Predictors of Epicardial Fat Volume Decrease after Dapagliflozin Treatment in Patients with Type 2 Diabetes

Background and Objectives: Dapagliflozin treatment proved to reduce the epicardial fat volume (EFV) in patients with type 2 diabetes (T2D). Despite the reduction in EFV being associated with improved diastolic function in patients with T2D, EVF is not routinely evaluated in T2D because it is costly and involves radiation exposure. This study aims to identify biomarkers that predict EFV reduction after dapagliflozin treatment in patients with T2D. Materials and Methods: In a prospective, observational, consecutive-case enrollment scenario, 52 patients with T2D were initiated on dapagliflozin 10 mg q.d. as part of the standard of care. At enrollment and after six months of dapagliflozin treatment, patients were evaluated using cardiac ultrasonography, native computer tomography, transient liver elastography, and metabolic lab tests. In addition, the atherogenic index of plasma (AIP), atherogenic coefficient (AC), triglyceride glucose index (TyG), cardiac risk ratio (CRR), and visceral abdominal index (VAI) were calculated. Results: Higher AIP (r = 0.28; p = 0.04), CRR (r = 0.28; p = 0.04), and TyG (r = 0.32; p = 0.01) are associated with more important reductions in the EFV. A lower conicity index (β = −0.29; p = 0.03), visceral fat volume at the 4th vertebrae (L4VFV) (β = −0.32; p = 0.02), left atrium volume (β = −3.08; p = 0.003), and right ventricle diameter (β = −2.13; p = 0.04) are associated with higher reductions in the EFV after six months of dapagliflozin treatment. A valid performance for predicting clinically relevant decreases in EFV after dapagliflozin treatment was observed for AIP (AUROC = 0.903; Youden = 0.732; p < 0.001), CRR (AUROC = 0.772; Youden = 0.595; p = 0.004), TyG (AUROC = 0.957; Youden = 0.904; p < 0.001), and VAI (AUROC = 0.898; Youden = 0.712; p < 0.001). Conclusion: Higher initial EFV values are associated with more important reductions in EFV in patients with T2D treated for six months with dapagliflozin. TyG values have the best prediction performances for EFV reduction, having the highest sum of sensitivity and specificity at the 0.904 threshold level. AIP, CRR, VAI, conicity index, L4VF, left atrium volume, and right ventricle volume are valid biomarkers for a decrease in EFV after dapagliflozin treatment in diabetes patients.

DO ADIPOSITY INDICES INFLUENCE VO2 MAX WITHIN NORMAL LIMITS? FITNESS VS. FATNESS

Introduction: The global burden of obesity doubled in children, tripled in adolescents and adults between 1975 and 2016.The central obesity is strongly associated with risk of type 2 diabetes and coronary artery diseases.Therefore,it is important to screen/detect obesity and its complications in early stages.Aim: of this study is to evaluate early markers of adult overweight/obesity, visceral obesity and aerobic fitness in young, healthy men, and also to find out association between visceral obesity and VO max as adequate research data is not available in this field. Forty young, 2 Methods: healthy adult men (aged 18-40 years) were randomly selected from the population of Vijayapura,Karnataka,India,in this study. The anthropometric parameters; weight, height, BMI, BSA, waist circumference and hip circumference were measured. The waist-hip ratio, Conicity index and A Body surface Index were calculated.VO max was measured by 2 Rockport 1-Mile walk test. A series of Pearson's correlation tests were performed to find out the influence of visceral adiposity indices on aerobic fitness. Results: All anthropometric parameters and adiposity indices measured in our study were within the normal range.A significant positive correlation was observed between age vs conicity index and age vs ABSI.We also found a significant negative correlation between adiposity indices and VO max in young healthy 2 adult males. Conclusion: Waist circumference, waist-hip ratio, conicity index and ABSI can be considered as useful anthropometric tools to diagnose central/visceral obesity in healthy men with normal BMI.Total fat and visceral fat may probably have some negative influence on cardiorespiratory function and aerobic fitness.

Influence of sodium intake and sociodemographic, lifestyle and anthropometric variables on blood cholesterol of hypertensive women

The restriction of sodium intake, one of the pillars of antihypertensive treatment, has been associated with the increase in cholesterol levels. Given this, we hypothesize that a sodium intake restriction may increase cholesterol levels in hypertensive women. The present study aimed to evaluate the influence of sodium intake, sociodemographic, lifestyle and anthropometric variables on the blood cholesterol levels of hypertensive women. This was a cross-sectional study with hypertensive and nondiabetic women aged 20 to 59 years, recruited from the primary healthcare units of Maceio, Alagoas, in the Brazilian Northeast. Sodium intake was estimated by the 24-hour urinary excretion of sodium; and blood cholesterol was estimated by capillary blood. Age (years), education level (<4 or ≥4 years), race (white or nonwhite), smoking and alcohol consumption were evaluated. The weight, height and waist circumference were measured and body mass index, conicity index and waist-to-height ratio were quantified. The percentage of body fat was measured using a tetrapolar bioelectrical impedance device. The relationship between blood cholesterol and other variables was assessed by multiple regression analysis. A significance level of 5% was used in the final model. This study included 165 hypertensive women. In linear regression, blood cholesterol wasdirectly proportional to age (p<0.001), education level (p=0.01) and race (p=0.04). These variables, as well assodium intake (p = 0.07) and conicity index (p = 0.12), were included in the multiple regression analysis. Sodium intake (p=0.03) and age (p=0.001) were related, in an inverse and a direct way, respectively, to the blood cholesterol in the hypertensive women studied.

Relationship of Anthropometric Indicators of General and Abdominal Obesity with Hypertension and Their Predictive Performance among Albanians: A Nationwide Cross-Sectional Study

Anthropometric indicators of general and abdominal obesity can predict cardiovascular disease outcomes. Their performance in predicting hypertension (HTN) varies across populations. We aimed to analyze the relationship of body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR) and conicity index (CI) with HTN, to examine their predictive performance and to determine their optimal cut-offs in a nationally representative sample of Albanians aged 15–59 years (n = 20,635). Logistic regression models were fitted and sex-specific receiver-operating characteristic (ROC) curves were constructed. The indicators were positively associated with HTN. Sex modified the relationships, as associations appeared significantly stronger among females than males in the highest categories of the indicators. The area under ROC curves (AUCs) for BMI were 0.729 (95% confidence interval (CI): 0.720–0.738) among females and 0.648 (95% CI: 0.633–0.663) among males, and AUCs for WHtR were 0.725 (95% CI: 0.716–0.734) among females and 0.637 (95% CI: 0.622–0.652) among males. However, the AUCs for BMI and WHtR did not differ significantly among females (p = 0.279) and males (p = 0.227). BMI outperformed WC and CI in both sexes. The optimal BMI cut-offs were 27.0 kg/m2 among females and 25.6 kg/m2 among males, and that for WHtR were 0.53 among females and 0.54 among males. BMI and WHtR demonstrated similar discriminatory power, and the identified cut-offs may inform initiatives for structured HTN screening in Albania.

PREVALENCE OF OBESITY AND ITS ASSOCIATION WITH CONICITY INDEX, BLOOD PRESSURE, AND OTHER DEMOGRAPHIC VARIABLES AMONG MUSLIM RURAL ADULT WOMEN (WITHIN REPRODUCTIVE AGE GROUP) OF RATUA-1 BLOCK, MALDA, WEST BENGAL, INDIA

Globally, more than 1.9 billion adults are overweight and more than 650 million are obese. Every year near about 2.8 million deaths are caused due to overweight or obesity. The objective of the present study is to nd out the prevalence of overweight and obesity and its association with Conicity index, blood pressure and other demographic variables among Muslim rural adult women of Ratua-1 block, Malda, West Bengal. METHODS: Present community based study was conducted among 129 Muslim women aged 26.71±5.51 years, from October 2020 to July 2021 among rural adult women of Ratua-1 block, Malda, West Bengal. The study participants were interviewed using predesigned and pretested questionnaire and anthropometric examination. RESULTS: Among 129 participants 24% were obese and 24% were overweight. Among the 17.05% had high Conicity index (CI), and 61.24% had elevated blood pressure. Signicant association existed between BMI and CI,WC & BP. CONCLUSION: Present study highlighted the high prevalence of overweight /obesity among rural adult muslim women, which may have serious public health implications at community level.

Abdominal Obesity in Overweight Schoolchildren from Portoviejo (Ecuador). Conicity Index Cut-Points for Sustainable Health

(1) Background: Abdominal obesity describes the accumulation of visceral fat. Monitoring of abdominal obesity in children aids prognosis of atherogenic risk and prediction of the emergence of different comorbidities, many of which persist into and throughout adulthood. For this reason, it is of great diagnostic value to the sustainability of health in populations. The aim of this study was to evaluate abdominal obesity in overweight schoolchildren from Portoviejo (Ecuador) and propose conicity index cut-points for sustainable health. (2) Methods: The sample was formed by 356 schoolchildren whose BMI z-score deemed them to be overweight. Height, weight, waist circumference (wstC), various skinfolds, percent body fat, conicity index (CI) and overweight classification according to wstC were determined. (3) Results: The mean age was 6.83 ± 1.2 years, 17.4% were obese, 34.8% were overweight and 47.8% were at risk of being overweight according to their BMI z-score. The mean height was 1.29 ± 0.12 m, whilst the mean weight was 35.21 ± 11.57 kg. When classifying according to wstC, 37.9% were identified as obese, 28.1% had high-risk abdominal adiposity and 34% were normal. The average CI was 1.16 ± 0.06, whilst that of body fat was 19.34 ± 6.03, with 56.2% of individuals having body fat values lower than 20%. (4) Conclusions: The sample showed a high prevalence of central obesity. Significant agreement was not found between classifications of nutritional status according to BMI z-score and wstC.

Differential Effects of Various Androgens on Polycystic Ovary Syndrome

The hyperandrogenism in polycystic ovary syndrome (PCOS) is associated with the risk for the future development of the cardiovascular disease. The objective of the study is to verify whether different androgens have the same harmful effect. This cross-sectional study enrolled 823 women with PCOS: 627 (76.2%) with biochemical hyperandrogenism and 196 (23.8%) with normal androgen levels. The role of individual androgen was evaluated using univariate and multivariate logistic regression. In normoandrogenemic PCOS (NA-PCOS), free androgen index (FAI) predicted significant abnormality in visceral adipose index (VAI, OR=9.2, p=0.002) and dehydroepiandrosterone (DHEA) predicted against alteration in β-cell function (OR=0.5, p=0.007). In hyperandrogenemic PCOS (HA-PCOS), FAI predicted derangements in waist triglyceride index (WTI), VAI, and lipid accumulation product (LAP) (OR ranging from 1.6 to 5.8, p<0.05). DHEA weakly predicted against VAI (OR 0.7, p=0.018), dehydroepiandrosterone sulfate (DHEAS) tended to predict against the conicity index (OR=0.7, p=0.037). After multiple regression, FAI retained significant strength to predict various anthropometric and metabolic abnormalities (OR ranging from 1.1 to 3.0, p<0.01), DHEA was kept as a protector factor against WTI, LAP, and VAI (OR ranging from 0.6 to 0.9; p<0.01) and DHEAS against the conicity index (OR=0.5, p<0.001). In conclusion, the free androgen index was the most powerful predictor of anthropometric and metabolic abnormalities of polycystic ovary syndrome. Conversely, DHEA and DHEAS demonstrated protective effects against disorders in some markers of obesity and abnormal metabolism.

Consumption of melatonin supplement improves cardiovascular disease risk factors and anthropometric indices in type 2 diabetes mellitus patients: a double-blind, randomized, placebo-controlled trial

Background Diabetes mellitus is a common chronic disease. Dyslipidemia and hypertension are two complications that may develop in diabetic patients if hyperglycemia, insulin resistance, and weight gain are not controlled. This study investigated the effects of melatonin supplementation on some cardiovascular disease risk factors and anthropometric indices in patients with type 2 diabetes mellitus (T2DM). Materials and methods In this double-blind, randomized, placebo-controlled trial, 50 T2DM patients were randomly allocated to intervention and control groups which received two tablets of either melatonin or placebo (250 mg) once a day for 8 weeks. Systolic blood pressure (SBP), mean arterial pressure (MAP), pulse pressure (PP), the atherogenic index of plasma (AIP), weight, body mass index (BMI), waist and hip circumference (WC, HC), a body shape index (ABSI), abdominal volume index (AVI), body adiposity index (BAI), lipid accumulation product (LAP), conicity index, and waist-to-height ratio (WHtR) were evaluated in all the patients pre- and post-intervention. Results Melatonin supplementation for 8 weeks significantly decreased the mean levels of SBP, MAP, PP, weight, BMI, WC, HC, BAI, AVI, conicity index, and WHtR post-intervention (p < 0.05). Also, the median changes of SBP, MAP, PP, weight, BMI, WC, HC BAI, AVI, and conicity index were significantly lower in the intervention group compared with the control group (p < 0.05). A significant increase (p < 0.001) was observed in the mean levels of ABSI in the intervention group. The median changes of ABSI were significantly greater in the intervention group compared with the control group (p < 0.001). Conclusions Consumption of melatonin supplement may be effective in controlling arterial pressure including SBP, MAP, and PP and anthropometric indices (as predictors of obesity) in T2DM patients. Trial registration Iranian Registry of Clinical Trials IRCT20190303042905N1. Registered on 17 May 2019.

Optimal cutoff values for anthropometric indices of obesity as discriminators of metabolic abnormalities in Korea: results from a Health Examinees study

Background Obesity is well known as a risk factor for cardiovascular disease. We aimed to determine the performance of and the optimal cutoff values for obesity indices to discriminate the presence of metabolic abnormalities as a primary risk factor for cardiovascular diseases in a Health Examinees study (HEXA). Methods The current study analyzed 134,195 participants with complete anthropometric and laboratory information in a Health Examinees study, consisting of the Korean population aged 40 to 69 years. The presence of metabolic abnormality was defined as having at least one of the following: hypertension, hyperglycemia, or dyslipidemia. The area under the receiver operating characteristic curve (AUC) and 95% confidence intervals (CIs) were calculated for body mass index, waist to hip ratio, waist to height ratio, waist circumference, and conicity index. Results The AUC of metabolic abnormalities was the highest for waist-to-height ratio (AUC [95% CIs], 0.677 [0.672–0.683] among men; 0.691 [0.687–0.694] among women), and the lowest for the C index (0.616 [0.611–0.622] among men; 0.645 [0.641–0.649] among women) among both men and women. The optimal cutoff values were 24.3 kg/m2 for the body mass index, 0.887 for the waist-to-hip ratio, 0.499 for the waist-to-height ratio, 84.4 cm for waist circumference and 1.20 m3/2/kg1/2 for the conicity index among men, and 23.4 kg/m2 for the body mass index, 0.832 for the waist-to-hip ratio, 0.496 for the waist-to-height ratio, 77.0 cm for the waist circumference and 1.18 m3/2/kg1/2 for the conicity index among women. Conclusion The waist-to-height ratio is the best index to discriminate metabolic abnormalities among middle-aged Koreans. The optimal cutoff of obesity indices is lower than the international guidelines for obesity. It would be appropriate to use the indices for abdominal obesity rather than general obesity and to consider a lower level of body mass index and waist circumference than the current guidelines to determine obesity-related health problems in Koreans.