strait Islander people aged 0-24 years. Fifteen studies provided population estimates. Data quality was limited by low response rates (10/15 studies) and suboptimal outcome measurements. Obesity is the most reported risk (13/15 studies). Aboriginal and Torres Strait Islander children have an excess risk of obesity from early childhood and prevalence increases with age: 32.1% of Aboriginal and Torres Strait Islander 18-24-year-olds had obesity and 50.8% had central adiposity. In a cohort of 486 9-14-year-olds in Darwin, 70% had ≥1 component of metabolic syndrome; 14% met the full criteria for the syndrome. The prevalence of cardiometabolic risk in Aboriginal and Torres Strait Islander young people is difficult to estimate due to limitations in measurement quality and sampling representativeness. Available data suggest that cardiometabolic risk markers are evident from early childhood. The establishment of national and state-level datasets and a core outcome set for cardiometabolic screening would provide opportunities for preventative action.

Central adiposity as a predictor of mortality in older adults: Identification of cutoffs using generalized additive models.

Background: Obesity is associated with premature mortality in adults; however, this association has been inconsistent in the older adult population. In addition, there is a lack of specific cutoff points for indicators of negative health outcomes in older adults. Methods: This is a prospective study with 796 non-institutionalized older adults. Data on sociodemographic characteristics, lifestyle, food consumption, and nutritional status were obtained at baseline. Generalized additive models were used to identify cutoff points for the waist circumference (WC) and waist-to-height ratio (WHtR) and Cox proportional hazards models to assess the independent association between adiposity and mortality. Results: Over the 9 years of follow-up, 197 deaths (24.7%) occurred, of which 51.8% were men, with a mean age of 76.1 ± 9.0 years. Older adults at higher risk of death had WHtR of <0.52 or ≥0.63 and WC of <83 cm or ≥101 cm. An increased risk of death was observed in older adults with high WC (HR: 2.03 95% CI: 1.20-3.41) and high WHtR (HR: 1.51 95% CI: 1.01-2.26) in the adjusted models, and an increase in WC was a risk factor for higher CVD mortality (HR: 2.09, 95% CI: 1.12-3.88) in the adjusted models. Conclusion: Adiposity was associated with an increased risk of death in older adults. In view of these results and considering the lack of cutoff points for anthropometric indices in Brazilian older adults, further studies are needed to confirm the WC and WHtR cutoff values found in this study.

Efficacy of Dietary Polyphenols from Whole Foods and Purified Food Polyphenol Extracts in Optimizing Cardiometabolic Health: A Meta-Analysis of Randomized Controlled Trials.

The evidence from clinical trials concerning the efficacy of dietary polyphenols on cardiometabolic health is divergent. Therefore, this review aimed to determine the pooled effect of dietary polyphenols on cardiometabolic risk markers and compare the difference in efficacy between whole polyphenol-rich foods and purified food polyphenol extracts. We conducted a random-effect model meta-analysis of randomized controlled trials (RCTs) on the effect of polyphenols on blood pressure, lipid profile, flow-mediated dilation (FMD), fasting blood glucose (FBG), waist circumference, and markers of inflammation. Effect size was expressed as weighted mean difference and 95% CI. RCTs published in English between 2000 and 2021 involving adult participants with cardiometabolic risks were searched in electronic databases. Forty-six RCTs involving 2494 participants with a mean age of 53.3 ±10 y were included in this review. Whole polyphenol-rich food but not purified food polyphenol extracts significantly reduced systolic blood pressure (SBP, -3.69 mmHg; 95% CI: -4.24, -3.15 mmHg; P = 0.00001) and diastolic blood pressure (DBP, -1.44 mmHg; 95% CI: -2.56, -0.31 mmHg; P = 0.0002). Concerning waist circumference, purified food polyphenol extracts led to a larger effect (-3.04 cm; 95% CI: -7.06, -0.98 cm; P = 0.14). Significant effects on total cholesterol (-9.03 mg/dL; 95% CI: -16.46, -1.06 mg/dL; P = 0.02) and TGs (-13.43 mg/dL; 95% CI: -23.63, -3.23; P = 0.01) were observed when purified food polyphenol extracts were considered separately. None of the intervention materials significantly affected LDL-cholesterol, HDL-cholesterol, FBG, IL-6, and CRP. When both whole food and extracts were pooled together, there was a significant reduction in SBP, DBP, FMD, TGs, and total cholesterol. These findings suggest that polyphenols both as whole food and purified extracts can be efficacious in reducing cardiometabolic risks. However, these results must be interpreted with caution because of high heterogeneity and risk of bias among RCTs. This study was registered on PROSPERO as CRD42021241807.

Diverse associations between adiposity and blood pressure among 80,000 multi-ethnic Chinese adults.

BACKGROUND: Adiposity is widely recognized as one of the risk factors for high blood pressure (BP) and increasing adiposity is associated with elevated BP. However, which measures of adiposity could be most strongly associated with BP in multi-ethnic population remains uncertain, giving rise to implications that population-based adiposity measures could be necessary. METHODS: 80,000 multi-ethnic adults recruited from 5 provinces across Southwest China during 2018 ~ 2019 were studied. Multiple linear regression was applied to investigate the associations of systolic blood pressure (SBP) with: (1) two measures of general adiposity, body mass index (BMI) and height-adjusted weight; and (2) three measures of central adiposity, waist circumference (WC), hip circumference (HC) and waist hip ratio (WHR). RESULTS: Two distinct population-specific patterns were identified, as "BMI to SBP" and "WC to SBP". 90% of the participants fall into "BMI to SBP" pattern, in which the associations of SBP with BMI were independent of WC, and SBP-WC associations were considerably decreased by adjustment for BMI. And in this pattern, 10 kg/m2 greater BMI was associated with 11.9 mm Hg higher SBP on average. As for the rest population (Han males in Yunnan and Tibetans in Lhasa), they are suited for "WC to SBP" pattern, 10 cm wider WC was associated with 3.4 mm Hg higher SBP. CONCLUSION: Our results indicated that when selecting proper predictors for BP, population-specific adiposity measures are needed, considering ethnicity, sex and residing regions. A better understanding of adiposity and BP may better contribute to the potential clinical practices and developing precision application strategies.

'At risk' waist-to-height ratio cut-off points recently adopted by NICE and US Department of Defense will unfairly penalize shorter adults. What is the solution?

OBJECTIVES: To a) demonstrate that adopting 'at risk' waist-to-height ratio (WHTR) cut-off points, recently approved by National Institute for Health and Care Excellence (NICE) and the United States Department of Defense (USDoD), will unfairly penalize shorter individuals and will be too lenient for taller individuals, b) to confirm that waist circumference (WC) of a sample of US service personnel, scales to approximately height0.5, supporting the notion that WC, to be independent of height (HT), should be normalized using WC.HT-0.5 (WHT•5R), and c) to identify the WHT•5R cut-off points that will reduce or eliminate this unwanted bias. SUBJECTS/METHODS: We employed a three independent cross-sectional sample design. All n = 58,742 participants underwent anthropometric assessment of body mass, stature and waist circumference. RESULTS: The allometric power-law model WC=a.HT^b for US service personnel identified the height exponent to be b= 0.418 (95 % CI 0.251-0.585), confirming that the simple body-shape index for WC to be independent of HT, should be WC.HT-0.5. Chi-square tests of independence and for linear trend confirmed that by adopting WHTR cut-off point, shorter individuals (both service personnel and non-service participants) will be over penalized (classified as being 'at risk'). New WC independent-of-height ratio cut-off points were found to resolve this problem. CONCLUSIONS: Adopting WHTR cut-off thresholds (either 0.5 or 0.55) will lead to shorter adults being unfairly classified as being 'at risk' in terms of their central adiposity and general health status. Adopting new WHT•5R cut-off point thresholds were found to greatly reduce or eliminate this bias.

Central obesity accelerates leukocyte telomere length (LTL) shortening in apparently healthy adults: A systematic review and meta-analysis.

Shorter telomere length is associated with numerous comorbidities; central obesity might trigger leukocyte telomere shortening; in the current meta-analysis we evaluated the association of central obesity with leukocyte telomere length among adults. A systematic search from Scopus, PubMed, Embase and Proquest electronic databases up to May 2021 was done. The final screening, provided five articles to be included in final meta-analysis. Those in the highest category of telomere length had 3.72 cm lower waist circumference (WC) compared with those in the lowest category (WMD=-3.718; CI=-7.180, -0.257 P = 0.035; I2 = 95.4%). Also, those in the highest LTL category had 0.02 lower waist to hip ratio (WHR) compared with those in the lowest category, although this association was not significant (WMD: -0.02; CI=-0.04, 0.01; P = 0.19; I2= 90.7%). In quality assessment of included studies, all of the studies had moderate or high quality score and there was no study with poor quality. Higher leukocyte telomere length was accompanied with lower WC among adults. This association was not significant for difference in WHR. Because of the high heterogeneity values and also because of the observational design of included studies, the inference of causality of these associations needs further investigations.Supplemental data for this article is available online at https://doi.org/10.1080/10408398.2021.1971155 .

Associations of maternal insulin sensitivity during pregnancy with childhood central adiposity in the Genetics of Glucose regulation in Gestation and Growth (Gen3G) cohort.

BACKGROUND: Childhood obesity has been associated with prenatal exposure to maternal hyperglycaemia, but we lack understanding about maternal insulin physiologic components that contribute to this association. OBJECTIVES: Evaluate the association between maternal insulin sensitivity during pregnancy and adiposity measures in childhood. METHODS: In 422 mother-child pairs, we tested associations between maternal insulin sensitivity measures at ~26 weeks of pregnancy and child adiposity measures, including dual-energy X-ray absorptiometry body composition and anthropometry (body mass index and waist circumference) at ~5 years. We used linear regression analyses to adjust for maternal age, ethnicity, gravidity, first-trimester body mass index, and child sex and age at mid-childhood. RESULTS: In early pregnancy, maternal mean age was 28.6 ± 4.3 years and median body mass index was 24.1 kg/m2 . Lower maternal insulin sensitivity indices were correlated with greater child adiposity based on anthropometry measures and on dual-energy X-ray absorptiometry total and trunk % fat in univariate associations (r = -0.122 to -0.159). Lower maternal insulin sensitivity was specifically associated with higher dual-energy X-ray absorptiometry trunk % fat (n = 359 for Matsuda; ß = -0.034 ± 0.013; p = 0.01) after adjustment for covariates, including maternal body mass index. CONCLUSIONS: Maternal insulin sensitivity during pregnancy may contribute to increased risk for higher offspring central adiposity in middle childhood.

Body mass index versus surrogate measures of central adiposity as independent predictors of mortality in type 2 diabetes.

BACKGROUND: An "obesity paradox" for mortality has been shown in chronic disorders such as diabetes, and attributed to methodological bias, including the use of body mass index (BMI) for obesity definition. This analysis investigated the independent association of BMI versus surrogate measures of central adiposity with all-cause mortality in individuals with type 2 diabetes. METHODS: The Renal Insufficiency And Cardiovascular Events Italian Multicentre Study is a prospective cohort study that enrolled 15,773 patients in 19 Italian centres in 2006-2008. Exposures were BMI and the surrogate measures of central adiposity waist circumference (WC), waist-to-height ratio (WHtR), and A Body Shape Index (ABSI). Vital status was retrieved on 31 October 2015 for 15,656 patients (99.3%), RESULTS: Age- and sex-adjusted hazard ratios and 95% confidence intervals were significantly higher in BMI-based underweight (1.729 [1.193-2.505), P = 0.004), moderately obese (1.214 [1.058-1.392), P = 0.006) and severely obese (1.703 [1.402-2.068), P < 0.0001), lower in overweight (0.842 [0.775-0.915), P < 0.0001) and similar in mildly obese (0.950 [0.864-1.045), P = 0.292), compared to normal-weight individuals. When further adjusting for smoking, physical activity (PA), and comorbidities, risk was lower also in mildly obese versus normal-weight patients. The BMI-mortality relationship did not change after sequentially excluding ever smokers, individuals with comorbidities, and those died within two years from enrollment and when analyzing separately participants below and above the median age. Conversely, a paradox relationship was observed among inactive/moderately inactive, but not moderately/highly active patients. Mortality risk adjusted for age, gender, smoking, PA and comorbidities was significantly higher in the highest tertile of WC (1.279 [1.089-1.501], P = 0.003), WHtR (1.372 [1.165-1.615], P < 0.0001), and ABSI (1.263 [1.067-1.495], P = 0.007) versus the lowest tertile. However, risk was lower in the intermediate versus lowest tertile for WC (0.823 [0.693-0.979], P = 0.028), similar for WHtR, and higher, though not significantly, for ABSI. CONCLUSIONS: An "overweight paradox" remained after controlling for age, smoking, and comorbidities, arguing against a collider bias or reverse causation. However, it could be partly explained by confounding from PA level, possibly through its impact on lean mass and cardiorespiratory fitness. No obesity paradox was observed with WHtR and especially ABSI, which predicted mortality risk associated with central adiposity better than WC. Trial registration ClinicalTrials.gov, NCT00715481, 15 July, 2008.

Body Weight, Central Adiposity, and Fasting Hyperglycemia Are Associated with Tumor Characteristics in a Brazilian Cohort of Women with Breast Cancer.

The aim of this study was to evaluate the association of overweight, obesity, excess central adiposity, hyperglycemia, and diabetes mellitus with tumor characteristics in breast cancer. In this retrospective cohort study that enrolled 2127 women with breast cancer, the independent variables collected were fasting blood glucose, body mass index, central adiposity (waist circumference and waist-to-hip circumference ratio (WHR)), and waist-to-height ratio. The tumor characteristics (infiltrating, ductal grade, hormone receptor-positive (HR+), human epidermal growth factor receptor, triple negative, size, lymph node involvement, and clinical stage) were the dependent variables. Most of the women were postmenopausal (73.5%), with an infiltrating tumor (83.0%), HR+ (82.0%), and overweight or obese (71.0%). For the premenopausal women, obesity was associated with grade 3 ductal tumor (odds ratio (OR): 1.70; 95% confidence interval (95% CI): 1.09-2.66), triple negative (OR: 1.37, 95% CI: 1.08-3.24), and size ≥ 2 cm (OR: 2.20, 95% CI: 1.36-3.56). For the postmenopausal women, obesity was associated with WHR, infiltrating tumor (OR: 1.73, 95% CI: 1.56-1.95), size ≥ 2 cm (OR: 1.38, 95% CI: 1.11-1.71), lymph node involvement (OR: 1.24, 95% CI: 1.02-1.56), and stages III-IV (OR: 1.76, 95% CI: 1.30-2.65). Excess body weight and central adiposity were associated with tumor aggressiveness characteristics in women with breast cancer, confirming the importance of nutritional status.

Genetically determined gut microbial abundance and 2-year changes in central adiposity and body composition: The POUNDS lost trial.

BACKGROUND AND AIM: Growing evidence has linked gut microbiota with regulation of adiposity. We aimed to examine whether the genetically determined relative abundance of gut microbial taxa was associated with long-term changes in adiposity and body composition among individuals who were overweight or obese in weight-loss diet interventions. METHODS: The study included 692 participants with overweight or obese from the POUNDS Lost trial. We created a genetic risk score (GRS) for the relevant abundance of gut microbial taxa using 20 single nucleotide polymorphisms identified from a recent genome-wide association study. Body composition was assessed using dual-energy X-ray absorptiometry. RESULTS: Higher GRS for the relative abundance of gut microbial taxa was significantly associated with greater reductions in waist circumference, total fat mass (FM), whole-body total percentage of fat mass (FM%), and percentage of trunk fat (TF%) at 2 years (p = 0.022, 0.034, 0.023, 0.023, respectively). In addition, dietary protein significantly modified the association between GRS for gut microbial abundance and changes in total FM, FM%, and TF% (p-interactions = 0.04, 0.013, and 0.006, respectively) at 6-month, when the maximum weight loss was achieved, even though such interactions were attenuated at 2 years. In the average-protein diet group, a higher microbial abundance GRS was associated with greater reductions in total FM (p = 0.007), FM% (p = 0.002), and TF% (p < 0.001) at 6 months, while no associations were found in the high-protein diet group (p > 0.05). CONCLUSION: Our results suggest that the higher genetically determined relative abundance of gut microbial taxa may be related to long-term improvement of whole-body and central fatness and body composition in response to low-calorie diet interventions.

Central adiposity increases the odds for plasma folate deficiency among Chinese women of reproductive age.

Objective: To explore the association between adiposity and plasma folate deficiency odds among women of reproductive age in China. Methods: A cross-sectional survey on nutritional status among women of reproductive aged 18-30 years in 2005-2006 in China was conducted. General adiposity was defined as body mass index (BMI) ≥24 kg/m2, and central adiposity was defined as waist circumference >80 cm. A plasma folate concentration <10.5 nmol/L (measured through microbiological assay) was defined as plasma folate deficiency. Odds ratios (ORs) and 95% confidence intervals (CIs) for plasma folate deficiency were calculated using a logistic regression model, with adjustment for potential confounders. Results: A total of 3,076 women of reproductive age were included in the final analysis. Compared to women with normal BMI and WC, women with both general and central adiposity had the highest odds for plasma folate deficiency (OR = 3.107, 95% CI: 1.819-5.307). Women with exclusively central adiposity had excess odds for plasma folate deficiency (WC > 80 cm, BMI <24 kg/m2; OR = 2.448, 95% CI: 1.144-5.241), which was higher than women with exclusively general adiposity (BMI ≥ 24 kg/m2, WC ≤ 80 cm; OR = 1.709, 95% CI: 1.259-2.319). The combined use of BMI and WC can detect more women (11.7%) at higher plasma folate deficiency odds than either used alone. Conclusions: Women with central adiposity in normal weight have higher odds for plasma folate deficiency than those with general obesity only. Early screening for central adiposity among women of reproductive age would be meaningful to prevent folate deficiency and improve life-cycle health.