Association of Genetic Variants Related to Combined Exposure to Higher Body Mass Index and Waist-to-Hip Ratio on Lifelong Cardiovascular Risk in UK Biobank

OBJECTIVE: This study examines the individual and combined association of body mass index (BMI) and 7 waist-to-hip ratio (WHR) with cardiovascular diseases (CVD) risk using genetic scores of the 8 obesity measurements as proxies. DESIGN: A 2×2 factorial analysis approach was applied, with participants divided into four groups of lifetime exposure to low BMI and WHR, high BMI, high WHR, and high BMI and WHR based on weighted genetic risk scores. The difference in CVD risk across groups was evaluated using multivariable logistic regression. SETTING: Cohort study. PARTICIPANTS: A total of 408,003 participants were included from the prospective observational UK Biobank study. RESULTS: A total of 58,429 of CVD events were recorded. Compared to the low BMI and WHR genetic scores group, higher BMI or higher WHR genetic scores were associated with an increase in CVD risk (high BMI: odds ratio (OR), 1.07; 95%CI, 1.04-1.10; high WHR: OR, 1.12; 95%CI, 1.09-1.16). A weak additive effect on CVD risk was found between BMI and WHR (high BMI and WHR: OR, 1.16; 95%CI, 1.12-1.19). Subgroup analysis showed similar patterns between different sex, age (<65, ≥65 years old), smoking status, Townsend deprivation index, fasting glucose level and medication uses, but lower systolic blood pressure was associated with higher CVD risk in obese participants. CONCLUSIONS: High BMI or WHR were associated with increased CVD risk, and their effects are weakly additive. Even though there were overlapping of effect, both BMI and WHR are important in assessing the CVD risk in the general population

Non-Laboratory-Based Risk Prediction Tools for Undiagnosed Pre-Diabetes: A Systematic Review

Early detection of pre-diabetes (pre-DM) can prevent DM and related complications. This review examined studies on non-laboratory-based pre-DM risk prediction tools to identify important predictors and evaluate their performance. PubMed, Embase, MEDLINE, CINAHL were searched in February 2023. Studies that developed tools with: (1) pre-DM as a prediction outcome, (2) fasting/post-prandial blood glucose/HbA1c as outcome measures, and (3) non-laboratory predictors only were included. The studies’ quality was assessed using the CASP Clinical Prediction Rule Checklist. Data on pre-DM definitions, predictors, validation methods, performances of the tools were extracted for narrative synthesis. A total of 6398 titles were identified and screened. Twenty-four studies were included with satisfactory quality. Eight studies (33.3%) developed pre-DM risk tools and sixteen studies (66.7%) focused on pre-DM and DM risks. Age, family history of DM, diagnosed hypertension and obesity measured by BMI and/or WC were the most common non-laboratory predictors. Existing tools showed satisfactory internal discrimination (AUROC: 0.68–0.82), sensitivity (0.60–0.89), and specificity (0.50–0.74). Only twelve studies (50.0%) had validated their tools externally, with a variance in the external discrimination (AUROC: 0.31–0.79) and sensitivity (0.31–0.92). Most non-laboratory-based risk tools for pre-DM detection showed satisfactory performance in their study populations. The generalisability of these tools was unclear since most lacked external validation

Additional file 1 of Feasibility and acceptability of electronic EQ-5D-5L for routine measurement of HRQOL in patients with chronic musculoskeletal problems in Hong Kong primary care

Additional file 1: Supplementary Materials on e-EQ-5D-5L platform, study questionnaires, interview guides and qualitative interview subject characteristics