Is a new waist circumference and BMI needed for African Americans for the diagnosis of metabolic syndrome?

African Americans are noted as having a low prevalence metabolic syndrome (MetS), which is partly attributed to a reported use of MetS criteria, such as waist circumference that is not appropriate for this population group. The purpose of this study was: 1) to investigate the gender specific optimal waist cut off points, which best identify individuals with metabolic abnormalities consistent with MetS, and are independent of body mass index (BMI) cutoff values; 2) to determine the gender specific cutoff values of BMI in relation to multiple metabolic risk factors; and 3) to assess the prevalence of metabolic syndrome. In this cross-sectional study, NHANES data from 1999-2006 was analyzed. 1445 participants had complete variables for metabolic syndrome criteria. The waist circumference of 95 cm for males and 98 cm for females were found as appropriate cut-off values to identify central obesity. Body mass index at which metabolic syndrome was observed was 28 kg/m² for males and 32 kg/m² for females. Using our newly estimated waist circumference thresholds, the age-adjusted prevalence of MetS was 30.9% in males and 30.3% in females. The results indicate that for the early detection of metabolic syndrome in African American adult males, a lower cutoff value of 95 cm, rather than the 102 cm currently used is needed. The metabolic syndrome abnormalities appear at higher body mass index and waist circumference among women. Based on our findings, the prevalence of metabolic syndrome is currently underestimated among African American adult males

Metabolic dysfunction-associated steatotic liver disease:A wide-angled perspective on a multifaceted problem

In dit proefschrift is metabole dysfunctie-geassocieerde steatotische leverziekte (MASLD) onderzocht, opgedeeld in drie delen:Deel 1 omvat een MRI-onderzoek naar vetstapeling in de lever en pancreas, en een genoombrede associatiestudie in de Amsterdamse multi-etnische populatie, waarbij een relatie tussen het gen MRC1 en niet-invasieve leverfibrosetesten wordt gevonden. Dit gen vertoont variaties tussen etnische groepen, wat wijst op een rol van MRC1 in de bestaande verschillen in MASLD tussen bevolkingsgroepen van verschillende afkomst.In deel 2 is gericht op nieuwe niet-invasieve levertesten van fibrosevorming in mensen met MASLD. Ten eerste een systematische review van de marker Pro-C3 voor het detecteren van fibrose, en ten tweede een onderzoek naar een nieuw niet-invasief biomarkerpanel, van ontdekking in muisstudies tot bevestiging in humane cohorten.Deel 3 van het proefschrift beschrijft de potentie van het darmmicrobioom om MASLD te beïnvloeden. Een fecestransplantatiestudie toont aan dat het manipuleren van het darmmicrobioom leidt tot veranderingen in circulerende metabolieten en lever-DNA-methylatie. Daarnaast beschrijft een muisonderzoek het effect van de boterzuurproducerende bacterie A. soehngenii op de ernst van MASLD, waarbij toediening ervan de suikerhuishouding verbeterde zonder verbetering van de leverhistologie.Gezamenlijk leveren de studies die in dit proefschrift beschreven zijn waardevolle inzichten in de complexiteit van MASLD en bieden ze verschillende potentiële mogelijkheden om de zorg voor mensen met MASLD te verbeteren door middel van genetische, metabole en microbioom-gerichte benaderingen

On identifying polycystic ovary syndrome in the Clinical Data Warehouse at Boston Medical Center

INTRODUCTION: Polycystic ovary syndrome (PCOS) is characterized by hyperandrogenemia, oligoanovulation, and numerous ovarian cysts. Although the most common cause of female factor infertility, its characteristics and metabolic risks are difficult to study due to its heterogeneity. Additionally, ethnic-specific data is scarce. Hospital electronic medical records and the diverse patient population at Boston Medical Center (BMC) may provide an avenue for investigating the longitudinal nature of PCOS and its race-specific characteristics. OBJECTIVES: 1. Describe the Clinical Data Warehouse (CDW) dataset available for studying PCOS. 2. Develop an automated method for extracting ovarian features from written ultrasound reports. 3. Identify PCOS patients from their record of the three cardinal PCOS features. METHODS: Patients evaluated on at least one of the three cardinal PCOS features, between October 1, 2003 and September 30, 2015 were queried from the BMC CDW. This thesis describes methods for cleaning the data, as well as the development of an ultrasound classifier based on natural language processing techniques. RESULTS: On a validation set of 1000 random ultrasounds, the automatic ultrasound classifier had a recall and precision for the presence of PCOM, 99.0% and 94.2%, respectively. Overall, 2421 cases of PCOS were identified, with 1010 not receiving a diagnosis. Black patients had twice the odds of being underdiagnosed compared to White patients (OR: 2.09; 95% CI: 1.69–2.59). CONCLUSIONS: Ascertaining PCOS through the medical record offers advantages over self-reported PCOS, including documentation of disease and recorded measurements. In the future, this PCOS dataset can be used in conjunction with cardiovascular and metabolic outcomes for developing a predictive model

Pediatric liver diseases: current challenges and future perspectives

Chronic liver diseases in children represent a rising problem with significant effects on public health. In fact, several pediatric liver diseases are precursors of adult chronic hepatopathies, cirrhosis and hepatocellular carcinoma. The prevalence of liver diseases in children is unknown. In the USA, every year, 15,000 children are hospitalized for liver diseases, but these disorders continue to be under-recognized or diagnosed late. The main reason is due to the frequent absence of symptoms in the vast majority of liver diseases, especially in the early stages. In the last few decades several advances have been made in understanding the pathogenesis of liver diseases, permitting the discovery of new therapeutic targets to treat liver diseases, thus improving the natural history of these disorders. In this article we discuss the most recent advances in the understanding of the pathogenesis, diagnosis and treatment of the most frequent pediatric liver diseases

Hemoglobin A1C and the Diagnosis of Diabetes and Prediabetes in Children and Adolescents

Although the American Diabetes Association (ADA) adopted the use of the glycated hemoglobin (A1C) test as a method of diabetes and prediabetes diagnosis, the ADA has not developed firm guidelines concerning the use of the A1C test in children and adolescents, as research has not validated thresholds in this group. Diabetes and prediabetes are diseases influenced by multiple factors, including race and ethnicity, age, vitamin D deficiency, and body mass index (BMI). The purpose of this study was to determine the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the A1C test compared to the gold standard use of the fasting plasma glucose (FPG) and 2-hour oral glucose tolerance test (OGTT) to detect diabetes and prediabetes in a children and adolescents considered to be at higher risk for impaired glucose metabolism. In addition, ROC curve analysis was performed to determine optimal thresholds for the diagnosis of prediabetes in available groups of the research sample. The study also to examined the correlation between A1C and race and ethnicity, age, vitamin D levels, and body mass index, in addition to comparing the relationship of A1C to beta cell dysfunction and insulin sensitivity. A retrospective review of 902 patient electronic medical records in an urban endocrinology clinic was conducted. Based on FPG and 2-hr glucose during the OGTT, patients were classified based on the ADA 2014 criteria as having diabetes or prediabetes Subjects ranged in age from 2-18 (11.6 ± 3.32), were predominantly minority (70.7% African American, 17.3% Hispanic, 12.0% Caucasian) and female (60.7%). The results yielded a high specificity (99.7%) and high negative predictive value (99.9%) for the whole sample, although the results were lower for the African American group. The results also yielded a low specificity (35.3%) but a high negative predictive value (99.8%) for the entire sample. Although results were once again lower for the African American subset. ROC curve analysis for prediabetes yielded a threshold of 5.8% for sample. Multiple regression found some correlation between fasting glucose and A1C, although statistical analysis was not possible for the aggregate sample. No statistically significant association was found between the A1C and age, vitamin D, and BMI in the sample. Correlation analysis found stronger associations between the A1C and beta cell dysfunction versus insulin sensitivity. In this predominantly minority population A1C had a high specificity and sensitivity for the diagnosis of diabetes. While the A1C resulted in a high number of false positives for prediabetes, A1C \u3c5.7% accurately identified individuals with normal glucose tolerance. Children and adolescents considered to be at higher risk for impaired glucose metabolism (family history of diabetes, obesity, minorities, or history of gestational diabetes) with A1C ≥5.7% or with symptoms of diabetes should undergo OGTT testing. In addition, different threshold levels for racial and ethnic groups should be considered in the diagnosis of prediabetes

Assessment of Social, Dietary and Biochemical Correlates of Cardiometabolic Risk in Pre-adolescent Hispanic Children

Obesity, elevated blood pressure and dyslipidemia are highly prevalent in Hispanic children. Compared to their non-Hispanic White peers, Hispanic children experience higher prevalence of obesity and hypertension. The Hispanic population in Tennessee has been growing, with about a tenth of newborn babies being Hispanic. This study aimed to: 1. Examine the influence of sociodemographic factors on Hispanic children’s cardiometabolic risk; 2. Assess the relationship between food group intake and cardiometabolic risk in Hispanic children; and 3. Evaluate the efficacy of non-traditional biomarkers for detecting cardiometabolic risk in Hispanic children. Data for the study came from a larger cross-sectional pilot study of metabolic syndrome in Hispanic children attending a community health center in Johnson City, TN. Descriptive and multiple logistic regression analyses were used. The prevalence of overweight and elevated blood pressure were 40.7% and 31.0% respectively. Children of obese mothers were more likely than children of mothers with normal body mass index to engage in less than three days of at least 60 minutes of vigorous physical activity (PA) per week (OR: 6.47: 95% CI: 1.61-26.0). Children whose mothers did not engage in moderate PA were more likely to have elevated blood pressure (OR: 2.50, 95%CI: 1.02-4.53); and to engage in less than three days of at least 60 minutes of vigorous PA per week (OR: 2.92, 95% CI: 1.18-7.24), than children whose mothers engaged in moderate PA. Children generally exceeded fruit and legume intake recommendations, but did not meet vegetable, wholegrain, dairy and fiber recommendations. Higher legume (OR: 0.052, 95% CI: 0.04-0.64), dairy (OR: 0.61, 95% CI: 0.37-0.99) and fiber intake (OR: 0.88, 95% CI: 0.81-0.96) were protective against elevated blood pressure, but only fruit intake was protective against overweight (OR: 0.93, 95% CI: 0.87-0.99). Leptin, C-peptide and TNF-α showed significant positive correlations with cardiometabolic risk factors. The optimal cut-offs for detecting three or more cardiometabolic risk factors were: leptin, 5.95 ng/ml, C-peptide, 0.73 ng/; and TNF-alpha, 4.28 pg/ml. Helping mothers to achieve and maintain a healthy BMI and promoting children’s consumption of more vegetables, fruits, dairy and fiber could help reduce cardiometabolic risk in Hispanic children

Early diagnosis of cardiovascular diseases in workers: role of standard and advanced echocardiography

Cardiovascular disease (CVD) still remains the main cause of morbidity and mortality and consequently early diagnosis is of paramount importance. Working conditions can be regarded as an additional risk factor for CVD. Since different aspects of the job may affect vascular health differently, it is important to consider occupation from multiple perspectives to better assess occupational impacts on health. Standard echocardiography has several targets in the cardiac population, as the assessment of myocardial performance, valvular and/or congenital heart disease, and hemodynamics. Three-dimensional echocardiography gained attention recently as a viable clinical tool in assessing left ventricular (LV) and right ventricular (RV), volume, and shape. Two-dimensional (2DSTE) and, more recently, three-dimensional speckle tracking echocardiography (3DSTE) have also emerged as methods for detection of global and regional myocardial dysfunction in various cardiovascular diseases, and applied to the diagnosis of subtle LV and RV dysfunction. Although these novel echocardiographic imaging modalities have advanced our understanding of LV and RV mechanics, overlapping patterns often show challenges that limit their clinical utility. This review will describe the current state of standard and advanced echocardiography in early detection (secondary prevention) of CVD and address future directions for this potentially important diagnostic strategy

Obesity- Related Health Risk: A Trajectory Based Approach

The purpose of this study was to evaluate the Edmonton Obesity Staging System (EOSS) approach as a tool for the identification of obesity-related health risk. Using 20 years of follow-up data from the Coronary Artery Risk Development in Young Adults (CARDIA) study (N=5115; age 18-34), trajectory modelling analysis was used to identify distinct clusters of individuals following similar patterns of obesity using modified EOSS criteria. The final model acquired through the Proc Traj macro suggests that there are 4 distinct EOSS stage-increase trajectories. After adjusting for covariates, individuals in the medium risk trajectory were twice more likely to follow protein consumption guidelines (OR=2.08 95% CI=1.18-3.65), 47% less likely to be black (0.53, 0.37-0.76), 43% less likely to have a history of dieting (0.57, 0.37-0.86), and were also less likely to be either occasional (0.51, 0.29-0.9) or frequent (0.25, 0.14-0.45) weight cyclers when compared to the highest risk trajectory