The prevalence of obesity in both the developed and developing world have increased, which leads to diverse health outcomes and is placing a heavy burden on the economy. Abdominal obesity proved to be one of the main features in predicting metabolic and cardiovascular disease (CVD) risk and may be the link that unifies the metabolic syndrome (MS) through pro-inflammatory pathways. While the pathogenesis of the MS and each of its components are complex and not well understood, abdominal obesity remains the mechanism that relates to increased lipolysis causing the liver to increase blood glucose and very low lipoprotein output. This in turns leads to raised blood glucose, triglycerides, low-density lipoprotein cholesterol (LDL-C), blood pressure and inflammatory markers (C-reactive protein, interleukin-6 and tumor necrosis factor-a) and decreased high-density lipoprotein cholesterol (HDL-C). Prevention of the metabolic syndrome and treatment of its main characteristics are now considered of utmost importance in order to combat the increased CVD risk and all-cause mortality. Decreasing sedentary behaviour through regular physical activity is a key element in successful treatment of obesity through an increase in energy expenditure, but the ability to decrease low-grade systemic inflammation may be an even greater outcome. Aims The aims of this study was firstly, to determine by means of a literature review, how obesity could be related to a state of chronic systemic inflammation (increased CRP and IL-6). Secondly to determine whether physical activity could serve as a suitable method to decrease inflammation associated with obesity and related disorders. Thirdly to determine if abdominal obesity is a predictor of the metabolic syndrome and CVD and finally, to determine if measures of obesity can predict risk for the metabolic syndrome and CVD risk. Methods For this review study, a computer-assisted literature search were utilized to identify research published between 1990 and 2005. the following databases were utilized for the search: NEXUS, Science Direct, PubMed and Medline. Keywords related to obesity (abdominal obesity, overweight), metabolic syndrome (insulin resistance syndrome, dysmetabolic syndrome, syndrome X), cardiovascular disease (coronary heart disease, coronary artery disease), cardiovascular risk factors (hypertension, dyslipidemia, diabetes mellitus, physical activity), inflammatory markers (CRP, IL-6, chronic low-grade inflammation) and physical activity (fitness, exercise and training) were included as part of the search, including the references identified by previous reviewers (not identified as part of the computerized literature search). Results and conclusions Several research studies concluded that obesity could be an inflammatory disorder due to low-grade systemic inflammation. Adipose tissue is known to be a sectretory organ producing cytokines, acute phase reactants and other circulating factors. The synthesis of adipose tissue TNF-a could induce the production of IL-6, CRP and other acute phase reactants. CRP is a acute phase reactant, synthesized primarily in hepatocytes and secreted by the liver in response to a variety of inflammatory cytokines of which IL-6 and TNF-a are mainly involved. CRP increases rapidly in response to trauma, inflammation and infection. Thus, enhanced levels of CRP can be used as a marker of inflammation. Several studies of large population cohorts provide evidence for an inverse, independent dose-response relation between plasma CRP concentration and level of physical activity in both men and women. Trends for decreased IL-6, TNF-a and CRP concentrations were linear with increasing amounts of reported exercise in most of the research studies, physical activity proved effective in lowering measures of adiposity (BMI, WHR, WC and percentage body fat) and obesity related inflammatory markers (CRP & IL-6). Thereby indicating a potential anti-inflammatory effect. In the studies reviewed in this article abdominal obesity is identified as a predictor and independent risk factor for CVD in both men and women. High levels of deep abdominal fat have also been correlated with components of the metabolic syndrome, glucose intolerance, hyperinsulinemia, hypertension, diabetes, increases in plasma triglyceride levels and a decrease in HDL-C levels (dyslipidemia) in many of the studies. Prospective epidemiological studies have revealed that abdominal obesity (determined by WC and WHR) conveys an independent prediction of CVD risk and is more relevant compared to general obesity (determined by BMI). Abdominal fat has been linked to metabolic risk factors like high systolic blood pressure, atherogenic dyslipidemia, with increased serum TG and decreased HDL-C, and glucose intolerance. Although magnetic resonance imaging (MRI) and computerized tomography (CT) have been used successfully in many studies to measure adipose compartments of the abdomen (subcutaneous and visceral fat), anthropometrical measures like WHR and WC have been proven to be an effective measure in predicting the metabolic syndrome. WC has also been included in the metabolic syndrome definitions of the WHO, ATP Ill and new IDF. / The prevalence of obesity in both the developed and developing world have increased, which leads to diverse health outcomes and is placing a heavy burden on the economy. Abdominal obesity proved to be one of the main features in predicting metabolic and cardiovascular disease (CVD) risk and may be the link that unifies the metabolic syndrome (MS) through pro-inflammatory pathways. While the pathogenesis of the MS and each of its components are complex and not well understood, abdominal obesity remains the mechanism that relates to increased lipolysis causing the liver to increase blood glucose and very low lipoprotein output. This in turns leads to raised blood glucose, triglycerides, low-density lipoprotein cholesterol (LDL-C), blood pressure and inflammatory markers (C-reactive protein, interleukin-6 and tumor necrosis factor-a) and decreased high-density lipoprotein cholesterol (HDL-C). Prevention of the metabolic syndrome and treatment of its main characteristics are now considered of utmost importance in order to combat the increased CVD risk and all-cause mortality. Decreasing sedentary behaviour through regular physical activity is a key element in successful treatment of obesity through an increase in energy expenditure, but the ability to decrease low-grade systemic inflammation may be an even greater outcome. Aims The aims of this study was firstly, to determine by means of a literature review, how obesity could be related to a state of chronic systemic inflammation (increased CRP and IL-6). Secondly to determine whether physical activity could serve as a suitable method to decrease inflammation associated with obesity and related disorders. Thirdly to determine if abdominal obesity is a predictor of the metabolic syndrome and CVD and finally, to determine if measures of obesity can predict risk for the metabolic syndrome and CVD risk. Methods For this review study, a computer-assisted literature search were utilized to identify research published between 1990 and 2005. the following databases were utilized for the search: NEXUS, Science Direct, PubMed and Medline. Keywords related to obesity (abdominal obesity, overweight), metabolic syndrome (insulin resistance syndrome, dysmetabolic syndrome, syndrome X), cardiovascular disease (coronary heart disease, coronary artery disease), cardiovascular risk factors (hypertension, dyslipidemia, diabetes mellitus, physical activity), inflammatory markers (CRP, IL-6, chronic low-grade inflammation) and physical activity (fitness, exercise and training) were included as part of the search, including the references identified by previous reviewers (not identified as part of the computerized literature search). Results and conclusions Several research studies concluded that obesity could be an inflammatory disorder due to low-grade systemic inflammation. Adipose tissue is known to be a sectretory organ producing cytokines, acute phase reactants and other circulating factors. The synthesis of adipose tissue TNF-a could induce the production of IL-6, CRP and other acute phase reactants. CRP is a acute phase reactant, synthesized primarily in hepatocytes and secreted by the liver in response to a variety of inflammatory cytokines of which IL-6 and TNF-a are mainly involved. CRP increases rapidly in response to trauma, inflammation and infection. Thus, enhanced levels of CRP can be used as a marker of inflammation. Several studies of large population cohorts provide evidence for an inverse, independent dose-response relation between plasma CRP concentration and level of physical activity in both men and women. Trends for decreased IL-6, TNF-a and CRP concentrations were linear with increasing amounts of reported exercise in most of the research studies, physical activity proved effective in lowering measures of adiposity (BMI, WHR, WC and percentage body fat) and obesity related inflammatory markers (CRP & IL-6). Thereby indicating a potential anti-inflammatory effect. In the studies reviewed in this article abdominal obesity is identified as a predictor and independent risk factor for CVD in both men and women. High levels of deep abdominal fat have also been correlated with components of the metabolic syndrome, glucose intolerance, hyperinsulinemia, hypertension, diabetes, increases in plasma triglyceride levels and a decrease in HDL-C levels (dyslipidemia) in many of the studies. Prospective epidemiological studies have revealed that abdominal obesity (determined by WC and WHR) conveys an independent prediction of CVD risk and is more relevant compared to general obesity (determined by BMI). Abdominal fat has been linked to metabolic risk factors like high systolic blood pressure, atherogenic dyslipidemia, with increased serum TG and decreased HDL-C, and glucose intolerance. Although magnetic resonance imaging (MRI) and computerized tomography (CT) have been used successfully in many studies to measure adipose compartments of the abdomen (subcutaneous and visceral fat), anthropometrical measures like WHR and WC have been proven to be an effective measure in predicting the metabolic syndrome. WC has also been included in the metabolic syndrome definitions of the WHO, ATP Ill and new IDF. / Thesis (M.A. (Human Movement Science))--North-West University, Potchefstroom Campus, 2006.

Type 2 diabetes and cardiovascular disease (CVD), major public health concerns in Canada and worldwide, are the main outcomes of Metabolic Syndrome (MetS). MetS is a clustering of five chronic disease risk factors, including abdominal obesity, dyslipidemia (elevated triglycerides and reduced high-density lipoprotein cholesterol level), hypertension, and elevated fasting plasma glucose. Abdominal obesity and insulin resistance are the main factors contributing to development of MetS and thus CVD and diabetes. Further, dyslipidemia (specifically the total cholesterol/HDL-C ratio) is necessary to be monitored in people with these diseases or risk factors. The Canadian Health Measures Survey (CHMS) has direct health measurements that provide the opportunity to identify risk factors associated with chronic disease. Further, dietary intake has been assessed in CHMS, which can be utilized to evaluate the association with diseases and risk factors controlling for potential covariates. To examine the association between dietary intake with MetS and associated risks and diseases in Canadian adults and adolescents, data from CHMS cycle1, 2007-2009 (n=5604, aged 6-79 y) were used in which dietary intake was assessed using a semi-quantitative food frequency questionnaire. Frequency of food intake (times/day) and the distribution of individuals with and without disease or risk factors by socio-demographic characteristic was determined. Further, the association between dietary intake and each disease or risk factor was evaluated using logistic models. Data manipulation, cleaning, and creation of new variables were done using IBM SPSS statistics for windows, version 20. All statistical analyses were conducted by STATA/SE 11, StataCorp. As per Statistics Canada’s recommendation, data were weighted and bootstrapped using specific commands in STATA in order to be representative of the Canadian population. Physically active Canadians had significantly more milk and dairy product, fresh fruit and vegetable, and fruit and vegetable juice intake compared to inactive Canadians. Low-income households had significantly greater intakes of sugar-sweetened beverages (SSBs) and lower amounts of fresh fruit and vegetables than high-income households. Individuals with the lowest level of education had greatest potato and lowest fruit and vegetable juice intake. The prevalence of abdominal obesity (12-79 y), elevated TC/HDL-C ratio (20-79 y), MetS (12-79 y), and diabetes (20-79 y) was 35.7%, 20.5%, 18.3%, and 7.5%, respectively. The overall estimated percent risk of CVD over 10 years in adults aged 30-74 y was 8.66%. Abdominal obesity had the greatest contribution (~90%) to development of MetS in each age group compared to other components of MetS. Also, abdominal obesity was a strong significant predictor for development of other risk factors and chronic diseases including elevated TC/HDL-C ratio, diabetes, and CVD (OR: 6.12, CI: 2.68-13.96; OR: 2.25, CI: 1.24-4.06, OR: 1.4, CI: 1.06-1.87, respectively). High consumption of diet soft drink was associated with increased risk of abdominal obesity, Mets, diabetes, and elevated TC/HDL-C ratio. High consumption of fruit and vegetables and cereal was associated with decreased risk of CVD over 10 years whereas potato intake increased the risk. Intake of nuts appeared to be associated with reduction in the risk of MetS among Canadians. Dietary fat intake of one to less than 5 times/week was associated with increased risk of abdominal obesity in individuals over 40 years of age compared to 12-19 y individuals. Further, “ever drinking” alcohol compared to “never drinking” alcohol was associated with decreased risk of diabetes and elevated TC/HDL-C ratio. Low level of education contributed to development of abdominal obesity. Thus, abdominally obese individuals with specifically elevated TC/HDL-C ratio are at risk of developing MetS, CVD, and diabetes. They need to be educated with specific focus on physical activity, and greater intake of fruit and vegetables, nuts, and lower intake of dietary fat, diet soft drinks, and potato. Additionally, considering the social determinants which might contribute to increase the risk of chronic diseases or risk factors such as income, housing, accessibility to facilities in neighborhoods, school programs, or community programs is essential.

The prevalence of obesity in both the developed and developing world have increased, which leads to diverse health outcomes and is placing a heavy burden on the economy. Abdominal obesity proved to be one of the main features in predicting metabolic and cardiovascular disease (CVD) risk and may be the link that unifies the metabolic syndrome (MS) through pro-inflammatory pathways. While the pathogenesis of the MS and each of its components are complex and not well understood, abdominal obesity remains the mechanism that relates to increased lipolysis causing the liver to increase blood glucose and very low lipoprotein output. This in turns leads to raised blood glucose, triglycerides, low-density lipoprotein cholesterol (LDL-C), blood pressure and inflammatory markers (C-reactive protein, interleukin-6 and tumor necrosis factor-a) and decreased high-density lipoprotein cholesterol (HDL-C). Prevention of the metabolic syndrome and treatment of its main characteristics are now considered of utmost importance in order to combat the increased CVD risk and all-cause mortality. Decreasing sedentary behaviour through regular physical activity is a key element in successful treatment of obesity through an increase in energy expenditure, but the ability to decrease low-grade systemic inflammation may be an even greater outcome. Aims The aims of this study was firstly, to determine by means of a literature review, how obesity could be related to a state of chronic systemic inflammation (increased CRP and IL-6). Secondly to determine whether physical activity could serve as a suitable method to decrease inflammation associated with obesity and related disorders. Thirdly to determine if abdominal obesity is a predictor of the metabolic syndrome and CVD and finally, to determine if measures of obesity can predict risk for the metabolic syndrome and CVD risk. Methods For this review study, a computer-assisted literature search were utilized to identify research published between 1990 and 2005. the following databases were utilized for the search: NEXUS, Science Direct, PubMed and Medline. Keywords related to obesity (abdominal obesity, overweight), metabolic syndrome (insulin resistance syndrome, dysmetabolic syndrome, syndrome X), cardiovascular disease (coronary heart disease, coronary artery disease), cardiovascular risk factors (hypertension, dyslipidemia, diabetes mellitus, physical activity), inflammatory markers (CRP, IL-6, chronic low-grade inflammation) and physical activity (fitness, exercise and training) were included as part of the search, including the references identified by previous reviewers (not identified as part of the computerized literature search). Results and conclusions Several research studies concluded that obesity could be an inflammatory disorder due to low-grade systemic inflammation. Adipose tissue is known to be a sectretory organ producing cytokines, acute phase reactants and other circulating factors. The synthesis of adipose tissue TNF-a could induce the production of IL-6, CRP and other acute phase reactants. CRP is a acute phase reactant, synthesized primarily in hepatocytes and secreted by the liver in response to a variety of inflammatory cytokines of which IL-6 and TNF-a are mainly involved. CRP increases rapidly in response to trauma, inflammation and infection. Thus, enhanced levels of CRP can be used as a marker of inflammation. Several studies of large population cohorts provide evidence for an inverse, independent dose-response relation between plasma CRP concentration and level of physical activity in both men and women. Trends for decreased IL-6, TNF-a and CRP concentrations were linear with increasing amounts of reported exercise in most of the research studies, physical activity proved effective in lowering measures of adiposity (BMI, WHR, WC and percentage body fat) and obesity related inflammatory markers (CRP & IL-6). Thereby indicating a potential anti-inflammatory effect. In the studies reviewed in this article abdominal obesity is identified as a predictor and independent risk factor for CVD in both men and women. High levels of deep abdominal fat have also been correlated with components of the metabolic syndrome, glucose intolerance, hyperinsulinemia, hypertension, diabetes, increases in plasma triglyceride levels and a decrease in HDL-C levels (dyslipidemia) in many of the studies. Prospective epidemiological studies have revealed that abdominal obesity (determined by WC and WHR) conveys an independent prediction of CVD risk and is more relevant compared to general obesity (determined by BMI). Abdominal fat has been linked to metabolic risk factors like high systolic blood pressure, atherogenic dyslipidemia, with increased serum TG and decreased HDL-C, and glucose intolerance. Although magnetic resonance imaging (MRI) and computerized tomography (CT) have been used successfully in many studies to measure adipose compartments of the abdomen (subcutaneous and visceral fat), anthropometrical measures like WHR and WC have been proven to be an effective measure in predicting the metabolic syndrome. WC has also been included in the metabolic syndrome definitions of the WHO, ATP Ill and new IDF. / The prevalence of obesity in both the developed and developing world have increased, which leads to diverse health outcomes and is placing a heavy burden on the economy. Abdominal obesity proved to be one of the main features in predicting metabolic and cardiovascular disease (CVD) risk and may be the link that unifies the metabolic syndrome (MS) through pro-inflammatory pathways. While the pathogenesis of the MS and each of its components are complex and not well understood, abdominal obesity remains the mechanism that relates to increased lipolysis causing the liver to increase blood glucose and very low lipoprotein output. This in turns leads to raised blood glucose, triglycerides, low-density lipoprotein cholesterol (LDL-C), blood pressure and inflammatory markers (C-reactive protein, interleukin-6 and tumor necrosis factor-a) and decreased high-density lipoprotein cholesterol (HDL-C). Prevention of the metabolic syndrome and treatment of its main characteristics are now considered of utmost importance in order to combat the increased CVD risk and all-cause mortality. Decreasing sedentary behaviour through regular physical activity is a key element in successful treatment of obesity through an increase in energy expenditure, but the ability to decrease low-grade systemic inflammation may be an even greater outcome. Aims The aims of this study was firstly, to determine by means of a literature review, how obesity could be related to a state of chronic systemic inflammation (increased CRP and IL-6). Secondly to determine whether physical activity could serve as a suitable method to decrease inflammation associated with obesity and related disorders. Thirdly to determine if abdominal obesity is a predictor of the metabolic syndrome and CVD and finally, to determine if measures of obesity can predict risk for the metabolic syndrome and CVD risk. Methods For this review study, a computer-assisted literature search were utilized to identify research published between 1990 and 2005. the following databases were utilized for the search: NEXUS, Science Direct, PubMed and Medline. Keywords related to obesity (abdominal obesity, overweight), metabolic syndrome (insulin resistance syndrome, dysmetabolic syndrome, syndrome X), cardiovascular disease (coronary heart disease, coronary artery disease), cardiovascular risk factors (hypertension, dyslipidemia, diabetes mellitus, physical activity), inflammatory markers (CRP, IL-6, chronic low-grade inflammation) and physical activity (fitness, exercise and training) were included as part of the search, including the references identified by previous reviewers (not identified as part of the computerized literature search). Results and conclusions Several research studies concluded that obesity could be an inflammatory disorder due to low-grade systemic inflammation. Adipose tissue is known to be a sectretory organ producing cytokines, acute phase reactants and other circulating factors. The synthesis of adipose tissue TNF-a could induce the production of IL-6, CRP and other acute phase reactants. CRP is a acute phase reactant, synthesized primarily in hepatocytes and secreted by the liver in response to a variety of inflammatory cytokines of which IL-6 and TNF-a are mainly involved. CRP increases rapidly in response to trauma, inflammation and infection. Thus, enhanced levels of CRP can be used as a marker of inflammation. Several studies of large population cohorts provide evidence for an inverse, independent dose-response relation between plasma CRP concentration and level of physical activity in both men and women. Trends for decreased IL-6, TNF-a and CRP concentrations were linear with increasing amounts of reported exercise in most of the research studies, physical activity proved effective in lowering measures of adiposity (BMI, WHR, WC and percentage body fat) and obesity related inflammatory markers (CRP & IL-6). Thereby indicating a potential anti-inflammatory effect. In the studies reviewed in this article abdominal obesity is identified as a predictor and independent risk factor for CVD in both men and women. High levels of deep abdominal fat have also been correlated with components of the metabolic syndrome, glucose intolerance, hyperinsulinemia, hypertension, diabetes, increases in plasma triglyceride levels and a decrease in HDL-C levels (dyslipidemia) in many of the studies. Prospective epidemiological studies have revealed that abdominal obesity (determined by WC and WHR) conveys an independent prediction of CVD risk and is more relevant compared to general obesity (determined by BMI). Abdominal fat has been linked to metabolic risk factors like high systolic blood pressure, atherogenic dyslipidemia, with increased serum TG and decreased HDL-C, and glucose intolerance. Although magnetic resonance imaging (MRI) and computerized tomography (CT) have been used successfully in many studies to measure adipose compartments of the abdomen (subcutaneous and visceral fat), anthropometrical measures like WHR and WC have been proven to be an effective measure in predicting the metabolic syndrome. WC has also been included in the metabolic syndrome definitions of the WHO, ATP Ill and new IDF. / Thesis (M.A. (Human Movement Science))--North-West University, Potchefstroom Campus, 2006.

Thesis (Ph.D. (Human Movement Science))--North-West University, Potchefstroom Campus, 2010.

Thesis (Ph.D. (Human Movement Science))--North-West University, Potchefstroom Campus, 2010.

Objective The prevalence of obesity and related diseases such as type 2 diabetes mellitus (T2DM) is increasing worldwide, and the Asian Indian population seems to be particularly susceptible to developing T2DM, even at a low body mass index (BMI). In Sweden, the age-adjusted prevalence of diabetes has not increased despite increasing self-reported obesity. However, modern data on the prevalence of obesity and T2DM in Scandinavia are absent.The biochemical links between obesity and subsequent T2DM are unknown, but the adipocyte-derived hormones leptin and adiponectin (adipokines) have been suggested as potential links because they both are related to insulin and glucose physiology. Some studies have found leptin to be an independent predictor of T2DM in men but not in women, although these results are inconsistent. In contrast, adiponectin has more consistently been linked to development of T2DM in both men and women. Furthermore, the leptin–adiponectin ratio may predict incident T2DM better than either of the two hormones separately.The aims of this thesis were to describe time trends in obesity and T2DM in northern Sweden, to evaluate leptin and adiponectin as predictors of deterioration in glucose metabolism including T2DM, and to evaluate leptin as a risk marker regarding ethnic differences, circ-annual variation, and intra-individual stability. Materials and methods Three large population surveys were used, the Northern Sweden MONICA (MONitoring of Trends and Determinants in CArdiovascular Disease) study, the Västerbotten Intervention Programme (VIP), and the Mauritius Non-Communicable Disease Study. Within the MONICA study, six cross-sectional surveys were performed in Sweden’s two northernmost counties, Norrbotten and Västerbotten, between 1986 and 2009. A total of 1000 men and 1000 women ages 25–64 years, also including from 1994 250 men and 250 women ages 65–74 years, were independently chosen for each survey. The overall participation rate was 75%. In 1999, a reinvestigation was performed in 74% of all participants from the three first surveys. Data from the MONICA surveys were used in papers I and IV and data from the reinvestigation survey in paper II. VIP is an ongoing population intervention program that started in the mid-eighties targeting cardiovascular risk factors and has covered the whole county of Västerbotten since 1991. Inhabitants are invited the years they turn 40, 50, and 60 years old, and the annual participation rate has varied between 48% and 67%. A subset (n=1780) from VIP was used in paper II for the circ-annual leptin analysis, and VIP data linked to the diabetes register in Västerbotten (DiabNorr) were used in a case referent study (640 patients with T2DM) in paper III. The Mauritius Non-Communicable Disease Study was performed in 1987 in 10 randomly selected (with probability proportional to size) population clusters. All eligible adults ages 25–74 years were invited, and the participation rate was 86% (n=5083). In 1992, a follow-up survey was performed in 49% of the initial participants. The Mauritius survey data were used in paper II. Results I. BMI increased in men ages 25–74 years and in women ages 25–44 years in northern Sweden between 1986 and 2004. The prevalence of obesity (BMI 30) increased in men ages 25–44 and 55–74 years and in women ages 25–44 years. The prevalence of obesity increased from 10.4% to 19.1% in men and from 12.9% to 17.9% in women ages 25–64 years. Waist circumference (WC) decreased in women of all ages and in men ages 55–64 years between 1986 and 1990. After 1990, WC increased again, and the prevalence of abdominal obesity rose markedly in women ages 25–64 years. II. Differences in circulating levels of leptin, leptin per BMI unit (leptin/BMI), and leptin per cm in WC (leptin/waist) were tested in men and women of Asian Indian, Creole (African), and Caucasian ethnicity. Asian Indian men and women had the highest leptin concentrations and Caucasian men and women the lowest while Creole men and women had intermediate values for leptin, leptin/BMI, and leptin/waist. No circ-annual variation in leptin concentrations was seen in Caucasians. The intra-individual test– retest stability for leptin was equal in men and women of different ethnicities, over 5–13 years, with an intra-class correlation of 0.65–0.82. III. High adiponectin concentrations predicted decreased risk of T2DM in both insulin-sensitive and insulin-resistant men and women, whereas high leptin levels predicted increased risk for T2DM only in insulinsensitive men. A high leptin–adiponectin ratio predicted T2DM in both men and women, and men with a high ratio had a shorter time to diagnosis than those with a low ratio. IV. In northern Sweden, fasting and post-load glucose increased in women ages 24–65 years with 0.2 mmol/l and 0.7 mmol/l, respectively, between 1990 and 2009. Consequently, the prevalence of impaired fasting glucose and impaired glucose tolerance (IGT) rose from 4.5% to 7.7%, and from 7.8% to 14.5%, respectively. In men, post-load glucose increased at 0.5 mmol/l, and the prevalence of IGT rose from 3.5% to 10.1%. The prevalence of diabetes did not increase. An independent relationship between leptin and changes in fasting and post-load glucose was seen in men but not in women. Conclusion An increasing obesity and concomitant deterioration in glucose metabolism was seen in northern Sweden in the period studied. High adiponectin concentrations predicted a decreased risk of T2DM in both men and women, whereas high leptin concentrations predicted an increase in fasting and post-load glucose as well as an increased risk of T2DM in men but not in women. Individual insulin resistance status modified the association between leptin and T2DM, and the leptin–adiponectin ratio may add further predictive information beyond the measures of the separate hormones. In relation to traditional anthropometric measures of obesity, Asian Indian men and women had the highest and Caucasians the lowest concentrations of leptin while Creole (African) men and women had intermediate levels. As a risk marker, leptin has a high intra-individual stability, equal in men and women and among different ethnicities over 5–13 years with no circ-annual variation.

Made available in DSpace on 2015-07-22T20:50:31Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-08-25 / Objetivo: Descrever a mortalidade (por todas as causas e por doenças cardiovasculares) e as incidências de diabetes e hipertensão entre nipo-brasileiros segundo a presença de obesidade abdominal definida a partir de diferentes medidas antropométricas. Material e Métodos: Neste estudo de coorte, utilizaram-se dados de 1567 nipo-brasileiros para o estudo de mortalidade (n = 727 para o estudo de incidência de diabetes e n = 655 para o estudo de incidência de hipertensão), com idade 30 anos e de ambos os sexos. Os indivíduos foram acompanhados por 14 anos e coletaram-se, na linha de base, informações sobre dados sócio-demográficos, de estilo de vida, metabólicos e antropométricos. Definiram-se, como variáveis dependentes (desfechos), a condição ao final do estudo (vivo versus óbito por todas as causas ou vivo versus óbito por doenças cardiovasculares) e a ocorrência de casos novos de diabetes ou de hipertensão (sim versus não). A presença de obesidade abdominal segundo cada uma das três medidas antropométricas (perímetro de cintura, razão cintura quadril e razão cintura estatura), na linha de base do estudo, foi a variável independente de principal interesse. Estimaram-se os coeficientes de mortalidade e de incidência de diabetes e hipertensão, por ponto e por intervalo com 95% de confiança. Em análise múltipla utilizou-se o modelo de Poisson para obter as razões ajustadas entre os coeficientes de mortalidade ou de incidência e a presença de obesidade abdominal. Utilizou-se, para cada sexo separadamente, a curva ROC na identificação dos pontos de corte das variáveis antropométricas com melhor capacidade preditiva dos desfechos de interesse. Resultados: O coeficiente geral de mortalidade foi de 10,68/1000 pessoas-ano e os de incidência de diabetes e de hipertensão foram, respectivamente, 20,28/1000 pessoas-ano e 49,81/1000 pessoas-ano. Observou-se, no início do estudo, elevada prevalência de obesidade abdominal (valores entre 38,5% e 74,4%). Em análise com modelo de regressão múltiplo, verificou-se que a presença de obesidade abdominal, pela razão cintura quadril, associou-se a mortalidade. Além disso, o sexo masculino, a idade 60 anos e ter hipertensão arterial foram fatores de risco independentes para a mortalidade e exercer atividade profissional foi fator de risco para o desenvolvimento do diabetes. Os pontos de corte identificados para o perímetro de cintura, razão cintura quadril e razão cintura estatura, como indicativos da presença de obesidade abdominal, especialmente entre os homens, foram menores que os propostos na literatura Conclusões: A prevalência de obesidade abdominal foi elevada entre os nipo-brasileiros e a razão cintura quadril elevada foi fator de risco independente para a mortalidade. É necessário reavaliar os pontos de corte propostos na literatura, particularmente entre os homens, considerando as diferenças na composição corporal dos distintos grupos étnicos. / Objective: To describe mortality (all causes and cardiovascular diseases) and incidences of diabetes and hypertension among Japanese-Brazilians according to the presence of abdominal obesity defined from different anthropometric measures. Methods: In this cohort study, we used in the mortality study data from 1567 Japanese-Brazilians (n = 727 in the diabetes incidence study and n = 655 in the hypertension incidence study) aged 30 years and both genders. The subjects were followed for 14 years and we collected at baseline socio-demographic, lifestyle, metabolic and anthropometric data. We defined as dependent variables (outcomes) the status at the end of the study (alive versus death from all causes or live versus death from cardiovascular diseases) and the occurrence of new cases of diabetes or hypertension (yes versus no). The presence of abdominal obesity at baseline according to each of the three anthropometric measures (waist circumference, waist-to-hip ratio and waist-to-height ratio) was the independent variable of principal interest. We estimated mortality rates and incidence of diabetes and hypertension, by point and by 95% confidence intervals. In multivariable analysis we used the Poisson model to obtain the adjusted mortality or incidence rate ratios and the presence of abdominal obesity. The ROC curve was used to identify anthropometric variables cutoff points with the best capacity to predict the interest outcomes, for each gender separately. Results: The overall mortality was 10.68/1,000 person-years and the diabetes and hypertension incidences were, respectively, 20.28/1,000 person-years and 49.81/1,000 person-years. It was noted at the beginning of the study, high prevalence of abdominal obesity (values between 38.5% and 74.4%). In analysis with multiple regression models, it was found that the presence of abdominal obesity by waist-to-hip ratio was associated with mortality. In addition, male gender, age 60 years and have hypertension were independent risk factors for mortality and work placement was a risk factor for developing diabetes. The cutoff points identified for waist circumference, waist-to-hip ratio and waist-to- height ratio, as indicative of the presence of abdominal obesity, especially among men, were lower than those proposed in the literature Conclusions: The prevalence of abdominal obesity was high among Japanese- Brazilians and waist-to-hip ratio was an independent risk factor for mortality. It is necessary to reevaluate the cutoff points proposed in the literature, particularly among men, considering the differences in body composition of different ethnic groups. / TEDE / BV UNIFESP: Teses e dissertações

Introdução: A obesidade abdominal associa-se ao risco para diabetes mellitus tipo 2 (DM) e doença cardiovascular (DCV). Entre os fatores associados à obesidade abdominal, destaca-se o importante papel da dieta. Objetivo: O presente estudo investigou a associação entre fatores dietéticos e adiposidade em nipo-brasileiros de Bauru, Estado de São Paulo. Métodos: Para o presente estudo, 772 participantes (329 homens e 443 mulheres) com idade entre 30-92 anos foram analisados em inquérito transversal de base populacional. Um questionário quantitativo de freqüência alimentar validado para essa população foi empregado para avaliar a dieta habitual. Índice de massa corporal (IMC, em kg/m2) e circunferência de cintura (CC, em cm) foram classificados de acordo com critérios da Organização Mundial de Saúde para a população asiática (obesidade geral IMC >= 25kg/m2; obesidade abdominal CC >= 90 cm para homens e >= 80 cm para mulheres). Modelos de regressão logística múltiplos foram utilizados na comparação entre o menor e o maior tercil de consumo alimentar em relação ao risco associado para obesidade abdominal, obesidade geral ou obesidade geral com obesidade abdominal, após ajuste para co-variáveis sócio-demográficas, de estilo de vida e bioquímicas. As análises foram estratificadas por gênero. Resultados: Em toda a população, maior consumo de embutidos foi associado à obesidade abdominal [Odds Ratio (OR) =2,09; IC95%: 1,05-4,18; Pde tendência = 0,009] e geral com abdominal (OR=2,41; IC95%: 1,40-4,15; Pde tendência = 0,006). Em homens, a ingestão de fibra de leguminosas (OR =0,27; IC95%: 0,08-0,84; Pde tendência = 0,015) foi inversamente associada à obesidade abdominal. Houve associação entre maior consumo de colesterol e de alimentos embutidos e obesidade geral com obesidade abdominal (OR=3,03, IC95%: 1,21-7,60, Pde tendência = 0,050 e OR=2,41, IC95%: 1,40-4,15, Pde tendência = 0,188, respectivamente). Entre as mulheres, o maior consumo de carnes vermelhas (OR=0,50; IC95%: 0,26; 0,98; Pde tendência = 0,121) foi inversamente associado à obesidade geral com abdominal, provavelmente devido ao baixo consumo geral. Conclusão: O consumo de alimentos embutidos foi associado à obesidade geral, abdominal e geral na presença de abdominal. Diferentes associações entre fatores dietéticos e medidas de adiposidade foram observadas segundo gênero. / Introduction. Abdominal obesity has been associated with type 2 diabetes mellitus (DM) and cardiovascular disease. Among the risk factors for abdominal obesity, diet has been considered one of the most important. Aims/hypothesis. This study investigated which dietary factors are associated with the distribution of body adiposity in Japanese-Brazilians from Bauru-Sao Paulo. Methods. Analysis using a population-based cross-sectional study can out in 772 subjects (329 men and 443 women) aged 30-92 years from Bauru, Brazil. Dietary intakes were assessed using a validated food-frequency questionnaire. Measurements of weight, height, and waist circumference (WC, in cm) were taken using the following WHO cut-offs for Asians: overall obesity, Body Mass Index (BMI) >= 25kg/m2; abdominal obesity, WC >= 90 for men and >= 80 for women. Multiple logistic regression models were used for comparison between the lowest with the highest tertile of intakes stratified by gender, after adjusting for socio-demographic, lifestyle, biochemical and nutritional confounders. Results. In overall population, higher intakes of processed meats were associated with abdominal obesity [Odds Ratio (OR) =2.09; IC95%: 1.05-4.18; Pfor trend = 0.009] and with overall with abdominal obesity (OR=2.41; IC95%: 1.40-4.15; Pfor trend = 0.006). In stratified analysis by gender, among men, bean fiber was inversely associated with abdominal obesity (OR=0.27; 95%CI: 0.08; 0.84; Pfor trend = 0.015), when compared participants in the highest to the lowest tertile of intakes. Higher intakes of cholesterol and processed meats were associated with overall with abdominal obesity (OR=3.03, 95%CI: 1.21-7.60, Pfor trend = 0.050 and OR=2.41, IC95%: 1.40-4.15, Pfor trend = 0.188, respectively). Among women, higher intakes of red meats were inversely associated to overall with abdominal obesity (OR=0.50; IC95%: 0.26; 0.98; Pfor trend = 0.121) probably related to low intake levels. Conclusions. Processed meats were associated with overall, abdominal and overall with abdominal obesity. Diferent associations were observed in dietary factors in relation to overall, abdominal as well as overall with abdominal obesity according to gender.

The aim of this thesis was to investigate the associations between fatty acid (FA) biomarkers, carbohydrate intake, and abdominal obesity (AO) and related anthropometric measures in a population-based cohort of men and women in Stockholm County. The overall hypothesis was that dietary fat quality assessed by serum and adipose tissue FA composition, and dietary intake of especially carbohydrates is associated with AO. FA composition was assessed by liquid gas chromatography, and AO was measured as waist circumference (WC), waist hip ratio (WHR) and sagittal abdominal diameter (SAD). Dietary intake was assessed by 7-day food records. Papers I, II, III, and IV were all observational studies based on a Swedish population in Stockholm County (n=5460). A sub-cohort of only men (n=301) was included in Papers II, III, and IV. In Paper I, serum proportions of the polyunsaturated FA (PUFA), linoleic acid (LA) (18:2n6), was inversely associated with AO in both men and women, whereas a positive association was observed between the saturated FA (SFA), palmitic acid (PA) (16:0) and AO measures. These findings support recent interventional studies suggesting that a higher relative intake of PUFA (LA) from vegetable oils as compared with 16:0 is associated with decreased abdominal adiposity. In Paper II, we investigated whether biomarkers of dietary fat quality were related to the corresponding FA intake from fat-rich foods reported in a short food frequency questionnaire (FFQ). Serum proportions of the long-chain n-3 PUFAs eicosapentaenoic acid (EPA) and docosahexanoic acid (DHA) were higher among men with higher total fish intake. Serum LA was higher among men who reported a consumption of more than 5 g/d of margarine. Absolute agreement between intakes assessed with FFQ of 60YO and 7-day food record of "Kost och Metabola syndromet"/"Diet and the Metabolic syndrome" (KOMET) was highest for alcohol, total fish, and eggs. Weighted Kappa statistics revealed the strongest agreement for alcohol, margarine, and fruits. In Paper III, carbohydrate intake was inversely associated with 16:0 in serum phospholipids (PL). Disaccharide and alcohol intake was positively and non-linearly associated with palmitoleic acid (16:1) and stearoyl-CoA-desaturase (SCD) activity in PL. Alcohol was consistently associated with higher SFA and monounsaturated FA (MUFA). Results of Paper IV indicated that total carbohydrate intake was inversely associated with measures of AO and central fat distribution, WHR and SAD, respectively. Likewise, monosaccharide intake was associated with lower AO. In contrast, alcohol intake was associated with AO prevalence and all anthropometric measurements. In conclusion, serum SFA (palmitic acid) was positively associated with AO, whereas n-6 PUFA (linoleic acid) was associated with lower AO. High intake of total carbohydrate and monosaccharides were associated with lower AO. Overall, these results support a beneficial role on adiposity of diets that are higher in polyunsaturated fat (vegetable oils) and total carbohydrates compared with saturated fat.

OBJECTIVE: The key objective of the present investigation was to compare associations between sagittal abdominal diameter (SAD), waist circumference, and BMI to the oral glucose tolerance test (OGTT), along with fasting glucose, HbA1c, and HOMA-IR, in a nationally representative sample of U.S. adults. The study also analyzed the effect of multiple covariates on the anthropometric and glucose metabolism associations. METHODS: A cross-sectional design, including 3,582 subjects, was used. SAD was assessed using an abdominal caliper. All other data were collected following strict NHANES protocol. The OGTT was the primary variable used to index glucose metabolism. Fasting glucose, HbA1c, and HOMA-IR were also evaluated. RESULTS: Mean ± SE values were as follows: SAD: 22.3 ± 0.1 cm; waist circumference: 98.0 ± 0.4 cm; BMI: 28.6 ± 0.2 kg/m2; OGTT: 113.9 ± 1.0 mg/dL; fasting glucose: 99.6 ± 0.3 mg/dL; HbA1c: 5.4 ± 0.01%; HOMA-IR: 3.2 ± 0.1. SAD consistently emerged as the best predictor of all the indices of glucose metabolism, before and after adjusting for the covariates, and with the sample stratified by gender, race, or age. SAD was not a better predictor of OGTT among normal weight adults and non-Hispanic black adults. CONCLUSION: Obesity, especially abdominal obesity, is strongly related to glucose metabolism and type 2 diabetes. In the present study, SAD was the best anthropometric predictor of glucose metabolism, notwithstanding the high correlations among SAD, waist circumference, and BMI. Due to the ease of taking a SAD measurement, we recommend that healthcare providers consider the use of this simple and inexpensive method to more precisely predict diabetes risk, especially among overweight and obese adults.