Relationship Between Obesity Indexes And Metabolism Of Blood Glucose And Lipids In Postmenopausal Women

Overweight and obesity are health problem in China at present.According to The Chinese Residents Nutrition and Chronic Disease Survey?2015?,the prevalence of overweight and obesity in adult are 42%in 2012.Overweight and obesity result in abnormal body fat distribution,such as inflammation,insulin resistance,leading to metabolic abnormalities of blood glucose and blood lipids,and then increasing the risk of cardiovascular disease?CVD?.Indexes for obesity situation includes body mass index?BMI?,waist circumference?WC?,waist hip ratio?WHR?and waist height ratio?WHtR?.However,these indexes are not the same related to glucose and lipid metabolism.Thus,it is of importance to further explore and compare the relationship between above mentioned indexes and hyperglycemia and dyslipidemia to prevent chronic disease.Objective:To explore and compare the relationship between different fat indexes and hyperglycemia,dyslipidemia and to evaluate their prediction on hyperglycemia,dyslipidemia in postmenopausal women.To search prospective cohort studies observing obesity indexes and the risk of CVD to investigate the different factors?gender,lifestyle,etc.?on the relative risk?RR?using meta-analysis.Methods:1.Human trial:A total of 2000 participants over the age of 35with natural menopause more than12 months were selected in random from Suzhou Industrial Park in 2014 community comprehensive intervention for prevention and control of chronic diseases.The participants were no smoker,no alcohol habit,not diagnosis of diabetes,family history of diabetes and not on hormone replacement therapy and not as a hysterectomy.Demographic characteristics were collected by trained investigators,with the method of questionnaire,including age,menstrual,cultural level,family average per capita monthly income,disease history,family history of disease,dietary survey,habits and customs,etc.Blood pressure,height,body weight,waist circumference,hip circumference,fasting plasma glucose?FPG?level,insulin,glycated hemoglobin?HbA1c?and blood lipid profiles were measured.2.Meta-analysis:After comprehensively searching prospective cohort studies related to obesity indexes and the risk of CVD,the studies observing BMI and hemorrhagic stroke?HS?risk?up to September,2016?was selected to meta-analysis.Using a standardized data-collection form,the following data were extracted from each included study:the first author's last name,publication year,country of origin,study name,study duration,age of participants,gender,number of cases,categorized BMI,the maximally adjusted RRs with 95%CIs for BMI,and statistical adjustment for potential confounding factors.For separated reports of gender in the study,we extract the data respectively.When the reference category was not the lowest category,we excluded the categories below the reference category for the linear dose-response analysis.The study quality was evaluated use the 9-star Newcastle-Ottawa Scale?NOS?.Dose-response analysis was conducted by increasing 5 kg/m² conversion RR value and 95%CI.We used a random-effects model to calculate the combined RR and 95%CI.Results1.Human trial1.1 The basic characteristicsAmong 387 women,43 women have been diagnosed with diabetes,21 women had a family history of diabetes.Finally,a total of 323 women included in the study.The age of subjects was from 43 to 85.For obesity indexes,BMI is 23.9±3.0 kg/m²;WC was 75.2±8.2cm;WHR was 0.84±0.06;and WHtR was 0.49±0.05,respectively.The group with abdominal obesity?WC?80cm?had 100 people accounting for 31.0%;?WHR?0.85?had 142 people accounting for 44.0%;?WHtR?0.50?had 139 people accounting for 43.0%.CVD risk factors as following:hypertension 145 people?44.9%?;hyperglycemia 273 people?84.5%?;and dyslipidemia 96 people?29.7%?.1.2 The correlation of obesity indexes and blood glucose and lipidsThe correlation of obesity indexes?BMI,WC,WHR and WHtR?were positively related with FPG?r=0.18,P?27?0.01;r=0.18,P?27?0.01;r=0.20,P?27?0.01;r=0.17,P?27?0.01?,with HbA1c?r=0.18,P?27?0.01;r=0.20,P?27?0.01;r=0.23,P?27?0.01;r=0.19,P?27?0.01?,with TG?r=0.22,P?27?0.01;r=0.28,P?27?0.01;r=0.28,P?27?0.01;r=0.28,P?27?0.01?and with LDL-c?r=0.20,P?27?0.01;r=0.20,P?27?0.01;r=0.18,P?27?0.01;r=0.20,P?27?0.01?,and negatively related with HDL-c?r=-0.20,P?27?0.01;r=-0.26,P?27?0.01;r=-0.18,P?27?0.01;r=-0.20,P?27?0.01?.There was no related with TC.1.3 The risk of obesity indexes for hyperglycemia and dyslipidemiaAmong obesity indexes,the OR of WC and WHtR were 2.94?95%CI:1.24-6.96?,1.91?95%CI:1.01-3.87?for hyperglycemia.,significantly increasing its risk after adjustment for age,blood pressure,blood lipid,dietary habits,daily physical activity and family per capita income.The risk of hyperglycemia was increased with BMI and WHR without statistical significance.TheORwere WC,WHRand WHtRwere2.38?95%CI:1.38-4.11?,3.06?95%CI:1.81-5.16?and 3.56?95%CI:2.06-6.15?for dyslipidemia,significantly increasing its risk after the adjustment.The risk of dyslipidemia was increased with BMI without statistical significance.1.4 ROC analysis of the obesity indexes and hyperglycemia,dyslipidemiaYI were 0.235,0.224 and AUC were 0.605,0.604 for WHtR and WC respectively.Thus,WHtR and WC were good for predicting hyperglycemia.YI were 0.358,0.297and AUC were 0.679,0.660 for WHR and WHtR,respectively.Thus,WHR and WHtR were good for predicting dyslipidemia.WHR combining with WHtR was better than WHtR combining with WC to predict hyperglycemia and dyslipidemia,and also was higher than independent WHR,WHtR.The best cut-off value of WHtR was 0.47 to predict hyperglycemia and dyslipidemia in this population.2.Meta analysis:According to the criteria,19 articles observing the relationship between BMI and the risk of HS were included in the meta-analysis.For a 5 kg/m² increase in BMI,the RR of HS was1.08?95%CI:0.98-1.18?.No publication bias?PEgger=0.17,PBegg=0.77?was observed.Subgroup analyses showed that the combined RR of HS was 1.19?95%CI:1.06-1.34?in male and 0.98?95%CI:0.90-1.06?in female,respectively,for a 5 kg/m²increase in BMI.The difference of gender is significant difference.Stroke mortality significantly increased?RR=1.29,95%CI:1.22-1.37?with BMI increase of 5 kg/m².On the other hand,geographic region,follow up,the number of cases,measurement methods of BMI and score of study had no effects for HS risk.The confounding factors for adjustment in each study were different.We found that the combined RR for adjusted for exercise was 0.99?95%CI:0.92-1.06?and RR for unadjusted was 1.17?95%CI:1.06-1.31?with significant difference between them.In male,the RR adjusted for exercise was 1.07?95%CI:0.97-1.19?and for unadjusted was1.30?95%CI:1.15-1.47?.In female,the RR adjusted for exercise was 0.94?95%CI:0.87-1.02?and for unadjusted was 1.15?95%CI:0.98-1.34?.The correlation between BMI and HS may be resulted in confounding factor of physical activity.The adjustment factors such as smoking,alcohol consumption,education,blood glucose,blood pressure and blood lipid was no significant difference.Conclusions1.The risk of hyperglycemia and dyslipidemia increased with the abdominal obesity.2.WHtR and WC were good for predicting hyperglycemia.WHR and WHtR were good for predicting dyslipidemia.WHR combining WHtR was better than WHR or WHtR to predict hyperglycemia and dyslipidemia.The best cut-off of WHtR was 0.47,to predict hyperglycemia and dyslipidemia.3.The Meta analysis did not found the association of BMI with HS.This was generally in agreement with our human trial,where BMI was not good to predict abnormal blood glucose and lipid.The evidence of evidence-based medicine of relationship between other obesity indexes and CVD risk need further accumulate.