harold e. bays, md kathleen m. fox, phd susan grandy, phd for the shield study group
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Waist circumference, hip circumference, body mass index (BMI) , and ratios: Which best predicts type 2 diabetes mellitus in men and women?. Harold E. Bays, MD Kathleen M. Fox, PhD Susan Grandy, PhD for the SHIELD Study Group. - PowerPoint PPT PresentationTRANSCRIPT
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Waist circumference, hip Waist circumference, hip circumference, body circumference, body mass index index
(BMI) , and ratios: Which best (BMI) , and ratios: Which best predicts type 2 diabetes mellitus in predicts type 2 diabetes mellitus in
men and women?men and women?Harold E. Bays, MD
Kathleen M. Fox, PhDSusan Grandy, PhD
for the SHIELD Study GroupNAASO – The Obesity Society Annual Scientific
Meeting, New OrleansOctober 24, 2007
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Adiposopathy is defined as pathogenic adipose tissue:
• Promoted by positive caloric balance and sedentary lifestyle in genetically and environmentally susceptible patients
• Anatomically manifested by adipocyte hypertrophy, adipose tissue accumulation (adiposity) in the visceral region, as well as ectopic fat (triglyceride) deposition in peripheral organs such as liver, muscle, and pancreas
• Whose adverse metabolic and immune consequences result in clinical metabolic disease
Bays HE et al. Future Cardiology. 2005;1(1):39-59
Bays HE. Expert Rev Cardiovas Ther. 2005;3(3):395-404
Background
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Bays H, Ballantyne C. Future Lipidology. 2006;1(4):389-420
Background
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Bays H, Ballantyne C. Future Lipidology. 2006;1(4):389-420
Background
EFRMD=excessive fat-related metabolic diseases
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Bays H, Ballantyne C. Future Lipidology. 2006;1(4):389420
Background
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Adiposopathy: Visceral and Peripheral Adipose Tissue
Bays H, Blonde L, Rosenson R. Expert Rev Cardiovas Ther. 4(6), 871–895 (2006)
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SHIELD• Study to Help Improve Early evaluation and management of
risk factors Leading to Diabetes (SHIELD)
• 5-year, national, longitudinal survey of diabetes, CVD, and cardiometabolic risk in US adults
• Purpose: To better understand patterns of health behavior, knowledge and attitudes of people living with type 2 diabetes (T2DM) and those at high risk for its development
• This analysis assessed anthropometric measures in predicting type 2 diabetes in men and women
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Objective
• To assess gender-specific associations between type 2 diabetes and adipose tissue parameters
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Methods: Identifying Cohorts• Screening questionnaire mailed to 200,000 nationally
representative US households– Part of the TNS* (formerly National Family Opinion) consumer panel– Responses for 211,097 adults from 127,420 households (64%
response rate)
• Used to identify individuals who self-reported:– T2DM and other metabolic diseases– Varying numbers of risk factors (0-5) associated with T2DM
diagnosis
• Follow up 64-item survey was sent to 22,001 people, along with tape measure and instructions for use• Type 1 diabetes (n=1000), T2DM (n=5000), History of gestational
diabetes (n=1000), Control/at risk (n=15,000, ~2400 in each risk level)
• Responses from 17,640 adults (80% response rate; 10,466 women & 6,686 men)
*TNS = Taylor Nelson Sofres
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Risk Factor Definitions
Risk Factor Definition
Abdominal obesity Men: waist circumference > 97cmWomen: waist circumference >89 cm
BMI 28 kg/m2
Dyslipidemia Diagnosed with cholesterol problems of any type
Hypertension Diagnosed with high blood pressure
CV event One or more CV problems or events (heartdisease/myocardial infarction, narrow or blockedarteries, stroke, coronary artery bypass graftsurgery/angioplasty/stents/surgery to cleararteries)
BMI= body mass index; CV=cardiovascular
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Adipose Tissue Measures
• Waist circumference (WC): assesses “pathogenic” visceral adipose tissue
• Body mass index (BMI): assesses overall obesity, with most of total fat being “protective” subcutaneous adipose tissue
• Hip circumference: “protective” gluteal subcutaneous adipose tissue
• WC-BMI ratio: pathogenic / ”protective” adipose tissue ratio• WC-HC ratio: pathogenic / “protective” adipose tissue ratio
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Statistical Analyses
• Distribution of measured and reported adipose tissue parameters by quintiles of all respondents
• Analyses stratified by gender
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Bays H, Dujovne C. Curr Atheroscler Rep. 2006;8(2):144-156
NHLBI Treatment Guidelines for Adult Obesity
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Results – T2DM WomenQuintilen=10466 women
BMI kg/m2 N (%)n=2212 T2DM women
Quintilen=9707
WC cm N (%)n=2013 T2DM women
1n=2093
<24.4 162 (7.3) 1n=1942 <83.8 173 (8.6)
2n=2093
24.4 to 28.3 361 (16.3) 2n=1941 83.8 to 94.0 264 (13.1)
3n=2094
28.4 to 32.3 425 (19.2) 3n=1941 94.1 to 104.1 354 (17.6)
4n=2093
32.4 to 37.8 536 (24.2) 4n=1942 104.2 to 116.8 529 (26.3)
5n=2093
≥37.8 728 (32.9) 5n=1941 ≥116.8 693 (34.4)
The highest percent of women with T2DM occurred at the highest BMI and at the highest WC.
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Results – T2DM WomenQuintilen=9623 women
WC:BMI ratio
N (%)n=1998 T2DM women
Quintilen=9558
WC:HC ratio
N (%)n=1985 T2DM women
1n=1925 <2.93 484 (24.2)
1n=1912 <0.81 217 (10.9)
2n=1925 2.93 to 3.17 413 (20.7)
2n=1911 0.81 to 0.86 295 (14.9)
3n=1924 3.18 to 3.38 369 (18.5)
3n=1911 0.87 to 0.90 384 (19.3)
4n=1924 3.39 to 3.64 363 (18.2)
4n=1912 0.91 to 0.95 473 (23.8)
5n=1925 >3.64 369 (18.5)
5n=1912 ≥0.95 616 (31.0)
The highest percent of women with T2DM occurred at the lowest WC:BMI ratio, and the highest WC:HC ratio.
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Results – T2DM MenQuintilen=6686 men
BMI kg/m2 N (%)n=1613
T2DM men
Quintilen=6418
WC cm N (%)n=1565
T2DM men
1n=1337
<25.1 161 (10.0) 1n=1284 <91.4 42 (2.7)
2n=1337
25.1 to 28.2 408 (25.3) 2n=1284 91.4 to 101.6 208 (13.3)
3n=1338
28.3 to 30.8 399 (24.7) 3n=1283
101.7 to 109.2 394 (25.2)
4n=1338
30.9 to 34.7 366 (22.7) 4n=1283
109.3 to 119.4 461 (29.5)
5n=1337
≥34.7 279 (17.3) 5n=1284 ≥119.4 460 (29.4)
The highest percent of men with T2DM occurred at the highest WC.
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ATP III: The ATP III: The Metabolic Syndrome SyndromeDiagnosis is established when 3 of these risk factors are present.
Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. JAMA 2001;285:2486-2497.
Risk Factor Defining LevelAbdominal obesity(Waist circumference)
Men Women
>102 cm (>40 in)>88 cm (>35 in)
TG 150 mg/dLHDL-C
Men Women
<40 mg/dL<50 mg/dL
Blood pressure 130/85 mm Hg
Fasting glucose 110 mg/dL
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Results – T2DM MenQuintilen=6357 men
WC:BMI ratio
N (%)n=1548
T2DM men
Quintilen=6031
WC:HC ratio
N (%)n=1470
T2DM men
1n=1271 <3.24 99 (6.4)
1n=1206 <0.90 21 (1.4)
2n=1272 3.24 to 3.46 156 (10.1)
2n=1206 0.90 to 0.95 46 (3.1)
3n=1272 3.47 to 3.64 257 (16.6)
3n=1207 0.96 to 1.00 147 (10.0)
4n=1271 3.65 to 3.87 414 (26.7)
4n=1206 1.01 to 1.05 357 (24.3)
5n=1271 ≥3.87 622 (40.2)
5n=1206 ≥1.05 899 (61.2)
The highest percent of men with T2DM occurred at the highest WC:BMI ratio and the highest WC:HC ratio.
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Summary• In univariate analyses of women, the number of
patients with T2DM gradually increased with increasing BMI, WC, and WC:HC ratio, but not WC:BMI, indicated that total peripheral, subcutaneous adipose tissue may not always be “protective”
• In men, univariate analyses indicated that WC:HC ratio was a better predictor of T2DM than WC:BMI, WC, or BMI, possibly reflecting the pathogenic effects of having both increased visceral adipose tissue & relative lack of “protective” gluteal and peripheral, subcutaneous adipose tissue.
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Back up slides
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Six “Faces” of Adiposopathy
Bays H, Blonde L, Rosenson R. Expert Rev Cardiovas Ther. 4(6), 871–895 (2006)
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Bays HE. Obesity Research 2004; Vol. 12 No. 8:1197-1211.
Adiposopathy: Treatment
“Finally, an emerging concept is that the development of anti-obesity agents must not only reduce fat mass (adiposity) but must also correct fat dysfunction (adiposopathy)”
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Adiposopathy: TreatmentAdiposopathy treatments and their effects upon select parameters that promote type 2 Adiposopathy treatments and their effects upon select parameters that promote type 2
diabetes mellitusdiabetes mellitus
Intervention
Visceral fat
Free fatty acids
Leptin Adiponectin
Tumor necrosis factor alpha
Diet/Exercise
↓ ↓ ↓ ↑ ↓
PPAR gamma agonists
↓/- ↓ ↓/- ↑ ↓
Orlistat ↓ ↓ ↓ ↑ ↓Sibutramine
↓ ↓ ↓ ↑/- ?
Cannabinoid receptor antagonists
↓ ↓ ↓ ↑ ↓Bays H, Blonde L, Rosenson R. Expert Rev Cardiovas Ther. 4(6), 871–895 (2006)
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Adiposopathy: TreatmentAdiposopathy treatments and their effects upon select parameters that promote hypertension
Intervention
Visceral fat
Free fatty acids
Leptin Adiponectin
Renin-angiotensin-aldosterone enzymes
Diet/Exercise
↓ ↓ ↓ ↑ ↓
PPAR gamma agonists
↓/- ↓ ↓/- ↑ -
Orlistat ↓ ↓ ↓ ↑ ?Sibutramine
↓ ↓ ↓ ↑/- ?
Cannabinoid receptor antagonists
↓ ↓ ↓ ↑ ?
Bays H, Blonde L, Rosenson R. Expert Rev Cardiovas Ther. 4(6), 871–895 (2006)
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Adiposopathy: TreatmentAdiposopathy treatments and their effects upon select parameters that promote dyslipidemia
Intervention
Visceral fat
Free fatty acids
Leptin Adiponectin
Androgens
Estrogens
Diet/Exercise
↓ ↓ ↓ ↑ ↓ (women)↑ (men)
↓/- (men)
PPAR gamma agonists
↓/- ↓ ↓/- ↑ ↓ ↓/- (men)
Orlistat ↓ ↓ ↓ ↑ ↓ (women)
?
Sibutramine
↓ ↓ ↓ ↑/- ↓ (women)
?
Cannabinoid receptor antagonists
↓ ↓ ↓ ↑ ? ?
Bays H, Blonde L, Rosenson R. Expert Rev Cardiovas Ther. 4(6), 871–895 (2006)
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Bays H, Ballantyne C. Future Lipidology. 2006;1(4):389-420; Bays H et al. Expert Rev Cardiovasc Ther. 2005;3(5):789-820
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Bays H, Ballantyne C. Future Lipidology. 2006;1(4):389-420