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Background: To compare the accuracy of different obesity indexes, including waist circumference (WC), weight-to-height ratio (WHtR), body mass index (BMI), and lipid accumulation product (LAP), in predicting metabolic syndrome (MetS) and to estimate the optimal cutoffs of these indexes in a rural Chinese adult population., Methods: This prospective cohort involved 8468 participants who were followed up for 6 years. MetS was defined by the International Diabetes Federation, American Heart Association, and National Heart, Lung, and Blood Institute criteria. The power of the 4 indexes for predicting MetS was estimated by receiver operating characteristic (ROC) curve analysis and optimal cutoffs were determined by the maximum of Youden's index., Results: As compared with WHtR, BMI, and LAP, WC had the largest area under the ROC curve (AUC) for predicting MetS after adjusting for age, smoking, drinking, physical activity, and education level. The AUCs (95% CIs) for WC, WHtR, BMI, and LAP for men and women were 0.862 (0.851-0.873) and 0.806 (0.794-0.817), 0.832 (0.820-0.843) and 0.789 (0.777-0.801), 0.824 (0.812-0.835) and 0.790 (0.778-0.802), and 0.798 (0.785-0.810) and 0.771 (0.759-0.784), respectively. The optimal cutoffs of WC for men and women were 83.30 and 76.80 cm. Those of WHtR, BMI, and LAP were approximately 0.51 and 0.50, 23.90 and 23.00 kg/m 2 , and 19.23 and 20.48 cm.mmol/L, respectively., Conclusions: WC as a preferred index over WHtR, BMI, and LAP for predicting MetS in rural Chinese adults of both genders; the optimal cutoffs for men and women were 83.30 and 76.80 cm.

This study compared the ability of body mass index (BMI), waist circumference (WC), conicity index, and waist-to-height ratio (WHtR) to predict incident hypertension and to identify the cutoffs of obesity indices for predicting hypertension in rural Chinese adults. This prospective cohort study recruited 9905 participants aged 18-70 years during a median follow-up of 6 years in rural China. Logistic regression and receiver operating characteristic (ROC) curve analyses were used to assess the association, predictive ability, and optimal cutoffs (in terms of hypertension risk factors) of the four obesity indices: BMI, WC, conicity index, and WHtR. The 6-year cumulative incidence of hypertension was 19.89% for men and 18.68% for women, with a significant upward trend of increased incident hypertension with increasing BMI, WC, conicity index, and WHtR (P for trend < 0.001) for both men and women. BMI and WHtR had the largest area under the ROC curve for identifying hypertension for both genders. The optimal cutoff values for BMI, WC, conicity index, and WHtR for predicting hypertension were 22.65 kg/m 2 , 82.70 cm, 1.20, and 0.49, respectively, for men, and 23.80 kg/m 2 , 82.17 cm, 1.20, and 0.52, respectively, for women. BMI, WC, conicity index, and WHtR cutoffs may offer a simple and effective way to screen hypertension in rural Chinese adults. BMI and WHtR were superior to WC and conicity index for predicting incident hypertension for both genders.

Objective: To investigate the association of change in waist circumference (WC) and incidence of dyslipidaemia in a cohort study of a rural Chinese population., Methods: Change in WC (ΔWC) was defined as the value at follow-up minus the corresponding value at baseline. Risk of dyslipidaemia associated with ΔWC was assessed by odds ratios and 95% confidence intervals in a logistic regression model, and the odds ratios were transformed to relative risks (RRs)., Results: Among 7691 participants without dyslipidaemia at baseline, 3213 (41.78%) showed dyslipidaemia at 6 year follow-up. Risk of dyslipidaemia was decreased for participants with the first quartile of ΔWC and normal baseline WC (adjusted RR [aRR] = 0.79 [95% confidence interval: 0.64-0.98]) and was increased with the fourth quartile of ΔWC and male gender, age 18 to 30 years, age 31 to 50 years, or normal baseline WC (aRR = 1.55 [1.19-2.03], 2.40 [1.16-4.95], 1.32 [1.06-1.64], and 1.66 [1.35-2.04], respectively). The risk of dyslipidaemia increased with change in WC from normal at baseline to abnormal at follow-up for both genders (aRR = 1.88 [1.39-2.55] for men and 1.60 [1.30-1.97] for women) and decreased with abnormal baseline WC changed to normal WC for women (aRR = 0.61 [0.45-0.83])., Conclusions: Dynamic change in waist circumference was closely related to the incidence of dyslipidaemia in a rural Chinese population. Waist circumference reduction could decrease dyslipidaemia risk, whereas WC increase may increase the risk. Interventions to control or reduce WC to within the normal range are important for early prevention of dyslipidaemia., (Copyright © 2017 John Wiley & Sons, Ltd.)

To compare the ability of a body shape index (ABSI) and body adiposity estimator (BAE) to BMI, waist circumference (WC) and waist:height ratio (WHtR) for predicting development of type 2 diabetes mellitus (T2DM) in rural adult Chinese. The prospective cohort study included 11 687 eligible participants who were free of T2DM at baseline. The risk of new-onset T2DM for ABSI, BAE, BMI, WC and WHtR quintiles was estimated by Cox proportional-hazards regression at follow-up. We also compared the power of ABSI and BAE to BMI, WC and WHtR for predicting the development of T2DM. With increasing ABSI, BAE, BMI, WC and WHtR, T2DM incidence was substantially increased (P trend<0·0001). After adjustment for multi-covariates, risk of T2DM was increased from the second to fifth quintile as compared with first quintile for ABSI (1·27; 95 % CI 0·95, 1·69; 1·35; 95 % CI 1·00, 1·82; 1·75; 95 % CI 1·33, 2·32 and 1·87; 95 % CI 1·40, 2·49; P trend<0·0001); BAE (1·82; 95 % CI 1·38, 2·41; 1·93; 95 % CI 1·38, 2·68; 2·73; 95 % CI 1·94, 3·84 and 4·18; 95 % CI 2·98, 5·87; P trend<0·0001); BMI (1·42; 95 % CI 1·03, 1·97; 1·62; 95 % CI 1·18, 2·23; 2·59; 95 % CI 1·92, 3·50 and 3·90; 95 % CI 2·90, 5·26; P trend<0·0001); WC (1·53; 95 % CI 1·08, 2·17; 1·66; 95 % CI 1·18, 2·33; 2·72; 1·97, 3·76 and 4·09; 95 % CI 2·97, 5·62; P trend<0·0001); and WHtR (1·40; 95 % CI 0·98, 1·99; 2·06; 95 % CI 1·47, 2·88; 2·90; 95 % CI 2·10, 4·01 and 4·22; 95 % CI 3·05, 5·85; P trend<0·0001). ABSI, BAE, BMI, WC and WHR were effective and comparable in discriminating cases from non-cases of T2DM. Risk of T2DM was increased with elevated ABSI and BAE, but the predictive ability for T2DM did not differ than that of BMI, WC and WHtR in a rural Chinese population.

Objectives: To examine the effect of change in body mass index (BMI) on incident hypertension by gender and age groups., Methods: A total of 10,145 non-hypertensive participants 18-75years old from rural areas in the middle of China were selected for this cohort study. Questionnaire interview and anthropometric and laboratory measurements were performed at baseline (during July to August 2007 and July to August 2008) and follow-up (during July to August 2013 and July to October 2014). Multiple logistic regression analysis was used to examine the relationship between change in BMI and incident hypertension., Results: During a mean follow-up of 6.03±0.69years, hypertension developed in 794 of 3986 men and 1184 of 6159 women. Both genders who were obese (BMI ≥28kg/m 2 for Chinese people) at follow-up, regardless of their obesity status at baseline, showed greater risk of hypertension than those who were non-obese (BMI <28kg/m 2 ) at both baseline and follow-up. We found a dose-response relationship between change in BMI and incident hypertension. Risk of hypertension was markedly greater with a BMI gain of the highest quartile or more as compared with a BMI reduction of the lowest quartile or more, except for women 60-75years old., Conclusions: Risk of hypertension was high for non-hypertensive people in rural China with stable obesity. BMI dynamic gain may be related to incident hypertension for men of all ages and young and middle-aged women., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Background: Risk of type 2 diabetes mellitus (T2DM) is increased in metabolically obese but normal-weight people. However, we have limited knowledge of how to prevent T2DM in normal-weight people. We aimed to evaluate the association between triglyceride glucose (TyG) index and incident T2DM among normal-weight people in rural China., Methods: We included data from 5706 people with normal body mass index (BMI) (18.5-23.9 kg/m 2 ) without baseline T2DM in a rural Chinese cohort followed for a median of 6.0 years. A Cox proportional-hazard model was used to assess the risk of incident T2DM by quartiles of TyG index and difference in TyG index between follow-up and baseline (TyG-D), estimating hazard ratios (HRs) and 95% confidence intervals (CIs). A generalized additive plot was used to show the nonparametric smoothed exposure-response association between risk of T2DM and TyG index as a continuous variable. TyG was calculated as ln [fasting triglyceride level (mg/dl) × fasting plasma glucose level (mg/dl)/2]., Results: Risk of incident T2DM was increased with quartiles 2, 3 and 4 versus quartile 1 of TyG index (adjusted HR [aHR] 2.48 [95% CI 1.20-5.11], 3.77 [1.83-7.79], and 5.30 [2.21-12.71], P trend  < 0.001 across quartiles of TyG index). Risk of incident T2DM was increased with quartile 4 versus quartile 1 of TyG-D (aHR 3.91 [2.22-6.87]). The results were consistent when analyses were restricted to participants without baseline metabolic syndrome and impaired fasting glucose level. The generalized additive plot showed cumulative increased risk of T2DM with increasing TyG index., Conclusions: Risk of incident T2DM is increased with increasing TyG index among rural Chinese people, so the index might be an important indicator for identifying people at high risk of T2DM.

Abstract A cross-sectional study was conducted; information for 9247 women living in rural China was collected by questionnaire interview and anthropometric and laboratory measurements during July to August 2013 and July to October 2014. Multiple logistic regression analysis was used to examine the association between parity and hypertension, estimating odds ratios and 95% confidence intervals (CIs). The biological interaction between parity and body mass index was estimated by the relative excess risk due to interaction, attributable proportion due to the interaction, and synergy index. In our study, the prevalence of multiparity and hypertension was 93.10% and 22.90% in premenopausal women and 98.04% and 51.06% in postmenopausal women, respectively. For premenopausal women, parity hypertension was not associated with hypertension. And for postmenopausal women, as compared with para 0-1 status, para 2, 3, 4, and ≥ 5 were positively associated with hypertension: adjusted odds ratios (95% CI) was 2.04 (1.24–3.38), 2.25 (1.32–3.82), 2.41 (1.34–4.36), and 2.10 (1.04–4.22), respectively. The interaction effect between multiparity and overweight/obesity on hypertension was additive (relative excess risk due to interaction [95% CI]: 1.59, 0.19–3.00; attributable proportion due to the interaction [95% CI]: 0.34, 0.02–0.67) only in postmenopausal women. Parity was independently related to hypertension, and the interaction effect between multiparity and overweight/obesity on hypertension was additive in rural postmenopausal women. Highlights • Parity may be related to hypertension in postmenopausal women aged <65 years. • Age may be the dominate factor that impact the hypertension in women aged ≥65 years. • A biological interaction effect may exist between parity and BMI on hypertension. [ABSTRACT FROM AUTHOR]

Summary Objective We aimed to determine dynamic status of metabolically healthy overweight or obesity (MHO) and metabolically unhealthy and normal weight (MUNW) and the risk of incident type 2 diabetes mellitus (T2DM). Methods Body mass index and metabolic health were assessed on 11,865 eligible participants ≥18 years from 6-year follow-up cohort study of a rural Chinese population. Participants were classified as metabolically healthy and normal weight (MHNW), MHO, MUNW and metabolically unhealthy overweight or obesity (MUO) at both baseline and follow-up examinations. Hazard ratio (HR) and 95% confidence interval (CI) were used to assess baseline and their changes of BMI-metabolic status and the risk of incident T2DM. Results Risk of T2DM was increased for all participants with baseline MHO, MUNW, and MUO (adjusted HR 1.94, 95% CI 1.33–2.81; 3.10, 95% CI 2.19–4.39; and 6.63, 95% CI 4.94–8.90, all P < 0.001, respectively). However, risk of T2DM was increased for participants with transformation from MHO to MUO (4.52, 95% CI 2.42–8.47, P < 0.001) as compared with stable MHNW, but not stable MHO (0.53, 95CI 0.20–1.40, P = 0.20). Risk of T2DM did not differ between participants with transformation from MUNW to metabolically healthy and those with stable MHNW ( P > 0.05), but was increased with stable MUNW (5.78, 95% CI 3.15–10.62, P < 0.001). The results were consistent when analyses were restricted to participants without baseline impaired fasting glucose level. Conclusions Our findings provide understanding for differentiating high-risk individuals for incident T2DM in Chinese population. [ABSTRACT FROM AUTHOR]

Aims/Introduction To clarify the association of the hypertriglyceridemic waist phenotype and type 2 diabetes mellitus among adults in China. Materials and Methods In the present case-control study, we included 1,685 patients with type 2 diabetes mellitus and 7,141 normal glucose-tolerant controls from the Henan Province of China in 2011. Elevated waist circumference ( GW) was defined as ≥90 cm for men and ≥80 cm for women. Hypertriglyceridemia ( HT) was defined as >1.7 m mol/L triglycerides ( TG) level. The association of hypertriglyceridemic waist phenotype and type 2 diabetes mellitus was investigated by sex, body mass index, physical activity, and family history of diabetes. Results Cases and controls differed in age, waist circumference ( WC), weight, TG level, fasting glucose, body mass index, smoking status, diabetic family history, physical activity and hypertriglyceridemic waist phenotype ( P < 0.05), but not alcohol drinking ( P = 0.63). In the overall sample, as compared with the phenotype of normal TG level and normal WC ( NTNW), normal TG level/enlarged WC ( NTGW), elevated TG level/normal WC ( HTNW) and elevated TG level/enlarged WC ( HTGW) were associated with type 2 diabetes mellitus (odds ratio 4.14, 2.42 and 6.23, respectively). Only HTGW was consistently associated with risk of type 2 diabetes mellitus, with or without adjustment. The strongest relationship between HTGW and type 2 diabetes mellitus was for subjects with body mass index <24.0 kg/m2 (odds ratio 6.54, 95% confidence interval 4.22-10.14) after adjustment for cofounding variables. Conclusion HTGW was stably and significantly associated with risk of type 2 diabetes mellitus in adult Chinese. [ABSTRACT FROM AUTHOR]

Background To examine the association of risk of incident type 2 diabetes mellitus (T2DM) with high pulse pressure (PP) by sex. Methods We performed a prospective cohort study of 12,272 eligible participants (4664 males and 7608 females) without diabetes at baseline. Participants were classified as having normal PP (20–60 mm Hg) and high PP (> 60 mm Hg) at baseline. The analysis was further stratified by sex, quartiles of age and high PP categories. Results During 6 years of follow-up, T2DM developed in 775 participants and the incidence was 10.57/1000 person-years. With PP 70 to 76 mm Hg, the multivariable adjusted hazard ratio (HR) (95% confidence interval) for incident T2DM in females was 1.722 (1.093–2.714) after adjustment for baseline age, smoking, alcohol intake, physical activity level and family history of T2DM, and 1.634 (1.037–2.575) after adjustment for the above factors and body mass index, waist circumference, blood lipid levels and fasting plasma glucose (FPG) category. After stratification by quartiles of age, for females aged 52 to 59, the multivariable adjusted HRs (95% CI) for high PP as compared to normal PP were 2.263 (1.517–3.377) and 2.140 (1.426–3.210) in different models. During follow-up, levels of FPG, fasting plasma insulin and homeostatic model assessment of insulin resistance index (HOMA-IR) were higher in females with higher than normal PP group, but β-cell function was impaired in the high PP group ( P < 0.05). Conclusion High PP may be related to incident T2DM among female in China, especially women 52 to 59 years old. [ABSTRACT FROM AUTHOR]