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Background: Metabolic dysfunction associated steatotic liver disease (MASLD) has been linked to heart failure with preserved ejection fraction (HFpEF). We sought to understand association between individuals with amounts of liver adiposity greater than would be predicted by their body mass index (BMI) in order to understand whether this disproportionate liver fat (DLF) represents a proxy of metabolic risk shared between liver and heart disease., Methods: We studied 2,932 participants in the Multi-Ethnic Study of Atherosclerosis (MESA) who received computed tomography (CT) measurements of hepatic attenuation. Quartiles of DLF were compared and multivariable linear regression was performed to evaluate the association of DLF with clinical, echocardiographic, and quality of life metrics., Results: Compared to the lowest quartile of DLF, individuals in the highest quartile of DLF were more likely to be male (52.0% vs 47.1%, P < .001), less likely to be Black or African American (14.8 % vs 38.1% P < .001), have higher rates of dysglycemia (31.9% vs 16.6%, P < .001) and triglycerides (140 [98.0, 199.0] vs 99.0 [72.0, 144.0] mg/dL, P > .001). These individuals had lower global longitudinal strain (-0.13 [-0.25, -0.02], P = .02), stroke volumes (-1.05 [-1.76, -0.33], P < .01), lateral e' velocity (-0.10 [-0.18, -0.02], P = .02), and 6-minute walk distances (-4.25 [-7.62 to -0.88], P = .01)., Conclusion: DLF is associated with abnormal metabolic profiles and ventricular functional changes known to be associated with HFpEF and may serve as an early metric to assess for those that may progress to clinical HFpEF., Competing Interests: Declaration of competing interest The authors have no conflicts of interest to declare., (Copyright © 2024 Elsevier Inc. All rights reserved.)

In this study of postmenopausal women in Malaysia, total adiposity was inversely associated with total BMD, while regional associations varied. No differences were detected across Malay, Chinese, and Indian ethnicities. Low BMD contributes substantially to morbidity and mortality, and increasing adiposity levels globally may be contributing to this., Purpose: To investigate associations of total and regional adiposity with bone mineral density (BMD) among a multi-ethnic cohort of postmenopausal women., Methods: Dual X-ray absorptiometry (DXA) imaging was undertaken for 1990 postmenopausal women without prior chronic diseases (30% Malay, 53% Chinese, and 17% Indian) from The Malaysian Cohort (TMC). The strength of the associations between standardized total and regional body fat percentages with total and regional BMD was examined using linear regression models adjusted for age, height, lean mass, ethnicity, education, and diabetes. Effect modification was assessed for ethnicity., Results: Women with a higher total body fat percentage were more likely to be Indian or Malay. Mean (SD) BMD for the whole-body total, lumbar spine, leg, and arm were 1.08 (0.11), 0.96 (0.15), 2.21 (0.22), and 1.36 (0.12) g/cm 2 , respectively. Total body and visceral fat percentage were inversely associated with total BMD (- 0.02 [95% CI - 0.03, - 0.01] and - 0.01 [- 0.02, - 0.006] g/cm 2 per 1 SD, respectively). In contrast, subcutaneous and gynoid fat percentages were positively associated with BMD (0.007 [0.002, 0.01] and 0.01 [0.006, 0.02] g/cm 2 , respectively). Total body fat percentage showed a weak positive association with lumbar BMD (0.01 [0.004, 0.02]) and inverse associations with leg (- 0.04 [- 0.06, - 0.03]) and arm (- 0.02 [- 0.03, - 0.02]) BMD in the highest four quintiles. There was no effect modification by ethnicity (p hetero  > 0.05)., Conclusion: Total adiposity was inversely associated with total BMD, although regional associations varied. There was no heterogeneity across ethnic groups suggesting adiposity may be a risk factor for low BMD across diverse populations., (© 2024. The Author(s).)

Introduction: Ethnic and gender differences in plasma lipid composition have been widely reported among the general population, but there are scarce data on athletes., Aim: To assess ethnic and gender differences in lipid profile across a large cohort of Olympic athletes practicing different sport disciplines METHODS: We enrolled 1165 Olympic athletes divided into power, endurance, and mixed disciplines according to European Society of Cardiology classification. Sixty-two (5.3%) were Afro-Caribbean. Body composition and fat mass percentage were measured. Blood samples were collected and lipid profile was investigated., Results: Compared to Caucasians, Afro-Caribbeans had better lipid profile characterized by lower LDL (90 ± 25 mg/dL vs. 97.1 ± 26.2 mg/dL, p = 0.032) lower LDL/HDL ratio (1.39 ± 0.5 vs. 1.58 ± 0.6, p = 0.012), lower non-HDL-cholesterol (102.5 ± 27.4 mg/dL vs. 111.5 ± 28.5 mg/dL, p = 0.015) and lower TC/HDL (2.59 ± 0.6 vs. 2.82 ± 0.7, p = 0.010). Female Afro-Caribbeans showed lower TG/HDL ratio (p = 0.045) and TC/HDL ratio (p = 0.028), due to higher HDL (p = 0.005) compared to male Afro-Caribbeans. In Caucasian athletes, females showed even more evident differences with lower TC, LDL, and higher HDL with subsequent lower ratios compared to men. Moreover, endurance Caucasian athletes had lower LDL (p = 0.003) and TG (p = 0.017) plasmatic levels and higher HDL levels compared to non-endurance Caucasian athletes (p< 0.0001) CONCLUSIONS: Ethnicity and gender have a significant influence on plasmatic lipid balance in elite athletes and Afro-Caribbeans have favorable lipid profiles compared to Caucasians. Moreover, endurance sports, particularly in Caucasian athletes, are associated with better lipid profile compared to other type of sports., (© 2024. The Author(s).)

Objective: Using a life course perspective, this longitudinal study examines the extent to which prenatal family- and neighborhood-level socioeconomic factors influence the cardiometabolic health of low-income Mexican American children. It was hypothesized that prenatal maternal residence in a more economically disadvantaged neighborhood and more family-level economic hardship would each be associated with higher adiposity and blood pressure (BP) at child age 4.5 years, and higher adiposity, BP, inflammation and a less healthy lipid profile at child age 7.5 years., Method: The sample consisted of 322 low-income, Mexican American mother-child dyads, 181 of whom completed the 7.5-year laboratory visit. Using maternal prenatal residence and U.S. census data, neighborhood concentrated disadvantage index was computed., Results: Higher prenatal neighborhood concentrated disadvantage predicted higher 4.5-year adiposity in children, which, in turn, predicted higher adiposity, BP, and inflammation, and less healthy lipid profile (higher triglycerides, lower high-density lipoprotein cholesterol) at 7.5 years. Higher child 4.5-year BP was concurrently associated with higher adiposity and predicted higher 7.5-year BP., Conclusions: Extending previous work with this sample, the current study found associations between cardiometabolic risk indicators as early as preschool among Mexican American children. Furthermore, this study builds on existing literature by expanding our understanding of the effect of prenatal neighborhood concentrated disadvantage on cardiometabolic phenotypes during early childhood. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Context: Prepubertal adiposity is associated with earlier puberty. It is unclear when this association starts, if all adiposity markers are similarly associated, and whether all pubertal milestones are similarly affected., Objective: To evaluate the association between different adiposity markers during childhood and the timing of different pubertal milestones in Latino girls., Design, Setting, and Participants: Longitudinal follow-up of 539 female participants of the Chilean Growth and Obesity Cohort recruited from childcare centers (mean age 3.5 years) from the southeast area of Santiago, Chile. Participants were singletons born between 2002 and 2003 within the normal birthweight range. Since 2006, a trained dietitian measured weight, height, waist circumference (WC) and skinfolds to estimate body mass index (BMI) Centers for Disease Control and Prevention percentiles, central obesity, percentage of fat mass (%FM), and fat mass index (FMI, fat mass/height2)., Main Outcome: Since 2009, sexual maturation was assessed every 6 months to assess age at (1) thelarche, (2) pubarche, (3) menarche, and (4) peak height velocity (PHV)., Results: At thelarche, 12.5% were obese and 2% had central obesity. The median age of pubarche, menarche, and PHV were all associated with markers of adiposity at different time points during childhood whereas thelarche only with %FM and FMI. Adiposity clusters models showed that children with trajectories of high WC, %FM, and FMI during childhood were related with earlier thelarche, pubarche, menarche, and PHV but BMI trajectories only with menarche and PHV., Conclusions: Higher WC, %FM, and FMI were associated with earlier age at thelarche, pubarche, menarche, and PHV. The effect of BMI was less consistent., (© The Author(s) 2023. Published by Oxford University Press on behalf of the Endocrine Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Body mass index (BMI) correlates with aspirin-induced bleeding risk. However, skeletal muscle mass (SMM) loss and fat gain commonly occur with aging, making BMI not a reasonable marker of bleeding risk in older individuals. In the present study, we aimed to investigate the prognostic value of myopenic obesity based on the percent of fat mass (%FM) for aspirin-induced bleeding in Chinese patients over 60 years old., Methods: We prospectively analyzed 185 patients taking aspirin for primary and secondary prevention of cardiovascular diseases. Body composition parameters were estimated using bioelectrical impedance analysis. We defined myopenic obesity (MO) as a height-adjusted appendicular SMM <7.0 kg/m 2 in males and <5.7 kg/m 2 in females with a %FM >29% in males and >41% in females or a BMI ≥25 kg/m 2 . The patients were categorized into four groups by the presence or absence of myopenia and obesity., Results: Based on the %FM grouping, the bleeding risk was significantly higher in the MO group, followed by the nonmyopenic obesity, myopenic nonobesity, and nonmyopenic nonobesity groups (P = 0.044). No statistically significant differences in the probability of bleeding events were observed among the four BMI-based groups (P = 0.502). Multivariate Cox analysis indicated that MO (hazard ratio [HR] 2.724, 95% confidence interval [CI] 1.073-6.918, P = 0.035), aspirin dose (100 vs 50 mg/day, HR 2.609, 95% CI 1.291-5.273, P = 0.008), concomitant use of histamine-2 receptor antagonists and proton pump inhibitors (HR 1.777, 95% CI 1.007-3.137, P = 0.047), and hemorrhage history (HR 2.576, 95% CI 1.355-4.897, P = 0.004) were associated with bleeding events independently., Conclusion: %FM-based MO was an independent predictor of aspirin-induced bleeding in older Chinese individuals. Reducing %FM rather than BMI should be an optimal strategy for the management of myopenic obesity., Competing Interests: The authors report no conflicts of interest in this work., (© 2023 Wang et al.)

This communication proposes the term "hidden obesity" to describe normal weight obesity, or increased adiposity without a corresponding increase in body mass index. It uses the concept of hidden hunger to craft semantics which will generate greater attention to this condition from all stake-holders, including policymakers and planners. The article describes simple tools which can be used to suspect and confirm the diagnosis of hidden obesity. This phenotype is very commonly seen in the south Asian population.

Background: Leptin, mainly secreted by fat cells, plays a core role in the regulation of appetite and body weight, and has been proposed as a mediator of metabolic programming. During pregnancy leptin is also secreted by the placenta, as well as being a key regulatory cytokine for the development, homeostatic regulation and nutrient transport within the placenta. South Asians have a high burden of type 2 diabetes, partly attributed to a "thin-fat-phenotype"., Objective: Our aim was to investigate how maternal ethnicity, adiposity and glucose- and lipid/cholesterol levels in pregnancy are related to placental leptin gene ( LEP ) DNA methylation., Methods: We performed DNA methylation analyses of 13 placental LEP CpG sites in 40 ethnic Europeans and 40 ethnic South Asians participating in the STORK-Groruddalen cohort., Results: South Asian ethnicity and gestational diabetes (GDM) were associated with higher placental LEP methylation. The largest ethnic difference was found for CpG11 [5.8% (95% CI: 2.4, 9.2), p<0.001], and the strongest associations with GDM was seen for CpG5 [5.2% (1.4, 9.0), p=0.008]. Higher maternal LDL-cholesterol was associated with lower placental LEP methylation, in particular for CpG11 [-3.6% (-5.5, -1.4) per one mmol/L increase in LDL, p<0.001]. After adjustments, including for nutritional factors involved in the one-carbon-metabolism cycle (vitamin D, B12 and folate levels), ethnic differences in placental LEP methylation were strongly attenuated, while associations with glucose and LDL-cholesterol persisted., Conclusions: Maternal glucose and lipid metabolism is related to placental LEP methylation, whilst metabolic and nutritional factors largely explain a higher methylation level among ethnic South Asians., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Sletner, Moen, Yajnik, Lekanova, Sommer, Birkeland, Jenum and Böttcher.)

Background: The mechanistic target of rapamycin (mTOR) pathway promoted by positive energy imbalance and insulin-like growth factors can be a mechanism by which obesity influences breast cancer risk. We evaluated the associations of body fatness with the risk of breast cancer varied with phosphorylated (p)-mTOR protein expression, an indication of the pathway activation., Methods: Women with newly diagnosed breast cancer (n = 715; 574 [80%] Black and 141 [20%] White) and non-cancer controls (n = 1983; 1280 [64%] Black and 713 [36%] White) were selected from the Women's Circle of Health Study. Surgical tumor samples among the cases were immunostained for p-mTOR (Ser2448) and classified as p-mTOR-overexpressed, if the expression level ≥ 75th percentile, or p-mTOR-negative/low otherwise. Anthropometrics were measured by trained staff, and body composition was determined by bioelectrical impedance analysis. Odds ratios (ORs) of p-mTOR-overexpressed tumors and p-mTOR-negative/low tumors compared to controls were estimated using polytomous logistic regression. The differences in the associations by the p-mTOR expression status were assessed by tests for heterogeneity., Results: Cases with p-mTOR-overexpressed tumors, but not cases with p-mTOR-negative/low tumors, compared to controls were more likely to have higher body mass index (BMI), percent body fat, and fat mass index (P-heterogeneity < 0.05), although the OR estimates were not significant. For the measurement of central adiposity, cases with p-mTOR overexpressed tumors had a higher odds of being at the Q3 (OR = 2.52, 95% CI = 1.46 to 4.34) and Q4 (OR = 1.99, 95% CI = 1.12 to 3.50) of waist circumference (WC) compared to controls. Similarly, cases with p-mTOR overexpressed tumors had a higher odds of being at the Q3 (OR = 1.82, 95% CI = 1.11 to 2.98) and Q4 (OR = 1.81, 95% CI = 1.11 to 2.98) of WHR compared to controls. These associations of WC and waist-to-hip ratio (WHR) did not differ by tumor p-mTOR status (P-heterogeneity = 0.27 and 0.48, respectively)., Conclusions: Our findings suggest that in this population composed of predominately Black women, body fatness is associated with breast cancer differently for p-mTOR overexpression and p-mTOR negative/low expression. Whether mTOR plays a role in the obesity and breast cancer association warrants confirmation by prospective studies., (© 2021. The Author(s).)

In contrast to the decreasing burden related to cardiovascular disease (CVD), the burden related to dysglycemia and adiposity complications is increasing in Czechia, and local drivers must be identified. A comprehensive literature review was performed to evaluate biological, behavioral, and environmental drivers of dysglycemia and abnormal adiposity in Czechia. Additionally, the structure of the Czech healthcare system was described. The prevalence of obesity in men and diabetes in both sexes has been increasing over the past 30 years. Possible reasons include the Eastern European eating pattern, high prevalence of physical inactivity and health illiteracy, education, and income-related health inequalities. Despite the advanced healthcare system based on the compulsory insurance model with free-for-service healthcare and a wide range of health-promoting initiatives, more effective strategies to tackle the adiposity/dysglycemia are needed. In conclusion, the disease burden related to dysglycemia and adiposity in Czechia remains high but is not translated into greater CVD. This discordant relationship likely depends more on other factors, such as improvements in dyslipidemia and hypertension control. A reconceptualization of abnormal adiposity and dysglycemia into a more actionable cardiometabolic-based chronic disease model is needed to improve the approach to these conditions. This review can serve as a platform to investigate causal mechanisms and secure effective management of cardiometabolic-based chronic disease.

Background and Aims: Obesity is associated with an increasing prevalence of cardiovascular diseases in Africa, but some obese individuals maintain cardiometabolic health. The aims were to track metabolically healthy overweight or obesity (MHO) over 10 years in African adults and to identify factors associated with a transition to metabolically unhealthy overweight or obesity (MUO)., Methods and Results: The participants were the South African cohort of the international Prospective Urban and Rural Epidemiological study. From the baseline data of 1937 adults, 649 women and 274 men were followed for 10 years. The combined overweight and obesity prevalence of men (19.2%-23.8%, p = .02) and women (58%-64.7%, p < .001), and the prevalence of the metabolic syndrome in all participants (25.4%-40.2%, p < .001) increased significantly. More than a quarter (26.2%) of the women and 10.9% of men were MHO at baseline, 11.4% of women and 5.1% of men maintained MHO over 10 years, while similar proportions (12.3% of women, 4.7% of men) transitioned to MUO. Female sex, age, and total fat intake were positively associated with a transition to MUO over 10 years, while physical activity was negatively associated with the transition. HIV positive participants were more likely to be MHO at follow-up than their HIV negative counterparts., Conclusions: One in two black adults with BMI ≥25 kg/m 2 maintained MHO over 10 years, while a similar proportion transitioned into MUO. Interventions should focus on lower fat intakes and higher physical activity to prevent the transition to MUO., Competing Interests: Declaration of competing interest The authors report financial and personal relationships with other people or organizations that could inappropriately influence (bias) their work as described in the attached CoI forms: Dr. HS and Dr. IM Kruger reports grants from South African National Research Foundation, grants from South Africa–Netherlands Research Programme on Alternatives in Development, grants from Population Health Research Institute, during the conduct of the study. Dr. HS Kruger reports personal fees from South African Sugar Association, personal fees from Danone Southern Africa outside the submitted work. Dr. Botha-Le Roux reports grants from South Africa–Netherlands Research Program on Alternatives in Development, grants from Population Health Research Institute, grants from South African Medical Research Council, grants from South African National Research Foundation during the conduct of the study. Dr. Schutte reports personal fees from Servier, personal fees and non-financial support from Takeda, personal fees from Novartis, personal fees from Omron, outside the submitted work. Dr Ricci, Pieters, Moss and Van Zyl have nothing to disclose., (Copyright © 2021 The Italian Diabetes Society, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.)

Objectives: This study examined how household food insecurity (HFI) and chronic stress relate to adiposity among Tsimane' hunter-forager-horticulturalists in remote Bolivia with limited access to energy-dense processed foods that promote weight gain among industrialized populations., Methods: Retrospective cross-sectional data on HFI (via the Household Food Insecurity Access Scale [HFIAS]), hair cortisol concentration (HCC), adiposity (BMI, body fat percentage [%BF]), and sociodemographics were collected from 171 men, 164 women, and 167 children. Linear mixed-effects models tested linear, quadratic, joint, and interactive relationships between adiposity measures and both the HFIAS score and HCC., Results: Among children, each 3-point HFIAS score increase was associated with a 0.44-point higher %BF (SE = 0.22, P = 0.04). However, each 20% increase in HCC was associated with a -0.29-point difference in %BF (SE = 0.12, P = 0.01). Among men, a slight curvilinear relationship emerged between HFIAS and BMI. HFIAS and HCC were unrelated to adiposity measures among women. HCC did not modify relationships between HFIAS and adiposity in any subgroup., Conclusions: These findings from a remote, small-scale population suggest that positive associations between HFI and adiposity are not isolated to contexts of industrialized food environments and heavy reliance on processed foods. However, these dynamics and the role of stress appear to differ by sex and age group., (© 2021 The Obesity Society.)

Preferential fat accumulation in visceral vs. subcutaneous depots makes obese individuals more prone to metabolic complications. Body fat distribution (FD) is regulated by genetics. FD patterns vary across ethnic groups independent of obesity. Asians have more and Africans have less visceral fat compared with Europeans. Consequently, Asians tend to be more susceptible to type 2 diabetes even with lower BMIs when compared with Europeans. To date, genome-wide association studies (GWAS) have identified more than 460 loci related to FD traits. However, the majority of these data were generated in European populations. In this review, we aimed to summarize recent advances in FD genetics with a focus on comparisons between European and non-European populations (Asians and Africans). We therefore not only compared FD-related susceptibility loci identified in three ethnicities but also discussed whether known genetic variants might explain the FD pattern heterogeneity across different ancestries. Moreover, we describe several novel candidate genes potentially regulating FD, including NID2 , HECTD4 and GNAS, identified in studies with Asian populations. It is of note that in agreement with current knowledge, most of the proposed FD candidate genes found in Asians belong to the group of developmental genes.

Background: A four-compartment (4C) model quantifies fat, water, mineral and residual. As such, 4C models are more accurate than two-compartment (2C) models based off cadaver reference values (RV), which necessitate assumptions regarding fat-free mass (FFM) characteristics. Nonetheless, research has yet to determine whether the FFM characteristics of Hispanics are similar to non-Hispanic Caucasians and RV., Aim: The aim of this analysis was to compare the FFM characteristics of Hispanics to non-Hispanic Caucasians and cadaver RV., Methods: Data from 2 separate research centers were pooled to create a sample of 100 and 119 Hispanic males and females (age: 18-54 yrs; BMI: 16.46-42.27 kg/m 2 ), respectively, and 47 and 55 non-Hispanic Caucasian males and females (age: 18-54 yrs; BMI: 16.00-36.67 kg/m 2 ), respectively (n = 331). A 4C model was determined using bioimpedance analysis for hydration, dual energy X-ray absorptiometry for mineral, and air displacement plethysmography for body density (4C-ADP). FFM was calculated via the 4C-ADP and FFM characteristics (i.e., density [D FFM ], water [TBW:FFM], bone mineral [Mo:FFM], and residual [R:FFM]) were compared between sexes and ethnicities using a one-way ANOVA and against RV via a one sample t-test., Results: In Hispanics, all FFM characteristics significantly differed from cadaver RV (all p < 0.05). In contrast, D FFM and TBW:FFM of non-Hispanic Caucasians were similar to cadaver RV for both sexes (all p > 0.05). Moreover, the R:FFM of non-Hispanic Caucasian females did not differ from cadaver RV (p = 0.403) whereas all other comparisons were significantly different (all p < 0.05). Sex comparisons within Hispanic participants revealed FFM characteristics were similar between males and females other than Mo:FFM (p < 0.001) whereas all FFM characteristics were similar between non-Hispanic Caucasian males and females (all p > 0.05). All of the ethnicity comparisons within males were statistically significant (all p < 0.05). Moreover, ethnicity comparisons within females were statistically significant for all comparisons other than Mo:FFM (p = 0.258)., Conclusion: The observed differences in FFM characteristics of Hispanics as compared to non-Hispanics Caucasians and reference values indicate that allied health professionals should employ appropriate caution when estimating body composition via 2C models in Hispanic populations., Competing Interests: Conflict of Interest The authors have no potential, perceived, or real conflicts of interest to disclose., (Copyright © 2020 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Type 2 diabetes is more common in non-Europeans and starts at a younger age and at lower BMI cut-offs. This review discusses the insights from genetic studies about pathophysiological mechanisms which determine risk of disease with a focus on the role of adiposity and body fat distribution in ethnic disparity in risk of type 2 diabetes. During the past decade, genome-wide association studies (GWAS) have identified more than 400 genetic variants associated with the risk of type 2 diabetes. The Eurocentric nature of these genetic studies has made them less effective in identifying mechanisms that make non-Europeans more susceptible to higher risk of disease. One possible mechanism suggested by epidemiological studies is the role of ethnic difference in body fat distribution. Using genetic variants associated with an ability to store extra fat in a safe place, which is subcutaneous adipose tissue, we discuss how different ethnic groups could be genetically less susceptible to type 2 diabetes by developing a more favourable fat distribution., (© 2020 The Authors. Journal of Internal Medicine published by John Wiley & Sons Ltd on behalf of Association for Publication.)

Background: Childhood obesity is a global epidemic, and its prevalence differs by ethnicity. The objective of this study was to estimate the change in ethnic inequalities in child adiposity at age 10 resulting from interventions on diet at age 8 and screen time and sports participation at age 9., Methods: We conducted a population-based cohort study, the Generation R Study, from 9,749 births in Rotterdam (2002-2006), of which 9,506 children remained in the analysis. We measured ethnicity, diet, screen time, and sports participation through questionnaires; we measured weight, body mass index (BMI), fat mass index, and fat-free mass index directly. We used sequential G-estimation to estimate the reduction in inequality that would result from the interventions., Results: We observed that sociodemographic characteristics, diet, screen time, sports participation, and all adiposity measurements were more favorable in children from Western versus non-Western ethnic backgrounds: weight = -1.2 kg (95% confidence interval [CI] = -1.7, -0.8), BMI = -1.0 kg/m (CI = -1.2, -0.9), and fat mass index = -0.8 kg/m (CI = -0.9, -0.7). We estimated that extreme intervention (maximum diet score of 10, no screen time, and >4 hours/week of sports) reduced ethnic inequalities by 21% (CI = 8%, 35%) for weight, 9% (CI = 4%, 14%) for BMI, and 9% (CI = 6%, 13%) for fat mass index. A diet score ≥5 points, screen time ≤2 hours/day, and sports participation >2 hours/week reduced ethnic inequalities by 17% (CI = 6%, 28%) for weight, 7% (CI = 3%, 11%) for BMI, and 7% (CI = 4%, 10%) for fat mass index., Conclusions: Our results are consistent with the hypothesis that interventions integrating diet, screen time, and sports participation have a moderate impact on reducing ethnic inequalities in child adiposity.

Background: Adipose tissue (AT) around and within non-AT organs (i.e., ectopic adiposity) is emerging as a strong risk factor for type 2 diabetes (T2D). Not known is whether major ectopic adiposity depots, such as hepatic, skeletal muscle, and pericardial adiposity (PAT), are associated with T2D independent of visceral adiposity (VAT). More data are particularly needed among high-risk nonobese minority populations, as the race/ethnic gap in T2D risk is greatest among nonobese. Methods: Thus, we measured several ectopic adiposity depots by computed tomography in 718 (mean age = 64 years) African-Caribbean men on the Island of Tobago overall, and stratified by obesity (obese N = 187 and nonobese N = 532). Results: In age, lifestyle risk factors, health status, lipid-lowering medication intake, body mass index and all other adiposity-adjusted regression analyses, and hepatic and skeletal muscle adiposity were associated with T2D among nonobese men only (all P  < 0.05), despite no association between VAT and PAT and T2D. Conclusions: Our results support the "ectopic fat syndrome" theory in the pathogenesis of T2D among nonobese African-Caribbean men. Longitudinal studies are needed to clarify the independent role of ectopic adiposity in T2D, and to identify possible biological mechanisms underlying this relationship, particularly in high-risk African ancestry and other nonwhite populations.

Arterial stiffness (AS) and obesity are recognized as important risk factors of cardiovascular disease (CVD). The purpose of this study was to investigate the relationship between AS and obesity. AS was defined as high augmentation index (AIx) and low elasticity (C1, large artery elasticity; C2, small artery elasticity) in participants enrolled in the Multi-Ethnic Study of Atherosclerosis at baseline. We compared AIx, C1, and C2 by body mass index (BMI) (< 25, 25-29.9, 30-39.9, ⩾ 40 kg/m 2 ) and waist-hip ratio (WHR) (< 0.85, 0.85-0.99, ⩾ 1). The obesity-AS association was tested across 10-year age intervals. Among 6177 participants (62 ± 10 years old, 52% female), a significant inverse relationship was observed between obesity and AS. After adjustments for CVD risk factors, participants with a BMI > 40 kg/m 2 had 5.4% lower AIx (mean difference [Δ] = -0.82%; 95% CI: -1.10, -0.53), 15.4% higher C1 (Δ = 1.66 mL/mmHg ×10; 95% CI: 1.00, 2.33), and 40.2% higher C2 (Δ = 1.49 mL/mmHg ×100; 95% CI: 1.15, 1.83) compared to those with a BMI < 25 kg/m 2 (all p for trend < 0.001). Participants with a WHR ⩾ 1 had 5.6% higher C1 (∆ = 0.92 mL/mmHg ×10; 95% CI: 0.47, 1.37) compared to those with a WHR < 0.85. The WHR had a significant interaction with age on AIx and C2, but not with BMI; the inverse relationships of the WHR with AIx and C2 were observed only in participants < 55 years between the normal (WHR < 0.85) and the overweight (0.85 ⩽ WHR < 0.99) groups. Different associations of WHR and BMI with arterial stiffness among older adults should be further investigated.

Objective: Little is known about the relationship between adiposity and telomere length in the United States population. The objective of our research was to examine this relationship in a representative, socioeconomically and sex-specific, diverse racial/ethnic population in the United States., Methods: Body mass index (BMI), % total body fat (TBF) and waist circumference (WC) with leukocyte telomere length (LTL) were examined according to sex-specific race/ethnicity using separate adjusted multivariate linear regressions on a sample of 4,919 respondents aged 20-84 years from the National Health and Nutrition Examination Survey's 1999-2002 data., Results: LTL was shortened .41%, .44%, and .16% in African American (AA) women and was associated with increasing BMI, %TBF, and WC, ( β :-.0041, 95%CI: -.0070, -.0012; P=.007; β :-.0044, 95% CI: -.0081, -.0007; P=.02; β :-.0016, 95%CI: -.0031, -.0001; P=.04, respectively). LTL was shortened .29% in White women and was associated with increasing %TBF ( β :-.0029, 95%CI: -.0048, -.0009; P=.006). There were no associations among AA men, White men or Mexican American men and women., Conclusions: LTL is associated with an obesity phenotype in AA women. Tailored intervention is needed to ameliorate the burden of excess adiposity and subsequent cellular aging., Competing Interests: Competing Interests: None declared., (Copyright © 2020, Ethnicity & Disease, Inc.)

Purpose: General and central adiposity are associated with the risk of developing prostate cancer (PCa), but the role of these exposures on PCa survival among men of African ancestry are less studied. This study aimed to investigate the association of anthropometry at diagnosis with all-cause and PCa-specific mortality and evaluate whether androgen deprivation therapy (ADT) modulated this risk., Methods: Associations between body mass index (BMI), waist circumference (WC), and waist-to-hip ratio (WHR) at diagnosis and mortality were examined in 242 men with newly diagnosed PCa enrolled between 2005 and 2007 and re-evaluated 10.9 years later. Multi-variable Cox proportional hazard models were used to examine associations of body size variables (using standard WHO cut-points and as continuous variables) with mortality, adjusted for sociodemographic characteristics, Gleason score, smoking, diabetes, primary treatment, and ADT therapy., Results: A total of 139 deaths (all-cause mortality 6.98/100 person-years) occurred (PCa-specific deaths, 56; other causes, 66; causes unknown, 17). In multi-variable analysis BMI, WC and WHR categories at diagnosis were not associated with all-cause mortality even after adjusting for ADT. While WHR (but not BMI or WC) when included as a continuous variable predicted lower PCa-specific mortality (multi-variable adjusted WHR per 0.1 difference: HR, 0.50; 95%CI 0.28, 0.93), the effect disappeared with ADT covariance and excluding deaths within the first 2 years., Conclusion: Our study suggests that central adiposity as measured by WHR may improve long-term survival among men of African ancestry. Metabolic studies to understand the mechanism for this association are needed.

Background and Aims: Visceral obesity is a marker of dysfunctional adipose tissue and ectopic fat infiltration. Many studies have shown that visceral fat dysfunction has a close relationship with cardiovascular disease. For a better identification of visceral adiposity dysfunction, the visceral adiposity index (VAI) is used. Coronary artery calcium score (CACS) is known to have a strong correlation with the total plaque burden therefore provides information about the severity of the coronary atherosclerosis. CACS is a strong predictor of cardiac events and it refines cardiovascular risk assessment beyond conventional risk factors. Our aim was to evaluate the association between VAI and CACS in an asymptomatic Caucasian population., Methods and Results: Computed tomography scans of 460 participants were analyzed in a cross-sectional, voluntary screening program. A health questionnaire, physical examination and laboratory tests were also performed. Participants with a history of cardiovascular disease were excluded from the analysis. Mean VAI was 1.41 ± 0.07 in men and 2.00 ± 0.15 in women. VAI showed a positive correlation with total coronary calcium score (r = 0.242) in males but not in females. VAI was stratified into tertiles by gender. In males, third VAI tertile was independently associated with CACS>100 (OR: 3.21, p = 0.02) but not with CACS>0 after the effects of conventional risk factors were eliminated., Conclusion: VAI tertiles were associated with calcium scores and the highest VAI tertile was an independent predictor for the presence of CACS>100 in males but not in females., Competing Interests: Declaration of Competing Interest The authors declare that they have no conflict interests., (Copyright © 2020 The Italian Society of Diabetology, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition, and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.)

Background: South Asians generally have an unfavourable metabolic phenotype compared with white Caucasians, including central obesity and insulin resistance. The Wnt protein family interacts with insulin signaling, and impaired Wnt signaling is associated with adiposity and type 2 diabetes mellitus. We aimed to investigate Wnt signaling in relation to insulin signaling in South Asians compared with white Caucasians., Methods: Ten Dutch South Asian men with prediabetes and overweight or obesity and 10 matched Dutch white Caucasians were included. Blood samples were assayed for the Wnt inhibitor sclerostin. Subcutaneous white adipose tissue (WAT) and skeletal muscle biopsies were assayed for Wnt and insulin signaling gene expression with quantitative reverse transcription polymerase chain reaction (Clinicaltrials.gov NCT02291458)., Results: Plasma sclerostin was markedly higher in South Asians compared with white Caucasians (+65%, P <0.01). Additionally, expression of multiple Wnt signaling genes and key insulin signaling genes were lower in WAT in South Asians compared with white Caucasians. Moreover, in WAT in both ethnicities, Wnt signaling gene expression strongly positively correlated with insulin signaling gene expression. In skeletal muscle, WNT10B expression in South Asians was lower, but expression of other Wnt signaling and insulin signaling genes was comparable between ethnicities. Wnt and insulin signaling gene expression also positively correlated in skeletal muscle, albeit less pronounced., Conclusion: South Asian men with overweight or obesity and prediabetes have higher plasma sclerostin and lower Wnt signaling gene expression in WAT compared with white Caucasians. We interpret that reduced Wnt signaling could contribute to impaired insulin signaling in South Asians., Competing Interests: No potential conflict of interest relevant to this article was reported., (Copyright © 2020 Korean Diabetes Association.)

Objectives: Vitamin D is involved in various physiologic and pathologic processes in the human body. The aim of this study was to determine the prevalence of vitamin D deficiency and the association of adiposity indicators with 25-hydroxyvitamin D (25[OH]D) in Chinese children and adolescents., Methods: This was a population-based, nationwide, multicenter cross-sectional study involving 10 696 participants (51.2% boys) 6 to 18 y of age. Total body fat mass was assessed by dual-energy x-ray absorptiometry, and measures of body mass index (BMI), fat mass index (FMI), fat mass percentage (FMP), and plasma 25(OH)D concentrations were obtained., Results: The adjusted mean of 25(OH)D was 39.3 nmol/L for all participants, 40.7 nmol/L for boys, and 37.9 nmol/L for girls. Of the children, 30% had vitamin D deficiency (25[OH]D <30 nmol/L) and 80% had vitamin D insufficiency (25[OH]D <50 nmol/L). The prevalence rates of vitamin D deficiency and insufficiency were higher in girls (31%, 83.4%, respectively) than in boys (22.8%, 78.7%, respectively). An L-shape relationship between age and 25(OH)D was observed in all children, with a threshold age of 14 y. Also, there was an inverted U-shaped association of BMI with 25(OH)D, and multivariable linear models shown FMI and FMP were inversely associated with 25(OH)D concentrations, particularly in boys (β = -0.86 and -0.83, respectively, all P < 0.05)., Conclusions: Vitamin D deficiency was widespread and its sex-specific association with an excess of body fat in Chinese children and adolescents. The findings indicate that targeted screening and treatment guidelines may be useful., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Objective: Early life physical activity may help prevent obesity, but objective quantification in infants is challenging., Methods: A total of 506 infants were examined from 2013 to 2016. Infants wore accelerometers for 4 days at ages 3, 6, 9, and 12 months. Daily log-transformed physical activity counts were computed, averaged, and standardized across assessments. A linear mixed model was used to examine trends in standardized physical activity counts as well as associations between physical activity and BMI z score, sum of subscapular and triceps skinfold thickness for overall adiposity (SS+TR), and their ratio for central adiposity (SS:TR)., Results: Among infants, 66% were black and 50% were female. For each additional visit, standardized physical activity counts increased by 0.23 (CI: 0.18 to 0.27; P < 0.0001). This translates to 126.3 unadjusted physical activity counts or a 4% increase for each visit beyond 3 months. In addition, a 1-SD increase in standardized physical activity counts (550 unadjusted physical activity counts) was associated with a 0.01-mm lower SS:TR (95% CI: -0.02 to -0.001; P = 0.03). However, standardized physical activity counts were not associated with BMI z score or SS+TR., Conclusions: Physical activity increased over infancy and was associated with central adiposity. Despite limitations, researchers should consider objective measurement in infants., (© 2020 The Authors. Obesity published by Wiley Periodicals, Inc. on behalf of The Obesity Society (TOS).)

Background: Australian Indigenous women experience high rates of social disadvantage and type 2 diabetes (T2D) in pregnancy, but it is not known how social factors and maternal behaviours impact neonatal adiposity in offspring of women with hyperglycaemia in pregnancy., Methods: Participants were Indigenous (n = 404) and Europid (n = 240) women with gestational diabetes mellitus (GDM) or T2D in pregnancy and their offspring in the Pregnancy and Neonatal Diabetes Outcomes in Remote Australia (PANDORA) study. Social, economic factors, and maternal behaviours were measured in pregnancy and six neonatal anthropometric outcomes were examined after birth., Results: On univariate analysis, maternal education < 12 years (p = 0.03), unemployment (p = 0.001), welfare income vs no welfare income (p = 0.001), lower area based socio-economic score (p < 0.001), and fast food intake > 2 times/week (p = 0.002) were associated with increased sum of skinfolds (SSF) in offspring. Smoking was significantly associated with a reduction in anthropometric measures, except SSF. In multivariable models adjusted for ethnicity, BMI and hyperglycaemia, social and economic factors were no longer significant predictors of neonatal outcomes. Smoking was independently associated with a reduction in length, head circumference and fat free mass. Frequent fast food intake remained independently associated with SSF (β-coefficient 1.08 mm, p = 0.02)., Conclusion: In women with hyperglycaemia in pregnancy, social factors were associated with neonatal adiposity, particularly skinfold measures. Promoting smoking cessation and limited intake of energy-dense, nutrient-poor foods in pregnancy are important to improve neonatal adiposity and lean mass outcomes. Addressing inequities in social and economic factors are likely to be important, particularly for Indigenous women or women experiencing social disadvantage., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Rationale: In black women, triglycerides are paradoxically normal in the presence of insulin resistance. This relationship may be explained by race-related differences in central adiposity and SCD (stearoyl-CoA desaturase)-1 enzyme activity index., Objective: In a cross-sectional study, to compare fasting and postprandial triglyceride-rich lipoprotein particle (TRLP) concentrations and size in black compared with white pre- and postmenopausal women and determine the relationship between TRLP subfractions and whole-body insulin sensitivity, hepatic and visceral fat, and SCD-1 levels., Methods and Results: In 122 federally employed women without diabetes mellitus, 73 black (58 African American and 15 African immigrant) and 49 white; age, 44±10 (mean±SD) years; body mass index, 30.0±5.6 kg/m 2 , we measured lipoprotein subfractions using nuclear magnetic resonance. Hepatic fat was measured by proton magnetic resonance spectroscopy, insulin sensitivity index calculated by minimal modeling from a frequently sampled intravenous glucose test, and red blood cell fatty acid profiles were measured by gas chromatography and were used to estimate SCD-1 indices. Hepatic fat, insulin sensitivity index, and SCD-1 were similar in black women and lower than in whites, regardless of menopausal status. Fasting and postprandial large, medium, and small TRLPs, but not very small TRLPs, were lower in black women. Fasting large, medium, and very small TRLPs negatively correlated with insulin sensitivity index and positively correlated with visceral and hepatic fat and SCD-1 activity in both groups. In multivariate models, visceral fat and SCD-1 were associated with total fasting TRLP concentrations (adjR2, 0.39; P =0.001). Black women had smaller postprandial changes in large ( P =0.005) and medium TRLPs ( P =0.007)., Conclusions: Lower visceral fat and SCD-1 activity may contribute to the paradoxical association of lower fasting and postprandial TRLP subfractions despite insulin resistance in black compared with white pre- and postmenopausal women. Similar concentrations of very small TRLPs are related to insulin resistance and could be important mediators of cardiometabolic disease risk in women., Clinical Trial Registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01809288.

Normal body mass index (BMI) is associated with lower risk for cardiometabolic diseases. However, there is a subset of individuals with BMI in this range who present with this metabolic abnormality (called metabolically unhealthy normal weight, MUHNW). Here we aimed to assess the adipose characteristics of people with MUHNW using dual-energy X-ray absorptiometry (DXA). This study included 3259 people with normal BMI who underwent health examinations from January 1, 2007 through December 31, 2016. Body fat percentage (%BF), android-gynoid percent fat ratio (AG ratio), and visceral adipose tissue (VAT) were measured simultaneously using DXA CoreScan software. Those with MUHNW comprised 12.67% of the sample. Among those with MUHNW, 71.6% of the women and 56.5% of the men showed high VAT amounts, but less than 40% of either showed high %BFs. Furthermore, considering the combined effects of fat amount and distribution, a normal BMI accompanied by high AG ratio and/or high VAT mass but low %BF presents a much higher risk for metabolic syndrome than when %BF is high, most predominantly in women. In conclusion, using DXA-measured abdominal fat, particularly VAT accumulation, is clinically more important than using %BF when assessing metabolic syndrome in those with normal BMI.

Background: Cardiovascular disease has its origins in adolescents. Endothelial dysfunction, arterial stiffness, and decreased endocardial oxygen supply: demand ratios are early functional markers of cardiovascular risk. The goal of this study was to determine the relationships of these markers to physical, inflammatory, and metabolic markers in healthy non-Hispanic, white adolescents., Methods: Thirty-four of the 75 subjects were female. Mean age was 15.0 ± 1.7 years and mean body mass index (BMI) was 22.0 ± 5.8 kg/m 2 (mean ± SD). Reactive hyperemia was measured using venous occlusion plethysmography. Arterial tonometry was used to measure the augmentation index (AIx 75 ) and the Buckberg subendocardial viability ratio. Blood samples were taken to measure inflammatory and lipid markers and oral glucose tolerance test was used to assess insulin sensitivity., Results: Reactive hyperemia decreased as body mass and fat mass increased. It also decreased with increasing neutrophil count. The Buckberg index was higher in males and was positively related to insulin sensitivity even when accounting for age, sex, and resting heart rate. AIx 75 was not related to any of the other variables., Conclusions: These results demonstrate that increased fat mass and decreased insulin sensitivity are related to poorer vascular function and cardiac risk in adolescents before the development of actual cardiovascular disease., (© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objective: It has been assumed that, for a given BMI, Asians have higher percent body fat (PBF) than Caucasians. As a result, it has been suggested that the BMI threshold for diagnosing obesity in Asians be lowered to less than  30 kg/m 2 . This study sought to compare PBF between Koreans and Australians., Methods: Whole-body fat mass and PBF were measured in 1,211 Koreans and 1,006 Australians using dual-energy x-ray absorptiometry (Lunar Prodigy; GE Healthcare, Madison, Wisconsin). The two groups were then matched for age and BMI by the propensity score method., Results: For a given age and BMI, Koreans had lower PBF than Australians, and the difference was statistically significant in women (mean difference: -2.13%; 95% CI: -2.61% to -1.65%) but not in men (difference: -0.54%; 95% CI: -1.22% to 0.14%). Matched-pair analysis (423 pairs of women and 208 pairs of men) also showed that Korean women had statistically lower PBF than their Australian counterparts (P < 0.001)., Conclusions: In individuals aged 60 years and older, Koreans do not have higher PBF than Australians after adjusting for BMI. These results suggest that there is no evidence for lowering the BMI threshold for the diagnosis of obesity in elderly Koreans., (© 2019 The Obesity Society.)

Purpose of Review: Excessive adiposity has become a public health problem worldwide, contributing to the rise in obesity-related diseases and associated morbidity and mortality. This review details the relative significance of race/ethnicity as it pertains to adiposity and non-alcoholic fatty liver disease (NAFLD)., Recent Findings: Fat distribution remains a more reliable measure of adiposity than anthropometric measures, with visceral adipose tissue (VAT) associated with increased risk of cardiometabolic disease. While obesity is the most common risk factor for NAFLD, the racial/ethnic prevalence of obesity does not completely parallel NAFLD risk. Combating racial/ethnic disparities in obesity requires understanding differential risk among various groups. Hispanics are disproportionally impacted by NAFLD and have high rates of obesity, VAT, and insulin resistance (IR). This contrasts with Blacks, who have high prevalence of obesity and IR, accompanied by a paradoxically favorable lipid profile and low prevalence of VAT and NAFLD. Many features of adiposity and NAFLD are mediated by genetic and environmental factors, the latter being modifiable and the focus of interventions.

Various indicators have been suggested as replacements of body mass index (BMI) for estimating body fat percentage, including the recently introduced relative fat mass (RFM). However, RFM has not been assessed in different ethnicities; therefore, we evaluated whether RFM can be used to estimate body fat percentage in Korean adults and whether RFM is a useful indicator of obesity. Based on the Korea National Health and Nutrition Examination Survey (KNHANES) 2008-2011, we analyzed a total of 18,706 individuals (7,970 men, 10,643 women) aged ≥20 years who underwent dual-energy X-ray absorptiometry. We compared obesity (body fat ≥25% for men, 35% for women) misclassification rate of RFM (≥25 for men, 35 for women) and BMI (≥25 kg/m 2 ). Diagnostic accuracy and optimal cut-offs of BMI and RFM were verified by comparing area under the receiver operating characteristic curve (AUC). RFM and BMI misclassification rates were similar obesity diagnosis based on body fat percentage (27.9% vs. 27.8%) among men. RFM misclassification rate was lower than that of BMI (22% vs. 45%) in women. AUC of RFM was higher in men (AUC: 0.79 vs. 0.78; p = 0.004) and lower in women (AUC: 0.80 vs. 0.83) than those of BMI (p < 0.001). In this study, RFM showed diagnostic accuracy for detecting excess body fat percentage, comparable to that of BMI. Using RFM with BMI could be beneficial in improving the diagnostic accuracy of obesity assessment in women.

Background: Type 2 diabetes etiology has a strong genetic component. More than 20 genetic variants have been associated with diabetes and other metabolic markers. However, the polymorphism rs7903146 of the TCF7L2 gene has shown the strongest association., Aim: To investigate the association of TCF7L2 (rs7903146) genotype with adiposity and metabolic markers in the Chilean adult population., Material and Methods: The association of TCF7L2 (rs7093146) with adiposity and metabolic markers was studied in 301 participants. The outcomes of the study were adiposity markers (body weight, body mass index (BMI), fat mass and waist circumference) and metabolic markers (blood glucose, insulin, HOMA-IR, lipid profile, high sensitivity C-reactive protein (CRP), alanine aminotransferase (ALT), gamma glutamyl transpeptidase (GGT) and leptin)., Results: There was an association between the polymorphism TCF7L2 genotype and fasting blood glucose. The latter increased by 4.86 mg/dl per each copy of the risk allele [(95% confidence intervals (CI): 0.48; 9.24), p = 0.03] in the unadjusted adjusted model. However, this association was slightly attenuated in the fully adjusted model [4.38 mg/dl (95% IC: 0.16; 8.60), p = 0.04)]. There were no associations between the TCF7L2 genotype and any other metabolic or adiposity outcome., Conclusions: These findings confirm the association between the TCF7L2 (rs7903146) and fasting glucose in the Chilean population. However, further studies are needed to confirm the association between the TCF7L2 and diabetes risk in the Chilean population.

Background: Diets rich in n-6 polyunsaturated fatty acids (PUFAs) and saturated fatty acids (SFA) have been associated with increased risk of obesity and the metabolic syndrome (MetS), but the evidence is inconsistent, whereas diets high in n-3 long-chain (LC) -PUFAs are associated with lower risk. There is limited information about the association of plasma phospholipid fatty acids (FAs) with obesity and the MetS among black South Africans., Objective: To investigate the association of dietary FAs and plasma phospholipid FA patterns, respectively, with measures of adiposity (body mass index, waist circumference, waist-to-height ratio) and the MetS in black South Africans., Methods: Factor analysis was used to identify FA patterns from 11 dietary FAs and 26 individual plasma phospholipid FAs. Cross-sectional association of the identified patterns with measures of adiposity and the MetS was investigated. A random sample of 711 black South African adults aged 30 to 70 years (273 men, 438 women) from the North West Province was selected from the South African leg of the Prospective Urban and Rural Epidemiology (PURE) study. Sequential regression models adjusted for confounders were applied to investigate the association between dietary FAs and plasma phospholipid FA patterns with measures of adiposity and the MetS., Results: Two patterns were derived from dietary FAs and six patterns from plasma phospholipid FAs that explained the cumulative variance of 89 and 73%, respectively. The association of FA patterns with adiposity and the MetS was weaker for dietary FA patterns than for plasma phospholipid FA patterns. The plasma phospholipid FA pattern with high loadings of saturated FAs (high-Satfat) and another with high loadings of n-3 very-long-chain PUFAs (n-3 VLC-PUFAs) were positively associated with measures of adiposity and the MetS, while patterns with positive loadings of LC monounsaturated fatty acids (n-9 LC-MUFA) and a positive loading of n-3 essential FAs (n-3 EFA) showed inverse associations with the MetS and some measures of adiposity., Conclusion: The n-9 LC-MUFA and n-3 EFA patterns seemed to provide possible protective associations with adiposity and the MetS, whereas the high-Satfat and n-3 VLC-PUFA patterns were associated with adiposity and the MetS in our study participants. The results are reflective of the metabolic difference between overweight and obese compared to lean individuals.

Living South Asians have low lean tissue mass relative to height, which contributes to their elevated type 2 diabetes susceptibility, particularly when accompanied by obesity. While ongoing lifestyle transitions account for rising obesity, the origins of low lean mass remain unclear. We analysed proxies for lean mass and stature among South Asian skeletons spanning the last 11,000 years (n = 197) to investigate the origins of South Asian low lean mass. Compared with a worldwide sample (n = 2,003), South Asian skeletons indicate low lean mass. Stature-adjusted lean mass increased significantly over time in South Asia, but to a very minor extent (0.04 z-score units per 1,000 years, adjusted R 2  = 0.01). In contrast stature decreased sharply when agriculture was adopted. Our results indicate that low lean mass has characterised South Asians since at least the early Holocene and may represent long-term climatic adaptation or neutral variation. This phenotype is therefore unlikely to change extensively in the short term, so other strategies to address increasing non-communicable disease rates must be pursued.

Background: South Asians have a high risk to develop type 2 diabetes, which may be related to substantial ectopic fat deposition. Since glucagon-like peptide-1 analogues can reduce ectopic fat accumulation, the aim of the present study was to assess the effect of treatment with liraglutide for 26 weeks on ectopic fat deposition and HbA1c in South Asian patients with type 2 diabetes., Methods: In a placebo-controlled trial, 47 South Asian patients with type 2 diabetes were randomly assigned to treatment with liraglutide (1.8 mg/day) or placebo added to standard care. At baseline and after 26 weeks of treatment we assessed abdominal subcutaneous, visceral, epicardial and paracardial adipose tissue volume using MRI. Furthermore, myocardial and hepatic triglyceride content were examined with proton magnetic resonance spectroscopy., Results: In the intention-to-treat analysis, liraglutide decreased body weight compared to placebo (- 3.9 ± 3.6 kg vs - 0.6 ± 2.2 kg; mean change from baseline (liraglutide vs placebo): - 3.5 kg; 95% CI [- 5.3, - 1.8]) without significant effects on the different adipose tissue compartments. HbA1c was decreased in both groups without between group differences. In the per-protocol analysis, liraglutide did decrease visceral adipose tissue volume compared to placebo (- 23 ± 27 cm 2 vs - 2 ± 17 cm 2 ; mean change from baseline (liraglutide vs placebo): - 17 cm 2 ; 95% CI [- 32, - 3]). Furthermore, HbA1c was decreased by liraglutide compared to placebo (- 1.0 ± 0.8% (- 10.5 ± 9.1 mmol/mol)) vs (- 0.6 ± 0.8% (- 6.1 ± 8.8 mmol/mol)), with a between group difference (mean change from baseline (liraglutide vs placebo): - 0.6% (- 6.5 mmol/mol); 95% CI [- 1.1, - 0.1 (- 11.5, - 1.5)]). Interestingly, the decrease of visceral adipose tissue volume was associated with the reduction of HbA1c (β: 0.165 mmol/mol (0.015%) per 1 cm 2 decrease of visceral adipose tissue volume; 95% CI [0.062, 0.267 (0.006, 0.024%)])., Conclusions: While the intention-to-treat analysis did not show effects of liraglutide on ectopic fat and HbA1c, per-protocol analysis showed that liraglutide decreases visceral adipose tissue volume, which was associated with improved glycaemic control in South Asians. Trial registration NCT02660047 (clinicaltrials.gov). Registered 21 January 2016.

The objective of the study was to analyse selected anthropometric features of children, adolescents and young adults from middle-class families in Kolkata, India, by BMI and adiposity categories. Standardized anthropometric measurements of 4194 individuals (1999 male and 2195 female) aged 7-21 were carried out between the years 2005 and 2011. The results were compared by BMI and adiposity categories. Statistical significance was assessed using two-way-ANOVA and linear regression analysis was performed. The study population could be differentiated in terms of BMI and adiposity categories for all examined anthropometric characteristics (p ≤ 0.001). After taking age into consideration, differences were observed for males in the case of body height and humerus breadth in BMI and adiposity categories, and for femur breadth in the case of adiposity categories. For females, differences were noted in body height measurements in BMI and adiposity categories, a sum of skinfold thicknesses in BMI categories, and upper-arm and calf circumferences in adiposity categories. The patterns of differences in the BMI categories were found to be similar to those in adiposity categories. The linear regression analysis results showed that there was a significant relationship between BMI and body fat ratio in the examined population. Underweight individuals, and those with low adiposity, were characterized by lower extremity circumferences and skeletal breadths. These features reached highest values in overweight/obese persons, characterized by high body fat. However, the differences observed between each BMI and adiposity category, in most cases, were only present in early childhood.

High body fat in apparently lean individuals is a commonly described phenotype in individuals of Asian descent, but very limited consolidated scientific literature is available on this topic. This phenotype is known as 'normal-weight obesity' and may explain the large disparity between the prevalence of obesity (as measured by BMI) and diabetes that occurs in these individuals. Routine use of obesity indicators that best predict body fat content would help to identify these individuals in clinical practice. In this debate, we would like to highlight that even though fat and BMI have a good correlation, as suggested by Kryst et al. (2019), clinicians, public health researchers and policymakers should consider the use of these indicators in conjunction with each other rather than individually. Future research is needed on pathogenic mechanisms, diagnostic modalities and therapeutic options in these individuals which will help to further characterize and manage these patients appropriately.

This study investigated associations between cardiovascular health (CVH), adiposity, and food insecurity by race, sex, and health literacy in a sample of 800 underserved patients with obesity (body mass index [BMI] ≥ 30 kg/m 2 ). CVH was assessed using American Heart Association Life's Simple 7 (LS7) and adiposity was estimated using BMI and waist circumference (WC). Mixed models including interaction terms between food insecurity and sex, race, and health literacy were analyzed for LS7, BMI, and WC. Stratified models were analyzed as indicated by significant interactions. Mean BMI and WC were 37.3 kg/m 2 (4.6 SD) and 113.5 cm (12.4 SD), respectively. Among patients, 31% were food insecure and 31% had low health literacy. There were significant positive associations between food insecurity and BMI ( p = 0.03) and WC ( p = 0.03) in the overall sample. In sex-stratified models, women who were food insecure had higher BMI ( p = 0.02) and WC ( p = 0.007) than their food secure counterparts. Further, food insecure patients with better health literacy had greater BMI ( p = 0.004) and WC ( p = 0.007) than their food secure counterparts. Results suggest that adiposity is a greater burden in food insecure patients, which may be an important consideration for obesity treatment in underserved populations.

Age- and sex-based BMI cut-offs are used to define overweight and obesity, but the relationship between BMI and body composition has not been very well studied in children or compared between children of different ethnic groups. Body size and composition in childhood are also influenced by size at birth. Our aim was to compare body size and composition at 2 years in children with different ethnicity and size at birth. We prospectively followed a multi-ethnic cohort of 300 children born with risk factors for neonatal hypoglycaemia (infants of diabetics, large or small at birth or late preterm) to 2 years corrected age. Complete data on weight, height and head circumference and body composition using bioelectrical impedance 24±1 months corrected age were available in 209 children. At birth, compared with European children, Chinese, Indian and other ethnicity children were lighter, and Indian children had smaller head circumferences, but birth lengths were similar in all ethnic groups. At 2 years, Pacific children were heavier and had higher BMI z scores, and Indian children had smaller head circumferences and lower BMI z scores than those from other ethnic groups. However, fat mass and fat-free mass indices were similar in all groups. At median BMI, fat mass:fat-free mass ratio was 23 % lower in Pacific than in Indian children (0·22 v. 0·27, P=0·03). BMI is not a good indicator of adiposity in this multi-ethnic cohort of 2-year-old New Zealand children.

Background: Waist circumference has been suggested as predictor for metabolic syndrome (MetS) in adolescents but it has not been compared with newly proposed anthropometric indexes. This study aimed to disclose the capacity of ten classic and novel anthropometric indexes to discriminate by the presence of MetS in this young population., Materials and Methods: A cross-sectional study was performed on 981 adolescents (13.2 ± 1.2 years) randomly recruited from eighteen schools in south-east Spain. Body fat percentage (BF%), abdominal volume index (AVI), body roundness index (BRI), body mass index (BMI), body adiposity index (BAI), body adiposity index for paediatrics (BAIp), conicity index (C-Index), waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR) and body shape index (ABSI) were measured and calculated. Receiver-operator curves (ROC) were created to determine the discriminatory capacity of these anthropometric parameters for MetS., Results: The prevalence of MetS was 7.0% for boys and 6.1% in girls. Participants with MetS had significantly higher levels of blood pressure and plasma levels of lipids, glucose and insulin. All anthropometric indexes were elevated in MetS individuals compared to the non-MetS group. AVI and WC showed the highest AUC values (0.83 for boys and 0.86 for girls). In contrast, according to ROC analyses, no anthropometric index was capable of discriminating the components of MetS (hypertension, hypertriglyceridemia, hyperglycaemia and low-HDL levels), except for abdominal obesity., Conclusion: We suggest the use of WC and AVI, with the cut-off points presented herein, for the discrimination between adolescents with or without MetS., (© 2018 Stichting European Society for Clinical Investigation Journal Foundation.)

Although cross-sectional studies have shown that obesity is associated with lower concentrations of large high-density lipoprotein (HDL) subclasses, it is unknown if changes in HDL subclasses are related to changes in body fat and its distribution over time. We therefore assessed changes in HDL subclass distribution over a 5.5-year free-living follow-up period in 24 black South African women. At baseline and follow-up, body composition and body fat distribution were measured using anthropometry, dual X-ray absorptiometry, and computerized tomography. HDL subclass distribution was quantified using Lipoprint®. Over the 5.5-year follow-up period, body fat (+17.3 ± 4.5 kg, p < 0.05) and trunk fat mass (+7.4 ± 1.9%, % fat mass, FM, p < 0.05) increased, while leg fat mass (-2.53 ± 0.56%, % FM, p < 0.001) and the distribution of large (-6.43 ± 2.12%, p < 0.05) HDL subclasses decreased. A percentage decrease in large HDL subclasses was associated with a percentage increase in central fat mass (visceral adipose tissue (VAT) area, p < 0.05) and a percentage decrease in peripheral fat mass (leg fat mass). These preliminary findings suggest that a relative redistribution of body fat from the periphery to the abdominal region were associated with a decrease HDL subclass size in black South African women and provide a novel link between body fat distribution and lipidology in this population.

Background: Short sleep duration has been consistently associated with obesity. However, few studies in adults have assessed whether this association varies by sex and race., Methods: In the 2013-2016 examination of 1116 participants from the biracial Bogalusa Heart Study, habitual sleep duration was measured in categories (<6 hours, 6-7 hours, 7-8 hours, > 8 hours) using self-report. Anthropometry was performed and adiposity was assessed using body mass index (BMI) and waist circumference. Linear regression models estimated the relationship between sleep duration and adiposity adjusting for age, education, employment, bed partner status, depressive symptoms, smoking status, physical activity, and the use of alcohol and sleeping pills. Effect modification by sex and race was examined using cross-product terms in the models and marginal means were reported., Results: Of 1116 participants (mean age 48.2 years), 58.3% were female, and 31.7% were Black. In adjusted analyses, women sleeping <6 hours had a 3.2 (95% CI 1.4, 5.0) kg/m 2 greater BMI and 6.1 (1.8, 10.4) cm greater waist circumference compared to women sleeping 7-8 hours. In contrast, men had similar BMIs and waist circumferences regardless of sleep duration (p's for interaction = 0.04 & 0.11). There was no effect modification by race., Conclusions: In this sample, lower habitual sleep duration was associated with greater adiposity among women compared to men. Further research is needed to understand the potential mechanisms of the adverse metabolic effects of short sleep in women., (Copyright © 2018 National Sleep Foundation. Published by Elsevier Inc. All rights reserved.)

Background: Body mass index (BMI) represents a normalization of weight to height and is used to classify adiposity. While the capacity of BMI as an adiposity index has been experimentally validated in Caucasians, but there has been little testing Asian populations., Methods: To determine whether weight scales to height squared in Asian Indians across the general population and in Asian Indian tribes an allometric analysis on the power law model, W = αH β , where W is weight (kg) and H is height (m) was performed on cross-sectional weight and height data from India (N = 43,880) collected through the Anthropological Survey of India. The database contained males 18-84 years of age spanning 161 districts of 14 states and including 33 different tribes (N = 5,549). Models were developed that were unadjusted and adjusted for tribe membership. The Korean National Health and Nutrition Examination Survey (KNHANES) was used to compare to height-weight data from the Anthropological Survey of India and to calculate BMI thresholds for obesity status using a receiver operating characteristic., Results: The unadjusted power was β = 2.08 (s = 0.02). The power for the general population (non-tribal) was β = 2.11 (s = 0.02). Powers when adjusted for tribe ranged from 1.87 to 2.35 with 24 of the 33 tribes resulting in statistically significant (p < 0.05) differences in powers from the general population. The coefficients of the adjusted terms ranged from -0.22 to 0.26 and therefore the scaling exponent does not deviate far from 2. Thresholds for BMI classification of overweight in the KNHANES database were BMI = 21 kg/m 2 (AUC = 0.89) for males 18 kg/m 2 (AUC = 0.97) for females. Obesity classification was calculated as BMI = 26 kg/m 2 (AUC = 0.81) and 23 kg/m 2 (AUC = 0.83) for females., Conclusions: Our study confirms that weight scales to height squared in Asian Indian males even after adjusting for tribe membership. We also demonstrate that optimal BMI thresholds are lower in a Korean population in comparison to currently used BMI thresholds. These results support the application of BMI in Asian populations with potentially lower thresholds.

Diet, obesity and adipokines play important roles in diabetes and CVD; yet, limited studies have assessed the relationship between diet and multiple adipokines. This cross-sectional study assessed associations between diet, adiposity and adipokines in Mexican Americans. The cohort included 1128 participants (age 34·7±8·2 years, BMI 29·5±5·9 kg/m2, 73·2 % female). Dietary intake was assessed by 12-month food frequency questionnaire. Adiposity was measured by BMI, total percentage body fat and percentage trunk fat using dual-energy X-ray absorptiometry. Adiponectin, apelin, C-reactive protein (CRP), dipeptidyl peptidase-4 (DPP-IV), IL-1β, IL-1ra, IL-6, IL-18, leptin, lipocalin, monocyte chemo-attractant protein-1 (MCP-1), resistin, secreted frizzled protein 4 (SFRP-4), SFRP-5, TNF-α and visfatin were assayed with multiplex kits or ELISA. Joint multivariate associations between diet, adiposity and adipokines were analysed using canonical correlations adjusted for age, sex, energy intake and kinship. The median (interquartile range) energy intake was 9514 (7314, 11912) kJ/d. Overall, 55 % of total intake was accounted for by carbohydrates (24 % from sugar). A total of 66 % of the shared variation between diet and adiposity, and 34 % of diet and adipokines were explained by the top canonical correlation. The diet component was most represented by sugar-sweetened beverages (SSB), fruit and vegetables. Participants consuming a diet high in SSB and low in fruits and vegetables had higher adiposity, CRP, leptin, and MCP-1, but lower SFRP-5 than participants with high fruit and vegetable and low SSB intake. In Mexican Americans, diets high in SSB but low in fruits and vegetables contribute to adiposity and a pro-inflammatory adipokine profile.

Study Question: Are higher overall and central adiposity associated with reduced fecundability, measured by time-to-pregnancy (TTP), in Asian women?, Summary Answer: Higher overall adiposity, but not central adiposity, was associated with longer TTP in Asian women., What Is Known Already: High body mass index (BMI) has been associated with a longer TTP, although the associations of body composition and distribution with TTP are less clear. There are no previous studies of TTP in Asian women, who have a relatively higher percentage of body fat and abdominal fat at relatively lower BMI., Study Design, Size, Duration: Prospective preconception cohort using data from 477 Asian (Chinese, Malay and Indian) women who were planning to conceive and enrolled in the Singapore PREconception Study of long-Term maternal and child Outcomes (S-PRESTO) study, 2015-2017., Participants/materials, Setting, Methods: Women's mean age was 30.7 years. Overall adiposity was assessed by BMI, sum of 4-site skinfold thicknesses (SFT) and total body fat percentage (TBF%, measured using air displacement plethysmography); central adiposity was assessed by waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR) and A body Shape Index (ABSI). Pregnancy occurring within one year from recruitment was ascertained by ultrasonography. Those who did not conceive within one year of recruitment, were lost to follow-up, or initiated fertility treatment were censored. TTP was measured in cycles. Discrete-time proportional hazards models were used to estimate the fecundability ratio (FR) and 95% confidence interval (CI) for each anthropometric measure in association with fecundability, adjusting for confounders., Main Results and the Role of Chance: Compared to women with a normal BMI of 18.5-22.9 kg/m2, women with higher BMI of 23-27.4 and ≥27.5 kg/m2 showed lower FR of 0.66 (95% CI 0.45, 0.97) and 0.53 (0.31, 0.89), respectively. Compared to women in the lowest quartile of SFT (25-52.9 mm), those in the highest quartile of ≥90.1 mm showed lower FR of 0.58 (95% CI 0.36, 0.95). Compared to women in the lowest quartile of TBF% (13.6-27.2%), those in the upper two quartiles of 33.0-39.7% and ≥39.8% showed lower FR of 0.56 (95% CI 0.32, 0.98) and 0.43 (0.24, 0.80), respectively. Association of high BMI with reduced fecundability was particularly evident among nulliparous women. Measures of central adiposity (WC, WHR, WHtR, ABSI) were not associated with fecundability., Limitations Reasons for Caution: Small sample size could restrict power of analysis.The analysis was confined to planned pregnancies, which could limit generalizability of findings to non-planned pregnancies, estimated at around 44% in Singapore. Information on the date of last menstrual period for each month was not available, hence the accuracy of self-reported menstrual cycle length could not be validated, potentially introducing error into TTP estimation. Measures of exposures and covariates such as cycle length were not performed repeatedly over time; cycle length might have changed during the period before getting pregnant., Wider Implications of the Findings: Other than using BMI as the surrogate measure of body fat, we provide additional evidence showing that higher amounts of subcutaneous fat that based on the measure of SFT at the sites of biceps, triceps, suprailiac and subscapular, and TBF% are associated with longer TTP. Achieving optimal weight and reducing total percentage body fat may be a potential intervention target to improve female fertility. The null results observed between central adiposity and TTP requires confirmation in further studies., Study Funding/competing Interest(s): This research is supported by Singapore National Research Foundation under its Translational and Clinical Research Flagship Programme and administered by the Singapore Ministry of Health's National Medical Research Council, (NMRC/TCR/004-NUS/2008; NMRC/TCR/012-NUHS/2014). Additional funding is provided by the Singapore Institute for Clinical Sciences, Agency for Science Technology and Research (A*STAR), Singapore. Y.S.C., K.M.G., F.Y. and Y.S.L. have received reimbursement to speak at conferences sponsored by companies selling nutritional products. Y.S.C., K.M.G. and S.Y.C. are part of an academic consortium that has received research funding from Abbott, Nutrition, Nestle and Danone. Other authors declared no conflicts of interest., Trial Registration Number: N/A.

Objective: Type 2 diabetes presents at a lower body mass index (BMI) in Chinese individuals than in white individuals. We sought to determine the role of subcutaneous adipose tissue (SCAT)-intrinsic factors, vs BMI or adiposity per se, in the vulnerability of Chinese individuals to obesity-associated impairment of insulin sensitivity., Research Design and Methods: Thirty-two Chinese and 30 white men and women from a cohort in the San Francisco Bay Area underwent anthropometric measurements, body composition (dual-energy X-ray absorptiometry) analyses, and measurement of fasting plasma glucose and insulin. Forty-eight also provided abdominal SCAT samples for transcriptional and biochemical analyses of tissue fibrosis., Results: BMI correlated with total body fat in white (r = 0.74, P < 0.001) but not Chinese individuals, whereas BMI correlated with visceral adipose tissue (VAT) accrual in both ethnicities (r = 0.88 and 0.81, respectively; P < 0.01). Insulin resistance (homeostatic model assessment of insulin resistance) worsened with VAT mass, but not total body fat, in Chinese subjects (r = 0.63, P < 0.01), whereas it worsened with both in white individuals. By contrast, SCAT mRNA levels of genes encoding profibrotic proteins rose remarkably along with both BMI and VAT mass in Chinese but not white subjects. Similarly, SCAT levels of hydroxyproline, an indicator of tissue collagen content that correlated with increasing VAT mass, were higher in Chinese vs white subjects, particularly in the setting of relative insulin resistance., Conclusions: Our findings dissociate BMI from adiposity in Chinese individuals and instead highlight SCAT fibrosis as a process linked to visceral adiposity and insulin resistance in this group.

Objective: Evidence suggests discrimination increases the risk of obesity. The biopsychosocial model of racism posits that psychological factors such as depressive symptoms may link experiences of perceived interpersonal discrimination to obesity. This study tested whether self-reported experiences of everyday discrimination were associated with adiposity indicators and whether depressive symptoms explained these associations., Methods: Cross-sectional survey data of 602 Latino adults living in Lawrence, Massachusetts, from the Latino Health and Well-being Project (2011-2013) were used. Participants completed questionnaires assessing perceived everyday discrimination and depressive symptoms. Anthropometric measures (i.e., BMI and waist circumference [WC]) were obtained by trained staff. Structural equation modeling was employed to test for direct and indirect effects of perceived everyday discrimination on adiposity., Results: Perceived everyday discrimination was directly and positively associated with higher BMI and WC, independent of sociodemographic factors, physical activity, and stressful life events. Perceived everyday discrimination was not indirectly associated with BMI and WC through depressive symptoms. However, perceived everyday discrimination was associated with higher levels of depressive symptoms., Conclusions: Self-reported everyday discrimination among Latino adults is associated with adiposity. Day-to-day interpersonal discrimination may be implicated in obesity disparities for Latino adults., (© 2018 The Obesity Society.)

Objective: Epidemiologic analyses indicate a lack of association between BMI (kg/m 2 ) and mortality among Hispanic adults. Because BMI provides only a surrogate for the real variable of interest, adiposity, this study evaluated associations between measures of body composition and mortality., Methods: Using data from US-residing Mexican Americans in the National Health and Nutrition Examination Survey (NHANES) III (n = 4,480) and NHANES 1999-2010 (n = 5,849), the association between seven measures of body composition measured via anthropometry and bio-electrical impedance analysis (i.e., waist circumference, waist-to-height ratios [WHtR], skinfolds, lean mass, fat mass, percent body fat, and BMI) and all-cause and cardiovascular and diabetes mortality were examined. Additional analyses were stratified by gender., Results: Waist circumference (hazard ratio [HR]: 1.04, 95% CI: 1.01-1.07) and WHtR (HR: 1.08, 95% CI: 1.03-1.14) were weakly associated with an increased all-cause mortality, while WHtR was associated with an increased risk of diabetes-related death (HR: 1.26, 95% CI: 1.07-1.49). In gender-stratified analyses, there was an increased risk of mortality in females who had increases in WHtR and waist circumference for all-cause mortality and cardiovascular deaths., Conclusions: Waist circumference and WHtR were associated with increased risk of all-cause and diabetes-related mortality in US-residing Mexican American adults., (© 2018 The Obesity Society.)

Background: Numerous studies have identified the role of Fat-mass-associated-gene (FTO) in the development of obesity., Aim: To investigate the association of FTO gene with adiposity markers in Chilean adults., Material and Methods: 409 participants were included in this cross-sectional study. The association between FTO (rs9939609) genotype and adiposity markers was determined using linear regression analyses. Adiposity markers included were: body weight, body mass index, fat mass, waist circumference, hip circumference and waist/hip ratio., Results: A fully adjusted model showed a significant association between FTO genotype and body weight (2.16 kg per each extra copy of the risk allele [95% confidence intervals (CI): 0.45 to 3.87], p = 0.014), body mass index (0.61 kg.m-2 [95% CI: 0.12 to 1.20], p = 0.050) and fat mass (1.14% [95% CI: 0.39 to 1.89], p = 0.010). The greater magnitude of association was found between the FTO gene and fat mass when the outcomes were standardized to z-score., Conclusions: This study confirms an association between the FTO gene and adiposity markers in Chilean adults, which is independent of major confounding factors.