METHODS: In a sample of 9448 participants followed for a mean of 15.3 years (186,158.5 person-years) from the Monitoring of Trends and Determinants in Cardiovascular Disease Augsburg/Cooperative Health Research in the Region of Augsburg population-based cohort conducted in Germany, we investigated the association of social connectivity, measured by the Social Network Index, and body mass index (BMI) with the risk of clinically validated T2D incidence using stratified Cox proportional hazards regression models adjusted for sociodemographic, life-style, cardiometabolic, and psychosocial risk factors.
RESULTS: During a mean follow-up of 14.1 years (186,158.5 person-years), 975 (10.3%) participants developed T2D. Participants with low social connectivity developed T2D at a higher rate than socially connected participants (10.0 versus 8.0 cases/10,000 person-years); however, BMI played a significant role in the association of social connectivity with T2D ( p < .001). In comparison to their socially connected counterparts, low social connectivity was associated with a higher rate of T2D incidence in normal-weight (6.0 versus 2.0 cases/10,000 person-years), but not overweight (13.0 versus 13.0 cases/10,000 person-years) or obese participants (32.0 versus 30.0 cases/10,000 person-years). Correspondingly, Cox regression analysis showed that 5-unit increments in BMI increased the risk of T2D in socially connected participants (hazard ratio = 3.03, 95% confidence interval = 2.48-3.79, p < .001) at a substantially higher rate than in low socially connected participants (hazard ratio = 1.77, 95% confidence interval = 1.45-2.16, p < .001).
CONCLUSION: The detrimental link between low social connectivity and increased risk of T2D is substantially stronger in participants with a lower BMI.
METHODS: This is an analysis of prospectively collected data on potential donors for an adult LDLT programme, between January 2017 and December 2019.
RESULTS: Fifty-five donors for 33 potential recipients were evaluated. The mean age was 31.6 ± 8.5 years, 52.7% were female and the ethnic divisions were: Chinese (50.9%), Indian (25.5%) and Malay (23.6%). The mean body mass index (BMI) among potential donors was 25.1 ± 4.0 kg/m2; 25.5% of donors had normal BMI, 23.6% were overweight and 50.9% were obese. Using the CAP modality of Fibroscan®, we identified the following grades of hepatic steatosis: 36.6% S0, 19.5% S1, 2.4% S2 and 41.5% S3. The non-utilization rate of our donors was 74.5% (41/55) and the main reasons were significant hepatic steatosis and/or obesity. Compared to suitable donors, unsuitable donors had significantly greater mean BMI, mean CAP scores, higher rates of dyslipidaemia and NAFLD.
CONCLUSION: NAFLD and obesity represent major challenges to an emerging LDLT programme in Malaysia.
OBJECTIVES: To examine: (i) the relationships between sleep characteristics, including social jetlag, and obesity-related outcomes during childhood, and (ii) whether these relationships are moderated by sex.
METHODS: This cross-sectional study included 381 children aged 9-11 years (49.6% female). Average sleep duration, social jetlag, and physical activity were assessed via wrist-worn accelerometry. Sleep disturbances were quantified from the Children's Sleep Habits Questionnaire. Obesity-related outcomes included age-specific body mass index Z-scores (zBMI) and waist-to-height ratio. Additionally % fat, total fat mass, and fat mass index were assessed via bioelectrical impedance analysis. Linear mixed models that nested children within schools were used to identify relationships among sleep characteristics and obesity-related outcomes.
RESULTS: Positive associations between social jetlag with zBMI, % fat, and fat mass index were seen in univariable and unadjusted multivariable analyses. Following adjustments for known confounders, social jetlag remained significantly associated with zBMI (β = 0.12, p = 0.013). Simple slopes suggested a positive association in girls (β = 0.19, p = 0.006) but not in boys (β = 0.03, p = 0.703).
CONCLUSIONS: Obesity prevention efforts, particularly in girls, may benefit from targeted approaches to improving the consistency of sleep timing in youth.
Objective: To assess whether sleep timing and napping behavior are associated with increased obesity, independent of nocturnal sleep length.
Design, Setting, and Participants: This large, multinational, population-based cross-sectional study used data of participants from 60 study centers in 26 countries with varying income levels as part of the Prospective Urban Rural Epidemiology study. Participants were aged 35 to 70 years and were mainly recruited during 2005 and 2009. Data analysis occurred from October 2020 through March 2021.
Exposures: Sleep timing (ie, bedtime and wake-up time), nocturnal sleep duration, daytime napping.
Main Outcomes and Measures: The primary outcomes were prevalence of obesity, specified as general obesity, defined as body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) of 30 or greater, and abdominal obesity, defined as waist circumference greater than 102 cm for men or greater than 88 cm for women. Multilevel logistic regression models with random effects for study centers were performed to calculate adjusted odds ratios (AORs) and 95% CIs.
Results: Overall, 136 652 participants (81 652 [59.8%] women; mean [SD] age, 51.0 [9.8] years) were included in analysis. A total of 27 195 participants (19.9%) had general obesity, and 37 024 participants (27.1%) had abdominal obesity. The mean (SD) nocturnal sleep duration was 7.8 (1.4) hours, and the median (interquartile range) midsleep time was 2:15 am (1:30 am-3:00 am). A total of 19 660 participants (14.4%) had late bedtime behavior (ie, midnight or later). Compared with bedtime between 8 pm and 10 pm, late bedtime was associated with general obesity (AOR, 1.20; 95% CI, 1.12-1.29) and abdominal obesity (AOR, 1.20; 95% CI, 1.12-1.28), particularly among participants who went to bed between 2 am and 6 am (general obesity: AOR, 1.35; 95% CI, 1.18-1.54; abdominal obesity: AOR, 1.38; 95% CI, 1.21-1.58). Short nocturnal sleep of less than 6 hours was associated with general obesity (eg, <5 hours: AOR, 1.27; 95% CI, 1.13-1.43), but longer napping was associated with higher abdominal obesity prevalence (eg, ≥1 hours: AOR, 1.39; 95% CI, 1.31-1.47). Neither going to bed during the day (ie, before 8pm) nor wake-up time was associated with obesity.
Conclusions and Relevance: This cross-sectional study found that late nocturnal bedtime and short nocturnal sleep were associated with increased risk of obesity prevalence, while longer daytime napping did not reduce the risk but was associated with higher risk of abdominal obesity. Strategic weight control programs should also encourage earlier bedtime and avoid short nocturnal sleep to mitigate obesity epidemic.
METHODS: The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2021 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population, an enhanced focus on social determinants of health, adverse pregnancy outcomes, vascular contributions to brain health, the global burden of cardiovascular disease, and further evidence-based approaches to changing behaviors related to cardiovascular disease.
RESULTS: Each of the 27 chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics.
CONCLUSIONS: The Statistical Update represents a critical resource for the lay public, policy makers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
Methods: a cross-sectional study was conducted, using the Kedah audit samples data extracted from the National Diabetes Registry (NDR) from the year 2014 to 2018. A total of 25,062 registered type 2 diabetes mellitus patients were selected using the inclusion and exclusion criteria from the registry. Only patients with complete data on their HbA1C, lipid profile, waist circumference and BMI were analysed using SPSS version 21.
Results: the means for the age, BMI and waist circumference of the samples were 61.5 (±10.85) years, 27.3 (±5.05) kg/m2 and 89.46 (±13.58) cm, respectively. Poor glycaemic control (HbA1c>6.5%) was observed in 72.7% of the patients, with females having poorer glycaemic control. The BMI and waist circumference were found to be significantly associated with glycaemic control (P<0.001). The total cholesterol, triglycerides and low-density lipoproteins values showed positive correlation with glycaemic control (r = 0.178, 0.157, 0.145, p<0.001), while high-density lipoproteins values are negatively correlated (r = -0.019, p<0.001).
Conclusion: implementing lifestyle changes such as physical activity and dietary modifications are important in the management of BMI, waist circumference and body lipids, which in turn results in improved glycaemic control.
DESIGN: GWG trajectories were identified using the latent class growth model. Binary logistic regression was performed to examine the associations between adverse pregnancy outcomes and these trajectories.
SETTING: Negeri Sembilan, Malaysia.
PARTICIPANTS: Two thousand one hundred ninety-three pregnant women.
RESULTS: Three GWG trajectories were identified: 'Group 1 - slow initial GWG but followed by drastic GWG', 'Group 2 - maintaining rate of GWG at 0·58 kg/week' and 'Group 3 - maintaining rate of GWG at 0·38 kg/week'. Group 1 had higher risk of postpartum weight retention (PWR) (adjusted OR (AOR) 1·02, 95 % CI 1·01, 1·04), caesarean delivery (AOR 1·03, 95 % CI 1·01, 1·04) and having low birth weight (AOR 1·04, 95 % CI 1·02, 1·05) compared with group 3. Group 2 was at higher risk of PWR (AOR 1·18, 95 % CI 1·16, 1·21), preterm delivery (AOR 1·03, 95 % CI 1·01, 1·05) and caesarean delivery (AOR 1·02, 95 % CI 1·01, 1·03), but at lower risk of having small-for-gestational-age infants (AOR 0·97, 95 % CI 0·96, 0·99) compared with group 3. The significant associations between group 1 and PWR were observed among non-overweight/obese women; between group 1 and caesarean delivery among overweight/obese women; group 2 with preterm delivery and caesarean delivery were only found among overweight/obese women.
CONCLUSIONS: Higher GWG as well as increasing GWG trajectories was associated with higher risk of adverse pregnancy outcomes. Promoting GWG within the recommended range should be emphasised in antenatal care to prevent the risk of adverse pregnancy outcomes.
METHODS: A case-control study was conducted involving 600 people with type 2 diabetes (300 chronic kidney disease cases, 300 controls) who participated in The Malaysian Cohort project. Retrospective subanalysis was performed on the chronic kidney disease cases to assess chronic kidney disease progression from the recruitment phase. We genotyped 32 single nucleotide polymorphisms using mass spectrometry. The probability of chronic kidney disease and predicted rate of newly detected chronic kidney disease progression were estimated from the significant gene-environment interaction analyses.
RESULTS: Four single nucleotide polymorphisms (eNOS rs2070744, PPARGC1A rs8192678, KCNQ1 rs2237895 and KCNQ1 rs2283228) and five environmental factors (age, sex, smoking, waist circumference and HDL) were significantly associated with chronic kidney disease. Gene-environment interaction analyses revealed significant probabilities of chronic kidney disease for sex (PPARGC1A rs8192678), smoking (eNOS rs2070744, PPARGC1A rs8192678 and KCNQ1 rs2237895), waist circumference (eNOS rs2070744, PPARGC1A rs8192678, KCNQ1 rs2237895 and KCNQ1 rs2283228) and HDL (eNOS rs2070744 and PPARGC1A rs8192678). Subanalysis indicated that the rate of newly detected chronic kidney disease progression was 133 cases per 1000 person-years (95% CI: 115, 153), with a mean follow-up period of 4.78 (SD 0.73) years. There was a significant predicted rate of newly detected chronic kidney disease progression in gene-environment interactions between KCNQ1 rs2283228 and two environmental factors (sex and BMI).
CONCLUSIONS: Our findings suggest that the gene-environment interactions of eNOS rs2070744, PPARGC1A rs8192678, KCNQ1 rs2237895 and KCNQ1 rs2283228 with specific environmental factors could modify the probability for chronic kidney disease.
MATERIALS AND METHODS: This cross-sectional study comprised 2,000 schoolchildren aged 6-12 years. Sleep-disordered breathing symptoms were assessed with Arabic version of Pediatric Sleep Questionnaire (PSQ). Overweight/obesity was evaluated using body mass index (BMI) and their association with SDB was tested using a regression analysis model.
RESULTS: Overall, 23% of children were at high risk of SDB. Prevalence of habitual snoring was 15.9% and sleep apnea 4%. Boys were at higher risk of SDB than girls (p = 0.026), while age had no effect (p = 0.254). High-risk SDB had a strong association with sleep symptoms compared to low-risk SDB (p < 0.05). Sleep-disordered breathing increased significantly in overweight and obese children (p = 0.017 and p < 0.001, respectively).
CONCLUSION: Around 23% Saudi schoolchildren are at risk of SDB. Related symptoms were strongly associated with high risk of SDB. Overweight and obesity had a strong and progressive association with SDB.
CLINICAL SIGNIFICANCE: The results will help in identifying children at high risk of developing SDB and plan for early intervention to avoid the progression of SDB later in life.
DESIGN: Analysis of cross-sectional data collected from participants in a prospective cohort study.
SETTING: The Victorian rural towns of Morwell and Sale in 2018-2019.
PARTICIPANTS: A weighted random sample of 1119 eligible participants from Morwell or Sale, aged ≥55-90 years for men and ≥60-90 years for women, was drawn from the Hazelwood Health Study's Adult Survey cohort.
MAIN OUTCOME MEASURES: Blood pressure, body mass index, left ventricular hypertrophy by electrocardiogram, estimated glomerular filtration rate and glycosylated haemoglobin (HbA1c ) were measured. Participants with hypertension were categorised as managed, undermanaged or unmanaged.
RESULTS: Testing undertaken of 498 participants estimated the weighted prevalence of hypertension (defined as blood pressure ≥ 140/90 mm Hg, a self-reported doctor diagnosis of hypertension or taking antihypertensive medication) to be 79.9% (95% confidence interval: 75.7-83.4). Of those, 54.5% (49.4-60.0) had managed hypertension (<140/90 mm Hg), 37.1% (32.3-42.1) undermanaged hypertension and 8.4% (5.9-11.9) a new finding of hypertension (unmanaged hypertension). Current employment (relative risk 1.47, 95% confidence interval: 1.06-2.02) and single marital status (relative risk 1.45, 1.4-1.84) were associated with under- or unmanaged hypertension. Compared with no hypertension, the hypertensive groups were more likely to demonstrate markers of end-organ damage such as left ventricular hypertrophy and impaired renal function.
CONCLUSION: Hypertension is a highly prevalent condition among older rural Australians which is suboptimally identified and managed.
OBJECTIVE: To develop international WC percentile cutoffs for children and adolescents with normal weight based on data from 8 countries in different global regions and to examine the relation with cardiovascular risk.
DESIGN AND SETTING: We used pooled data on WC in 113,453 children and adolescents (males 50.2%) aged 4 to 20 years from 8 countries in different regions (Bulgaria, China, Iran, Korea, Malaysia, Poland, Seychelles, and Switzerland). We calculated WC percentile cutoffs in samples including or excluding children with obesity, overweight, or underweight. WC percentiles were generated using the general additive model for location, scale, and shape (GAMLSS). We also estimated the predictive power of the WC 90th percentile cutoffs to predict cardiovascular risk using receiver operator characteristics curve analysis based on data from 3 countries that had available data (China, Iran, and Korea). We also examined which WC percentiles linked with WC cutoffs for central obesity in adults (at age of 18 years).
MAIN OUTCOME MEASURE: WC measured based on recommendation by the World Health Organization.
RESULTS: We validated the performance of the age- and sex-specific 90th percentile WC cutoffs calculated in children and adolescents (6-18 years of age) with normal weight (excluding youth with obesity, overweight, or underweight) by linking the percentile with cardiovascular risk (area under the curve [AUC]: 0.69 for boys; 0.63 for girls). In addition, WC percentile among normal weight children linked relatively well with established WC cutoffs for central obesity in adults (eg, AUC in US adolescents: 0.71 for boys; 0.68 for girls).
CONCLUSION: The international WC cutoffs developed in this study could be useful to screen central obesity in children and adolescents aged 6 to 18 years and allow direct comparison of WC distributions between populations and over time.