Fred Paccaud

Metabolically healthy obesity: different prevalences using different criteria

Objective:To estimate the prevalence of metabolically healthy obesity (MHO) according to different definitions.Methods:Population-based sample of 2803 women and 2557 men participated in the study. Metabolic abnormalities were defined using six sets of criteria, which included different combinations of the following: waist; blood pressure; total, high-density lipoprotein or low-density lipoprotein-cholesterol; triglycerides; fasting glucose; homeostasis model assessment; high-sensitivity C-reactive protein; personal history of cardiovascular, respiratory or metabolic diseases. For each set, prevalence of MHO was assessed for body mass index (BMI); waist or percent body fat.Results:Among obese (BMI ⩾30u2009kg/m2) participants, prevalence of MHO ranged between 3.3 and 32.1% in men and between 11.4 and 43.3% in women according to the criteria used. Using abdominal obesity, prevalence of MHO ranged between 5.7 and 36.7% (men) and 12.2 and 57.5% (women). Using percent body fat led to a prevalence of MHO ranging between 6.4 and 43.1% (men) and 12.0 and 55.5% (women). MHO participants had a lower odd of presenting a family history of type 2 diabetes. After multivariate adjustment, the odds of presenting with MHO decreased with increasing age, whereas no relationship was found with gender, alcohol consumption or tobacco smoking using most sets of criteria. Physical activity was positively related, whereas increased waist was negatively related with BMI-defined MHO.Conclusion:MHO prevalence varies considerably according to the criteria used, underscoring the need for a standard definition of this metabolic entity. Physical activity increases the likelihood of presenting with MHO, and MHO is associated with a lower prevalence of family history of type 2 diabetes.

Prevalence and characteristics of vitamin or dietary supplement users in Lausanne, Switzerland: the CoLaus study.

Background and objectives:Vitamin+mineral supplement (VMS) and dietary supplement (DS) use is widespread in the general population, but the motivations for such use are poorly known. The prevalence and characteristics of VMS and DS users in Lausanne, Switzerland, were thus assessed.Method:Cross-sectional study was performed including 3249 women and 2937 men (CoLaus study). VMS were defined as single or multivitamin–multimineral preparations. DS included omega-3 or omega-6 fatty acids, herbal teas, plant or animal extracts and bacterial (Lactobacillus) preparations. Calcium and iron supplements were assessed separately.Results:Twenty-six percent of the subjects reported using VMS or DS. VMS were the most frequently consumed item (16.8%), followed by DS (10%), calcium (6.6%) and iron (1.8%). Women reported a higher consumption than men. In women, VMS, DS and calcium use increased and iron use decreased with age, whereas in men only VMS and calcium intake increased with age. Multivariate analysis showed female gender, being born in Switzerland, increased age, higher education and increased physical activity to be positively related with VMS and DS. On bivariate analysis, VMS and DS users presented more frequently with arthritis, anxiety, depression and osteoporosis, but on multivariate analysis only positive relationships between DS use and anxiety/depression (odds ratio (OR)=1.40; 95% confidence interval (CI): [1.16–1.70]) and calcium and osteoporosis (OR=10.6; 95% CI [7.77–14.4]) were found.Conclusion:VMS and DS use is common in the population of Lausanne and associated with a better health profile. Calcium supplements are taken to prevent osteoporosis, whereas the rationale for taking other VMS and DS is unclear.

Alcohol drinking, the metabolic syndrome and diabetes in a population with high mean alcohol consumption.

Diabet. Med. 27, 1241–1249 (2010)

Epidemiology of Masked and White-Coat Hypertension: The Family-Based SKIPOGH Study

Objective We investigated factors associated with masked and white-coat hypertension in a Swiss population-based sample. Methods The Swiss Kidney Project on Genes in Hypertension is a family-based cross-sectional study. Office and 24-hour ambulatory blood pressure were measured using validated devices. Masked hypertension was defined as office blood pressure<140/90 mmHg and daytime ambulatory blood pressure≥135/85 mmHg. White-coat hypertension was defined as office blood pressure≥140/90 mmHg and daytime ambulatory blood pressure<135/85 mmHg. Mixed-effect logistic regression was used to examine the relationship of masked and white-coat hypertension with associated factors, while taking familial correlations into account. High-normal office blood pressure was defined as systolic/diastolic blood pressure within the 130–139/85–89 mmHg range. Results Among the 652 participants included in this analysis, 51% were female. Mean age (±SD) was 48 (±18) years. The proportion of participants with masked and white coat hypertension was respectively 15.8% and 2.6%. Masked hypertension was associated with age (odds ratio (OR)u200a=u200a1.02, pu200a=u200a0.012), high-normal office blood pressure (ORu200a=u200a6.68, p<0.001), and obesity (ORu200a=u200a3.63, pu200a=u200a0.001). White-coat hypertension was significantly associated with age (ORu200a=u200a1.07, p<0.001) but not with education, family history of hypertension, or physical activity. Conclusions Our findings suggest that physicians should consider ambulatory blood pressure monitoring for older individuals with high-normal office blood pressure and/or who are obese.

Not all inflammatory markers are linked to kidney function: results from a population-based study.

Background: Several studies have reported increased levels of inflammatory biomarkers in chronic kidney disease (CKD), but data from the general population are sparse. In this study, we assessed levels of the inflammatory markers C-reactive protein (hsCRP), tumor necrosis factor α (TNF-α), interleukin (IL)-1β and IL-6 across all ranges of renal function. Methods: We conducted a cross-sectional study in a random sample of 6,184 Caucasian subjects aged 35–75 years in Lausanne, Switzerland. Serum levels of hsCRP, TNF-α, IL-6, and IL-1β were measured in 6,067 participants (98.1%); serum creatinine-based estimated glomerular filtration rate (eGFRcreat, CKD-EPI formula) was used to assess renal function, and albumin/creatinine ratio on spot morning urine to assess microalbuminuria (MAU). Results: Higher serum levels of IL-6, TNF-α and hsCRP and lower levels of IL-1β were associated with a lower renal function, CKD (eGFRcreat <60 ml/min/1.73 m2; n = 283), and MAU (n = 583). In multivariate linear regression analysis adjusted for age, sex, hypertension, smoking, diabetes, body mass index, lipids, antihypertensive and hypolipemic therapy, only log-transformed TNF-α remained independently associated with lower renal function (β –0.54 ±0.19). In multivariate logistic regression analysis, higher TNF-α levels were associated with CKD (OR 1.17; 95% CI 1.01–1.35), whereas higher levels of IL-6 (OR 1.09; 95% CI 1.02–1.16) and hsCRP (OR 1.21; 95% CI 1.10–1.32) were associated with MAU. Conclusion: We did not confirm a significant association between renal function and IL-6, IL-1β and hsCRP in the general population. However, our results demonstrate a significant association between TNF-α and renal function, suggesting a potential link between inflammation and the development of CKD. These data also confirm the association between MAU and inflammation.

Fibroblast growth factor 23 and markers of mineral metabolism in individuals with preserved renal function.

Fibroblast growth factor 23 (FGF23) is a bone-derived hormone that regulates phosphate homeostasis. Circulating FGF23 is elevated in chronic kidney disease (CKD) and independently associated with poor renal and cardiovascular outcomes and mortality. Because the study of FGF23 in individuals with normal renal function has received little attention, we examined in a large, population-based study of 1128 participants the associations of FGF23 with markers of mineral metabolism and renal function. The median estimated glomerular filtration rate (eGFR) of the cohort was 105 ml/min per 1.73 m(2), and the median plasma FGF23 was 78.5 RU/ml. FGF23xa0increased and plasma 1,25-dihydroxyvitamin D3xa0decreased significantly below an eGFR threshold of 102 and 99 ml/min per 1.73 m(2), respectively. Inxa0contrast, plasma parathyroid hormone increased continuously with decreasing eGFR and was first significantly elevated at an eGFR of 126 ml/min per 1.73 m(2). On multivariable analysis adjusting for sex, age, body mass index, and GFR, FGF23 was negatively associated with 1,25-dihydroxyvitamin D3, and urinary absolute and fractional calcium excretion but not with serum calcium or parathyroid hormone. We found a positive association of FGF23 with plasma phosphate, but no association with urinary absolute or fractional phosphate excretion and, unexpectedly, a positive association with tubular maximum phosphate reabsorption/GFR. Thus, in the absence of CKD, parathyroid hormone increases earlier than FGF23 when the eGFR decreases. The increase in FGF23 occurs at a higher eGFRxa0threshold than previously reported and is closely associated with a decrease in 1,25-dihydroxyvitamin D3. We speculate that the main demonstrable effect of FGF23 in the setting of preserved renal function is suppression of 1,25-dihydroxyvitamin D3 rather than stimulation of renal phosphate excretion.

The relation of body mass index and abdominal adiposity with dyslipidemia in 27 general populations of the WHO MONICA Project

BACKGROUND AND AIMSnThe association between adiposity measures and dyslipidemia has seldom been assessed in a multipopulational setting.nnnMETHODS AND RESULTSn27 populations from Europe, Australia, New Zealand and Canada (WHO MONICA project) using health surveys conducted between 1990 and 1997 in adults aged 35-64 years (nxa0=xa040,480). Dyslipidemia was defined as the total/HDL cholesterol ratio >6 (men) and >5 (women). Overall prevalence of dyslipidemia was 25% in men and 23% in women. Logistic regression showed that dyslipidemia was strongly associated with body mass index (BMI) in men and with waist circumference (WC) in women, after adjusting for region, age and smoking. Among normal-weight men and women (BMI<25xa0kg/m(2)), an increase in the odds for being dyslipidemic was observed between lowest and highest WC quartiles (ORxa0=xa03.6, pxa0<xa00.001). Among obese men (BMI ≥ 30), the corresponding increase was smaller (ORxa0=xa01.2, pxa0=xa00.036). A similar weakening was observed among women. Classification tree analysis was performed to assign subjects into classes of risk for dyslipidemia. BMI thresholds (25.4 and 29.2xa0kg/m(2)) in men and WC thresholds (81.7 and 92.6xa0cm) in women came out at first stages. High WC (>84.8xa0cm) in normal-weight men, menopause in women and regular smoking further defined subgroups at increased risk.nnnCONCLUSIONnstandard categories of BMI and WC, or their combinations, do not lead to optimal risk stratification for dyslipidemia in middle-age adults. Sex-specific adaptations are necessary, in particular by taking into account abdominal obesity in normal-weight men, post-menopausal age in women and regular smoking in both sexes.

Inflammatory markers and blood pressure: sex differences and the effect of fat mass in the CoLaus Study

Several studies have reported high levels of inflammatory biomarkers in hypertension, but data coming from the general population are sparse, and sex differences have been little explored. The CoLaus Study is a cross-sectional examination survey in a random sample of 6067 Caucasians aged 35–75 years in Lausanne, Switzerland. Blood pressure (BP) was assessed using a validated oscillometric device. Anthropometric parameters were also measured, including body composition, using electrical bioimpedance. Crude serum levels of interleukin-6 (IL-6), tumor necrosis factor α (TNF-α) and ultrasensitive C-reactive protein (hsCRP) were positively and IL-1β (IL-1β) negatively (P<0.001 for all values), associated with BP. For IL-6, IL-1β and TNF-α, the association disappeared in multivariable analysis, largely explained by differences in age and body mass index, in particular fat mass. On the contrary, hsCRP remained independently and positively associated with systolic (β (95% confidence interval): 1.15 (0.64; 1.65); P<0.001) and diastolic (0.75 (0.42; 1.08); P<0.001) BP. Relationships of hsCRP, IL-6 and TNF-α with BP tended to be stronger in women than in men, partly related to the difference in fat mass, yet the interaction between sex and IL-6 persisted after correction for all tested confounders. In the general population, the associations between inflammatory biomarkers and rising levels of BP are mainly driven by age and fat mass. The stronger associations in women suggest that sex differences might exist in the complex interplay between BP and inflammation.

High- and persistent- body-weight misperception levels in overweight and obese Swiss adults, 1997–2007

High- and persistent- body-weight misperception levels in overweight and obese Swiss adults, 1997–2007

4B.05: PLASMA COPEPTIN IS ASSOCIATED WITH INSULIN RESISTANCE IN A SWISS POPULATION-BASED STUDY.

Objective: Previous studies suggest that arginine vasopressin may have a role in metabolic syndrome (MetS) and diabetes by altering liver glycogenolysis, insulin, and glucagon secretion and pituitary ACTH release. We tested whether plasma copeptin, the stable C-terminal fragment of arginine vasopressin prohormone, was associated with insulin resistance and MetS in a Swiss population-based study. Design and method: We analyzed data from the population-based Swiss Kidney Project on Genes in Hypertension. Copeptin was assessed by an immunoluminometric assay. Insulin resistance was derived from the HOMA model and calculated as follows: (FPI x FPG)/22.5, where FPI is fasting plasma insulin concentration (mU/L) and FPG fasting plasma glucose (mmol/L). Subjects were classified as having the MetS according to the National Cholesterol Education Program Adult Treatment Panel III criteria. Mixed multivariate linear regression models were built to explore the association of insulin resistance with copeptin. In addition, multivariate logistic regression models were built to explore the association between MetS and copeptin. In the two analyses, adjustment was done for age, gender, center, tobacco and alcohol consumption, socioeconomic status, physical activity, intake of fruits and vegetables and 24u200ah urine flow rate. Copeptin was log-transformed for the analyses. Results: Among the 1,089 subjects included in this analysis, 47% were male. Mean (SD) age and body mass index were 47.4 (17.6) years 25.0 (4.5) kg/m2. The prevalence of MetS was 10.5%. HOMA-IR was higher in men (median 1.3, IQR 0.7–2.1) than in women (median 1.0, IQR 0.5–1.6,Pu200a<u200a0.0001). Plasma copeptin was higher in men (median 5.2, IQR 3.7–7.8u200apmol/L) than in women (median 3.0, IQR 2.2–4.3u200apmol/L), Pu200a<u200a0.0001. HOMA-IR was positively associated with log-copeptin after full adjustment (&bgr; (95% CI) 0.19 (0.09–0.29), Pu200a<u200a0.001). MetS was not associated with copeptin after full adjustment (Pu200a=u200a0.92). Conclusions: Insulin resistance, but not MetS, was associated with higher copeptin levels. Further studies should examine whether modifying pharmacologically the arginine vasopressin system might improve insulin resistance, thereby providing insight into the causal nature of this association.