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1.  Prediction of metabolic syndrome among postmenopausal Ghanaian women using obesity and atherogenic markers 
Metabolic syndrome (MetS) is an important health problem which puts individuals at risk for cardiovascular diseases and type 2 diabetes as well as obesity-related cancers such as colon and renal cell in men, and endometrial and oesophageal in women.
This study was aimed at examining how obesity indicators and related determinants influence metabolic syndrome, and how the factors can be used to predict the syndrome and its cut-offs in postmenopausal Ghanaian women.
Two hundred and fifty (250) Ghanaian subjects were involved in the study with one hundred and forty-three (143) being premenopausal women and one hundred and seven (107) postmenopausal women. The influence of traditional metabolic risk factors including high blood pressure, dyslipidemia and glucose intolerance on obesity and atherogenic indices i.e. body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), Waist-to-thigh ratio (WTR), waist-to-height ratio (WHtR), high density lipoprotein cholesterol to total cholesterol ratio (HDL-C/TC), high density lipoprotein cholesterol to low density lipoprotein ratio (HDL-C/LDL-C) and triglyceride to high density lipoprotein cholesterol ratio (TG/HDL-C) were identified according to the Harmonization (H_MS) criterion.
The predominant anthropometric marker that significantly influence metabolic risk factors among the pre- and postmenopausal women was waist-to-hip ratio (premenopausal: p- 0.004, 0.026 and 0.002 for systolic blood pressure (SBP), fasting blood glucose (FBG) and HDL-C; postmenopausal: p-0.012, 0.048, 0.007 and 0.0061 for diastolic blood pressure (DBP), FBG, triglyceride (TG) and high density lipoprotein cholesterol (HDL-C) respectively). Using the receiver operating characteristic (ROC) analysis, the area under the curve for WC, WHR, TG/HDL-C and HDL-C/TC among postmenopausal women were estimated at 0.6, 0.6, 0.8 and 0.8 respectively. The appropriate cut-off values for WC, WHR, TG/HDL-C and HDL-C/TC that predicted the presence of metabolic syndrome were 80.5 cm, 0.84, 0.61 and 0.34 respectively.
The presence of metabolic syndrome among Ghanaian postmenopausal women can be predicted using WC, WHR, TG/HDL-C and HDL-C/TC.
PMCID: PMC3479426  PMID: 22883105
Metabolic syndrome; Abdominal adiposity; Insulin resistance; Postmenopausal and premenopausal women
2.  Assessment of the Relationship between Lipid Parameters and Obesity Indices in Non-Diabetic Obese Patients: A Preliminary Report 
The aim of this cross-sectional study was to examine the relationship between obesity and lipid markers.
We divided 66 non-diabetic adult obese patients (mean age: 55.8±11.6 years) into 3 groups according to body mass index (BMI). All patients were measured for waist circumference (WC), hip circumference (HC), body mass index (BMI), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), body adiposity index (BAI), and visceral adiposity index (VAI). Serum levels of total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and triglycerides (TG) were determined, and lipid indices TC/HDL, LDL/HDL, and TG/HDL were also estimated.
TC and LDL-C in Group III were lower than in Group I (5.0±1.0 vs. 6.0±1.0 mmol/L, and 2.9±0.9 vs. 3.8±1.2 mmol/L; p<0.05 for both). Negative correlations were found between: BMI and TC, LDL, and HDL (r=−0.291; r=−0.310, r=−0.240, respectively); and WC, WHR, VAI, and HDL (r=−0.371, r=−0.296, r=−0.376, respectively). Positive correlations were found between WC, WHR, and TG/HDL (r=0.279, r=0.244, respectively) and between VAI and: TC (r=0.327), TG (r=0.885), TC/HDL (r=0.618), LDL/HDL (r=0.480), and TG/HDL (r=0.927).
Obesity is associated with lipid disturbances, especially with HDL-C reduction, in obese non-diabetic patients. VAI is strongly related to lipid profile and thus may be the most valuable obesity index in obese patients with dyslipidemias.
PMCID: PMC4271804  PMID: 25512170
Dyslipidemias; Obesity; Therapeutics
3.  Younger age of escalation of cardiovascular risk factors in Asian Indian subjects 
Cardiovascular risk factors start early, track through the young age and manifest in middle age in most societies. We conducted epidemiological studies to determine prevalence and age-specific trends in cardiovascular risk factors among adolescent and young urban Asian Indians.
Population based epidemiological studies to identify cardiovascular risk factors were performed in North India in 1999–2002. We evaluated major risk factors-smoking or tobacco use, obesity, truncal obesity, hypertension, dysglycemia and dyslipidemia using pre-specified definitions in 2051 subjects (male 1009, female 1042) aged 15–39 years of age. Age-stratified analyses were performed and significance of trends determined using regression analyses for numerical variables and Χ2 test for trend for categorical variables. Logistic regression was used to identify univariate and multivariate odds ratios (OR) for correlation of age and risk factors.
In males and females respectively, smoking or tobacco use was observed in 200 (11.8%) and 18 (1.4%), overweight or obesity (body mass index, BMI ≥ 25 kg/m2) in 12.4% and 14.3%, high waist-hip ratio, WHR (males > 0.9, females > 0.8) in 15% and 32.3%, hypertension in 5.6% and 3.1%, high LDL cholesterol (≥ 130 mg/dl) in 9.4% and 8.9%, low HDL cholesterol (<40 mg/dl males, <50 mg/dl females) in 16.2% and 49.7%, hypertriglyceridemia (≥ 150 mg/dl) in 9.7% and 6%, diabetes in 1.0% and 0.4% and the metabolic syndrome in 3.4% and 3.6%. Significantly increasing trends with age for indices of obesity (BMI, waist, WHR), glycemia (fasting glucose, metabolic syndrome) and lipids (cholesterol, LDL cholesterol, HDL cholesterol) were observed (p for trend < 0.01). At age 15–19 years the prevalence (%) of risk factors in males and females, respectively, was overweight/obesity in 7.6, 8.8; high WHR 4.9, 14.4; hypertension 2.3, 0.3; high LDL cholesterol 2.4, 3.2; high triglycerides 3.0, 3.2; low HDL cholesterol 8.0, 45.3; high total:HDL ratio 3.7, 4.7, diabetes 0.0 and metabolic syndrome in 0.0, 0.2 percent. At age groups 20–29 years in males and females, ORs were, for smoking 5.3, 1.0; obesity 1.6, 0.8; truncal obesity 4.5, 3.1; hypertension 2.6, 4.8; high LDL cholesterol 6.4, 1.8; high triglycerides 3.7, 0.9; low HDL cholesterol 2.4, 0.8; high total:HDL cholesterol 1.6, 1.0; diabetes 4.0, 1.0; and metabolic syndrome 37.7, 5.7 (p < 0.05 for some). At age 30–39, ORs were- smoking 16.0, 6.3; overweight 7.1, 11.3; truncal obesity 21.1, 17.2; hypertension 13.0, 64.0; high LDL cholesterol 27.4, 19.5; high triglycerides 24.2, 10.0; low HDL cholesterol 15.8, 14.1; high total:HDL cholesterol 37.9, 6.10; diabetes 50.7, 17.4; and metabolic syndrome 168.5, 146.2 (p < 0.01 for all parameters). Multivariate adjustment for BMI, waist size and WHR in men and women aged 30–39 years resulted in attenuation of ORs for hypertension and dyslipidemias.
Low prevalence of multiple cardiovascular risk factors (smoking, hypertension, dyslipidemias, diabetes and metabolic syndrome) in adolescents and rapid escalation of these risk factors by age of 30–39 years is noted in urban Asian Indians. Interventions should focus on these individuals.
PMCID: PMC2713196  PMID: 19575817
4.  A novel quantitative body shape score for detecting association between obesity and hypertension in China 
BMC Public Health  2015;15:7.
Obesity is a major independent risk factor for chronic diseases such as hypertension and coronary diseases, it might not be only related to the amount of body fat but its distribution. The single body mass index (BMI), waist circumference (WC), waist to hip ratio (WHR) or waist to stature ratio (WSR) provides limited information on fat distribution, and the debate about which one is the best remained. On the other hand, the current classification of body shape is qualitative rather than quantitative, and only crudely measure fat distribution. Therefore, a synthetical index is highly desirable to quantify body shape.
Based on the China Health and Nutrition Survey (CHNS) data, using Lohmäller PLSPM algorithm, six Partial Least Squares Path Models (PLSPMs) between the different obesity measurements and hypertension as well as two synthetical body shape scores (BSS1 by BMI/WC/Hip circumference, BSS2 by BMI/WC/WHR/WSR) were created. Simulation and real data analysis were conducted to assess their performance.
Statistical simulation showed the proposed model was stable and powerful. Totally 15,172 (6,939 male and 8,233 female) participants aged from 18 to 87 years old were included. It indicated that age, height, weight, WC, WHR, WSR, SBP, DBP, the prevalence of hypertension and obesity were significantly sex-different. BMI, WC, WHR, WSR, Hip, BSS1 and BSS2 between hypertension and normotensive group are significantly different (p < 0.05). PLSPM method illustrated the biggest path coefficients (95% confidence interval, CI) were 0.220(0.196, 0.244) for male and 0.205(0.182, 0.228) for female in model of BSS1. The area under receiver-operating characteristic curve (AUC(95% CI)) of BSS1(0.839(0.831,0.847)) was significantly larger than that of BSS2(0.834(0.825,0.842)) as well as the four single indices for female, and similar trend can be found for male.
BSS1 was an excellent measurement for quantifying body shape and detecting the association between body shape and hypertension.
PMCID: PMC4308906  PMID: 25595192
Chinese adults; China Health and Nutrition Survey; Anthropometric indices; Obesity; Hypertension; Body shape score
5.  Rural and urban differences in metabolic profiles in a Cameroonian population 
The difference between modern lifestyle in urban areas and the traditional way of life in rural areas may affect the population's health in developing countries proportionally. In this study, we sought to describe and compare the metabolic (fasting blood sugar and lipid profile) profile in an urban and rural sample of a Cameroonian population, and study the association to anthropometric risk factors of obesity.
332 urban and 120 rural men and women originating from the Sanaga Maritime Department and living in the Littoral Region in Cameroon voluntarily participated in this study. In all participants, measurement of height, weight, waist circumference, hip circumference, blood pressure systolic (SBP) and blood pressure diastolic (DBP), resting heart rate (RHR), blood glucose and lipids was carried out using standard methods. Total body fat (BF%) was measured using bio-impedancemetry. Body mass index (BMI) and waist to hip ratio (WHR) were calculated. Low Density Lipoprotein-cholesterol (LDL-c) concentrations were calculated using the Friedwald formula. World Health Organization criteria were used to define high and low levels of blood pressure, metabolic and anthropometric factors.
The highest blood pressure values were found in rural men. Concerning resting heart rate, only the youngest women's age group showed a significant difference between urban and rural areas (79 ± 14 bpm vs 88 ± 12 bpm, p = 0.04) respectively. As opposed to the general tendency in our population, blood glucose was higher in rural men and women compared to their urban counterparts in the older age group (6.00 ± 2.56 mmol/L vs 5.72 ± 2.72 mmol/L, p = 0.030; 5.77 ± 3.72 vs 5.08 ± 0.60, p = 0,887 respectively). Triglycerides (TG) were significantly higher in urban than rural men (1.23 ± 0.39 mmol/L vs 1.17 ± 0.64 mmol/L, p = 0.017). High Density Lipoprotein-cholesterol (HDL-c) levels were higher in rural compared to urban men (2.60 ± 0.10 35mmol/L vs 1.97 ± 1.14 mmol/L, p<0.001 respectively). However, total Cholesterol (TC) and LDL-c were significantly higher in urban than in rural men (p<0.001 and p = 0.005) and women (p<0.001 respectively. Diabetes’ rate in this population was 6.6%. This rate was higher in the rural (8.3%) than in the urban area (6.0%). Age and RHR were significantly higher in diabetic women than in non-diabetics (p = 0.007; p = 0.032 respectively). In a multiple regression, age was an independent predictor of SBP, DBP and RHR in the entire population. Age predicted blood glucose in rural women only. BMI, WC and BF% were independent predictors of RHR in rural population, especially in men. WC and BF% predicted DBP in rural men only. Anthropometric parameters did not predict the lipid profile.
Lipid profile was less atherogenic in rural than in urban area. The rural population was older than the urban one. Blood pressure and blood glucose were positively associated to age in men and women respectively; this could explain the higher prevalence of diabetes in rural than in urban area. The association of these metabolic variables to obesity indices is more frequent and important in urban than in rural area.
PMCID: PMC3282926  PMID: 22187583
Adults; anthropometry; lipid profile; blood glucose; blood pressure; diabetes; urban; rural; Cameroon
6.  The association between metabolic syndrome and vascular endothelial dysfunction in adolescents 
The aim of this study was to investigate the association between metabolic syndrome (MS) and vascular endothelial cell dysfunction (ECD) in adolescents. Sixty obese pediatric inpatients at the General Hospital of Tianjin Medical University from February 2011 to February 2012 were included. Among these, 30 patients were obese and 30 patients were diagnosed with MS. Thirty healthy subjects were randomly selected as the control group. A series of indices, including height, body weight, waist circumference, hip circumference, waist/hip circumference and body mass index (BMI), as well as total cholesterol (TC), triglyceride (TG), low-density lipoprotein (LDL) and high-density lipoprotein (HDL) levels were evaluated. von Willebrand factor (vWF) and plasminogen activator inhibitor-1 (PAI-1) levels were determined using an enzyme linked immunosorbent assay (ELISA). Correlation analysis between height, body weight, waist circumference, hip circumference, waist/hip circumference, BMI, TC, TG, LDL, HDL and PAI-1, as well as vWF was performed. Significant increases of vWF and PAI-1 levels were observed in the MS group compared with the control group (P<0.05). For the adolescents in the obese group, a significant increase of PAI-1 level was observed compared with the control group (P<0.05). No significant difference was observed between the vWF levels in the obese and control groups. PAI-1 was positively associated with BMI, waist circumference, waist/hip circumference, TC, TG, LDL, fasting plasma glucose (FPG), fasting insulin (FINS), systolic blood pressure (SBP) and diastolic blood pressure (DBP), respectively (P<0.05). In addition, PAI-1 was negatively associated with HDL levels (P<0.05). PAI-1 and vWF may be used as biomarkers for the diagnosis of ECD. ECD in individuals with MS may be associated with obesity, blood fat, blood sugar and blood pressure. FPG, TC and TG may be risk factors for ECD.
PMCID: PMC3702726  PMID: 23837050
metabolic syndrome; vascular endothelium functional lesion; von Willebrand factor; plasminogen activator inhibitor-1
7.  Anthropometric measures and lipid CHD risk factors in Korean Immigrants with Type 2 Diabetes 
The purpose of this study was to 1) describe anthropometric measures among Korean immigrants with type 2 diabetes (T2DM); and, 2) examine the relationships between measures of obesity with several forms of dyslipidemia in this group.
Obesity and dyslipidemia are commonly associated with T2DM and they are risk factors for coronary heart disease (CHD), the leading cause of death for people with diabetes. Asians are predisposed to abdominal obesity and experience significant CHD risk at lower BMI levels. Despite high prevalence of diabetes among Korean immigrants, relationships among anthropometric measures and lipid-related CHD risk factors have not been examined.
A convenience sample of 143 adult Korean immigrants with T2DM between the ages of 30–80 participated in the study. Body mass index (BMI), waist circumference (WC), and waist-to-hip ratio (WHR) were obtained using standardized procedures. Total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL), and high-density lipoprotein cholesterol (HDL) were assessed using a finger stick blood test. Hierarchical linear regressions were conducted to identify which of the anthropometric measures was significantly related to individuals’ cholesterol levels.
Central obesity measures, not BMI, were significantly associated with dyslipidemia in Korean immigrants with T2DM independent of potential confounds such as hemoglobin A1C, cigarette smoking, age, and cholesterol medication. Different central obesity measures were associated with different cholesterol types for Korean diabetic men and women. In men, WHR was positively associated with LDL and TC levels. In women, WC was negatively associated with HDL.
Central obesity measures (WC and WHR) are better indicators for assessing lipid-related CHD risk factor among Korean immigrants with T2DM than BMI. Gender difference in the association between central obesity measures and lipid types should be considered in CHD risk assessment of Korean immigrants with T2DM.
PMCID: PMC3137761  PMID: 21263345
type 2 diabetes; BMI; waist circumference; waist-hip ratio; lipids; Korean Americans
8.  Assessment of adiponectin level in obese and lean Nepalese population and its possible correlation with lipid profile: A cross-sectional study 
Adiponectin- one of the most important adipokines plays a pivotal role in carbohydrate and lipid metabolism and vascular biology. Changing food trend and lifestyle has tremendously affected the health status of Nepalese population. Studies have shown that between 1996 and 2006 obesity in Nepal has increased from 1.6% to 10%. Studies have been conducted in Nepal on the prevalence of obesity and its correlation with lipid profile. But based on our knowledge, this is the first study correlating adiponectin with obesity and lipid profile in Nepal. This piece of work will certainly help to assess the impact of obesity in Nepalese population.
Materials and Methods:
Fifty four obese and Thirty six normal/lean participants were included from different locations of Kathmandu Valley. Anthropometric measurements like age, BMI, Waist circumference, hip circumference, waist to hip ratio, mid thigh circumference and chest circumferences were taken from each participant. Blood glucose, lipid profile and serum adiponectin levels were measured from overnight fasting samples.
Significant differences were observed in BMI, Waist Circumference, Hip Circumference, Waist to Hip Ratio (WHR) and Chest circumference between obese and normal groups. Fasting Blood Glucose, Serum Triglyceride, HDL Cholesterol, LDL Cholesterol, Total Cholesterol/HDL ratio, Non-HDL Cholesterol and Adiponectin Levels were significant between the groups. Inverse correlations were observed between adiponectin level and BMI, Waist Circumference, Hip Circumference, Waist to Hip ratio, Chest Circumference, Fasting Blood Glucose, Triglyceride, Total Cholesterol/HDL ratio, LDL/HDL Cholesterol ratio and Non-HDL Cholesterol levels. Positive correlation was found between adiponectin and HDL Cholesterol levels.
Our study showed significant inverse association of serum adiponectin with obesity and lipid profile parameters except for Serum HDL Cholesterol level in Nepalese population.
PMCID: PMC3830357  PMID: 24251211
Adiponectin; lipid profile; obesity
9.  Association of lipid profile and waist circumference as cardiovascular risk factors for overweight and obesity among school children in Qatar 
Childhood obesity is a national as well as worldwide problem. The aim of this study was to evaluate the association of overweight and obesity among Qatari children with lipid profile and waist circumference as adverse cardiovascular risk factors in children aged 6–11 years. International Obesity Task Force reference values were used to screen for overweight and obesity.
A cross-sectional study in a randomly selected sample was conducted in 315 Qatari primary school students aged 6–11 years. Anthropometric measurements, including body weight, height, waist circumference, and body mass index were calculated for 151 girls and 164 boys. Weight categories were based on International Obesity Task Force reference values. Fasting blood glucose, total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and triglycerides were measured, and atherogenic index was calculated.
In total, 31.71% of boys and 32.78% of girls were overweight or obese. Overweight and obese children screened against International Obesity Task Force reference values had a significantly increased risk of high waist circumference (P < 0.0001), hypertriglyceridemia (P = 0.002), low HDL-C (P = 0.017), and atherogenic index (P = 0.021) compared with children who were not overweight or obese. The partial correlation coefficient for the cardiovascular risk marker of waist circumference indicated a positive significant association with total cholesterol (r = 0.465, P = 0.003), triglycerides (r = 0.563, P < 0.001), and LDL-C (r = 0.267, P = 0.003), and a significant negative association with HDL-C (r = −0.361, P = 0.004). Overweight and obesity significantly increase the odds ratios (ORs) and 95% confidence interval (CIs) of cardiovascular risk factors as follows: hypertriglyceridemia (OR 6.34, CI 2.49–13.44, P < 0.0001); LDL-C (OR 3.18, CI 1.04–9.75, P = 0.043); hypercholesterolemia (OR 1.88, CI 1.10–3.19, P = 0.020); and increased waist circumference (OR 1.40, CI 1.29–1.55, P = 0.022). Overweight and obesity significantly increased the risk of atherosclerosis (assessed by atherogenic index) by about two-fold (OR 1.83, 95% CI 1.06–3.15, P = 0.025).
Overweight and obese children screened by International Obesity Task Force reference values are at increased risk of cardiovascular disease in adulthood.
PMCID: PMC3532017  PMID: 23277742
cardiovascular risks; children; lipid profile; obesity; and waist circumference
10.  Glycolipid metabolic status of overweight/obese adolescents aged 9- to 15-year-old and the BMI-SDS/BMI cut-off value of predicting dyslipidemiain boys, Shanghai, China: a cross-sectional study 
The prevalence of adolescents’ obesity and overweight has dramatically elevated in China. Obese children were likely to insulin resistance and dyslipidemia, which are risk factors of cardiovascular diseases. However there was no cut-off point of anthropometric values to predict the risk factors in Chinese adolescents. The present study was to investigate glycolipid metabolism status of adolescents in Shanghai and to explore the correlations between body mass index standard deviation score (BMI-SDS) and metabolic indices, determine the best cut-off value of BMI-SDS to predict dyslipidemia.
Fifteen schools in Shanghai’s two districts were chosen by cluster sampling and primary screening was done in children aged 9-15 years old. After screening of bodyweight and height, overweight and obese adolescents and age-matched children with normal body weight were randomly recruited in the study. Anthropometric measurements, biochemical measurements of glycolipid profiles were done. SPSS19.0 was used to analyze the data. Receiver operating characteristic (ROC) curves were made and the best cut-off values of BMI-SDS to predict dyslipidemia were determined while the Youden indices were maximum.
Five hundred and thirty-eight adolescents were enrolled in this research, among which 283 have normal bodyweight, 115 were overweight and 140 were obese. No significant differences of the ages among 3 groups were found. There were significant differences of WC-SDS (p<0.001), triacylglycerol (p<0.05), high and low density lipoprotein cholesterol (p<0.01), fasting insulin (p<0.01) and C-peptide (p<0.001) among 3 groups. Significant difference of fasting glucose was only found between normal weight and overweight group. Significant difference of total cholesterol was found between obese and normal weight group. There was no significant difference of glycated hemoglobin among 3 groups. The same tendency was found in boys but not in girls. Only HDL-C reduced and TG increased while BMI elevated in girls. The best cut-off value of BMI-SDS was 1.22 to predict dyslipidemia in boys. The BMI cut-off was 21.67 in boys.
Overweight and obese youths had reduced insulin sensitivity and high prevalence of dyslipidemia.When BMI-SDS elevated up to 1.22 and BMI was higher than 21.67 in boys, dyslipidemia may happen.
PMCID: PMC3766195  PMID: 23984682
Adolescents; Children; Lipid metabolism; Obesity; Overweight; BMI-SDS; China
11.  Central obesity in Yemeni children: A population based cross-sectional study 
World Journal of Cardiology  2013;5(8):295-304.
AIM: To establish percentile curves and to explore prevalence and correlates of central obesity among Yemeni children in a population based cross-sectional study.
METHODS: A representative sample of 3114 Yemeni children (1564 boys, 1550 girls) aged 6-19 years participating in the HYpertension and Diabetes in Yemen study was studied. Data collection was conducted at home by survey teams composed of two investigators of both genders. Study questionnaire included questions about demographics, lifestyle, and medical history. Anthropometric measurements included body weight, height, waist circumference (WC) and hip circumferences. Waist to hip ratio (WHR) and waist-to-height ratio (WHtR) were then calculated. Age and gender specific smoothed percentiles of WC, WHR, and WHtR were obtained using lambda-mu-sigma parameters (LMS method). The independent predictors of central obesity defined as (1) WC percentile ≥ 90th; (2) WHtR ≥ 0.5; or (3) WC percentile ≥ 90th and WHtR ≥ 0.5, were identified at multivariate logistic regression analysis adjusted for age, gender, urban/rural location, years of school education, sedentary/active life-style.
RESULTS: Percentile curves for WC, WHR and WHtR are presented. Average WC increased with age for both genders. Boys had a higher WC than girls until early adolescence and thereafter girls had higher values than boys. WHR decreased both in boys and girls until early adolescence. Thereafter while in boys it plateaued in girls it continued to decrease. Mean WHtR decreased until early adolescence with no gender related differences and thereafter increased more in girls than in boys towards adult age. Prevalence of central obesity largely varied according to the definition used which was 10.9% for WC ≥ 90th percentile, 18.3% for WHtR ≥ 0.5, and 8.6% when fulfilling both criteria. At adjusted logistic regression WC ≥ 90th percentiles and WHtR ≥ 0.5 were less prevalent in rural than in urban areas (OR = 0.52, 95%CI: 0.41-0.67 and 0.66, 0.54-0.79 respectively), being more prevalent in children with sedentary lifestyle rather than an active one (1.52, 95%CI: 1.17-1.98 and 1.42, 95%CI: 1.14-1.75, respectively).
CONCLUSION: Yemeni children central obesity indices percentile curves are presented. Central obesity prevalence varied according to the definition used and was more prevalent in urban sedentary subjects.
PMCID: PMC3761183  PMID: 24009819
Central obesity; Waist circumference; Waist-to-height ratio; Waist to hip ratio; Developing countries
12.  Relationship of High Sensitivity C-Reactive Protein Levels to Anthropometric and other Metabolic Parameters in Indian Children with Simple Overweight and Obesity 
Context: High senstivity C-reactive protein (hsCRP) levels correlate well other parameters of obesity related metabolic syndrome (MS) and can be used as predictors of future cardiovascular disease risk. There is limited data on hsCRP levels in Indian children with simple obesity.
Aim: To study the relationship of hsCRP levels with various anthropometric as well as metabolic parameters in children with simple overweight and obesity.
Materials and Methods: This case control study was conducted in Paediatric Endocrinology clinic of a tertiary care hospital in Northern India. Levels of hsCRP were estimated in 100 overweight and obese children (BMI between 85th and 95th percentiles according to age & gender specific CDC 2000 growth charts) aged between 6 and 16 years and in 100 nearly age and sex matched healthy controls. These levels were then correlated to various anthropometric (body mass index, BMI; waist circumference, WC; hip circumference, HC; waist hip ratio, WHR; blood pressure) and biochemical (fasting blood glucose, FBG; total cholesterol, TC; high-density lipoprotein-cholesterol, HDL-C; low-density lipoprotein cholesterol, LDL-C; very low-density lipoprotein-cholesterol, VLDL-C; triglycerides, TG) parameters.
Results: Mean levels of hsCRP were significantly higher in the study group (3.92±2.20 versus 2.15±1.05 mg/L) as compared to controls. Significantly more (58% versus 10%) subjects in the study group had hsCRP (>3 mg/L). Of all the parameters studied, only BMI showed a positive correlation with hsCRP levels in the study group. Multiple logistic regression analysis for predicting outcome of high hsCRP showed positive correlation with BMI; with every 1 kg/m2 increase in BMI, odds of high hsCRP level were increased by 37% (OR=1.37; 95% CI 1.23-1.53, p-value <0.0001). Mean values of all the biochemical parameters except HDL-C were significantly higher in the study group.
Conclusion: Levels of hsCRP were significantly elevated in overweight and obese children as compared to non-obese children. In addition, these patients also showed abnormalities of lipid and glucose metabolism.
PMCID: PMC4190765  PMID: 25300641
Childhood obesity; Subclinical inflammation; Hscrp levels
13.  Association between adiposity indices and cardiometabolic risk factors among adults living in Puerto Rico 
Public health nutrition  2011;14(10):1714-1723.
To compare the general adiposity index (BMI) with abdominal obesity indices (waist circumference (WC), waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR)) in order to examine the best predictor of cardiometabolic risk factors among Hispanics living in Puerto Rico.
Secondary analysis of measurements taken from a representative sample of adults. Logistic regression models (prevalence odds ratios (POR)), partial Pearson’s correlations (controlling for age and sex) and receiver-operating characteristic (ROC) curves were calculated between indices of obesity (BMI, WC, WHR and WHtR) and blood pressure, HDL cholesterol (HDL-C), LDL cholesterol (LDL-C), total cholesterol (TC):HDL-C, TAG, fasting blood glucose, glycosylated Hb, high-sensitivity C-reactive protein (hs-CRP), fibrinogen, plasminogen activator inhibitor-1 (PAI-1) and an aggregated measure of cardiometabolic risk.
Household study conducted between 2005 and 2007 in the San Juan Metropolitan Area in Puerto Rico.
A representative sample of 858 non-institutionalized adults.
All four obesity indices significantly correlated with the cardiometabolic risk factors. WHtR had the highest POR for high TC:HDL-C, blood pressure, hs-CRP, fibrinogen and PAI-1; WC had the highest POR for low HDL-C and high LDL-C and fasting blood glucose; WHR had the highest POR for overall cardiometabolic risk, TAG and glycosylated Hb. BMI had the lowest POR for most risk factors and smallest ROC curve for overall cardiometabolic risk.
The findings of the study suggest that general adiposity and abdominal adiposity are both associated with cardiometabolic risk in this population, although WC, WHR and WHtR appear to be slightly better predictors than BMI.
PMCID: PMC3438511  PMID: 21729484
Waist circumference; Waist-to-hip ratio; BMI; Waist-to-height ratio; Cardiometabolic risk
14.  Waist circumference, waist-hip ratio and waist-height ratio percentiles and central obesity among Pakistani children aged five to twelve years 
BMC Pediatrics  2011;11:105.
Central obesity has been associated with the risk of cardiovascular and metabolic disease in children and anthropometric indices predictive of central obesity include waist circumference (WC), waist-hip ratio (WHR) and waist-height ratio (WHtR). South Asian children have higher body fat distribution in the trunk region but the literature regarding WC and related indices is scarce in this region. The study was aimed to provide age- and gender-specific WC, WHR and WHtR smoothed percentiles, and to explore prevalence and correlates of central obesity, among Pakistani children aged five to twelve years.
A population-based cross-sectional study was conducted with a representative multistage random cluster sample of 1860 primary school children aged five to twelve years in Lahore, Pakistan. Smoothed percentile curves were constructed for WC, WHR and WHtR by the LMS method. Central obesity was defined as having both age- and gender-specific WC percentile ≥90th and WHtR ≥0.5. Chi-square test was used as the test of trend. Multivariate logistic regression was used to quantify the independent predictors of central obesity and adjusted odds ratios (aOR) with 95% CI were obtained. Linear regression was used to explore the independent determinants of WC and WHtR. Statistical significance was considered at P < 0.05.
First ever age- and gender-specific smoothed WC, WHR and WHtR reference curves for Pakistani children aged five to twelve years are presented. WC increased with age among both boys and girls. Fiftieth WC percentile curves for Pakistani children were higher as compared to those for Hong Kong and British children, and were lower as compared to those for Iranian, German and Swiss children. WHR showed a plateau pattern among boys while plateau among girls until nine years of age and decreased afterwards. WHtR was age-independent among both boys and girls, and WHtR cut-off of ≥0.5 for defining central obesity corresponded to 85th WHtR percentile irrespective of age and gender. Twelve percent children (95% CI 10.1-13.0) had a WC ≥90th percentile and 16.5% children (95% CI 14.7-18.1) had a WHtR ≥0.5 while 11% children (95% CI 8.9-11.6) had both WC ≥90th percentile and WHtR ≥0.5. Significant predictors of central obesity included higher grade, urban area with high socioeconomic status (SES), high-income neighborhood and higher parental education. Children studying in higher grade (aOR 5.11, 95% CI 1.76-14.85) and those living in urban area with high SES (aOR 82.34, 95% CI 15.76-430.31) showed a significant independent association. Urban area with high SES and higher parental education showed a significant independent association with higher WC and higher WHtR while higher grade showed a significant independent association with higher WC.
Comprehensive worldwide reference values are needed to define central obesity and the present study is the first one to report anthropometric indices predictive of central obesity for Pakistani school-aged children. Eleven percent children were centrally obese and strong predictors included higher grade, urban area with high SES and higher parental education. These findings support the need for developing a National strategy for childhood obesity and implementing targeted interventions, prioritizing the higher social class and involving communities.
PMCID: PMC3239239  PMID: 22104025
15.  Lipid Profile In Relation To Anthropometric Indices and Insulin Resistance in Overweight Women with Polycystic Ovary Syndrome 
Health Promotion Perspectives  2013;3(2):206-216.
Background: The present study was aimed to investigate lipid profile in relation to anthropometric indices and insulin resistance in overweight or obese women with polycystic ovary syndrome (PCOS).
Methods: In this cross-sectional study, lipid profile and anthropometric indices including body mass index (BMI), waist and hip circumference, waist to hip ratio (WHR), and waist to height ratio (WHtR) were evaluated in 63 overweight or obese PCOS patients subdivided into insulin-resistant (IR) and non insulin-resistant (NIR) groups. IR was defined as homeostasis model of insulin resistance (HOMA-IR) ≥3.8.
Results: Fasting insulin concentration and HOMA-IR were higher (P<0.001) and high-density lipoprotein cholesterol (P=0.012) was lower in IR group. All of the anthropometric measures other than WHR and BMI showed significant correlations with several lipid parameters. Amongst, WHtR showed the strongest correlation with total cholesterol (TC) (r=0.37; P=0.004) and low density lipoprotein cholesterol (LDL-C) (r=0.33; P=0.011) in the whole PCOS patients.
Conclusion: Anthropometric characteristics (especially BMI and hip circum­ference) are more important parameters correlated to lipid profile than IR in overweight or obesePCOS patients, confirming the importance of early treat­ment of obesity to prevent dyslipidemia in the future.
PMCID: PMC3963667  PMID: 24688970
Lipid profile; Dyslipidemia; Insulin resistance; Obesity; Polycystic ovary syndrome
16.  Cardiovascular risk factor levels and their relationships with overweight and fat distribution in children: the Fleurbaix Laventie Ville Santé II study 
Metabolism  2007;56(5):614-622.
To document for the first time in a general population of French children, the prevalence and levels of cardiovascular risk factors, and to assess, separately in boys and girls, whether these risk factors were associated with fat mass distribution independently of subcutaneous overall adiposity.
Subjects and design
A cross sectional analysis of baseline data from 452 children (235 boys and 217 girls) aged 8–17 years included in 1999 in a population-based epidemiologic study, the Fleurbaix Laventie Ville Santé II (FLVS II) study.
Overweight was defined according to the International Obesity Task Force (IOTF) references and to the 90th percentiles of the French BMI curves. The thresholds of parameters defining cardiovascular and metabolic risk were the 95th percentile of the Task Force Report on High Blood Pressure in Children and Adolescents for blood pressure, and those of the American Academy of Pediatrics for lipids. Anthropometric and biologic parameters were described by gender and according to overweight. Partial correlations between cardiovascular risk factors and anthropometric measures of adiposity (BMI, sum of four skinfold thicknesses, waist circumference, waist-to-height ratio) were calculated. In a second step, these correlations were additionally adjusted for the sum of four skinfold thicknesses.
High plasma triglycerides, high insulin concentration and low plasma HDL cholesterol were associated with all measures of adiposity (|r|≥0.20; p<0.002). When obese children were excluded, overweight children already had high triglycerides and low HDL cholesterol levels respectively 2 and 20 times more frequently than normal weight children. Among overweight children, 7.7% had at least two risk factors among high blood pressure, high plasma triglycerides or glucose, and low HDL concentrations, versus 0.25% among normal weight children (p=0.002). After adjusting for the sum of skinfolds, an independent association between the risk factors and waist circumference was found in girls.
(a) Modest excess weight is associated with increased levels of cardiovascular risk factors. (b) In girls, abdominal fat distribution is associated with cardiovascular risk factors, independently of overall adiposity. (c) International definition of abdominal obesity in children is required to standardize studies and progress in the evaluation of childhood obesity and its consequences.
PMCID: PMC1988890  PMID: 17445535
Abdominal Fat; Adolescent; Anthropometry; Blood Glucose; metabolism; Blood Pressure; physiology; Cardiovascular Diseases; blood; epidemiology; Child; Cholesterol; blood; Cross-Sectional Studies; Female; France; epidemiology; Humans; Insulin; blood; Male; Obesity; blood; epidemiology; Prevalence; Risk Factors; Triglycerides; blood
17.  The relationships of body mass index, waist-to-height ratio, and body fat percentage with blood pressure and its hemodynamic determinants in Korean adolescents: a school-based study 
Korean Journal of Pediatrics  2013;56(12):526-533.
Obesity is an important risk factor for hypertension in adolescents. We investigated the relationship of obesity-related indices (body mass index [BMI], waist-to-height ratio [WHR], and body fat percentage [%BF]) with blood pressure and the hemodynamic determinants of blood pressure in Korean adolescents.
In 2008, 565 adolescents, aged 12-16 years, were examined. The %BF of the participants was measured by bioelectrical impedance analysis. Echocardiography and brachial artery pulse tracing were used to estimate the stroke volume (SV), cardiac output (CO), total vascular resistance (TVR), and total arterial compliance (TAC).
We noted that BMI, WHR, and %BF were positively correlated with systolic blood pressure (SBP) and diastolic blood pressure (DBP). The positive correlation between BMI and blood pressure (SBP and DBP) persisted after adjustment for WHR and %BF. However, after adjustment for BMI, the positive associations between blood pressure (SBP and DBP) and WHR as well as %BF, were not noted. With regard to the hemodynamic factors, BMI, but not WHR and %BF, was an independent positive factor correlated with SV and CO. TVR had an independent negative association with BMI; however, it was not associated with WHR or %BF. Moreover, we noted that BMI, WHR, and %BF did not affect TAC.
In Korean adolescents, BMI had an independent positive correlation with SBP and DBP, possibly because of its effects on SV, CO, and TVR. WHR and %BF are believed to indirectly affect SBP and DBP through changes in BMI.
PMCID: PMC3885788  PMID: 24416048
Adolescent; Obesity; Blood pressure; Body mass index
18.  Changes in serum lipid profile of obese or overweight children and adolescents following a lifestyle modification course 
ARYA Atherosclerosis  2012;8(3):143-148 .
Considering rapid global increase in children obesity and high prevalence of dyslipidemia in obese and overweight children, this study aimed to evaluate the effect of an educational course on changes of lipid profile in children.
This non-pharmacological clinical trial study was performed on 4-18 year-old children attending outpatient clinics of Isfahan Endocrine and Metabolism Research Center (Iran). Anthropometric measurements were conducted for all children. Fasting blood samples were taken from right hand of the participants at the first laboratory visit. Biochemical tests including measurement of total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) were also carried out. Children took part in one educational session in which they were taught about ways and benefits of having regular physical activity once a day and having healthy foods. All children were followed up for about four months and anthropometrics and biochemical tests were repeated. Data was analyzed using SPSS16.
A total number of 412 children (245 girls and 167 boys) were divided into four age groups of under 6, 6-9, 10-13, and 14-18 years old. Baseline anthropometric measures were significantly higher in boys. However, there was no difference between boys and girls in baseline lipid profile. Children's body mass index (BMI) z-score increased in all age groups except for 14-18 year-old boys. In boys older than 10 years, there were significant reductions in LDL-C and TC. In girls over 10 years of age, there was a significant increase in HDL-C. Although anthropometric measurements did not change in children (except for 14-18 year-old-boys), there was a significant reduction in children's lipid profile after the study.
Our study showed that although one session of interventional education had no significant effects on children's anthropometric measurements, it could change their lipid profile. Moreover, the intervention was more effective on improving lipid profile in children over 10 years of age. Therefore, effective interventional strategies must be invented and implemented on children based on their age group.
PMCID: PMC3557010  PMID: 23359278
Children Obesity; Education; Anthropometry; Lipid Profile; Lifestyle
19.  The Use of Stunkard’s Figure Rating Scale to Identify Underweight and Overweight in Chinese Adolescents 
PLoS ONE  2012;7(11):e50017.
To compare the performance of Stunkard’s current body size (CBS) with self-reported body mass index (BMI), waist circumference (WC) and waist to stature ratio (WSR) in predicting weight status in Chinese adolescents, and to determine the CBS cutoffs for overweight/obesity and underweight.
This cross-sectional study was conducted in a sample of 5,418 secondary school students (45.2% boys; mean age 14.7 years). Height and weight were measured by trained teachers or researchers. Subjects were classified as underweight, normal weight, or overweight/obese according to the International Obesity Task Force cutoffs. Subjects were asked to select the figure that best resembled their CBS on the Stunkard’s figure rating scale. Self-reported height, weight, WC and WSR were also obtained. The performance of CBS, self-reported BMI, WC and WSR as a weight status indicator was analysed by sex-specific receiver operating characteristic curves. The optimal CBS cutoffs for underweight and overweight/obesity were determined based on the Youden Index.
Principal Findings
Apart from self-reported BMI, CBS had the greatest area under curve (AUC) for underweight in boys (0.82) and girls (0.81). For overweight/obesity, CBS also had a greater AUC (0.85) than self-reported WC and WSR in boys, and an AUC (0.81) comparable to self-reported WC and WSR in girls. In general, CBS values of 3 and 5 appeared to be the optimal cutoffs for underweight and overweight/obesity, respectively, in different sex-age subgroups.
CBS is a potentially useful indicator to assess weight status of adolescents when measured and self-reported BMI are not available.
PMCID: PMC3506537  PMID: 23189177
20.  Variations in Aging, Gender, Menopause, and Obesity and Their Effects on Hypertension in Taiwan 
Aim. We assessed obesity, sex, menopause, and gender differences on hypertension in a Hakka-majority Taiwanese sample. Methods. 9621 subjects aged 20 and over participated in this community-based study. Trained nurses collected blood pressure (BP) measurements and anthropometric indices, including weight, height, hip circumference (HC), waist circumference (WC), body mass index (BMI), waist to height ratio (WHtR), and waist to hip ratio (WHR). Results. Levels of systolic and diastolic BP significantly increased at a dose-dependent relationship based on four anthropometric indices (BMI, WC, WHR, and WHtR); the slopes for SBP and DBP differed. After controlling for other covariates using multivariate logistic regression, we found the adjusted odds ratios (OR) of hypertension to be significantly related to the four anthropometric indices. Notably, the effect of obesity on the ORs for hypertension was considerably higher in premenopausal women, but we found no such phenomenon among men. BMI, WC, WHR, and WHtR had significant linear associations with BP. Conclusion. Obesity indices are significantly correlated with the risk of hypertension across gender and age, with BMI having the highest relative potency. The effect of obesity on the risk of hypertension is especially high in premenopausal women, implying a relationship between hormones and hypertension.
PMCID: PMC4243128  PMID: 25436143
21.  Is waist-to-height ratio a useful indicator of cardio-metabolic risk in 6-10-year-old children? 
BMC Pediatrics  2013;13:91.
Childhood obesity is a public health problem worldwide. Visceral obesity, particularly associated with cardio-metabolic risk, has been assessed by body mass index (BMI) and waist circumference, but both methods use sex-and age-specific percentile tables and are influenced by sexual maturity. Waist-to-height ratio (WHtR) is easier to obtain, does not involve tables and can be used to diagnose visceral obesity, even in normal-weight individuals. This study aims to compare the WHtR to the 2007 World Health Organization (WHO) reference for BMI in screening for the presence of cardio-metabolic and inflammatory risk factors in 6–10-year-old children.
A cross-sectional study was undertaken with 175 subjects selected from the Reference Center for the Treatment of Children and Adolescents in Campos, Rio de Janeiro, Brazil. The subjects were classified according to the 2007 WHO standard as normal-weight (BMI z score > −1 and < 1) or overweight/obese (BMI z score ≥ 1). Systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting glycemia, low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglyceride (TG), Homeostatic Model Assessment – Insulin Resistance (HOMA-IR), leukocyte count and ultrasensitive C-reactive protein (CRP) were also analyzed.
There were significant correlations between WHtR and BMI z score (r = 0.88, p < 0.0001), SBP (r = 0.51, p < 0.0001), DBP (r = 0.49, p < 0.0001), LDL (r = 0.25, p < 0.0008, HDL (r = −0.28, p < 0.0002), TG (r = 0.26, p < 0.0006), HOMA-IR (r = 0.83, p < 0.0001) and CRP (r = 0.51, p < 0.0001). WHtR and BMI areas under the curve were similar for all the cardio-metabolic parameters. A WHtR cut-off value of > 0.47 was sensitive for screening insulin resistance and any one of the cardio-metabolic parameters.
The WHtR was as sensitive as the 2007 WHO BMI in screening for metabolic risk factors in 6-10-year-old children. The public health message “keep your waist to less than half your height” can be effective in reducing cardio-metabolic risk because most of these risk factors are already present at a cut point of WHtR ≥ 0.5. However, as this is the first study to correlate the WHtR with inflammatory markers, we recommend further exploration of the use of WHtR in this age group and other population-based samples.
PMCID: PMC3686671  PMID: 23758779
Waist-to-height ratio; Obesity; Insulin resistance; Cardiovascular disease; Body mass index
22.  Prevalence of cardiovascular disease risk factors in people of Asian Indian origin: Age and sex variation 
No study has been undertaken on people of Asian Indian origin to investigate the age and sex variation in the prevalence of cardiovascular disease (CVD) risk factors.
To investigate the age and sex variation in the prevalence of CVD risk factors among the people of Asian Indian origin.
Materials and Methods:
A total of 682 (302 males and 380 females) participants aged 25–85 years took part in the study. The subjects were categorized into 4 groups, namely, Group I (25–34 years), Group II (35–44 years), Group III (45–54 years), and Group IV (55 years and above). Height, weight, and the circumferences of minimum waist (MWC) and maximum hip were collected using standard techniques. Waist–hip ratio (WHR) was then calculated. Percentage of body fat (%BF) and body mass index (BMI) were measured using an Omron body fat analyzer. Left arm systolic (SBP) and diastolic (DBP) blood pressure were taken from each participant with the help of an Omron MI digital electronic blood/pulse monitor. Metabolic profiles, namely, total cholesterol (TC), triglyceride (TG), high (HDL), low (LDL), very low-density lipoprotein (VLDL), and fasting blood glucose (FBG) were also measured using an autoanalyzer.
One-way analysis of variance revealed significant differences for age, BMI, MWC, WHR, SBP, DBP, TC, TG, LDL, VLDL, and TC:HDL and TG:HDL ratios across the groups. It was observed that there were significant sex-specific group differences (male [χ2 (12)] =29.22, P < 0.01 and female [χ2 (12)] =56.69, P < 0.001) for obesity, high BP, high TC, high TG, and high FBG. But no significant group-specific sex difference was evident for either of the risk factors, except for Group IV.
Age irrespective of sex modulates CVD risk factors and warranted prevention as early as middle age.
PMCID: PMC2945204  PMID: 20877691
Aging; Asian Indians; cardiovascular disease; metabolic syndrome; obesity
23.  Lipid Profile in Relation to Anthropometric Measurements among College Male Students in Riyadh, Saudi Arabia: A Cross-Sectional Study 
Anthropometric measurements can easily reflect any changes in the lipid concentration in the human body.
The present work is aimed at studying lipid profile and its relation to anthropometric measurements in college males from Riyadh, Saudi Arabia.
Subjects and methods:
This study was conducted from September 2006 to December 2008. 333 students aged 18-35 years of Riyadh College of Health Science - male section - participated in the study. Anthropometric measurements including weight, height, waist and hip circumferences were measured. Body Mass Index (BMI) was calculated. Fasting blood sugar and lipid profile including total cholesterol (TC), Low density lipoprotein cholesterol (LDL), high density lipoprotein cholesterol (HDL) and triglycerides (TG) were estimated. Socio-demographic data were collected from a questionnaire.
Mean TC level was 4.227 ± 0.869 mmol/l, while for LDL, HDL and TG were 2.57 ± 0.724, 1.360 ± 0.545 and 1.385 ± 0.731 mmol/l, respectively. Mean TC level did not differ significantly across weight groups except among obese patients. Mean HDL, LDL and TG did not differ significantly among different groups at 5% level of significance. There was positive, statistically non-significant correlation between age and BMI. The correlation between age and all lipid parameters were statistically non-significant. There was positive correlation between BMI and TC and LDL, while there was a negative correlation between BMI and HDL. There was no correlation between BMI and triglycerides.
BMI, waist and hip circumferences all increase with age. The level of TC, LDL and TG go high with increase in age and BMI.
PMCID: PMC3614826  PMID: 23675226
obesity; waist circumference; hip circumference; overweight; BMI; total cholesterol; HDL; LDL; TG; dyslipidemia
24.  Association of waist circumference, body mass index and conicity index with cardiovascular risk factors in postmenopausal women 
Cardiovascular Journal of Africa  2012;23(8):442-445.
In menopause, changes in body fat distribution lead to increasing risk of cardiovascular disease and metabolic disorders. The aim of this study was to assess the association of adiposity using the conicity index (CI), body mass index (BMI) and waist circumference (WC) with cardiovascular risk factors (hypertension, diabetes and dyslipidaemia). The sample of this cross-sectional study was collected from June to October 2010 and 165 consecutive menopausal women who had attended the Health and Treatment Centre and Endocrine Research Centre of Firoozgar Hospital in Tehran, Iran were assessed. Age, weight, height, WC, waist–hip ratio (WHR), CI and fat mass were measured. Systolic and diastolic blood pressure (SBP and DBP), fasting blood glucose, insulin, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and total cholesterol (TC) levels were also determined. All statistical analyses were performed by SPSS version 17 (SPSS Inc, Chicago, IL, USA).
Results showed that BMI was positively and significantly associated with SBP (r = 0.21; p = 0.009). WC was positively and significantly correlated with SBP (r = 0.26; p = 0.02) and DBP (r = 0.16; p = 0.05). WHR was also significantly and positively associated with SBP (r = 0.29; p = 0.001). Age and WC were associated with CI quartiles at the 0.05 significance level. The correlation of CI quartiles with SBP and weight were at the 0.01 significance level.
We showed a significant association of WC with SBP and DBP, and that BMI could be an important determining factor of SBP. For assessing the association between CI and cardiovascular risk factors, future studies with larger sample sizes are recommended.
PMCID: PMC3721927  PMID: 23044499
body mass index; cardiovascular risk factors; conicity index; waist circumference
25.  The association between obesity and blood pressure in Thai public school children 
BMC Public Health  2014;14:729.
The prevalence of obesity has substantially increased in the past 3 decades in both developed and developing countries and may lead to an increase in high blood pressure (BP) at an early age. This study aimed to determine the prevalence of obesity and its association with blood pressure among primary school children in central Thailand.
A cross-sectional study was conducted in two public schools in Bangkok in 2012. A total of 693 students (317 boys and 376 girls) aged 8–12 years participated voluntarily. Anthropometric measurements of weight, height, waist circumference (WC) and BP were collected. Fasting venous blood samples were obtained for biochemical analysis of fasting plasma glucose (FPG) and lipid parameters. Child nutritional status was defined by body mass index (BMI) for age based on the 2000 Center for Diseases Control and Prevention growth charts. The cutoff for abdominal obesity was WC at the 75 percentile or greater. Hypertension was defined according to the 2004 Pediatrics US blood pressure reference. Multinomial logistic regression was used to examine the relationship between high BP and obesity after controlling for other covariates.
The prevalence of obese children was 30.6% for boys and 12.8% for girls (mean prevalence 20.9%). Pre-hypertension (Pre-HT) was 5.7% and 2.7% for boys and girls and hypertension (HT) was 4.7% for boys and 3.2% for girls, respectively. Children with pre-HT and HT had significantly higher body weight, height, WC, BMI, SBP, DBP, TG, and TC/HDL-C levels but lower HDL-C levels than those children with normotension. After controlling for age, sex, glucose and lipid parameters, child obesity was significantly associated with pre-HT and HT (odds rations (ORs) = 9.00, 95% CI: 3.20-25.31 for pre-HT and ORs = 10.60, 95% CI: 3.75-30.00 for HT). So also was WC (abdominal obesity) when considered alone (ORs = 6.20, 95% CI: 2.60-14.81 for pre-HT and ORs = 13.73, 95% CI: 4.85-38.83 for HT) (p-value < 0.001).
Obesity among school children was positively associated with higher BP. Prevention of childhood obesity should be strengthened to prevent the risk of early high BP including cardiovascular risk factors.
PMCID: PMC4223408  PMID: 25034700
Child obesity; High blood pressure; School children; Waist circumference

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