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Waist circumference as a vital sign in clinical practice: a Consensus Statement from the IAS and ICCR Working Group on Visceral Obesity.
Ross, R, Neeland, IJ, Yamashita, S, Shai, I, Seidell, J, Magni, P, Santos, RD, Arsenault, B, Cuevas, A, Hu, FB, et al
Nature reviews. Endocrinology. 2020;(3):177-189
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Abstract
Despite decades of unequivocal evidence that waist circumference provides both independent and additive information to BMI for predicting morbidity and risk of death, this measurement is not routinely obtained in clinical practice. This Consensus Statement proposes that measurements of waist circumference afford practitioners with an important opportunity to improve the management and health of patients. We argue that BMI alone is not sufficient to properly assess or manage the cardiometabolic risk associated with increased adiposity in adults and provide a thorough review of the evidence that will empower health practitioners and professional societies to routinely include waist circumference in the evaluation and management of patients with overweight or obesity. We recommend that decreases in waist circumference are a critically important treatment target for reducing adverse health risks for both men and women. Moreover, we describe evidence that clinically relevant reductions in waist circumference can be achieved by routine, moderate-intensity exercise and/or dietary interventions. We identify gaps in the knowledge, including the refinement of waist circumference threshold values for a given BMI category, to optimize obesity risk stratification across age, sex and ethnicity. We recommend that health professionals are trained to properly perform this simple measurement and consider it as an important 'vital sign' in clinical practice.
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Continuous cardiometabolic risk score definitions in early childhood: a scoping review.
Kamel, M, Smith, BT, Wahi, G, Carsley, S, Birken, CS, Anderson, LN
Obesity reviews : an official journal of the International Association for the Study of Obesity. 2018;(12):1688-1699
Abstract
BACKGROUND Cardiometabolic risk (CMR) in young children has been measured using various approaches, including a continuous summary score that incorporates components such as adiposity, lipids, metabolic factors and blood pressure. OBJECTIVES The objective of this study was to comprehensively review definitions of continuous CMR scores in children <10 years of age. METHODS A scoping review was conducted using a systematic search of four scientific databases up to June 2016. Inclusion criteria were children <10 years of age and report of a continuous CMR score. RESULTS Ninety-one articles were included. Most studies were published from 2007 to 2016 (96%). Nearly all continuous CMR scores (90%) were calculated using the sum or the mean of z-scores, and many articles age-standardized and sex-standardized components within their own population. The mean number of variables included in the risk scores was 5 with a range of 3-11. The most commonly included score components were waist circumference (52%), triglycerides (87%), high-density lipoprotein cholesterol (67%), glucose (43%) and systolic blood pressure (52%). IMPORTANCE Continuous CMR scores are emerging frequently in the child health literature and are calculated using numerous methods with diverse components. This heterogeneity limits comparability across studies. A harmonized definition of CMR in childhood is needed.
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Replacing Sedentary Time: Meta-analysis of Objective-Assessment Studies.
Del Pozo-Cruz, J, García-Hermoso, A, Alfonso-Rosa, RM, Alvarez-Barbosa, F, Owen, N, Chastin, S, Del Pozo-Cruz, B
American journal of preventive medicine. 2018;(3):395-402
Abstract
CONTEXT The aim was to summarize estimates of the potential benefits for cardiometabolic risk markers and all-cause mortality of replacing time spent in sedentary behaviors with light-intensity physical activity or with moderate to vigorous physical activity, from studies using device-based measurement. EVIDENCE ACQUISITION Four databases covering the period up to December 2016 were searched and analyzed (February 2017). Data were extracted by two independent reviewers. For the meta-analyses, the estimated regression coefficients (β) and 95% CIs were analyzed for BMI, waist circumference, and high-density lipoprotein cholesterol. Pooled relative rate and 95% CIs were calculated for fasting glucose, fasting insulin, and homeostatic model assessment-insulin resistance values. Hazard ratios were extracted from studies of all-cause mortality risk. EVIDENCE SYNTHESIS Ten studies (with 17,390 participants) met the inclusion criteria. Reallocation of 30 minutes of sedentary time to light-intensity physical activity was associated with reductions in waist circumference, fasting insulin, and all-cause mortality risk; and with an increase in high-density lipoprotein cholesterol. Reallocating 30 minutes of sedentary time to moderate to vigorous physical activity was associated with reductions in BMI, waist circumference, fasting glucose, fasting insulin, and all-cause mortality (not pooled) and with an increase in high-density lipoprotein cholesterol. CONCLUSIONS Replacing sedentary time with either light-intensity physical activity or moderate to vigorous physical activity may be beneficial, but when sedentary time is replaced with moderate to vigorous physical activity, the predicted impacts are stronger and apparent for a broader range of risk markers. These findings point to potential benefits of replacing sedentary time with light-intensity physical activity, which may benefit those less able to tolerate or accommodate higher-intensity activities, including many older adults.
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Evaluation of Internet-Based Interventions on Waist Circumference Reduction: A Meta-Analysis.
Seo, DC, Niu, J
Journal of medical Internet research. 2015;(7):e181
Abstract
BACKGROUND Internet-based interventions are more cost-effective than conventional interventions and can provide immediate, easy-to-access, and individually tailored support for behavior change. Waist circumference is a strong predictor of an increased risk for a host of diseases, such as hypertension, diabetes, and dyslipidemia, independent of body mass index. To date, no study has examined the effect of Internet-based lifestyle interventions on waist circumference change. OBJECTIVE This study aimed to systematically review the effect of Internet-based interventions on waist circumference change among adults. METHODS This meta-analysis reviewed randomized controlled trials (N=31 trials and 8442 participants) that used the Internet as a main intervention approach and reported changes in waist circumference. RESULTS Internet-based interventions showed a significant reduction in waist circumference (mean change -2.99 cm, 95% CI -3.68 to -2.30, I(2)=93.3%) and significantly better effects on waist circumference loss (mean loss 2.38 cm, 95% CI 1.61-3.25, I(2)=97.2%) than minimal interventions such as information-only groups. Meta-regression results showed that baseline waist circumference, gender, and the presence of social support in the intervention were significantly associated with waist circumference reduction. CONCLUSIONS Internet-based interventions have a significant and promising effect on waist circumference change. Incorporating social support into an Internet-based intervention appears to be useful in reducing waist circumference. Considerable heterogeneity exists among the effects of Internet-based interventions. The design of an intervention may have a significant impact on the effectiveness of the intervention.
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The efficacy of Irvingia gabonensis supplementation in the management of overweight and obesity: a systematic review of randomized controlled trials.
Onakpoya, I, Davies, L, Posadzki, P, Ernst, E
Journal of dietary supplements. 2013;(1):29-38
Abstract
The aim of this systematic review was to evaluate the evidence from randomized controlled trials (RCTs) involving the use of the African Bush Mango, Irvingia gabonensis for body weight reduction in obese and overweight individuals. Electronic and nonelectronic searches were conducted to identify relevant RCTs. The bibliographies of located articles were also searched. No age, gender, or language restrictions were imposed. The reporting quality of identified RCTs was assessed using a methodological checklist adapted from the Consolidated Standard of Reporting Trials Statement and Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Two reviewers independently determined eligibility and assessed the reporting quality of included studies. Three RCTs were identified, and all were included. The RCTs all had flaws in the reporting of their methodology. All RCTs reported statistically significant reductions in body weight and waist circumference favoring I. gabonensis over placebo. The results from the RCTs also suggest positive effects of I. gabonensis supplementation on the blood lipid profile. Adverse events included headache and sleep difficulty. Due to the paucity and poor reporting quality of the RCTs, the effect of I. gabonensis on body weight and related parameters are unproven. Therefore, I. gabonensis cannot be recommended as a weight loss aid. Future research in this area should be more rigorous and better reported.