INTRODUCTIONCurrent international Royal College of Obstetricians and Gynaecologists (RCOG) guidelines list maternal obesity (body mass index [BMI] ≥ 30.0 kg/m2) as a risk factor for venous thromboembolism (VTE). Although the World Health Organization (WHO) has recommended lower BMI cutoff points for Asians when risk stratifying for diseases associated with obesity, this has not been extended to maternal obesity. In the present study, we compared the difference in using Asian-specific BMI cutoff points as opposed to those in international guidelines in determining the population at risk for VTE, as defined by RCOG guidelines.

METHODSAll spontaneous deliveries (n = 94) and Caesarean sections (n = 41) over a three-week period, and instrumental deliveries (n = 15) over a two-month period, were reviewed and risk stratified based on Asian-specific, as well as international, BMI cut-off points.

RESULTSFor the group that underwent spontaneous vaginal delivery, the percentage of patients at risk for VTE nearly doubled (from 8.5% to 16.0%) with the revised risk stratification, while that of patients who had instrumental delivery had more than a two-fold increase (250%). In the initial risk stratification of the post-Caesarean patients, none were at high risk of VTE. However, when the lower cut-off points of 27.5 kg/m2 and 23.0 kg/m2 were used, one and three patients were respectively identified to be at high risk.

CONCLUSIONFurther research and consideration regarding the adjustment of international risk stratification guidelines to accommodate population-specific differences are required so that at-risk patients are not missed.

Adult ; Body Mass Index ; Female ; Humans ; Obesity ; complications ; Practice Guidelines as Topic ; Pregnancy ; Pregnancy Complications, Hematologic ; ethnology ; etiology ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Singapore ; Venous Thromboembolism ; ethnology ; etiology

PURPOSE: Although obesity has been associated with imbalances in cardiac autonomic nervous system, it is unclear whether there are differential relationships between adiposity measures and heart rate variability (HRV) measures. We aimed to examine differences in the relationship between adiposity measures and HRV indices in a healthy Korean population. MATERIALS AND METHODS: In all, 1409 non-smokers (811 males, 598 females) without known histories of cardiovascular (CV), endocrine, or neurological diseases underwent adiposity measurements [(body mass index (BMI), percentage of body fat mass (PBF), and waist-to-hip ratio (WHR)], the HRV assessment (SDNN, RMSSD, LF, HF, LF/HF, and pNN50), and examination for CV risk factors (fasting glucose, LDL-cholesterol, HDL-cholesterol, triglycerides, hs-CRP, and blood pressure). RESULTS: Compared with BMI and PBF, WHR was more strongly correlated with each HRV index and more likely to predict decreased HRV (<15 percentile vs. > or =15 percentile of each HRV index) in ROC curves analysis. In linear regression analysis, all adiposity measures were inversely associated with each HRV measure before adjusting for age, gender, and CV risk factors (p<0.05). After adjusting for the covariates, WHR was inversely related to RMSSD, LF, and pNN50; PBF with RMSSD, HF, and pNN50; BMI with RMSSD (p<0.05). The inversed association between HRV indices and the gender-specific WHR tertile was significant for subjects with BMI > or =25 kg/m2, but not for those with BMI <25 kg/m2. CONCLUSION: WHR and PBF appear to be better indicators for low HRV than BMI, and the association between abdominal adiposity and HRV may be stronger in overweight subjects.
*Adiposity ; Adult ; Female ; Heart/physiopathology ; Heart Diseases/complications/diagnosis/ethnology ; Heart Rate/*physiology ; Humans ; Male ; Middle Aged ; Models, Statistical ; Obesity/*complications/*diagnosis/ethnology ; Overweight/complications/diagnosis/ethnology ; ROC Curve ; Regression Analysis ; Republic of Korea ; Risk Factors

OBJECTIVEFor prevention of obesity in Chinese population, it is necessary to define the optimal range of healthy weight and the appropriate cut-off points of BMI and waist circumference for Chinese adults. The Working Group on Obesity in China under the support of International Life Sciences Institute Focal point in China organized a meta-analysis on the relation between BMI, waist circumference and risk factors of related chronic diseases (e.g., high diabetes, diabetes mellitus, and lipoprotein disorders).

METHODS13 population studies in all met the criteria for enrollment, with data of 239,972 adults (20-70 year) surveyed in the 1990s. Data on waist circumference was available for 111,411 persons and data on serum lipids and glucose were available for more than 80,000. The study populations located in 21 provinces, municipalities and autonomous regions in mainland China as well as in Taiwan. Each enrolled study provided data according to a common protocol and uniform format. The Center for data management in Department of Epidemiology, Fu Wai Hospital was responsible for statistical analysis.

RESULTS AND CONCLUSIONThe prevalence of hypertension, diabetes, dyslipidemia and clustering of risk factors all increased with increasing levels of BMI or waist circumference. BMI at 24 with best sensitivity and specificity for identification of the risk factors, was recommended as the cut-off point for overweight, BMI at 28 which may identify the risk factors with specificity around 90% was recommended as the cut-off point for obesity. Waist circumference beyond 85 cm for men and beyond 80 cm for women were recommended as the cut-off points for central obesity. Analysis of population attributable risk percent illustrated that reducing BMI to normal range (< 24) could prevent 45%-50% clustering of risk factors. Treatment of obese persons (BMI > or = 28) with drugs could prevent 15%-17% clustering of risk factors. The waist circumference controlled under 85 cm for men and under 80 cm for women, could prevent 47%-58% clustering of risk factors. According to these, a classification of overweight and obesity for Chinese adults is recommended.

Adult ; Aged ; Body Mass Index ; Body Weight ; China ; Diabetes Mellitus ; epidemiology ; ethnology ; Female ; Health Surveys ; Humans ; Hypertension ; epidemiology ; ethnology ; Male ; Middle Aged ; Obesity ; classification ; complications ; ethnology ; Reference Values ; Risk Factors ; Sex Factors ; Thorax ; anatomy & histology

OBJECTIVE: To determine the physical activity (PA) behavior, needs and preferences for underserved, ethnically diverse women with a history of endometrial cancer (EC). METHODS: Women with a history of EC (41 non-Hispanic black, 40 non-Hispanic white, and 18 Hispanic) completed a needs assessment during their regular follow-up appointments at Montefiore Medical Center in Bronx, NY, USA. An 8-week pilot PA intervention based on the results of the needs assessment was conducted with 5 EC survivors. RESULTS: Mean body mass index (BMI) among the 99 respondents was 34.1+/-7.6 kg/m2, and 66% did not exercise regularly. Self-described weight status was significantly lower than actual BMI category (p<0.001). Of the 86% who were interested in joining an exercise program, 95% were willing to attend at least once weekly. The primary motivations were improving health, losing weight, and feeling better physically. Despite the high interest in participation, volunteer rate was very low (8%). However, adherence to the 8-week pilot PA intervention was high (83%), and there were no adverse events. Body weight decreased in all pilot participants. CONCLUSION: These data show that ethnically diverse EC survivors have a great need for, and are highly interested in, PA interventions. However, greater care needs to be taken to assess and identify barriers to increase participation in such programs.
Aged ; Body Mass Index ; Endometrial Neoplasms/epidemiology/*ethnology/*rehabilitation ; Ethnic Groups ; Exercise/physiology ; Female ; Health Behavior/ethnology ; Humans ; Middle Aged ; *Motor Activity ; *Needs Assessment/statistics & numerical data ; Obesity/complications/therapy ; Pilot Projects ; Surveys and Questionnaires ; *Survivors/statistics & numerical data

Esophageal cancer is a common cancer worldwide and has a poor prognosis. The incidence of esophageal squamous cell cancer has been decreasing, whereas the incidence of esophageal adenocarcinoma has been increasing rapidly, particularly in Western men. Squamous cell cancer continues to be the major type of esophageal cancer in Asia, and the main risk factors include tobacco smoking, alcohol consumption, hot beverage drinking, and poor nutrition. In contrast, esophageal adenocarcinoma predominately affects the whites, and the risk factors include smoking, obesity, and gastroesophageal reflux disease. In addition, Asians and Caucasians may have different susceptibilities to esophageal cancer due to different heritage backgrounds. However, comparison studies between these two populations are limited and need to be addressed in the near future. Ethnic differences should be taken into account in preventive and clinical practices.
Adenocarcinoma ; ethnology ; etiology ; genetics ; Alcohol Drinking ; adverse effects ; Asia ; epidemiology ; Asian Continental Ancestry Group ; genetics ; Carcinoma, Squamous Cell ; ethnology ; etiology ; genetics ; Esophageal Neoplasms ; ethnology ; etiology ; genetics ; European Continental Ancestry Group ; genetics ; Gastroesophageal Reflux ; complications ; Genetic Predisposition to Disease ; Humans ; Incidence ; Obesity ; complications ; Polymorphism, Single Nucleotide ; Risk Factors ; Smoking ; adverse effects ; United States ; epidemiology

INTRODUCTIONElevated levels of psychopathology have been described in various groups of obese patients. This study aimed to describe the presence of depressive and binge eating symptoms in patients presented for clinical weight management at a general hospital in Singapore, as well as their health-related quality of life (HRQOL). Correlations between these symptoms and other demographic and clinical variables were also sought.

MATERIALS AND METHODSPatients presented at a clinical weight management programme were asked to complete the Beck Depression Inventory (BDI), Binge Eating Scale (BES) and the Short Form-36 (SF-36). Clinical and demographic data were also collected.

RESULTSOf the group, 17.1% reported moderate or severe binge eating symptoms and 9.7% reported moderate or severe depressive symptoms. HRQOL, mostly in physical health domains, was lower in this sample compared to local norms. Within the group, binge eating and depressive symptoms, but not increasing obesity, predicted poorer HRQOL.

CONCLUSIONSPsychological symptoms are significantly present in patients presented for clinical weight management and these contribute to poorer quality of life. Addressing these symptoms will improve the overall well-beings of these patients and the total benefits gained will exceed the benefits of weight loss per se.

Adult ; Aged ; Depression ; complications ; diagnosis ; epidemiology ; Feeding and Eating Disorders ; complications ; epidemiology ; Female ; Health Status Indicators ; Humans ; Male ; Mental Disorders ; epidemiology ; physiopathology ; Middle Aged ; Obesity ; complications ; ethnology ; psychology ; therapy ; Psychiatric Status Rating Scales ; Quality of Life ; psychology ; Singapore ; epidemiology ; Young Adult

PURPOSE: This study determined which obesity measurement correlates the best with diabetes and prediabetes. MATERIALS AND METHODS: This cross-sectional study enrolled 1603 subjects (611 men, 992 women; age 30-64 years) at the Cardiovascular and Metabolic Diseases Etiology Research Center. Body mass index, waist circumference, waist-height ratio, waist-hip ratio, waist-thigh ratio, and visceral fat were used as measures of obesity. Visceral fat was acquired using dual-energy X-ray absorptiometry (DXA). The prevalences of diabetes and prediabetes were defined using the criteria in the American Diabetes Association 2015 guidelines. RESULTS: After adjusting for age and other potential confounding factors, participants with a visceral fat mass in the upper 10th percentile had a higher odds ratio (OR) for diabetes and prediabetes than the upper 10th percentile of other adiposity indices [men, OR=15.9, 95% confidence interval (CI)=6.4-39.2; women, OR=6.9, 95% CI=3.5-13.7]. Visceral fat mass also had the highest area under the curve with diabetes and prediabetes in both men (0.69, 95% CI=0.64-0.73) and women (0.70, 95% CI=0.67-0.74) compared to other anthropometric measurements of obesity. CONCLUSION: Visceral fat mass measured using DXA is an indicator of diabetes or prediabetes, due to its ability to differentiate between abdominal visceral and subcutaneous fat.
Absorptiometry, Photon ; *Adiposity ; Adult ; Anthropometry ; Asian Continental Ancestry Group/*statistics & numerical data ; Biomarkers/blood ; Body Mass Index ; Cross-Sectional Studies ; Diabetes Mellitus/*ethnology ; Female ; Humans ; *Intra-Abdominal Fat ; Male ; Middle Aged ; Obesity/complications/*ethnology ; Odds Ratio ; Prediabetic State/*ethnology ; Prevalence ; Prospective Studies ; Republic of Korea/epidemiology ; Waist Circumference

OBJECTIVETo investigate the relationship between the G1057D variants of insulin receptor substrate-2(IRS2) gene and type 2 diabetes mellitus (T2DM) in subjects.

METHODSFour hundred and thirty-nine Chinese Han subjects, including 218 patients with T2DM and 221 normal controls, were selected from the Hans in the Liaoning area, and each group was divided into two subgroups according to body mass index. The G1057D variants of IRS2 were detected by polymerase chain reaction-restriction fragment length polymorphism(PCR-RFLP) and their relationships with T2DM were analyzed.

RESULTS(1) The frequency of G1057D variant was 29% in all subjects. The frequency of DD genotype was significantly lower in non-obese DM group than in non-obese control group. The Logistic regression analysis showed that the odds ratio of DD genotype was 0.265. The frequency of DD genotype was significantly higher in obese DM group than in obese control group. The Logistic regression analysis showed that the odds ratio of DD genotype was 3.991. (2) In the non-obese control group, the FPG and 2hCP of DD genotypes were lower than those of GG genotypes (P< 0.05, P< 0.01), the HOMA-B of DD genotypes was higher than that of GG genotype (P< 0.01). In the non-obese DM group, the waistline/hip ratio (WHR) of DD genotypes was higher than that of GG genotypes(P< 0.01). In the obese DM group, the WHR, HOMA-IR, 2hPG, 2hINS and 2hCP levels of DD genotypes were higher than those of GG genotypes, while the level of HOMA-B of DD genotypes was lower than that of GG genotypes. In the obese control group, the WHR, HOMA-IR, 2hPG, 2hINS and 2hCP levels of DD genotype were higher than those of GG genotype, and the HOMA-B level of DD genotype was lower than that of GG genotypes (P< 0.05).

CONCLUSIONThe relationships between G1057D variants of IRS2 and T2DM are mediated by obesity.

Asian Continental Ancestry Group ; genetics ; China ; Diabetes Mellitus, Type 2 ; ethnology ; etiology ; genetics ; Gene Frequency ; Genetic Predisposition to Disease ; Genotype ; Humans ; Insulin Receptor Substrate Proteins ; genetics ; Obesity ; complications ; Polymerase Chain Reaction ; Polymorphism, Genetic ; Polymorphism, Restriction Fragment Length

INTRODUCTIONWe assessed the predictors of poor glycaemic control among older patients with type 2 diabetes mellitus (T2DM) in Malaysia.

METHODSThis cross-sectional study used the data of 21,336 patients aged ≥ 60 years with T2DM from the Adult Diabetes Control and Management Registry 2008-2009.

RESULTSPredictors of poor glycaemic control were: age groups 60-69 years (odds ratio [OR] 1.96, 95% confidence interval [CI] 1.66-2.33) and 70-79 years (OR 1.43, 95% CI 1.20-1.71); Malay (OR 1.53, 95% CI 1.41-1.66) and Indian (OR 1.32, 95% CI 1.19-1.46) ethnicities; T2DM durations of 5-10 years (OR 1.46, 95% CI 1.35-1.58) and > 10 years (OR 1.75, 95% CI 1.59-1.91); the use of oral antidiabetic agents only (OR 5.86, 95% CI 3.32-10.34), insulin only (OR 17.93, 95% CI 9.91-32.43), and oral antidiabetic agents and insulin (OR 29.42, 95% CI 16.47-52.53); and elevated blood pressure (OR 1.10, 95% CI 1.01-1.20), low-density lipoprotein cholesterol (OR 1.48, 95% CI 1.38-1.59) and triglycerides (OR 1.61, 95% CI 1.51-1.73). Hypertension (OR 0.71, 95% CI 0.64-0.80), hypertension and dyslipidaemia (OR 0.68, 95% CI 0.61-0.75), pre-obesity (OR 0.89, 95% CI 0.82-0.98) and obesity (OR 0.76, 95% CI 0.70-0.84) were less likely to be associated with poor glycaemic control.

CONCLUSIONYoung-old and middle-old age groups (i.e. < 80 years), Malay and Indian ethnicities, longer T2DM duration, the use of pharmacological agents, and elevated blood pressure and lipid levels were associated with poor glycaemic control. The presence of comorbidities, pre-obesity and obesity were less likely to be associated with poor glycaemic control.

Aged ; Aged, 80 and over ; Asian Continental Ancestry Group ; Blood Pressure ; Cholesterol, LDL ; blood ; Comorbidity ; Cross-Sectional Studies ; Diabetes Mellitus, Type 2 ; blood ; complications ; ethnology ; Female ; Glycated Hemoglobin A ; metabolism ; Humans ; Hyperglycemia ; blood ; Hypertension ; complications ; Hypoglycemic Agents ; therapeutic use ; Insulin ; blood ; Male ; Middle Aged ; Obesity ; complications ; Registries ; Sex Factors ; Singapore ; Triglycerides ; blood

OBJECTIVETo study the association of muscle-specific glycogen-targeting regulatory subunit of the glucogen-bound protein phosphatase 1 (PPP1R3) gene codon 905 Asp/Tyr polymorphism with type 2 diabetes in Chinese Han population in Hefei region of Anhui province.

METHODSPPP1R3 gene Asp905Tyr polymorphism was detected by polymerase chain reaction and appropriate restriction enzyme (PCR-RFLP) in 262 type 2 diabetic cases and 104 normal controls. Case and control groups were divided into subgroups by body mass index (BMI) 25 kg/m2.

RESULTSWhen PPP1R3 gene Asp905Tyr polymorphism was not associated with type 2 diabetes mellitus. When subjects with BMI < 25 kg/m2 and Tyr/Tyr genotypes were used as reference. Subjects with Asp905 and BMI > or = 25 kg/m2 had a 3.69-fold increase of risk suffering from type 2 diabetes (OR = 3.69, 95% CI: 1.38-8.89, P=0.006).

CONCLUSIONSPPP1R3 gene Asp905Tyr polymorphism did not seem to play a critical role in the development of type 2 diabetes mellitus in Han population of Chinese in Anhui province but interaction between the Asp905 and BMI cause the increase of risk of type 2 diabetes.

Adult ; Alleles ; Aspartic Acid ; genetics ; China ; epidemiology ; ethnology ; Diabetes Mellitus, Type 2 ; epidemiology ; etiology ; genetics ; Female ; Gene Frequency ; Genotype ; Humans ; Male ; Middle Aged ; Obesity ; complications ; Phosphoprotein Phosphatases ; genetics ; Polymerase Chain Reaction ; Polymorphism, Genetic ; Polymorphism, Restriction Fragment Length ; Protein Phosphatase 1 ; Risk Factors ; Tyrosine ; genetics