Prediction of Hypertension Based on Anthropometric Parameters in Adolescents in Eastern Sudan: A Community-Based Study.

Anthropometric measures such as body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR) are associated with elevated blood pressure and hypertension in adolescents. We aimed to assess these anthropometric measures (BMI, WC, and WHtR) and examine their association with hypertension in adolescents. Adolescents' BMI, mid-upper arm circumference (MUAC), WC, body roundness index (BRI), waist-to-hip ratio (WHR), WHtR, and a body shape index(ABSI) values were measured and calculated. Receiver operating characteristic curves (ROCs) were created to determine the discriminatory capacities of these anthropometric parameters for hypertension. The cutoff points for these parameters were identified using Youden's index. A total of 401 adolescents [186(46.4%) were females and 215 (53.6%) were males] were included. The median (interquartile range, IQR) age was 14.0 (12.1‒16.2) years. Thirty-six adolescents were found to have hypertension. Among the anthropometric parameters, MUAC (area under the curve (AUC] = 0.76, at the cutoff 26.1 cm, sensitivity = 61.0, specificity = 83.0), WC (AUC= 0.74, at the cutoff 70.3 cm, sensitivity = 66.7, specificity = 77.0), BMI (AUC= 0.73, at the cutoff 17.4 kg/m2, sensitivity = 83.3, specificity = 59.0), and hip circumference (HC) (AUC= 0.72, at the cutoff 91.0 cm, sensitivity = 55.6, specificity = 83.0) performed fairly in detecting hypertension in adolescents, whereas WHR, WHtR, ABSI, and BRI performed poorly. A univariate analysis showed that, except for WHR, all anthropometric parameters (BMI, MUAC, WC, HC, WHtR, BRI, and ABSI) were associated with hypertension. However, in a multivariate analysis, only increased MUAC (adjusted odds ratio [AOR]= 1.24, 95% CI= 1.03‒1.50) was associated with hypertension. This study showed that MUAC, WC, BMI, and HC could be used to detect hypertension in adolescents. Other parameters,namelyWHR, WHtR, ABSI, and BRI, perform poorly in this regard. Larger studies are needed in the future.

Saad AH ，Hassan AA ，Al-Nafeesah A ，AlEed A ，Adam I ... -  《-》

Utility of Anthropometric Indexes for Detecting Metabolic Syndrome in Resource-Limited Regions of Northwestern China: Cross-Sectional Study.

Anthropometric indexes offer a practical approach to identifying metabolic syndrome (MetS) and its components. However, there is a scarcity of research on anthropometric indexes tailored to predict MetS in populations from resource-limited regions. This study aimed to examine the association between 8 easy-to-collect anthropometric indexes and MetS, and determine the most appropriate indexes to identify the presence of MetS for adults in resource-limited areas. A total of 10,520 participants aged 18-85 years from Ningxia Hui Autonomous Region, China, were included in this cross-sectional study. Participants were recruited through a stratified sampling approach from January 1, 2020, to December 31, 2021. MetS was defined using the International Diabetes Federation (IDF) criteria. Eight anthropometric indexes were examined, including BMI, waist-to-height ratio (WHtR), weight-adjusted waist index (WWI), conicity index, a body shape index (ABSI), lipid accumulation products (LAP), visceral obesity index (VAI), and the triglyceride-glucose (TyG) index. Logistic regression analysis and restricted cubic splines (RCSs) were applied to identify the association between the anthropometric indexes. The receiver operating characteristic curve and the area under the curve (AUC) were analyzed to identify and compare the discriminative power of anthropometric indexes in identifying MetS. The Youden index was used to determine a range of optimal diagnostic thresholds. Logistic regression analysis was applied to identify the association between the anthropometric indexes. A total of 3324 (31.60%) participants were diagnosed with MetS. After adjusting for age, ethnicity, current residence, education level, habitual alcohol consumption, and tobacco use, all the 8 indexes were positively correlated with the risks of MetS (P<.05). LAP presented the highest adjusted odds ratios (adjOR 35.69, 95% CI 34.59-36.80), followed by WHtR (adjOR 29.27, 95% CI 28.00-30.55), conicity index (adjOR 11.58, 95% CI 10.95-12.22), TyG index (adjOR 5.53, 95% CI 5.07-6.04), BMI (adjOR 3.88, 95% CI 3.71-4.05), WWI (adjOR 3.23, 95% CI 3.02-3.46), VAI (adjOR 2.11, 95% CI 2.02-2.20), and ABSI (adjOR 1.71, 95% CI 1.62-1.80). Significantly nonlinear associations between the 8 indexes and the risk of MetS (all Pnonlinear<.001) were observed in the RCSs. WHtR was the strongest predictor of MetS for males (AUC 0.91, 95% CI 0.90-0.92; optimal cutoff 0.53). LAP were the strongest predictor of MetS for females (AUC 0.89, 95% CI 0.89-0.90; optimal cutoff 28.67). Statistical differences were present between WHtR and all other 7 anthropometric indexes among males and overall (all P<.05). In females, the AUC values between LAP and BMI, WWI, ABSI, conicity index, VAI, and TyG index were significantly different (P<.001). No statistical difference was observed between LAP and WHtR among females. According to 8 anthropometric and lipid-related indices, it is suggested that WHtR and LAP are the most appropriate indexes for identifying the presence of MetS in resource-limited areas.

Yang D ，Ma L ，Cheng Y ，Shi H ，Liu Y ，Shi C ... -  《JMIR Public Health and Surveillance》

Comparison of Two Modern Survival Prediction Tools, SORG-MLA and METSSS, in Patients With Symptomatic Long-bone Metastases Who Underwent Local Treatment With Surgery Followed by Radiotherapy and With Radiotherapy Alone.

Survival estimation for patients with symptomatic skeletal metastases ideally should be made before a type of local treatment has already been determined. Currently available survival prediction tools, however, were generated using data from patients treated either operatively or with local radiation alone, raising concerns about whether they would generalize well to all patients presenting for assessment. The Skeletal Oncology Research Group machine-learning algorithm (SORG-MLA), trained with institution-based data of surgically treated patients, and the Metastases location, Elderly, Tumor primary, Sex, Sickness/comorbidity, and Site of radiotherapy model (METSSS), trained with registry-based data of patients treated with radiotherapy alone, are two of the most recently developed survival prediction models, but they have not been tested on patients whose local treatment strategy is not yet decided. (1) Which of these two survival prediction models performed better in a mixed cohort made up both of patients who received local treatment with surgery followed by radiotherapy and who had radiation alone for symptomatic bone metastases? (2) Which model performed better among patients whose local treatment consisted of only palliative radiotherapy? (3) Are laboratory values used by SORG-MLA, which are not included in METSSS, independently associated with survival after controlling for predictions made by METSSS? Between 2010 and 2018, we provided local treatment for 2113 adult patients with skeletal metastases in the extremities at an urban tertiary referral academic medical center using one of two strategies: (1) surgery followed by postoperative radiotherapy or (2) palliative radiotherapy alone. Every patient's survivorship status was ascertained either by their medical records or the national death registry from the Taiwanese National Health Insurance Administration. After applying a priori designated exclusion criteria, 91% (1920) were analyzed here. Among them, 48% (920) of the patients were female, and the median (IQR) age was 62 years (53 to 70 years). Lung was the most common primary tumor site (41% [782]), and 59% (1128) of patients had other skeletal metastases in addition to the treated lesion(s). In general, the indications for surgery were the presence of a complete pathologic fracture or an impending pathologic fracture, defined as having a Mirels score of ≥ 9, in patients with an American Society of Anesthesiologists (ASA) classification of less than or equal to IV and who were considered fit for surgery. The indications for radiotherapy were relief of pain, local tumor control, prevention of skeletal-related events, and any combination of the above. In all, 84% (1610) of the patients received palliative radiotherapy alone as local treatment for the target lesion(s), and 16% (310) underwent surgery followed by postoperative radiotherapy. Neither METSSS nor SORG-MLA was used at the point of care to aid clinical decision-making during the treatment period. Survival was retrospectively estimated by these two models to test their potential for providing survival probabilities. We first compared SORG to METSSS in the entire population. Then, we repeated the comparison in patients who received local treatment with palliative radiation alone. We assessed model performance by area under the receiver operating characteristic curve (AUROC), calibration analysis, Brier score, and decision curve analysis (DCA). The AUROC measures discrimination, which is the ability to distinguish patients with the event of interest (such as death at a particular time point) from those without. AUROC typically ranges from 0.5 to 1.0, with 0.5 indicating random guessing and 1.0 a perfect prediction, and in general, an AUROC of ≥ 0.7 indicates adequate discrimination for clinical use. Calibration refers to the agreement between the predicted outcomes (in this case, survival probabilities) and the actual outcomes, with a perfect calibration curve having an intercept of 0 and a slope of 1. A positive intercept indicates that the actual survival is generally underestimated by the prediction model, and a negative intercept suggests the opposite (overestimation). When comparing models, an intercept closer to 0 typically indicates better calibration. Calibration can also be summarized as log(O:E), the logarithm scale of the ratio of observed (O) to expected (E) survivors. A log(O:E) > 0 signals an underestimation (the observed survival is greater than the predicted survival); and a log(O:E) < 0 indicates the opposite (the observed survival is lower than the predicted survival). A model with a log(O:E) closer to 0 is generally considered better calibrated. The Brier score is the mean squared difference between the model predictions and the observed outcomes, and it ranges from 0 (best prediction) to 1 (worst prediction). The Brier score captures both discrimination and calibration, and it is considered a measure of overall model performance. In Brier score analysis, the "null model" assigns a predicted probability equal to the prevalence of the outcome and represents a model that adds no new information. A prediction model should achieve a Brier score at least lower than the null-model Brier score to be considered as useful. The DCA was developed as a method to determine whether using a model to inform treatment decisions would do more good than harm. It plots the net benefit of making decisions based on the model's predictions across all possible risk thresholds (or cost-to-benefit ratios) in relation to the two default strategies of treating all or no patients. The care provider can decide on an acceptable risk threshold for the proposed treatment in an individual and assess the corresponding net benefit to determine whether consulting with the model is superior to adopting the default strategies. Finally, we examined whether laboratory data, which were not included in the METSSS model, would have been independently associated with survival after controlling for the METSSS model's predictions by using the multivariable logistic and Cox proportional hazards regression analyses. Between the two models, only SORG-MLA achieved adequate discrimination (an AUROC of > 0.7) in the entire cohort (of patients treated operatively or with radiation alone) and in the subgroup of patients treated with palliative radiotherapy alone. SORG-MLA outperformed METSSS by a wide margin on discrimination, calibration, and Brier score analyses in not only the entire cohort but also the subgroup of patients whose local treatment consisted of radiotherapy alone. In both the entire cohort and the subgroup, DCA demonstrated that SORG-MLA provided more net benefit compared with the two default strategies (of treating all or no patients) and compared with METSSS when risk thresholds ranged from 0.2 to 0.9 at both 90 days and 1 year, indicating that using SORG-MLA as a decision-making aid was beneficial when a patient's individualized risk threshold for opting for treatment was 0.2 to 0.9. Higher albumin, lower alkaline phosphatase, lower calcium, higher hemoglobin, lower international normalized ratio, higher lymphocytes, lower neutrophils, lower neutrophil-to-lymphocyte ratio, lower platelet-to-lymphocyte ratio, higher sodium, and lower white blood cells were independently associated with better 1-year and overall survival after adjusting for the predictions made by METSSS. Based on these discoveries, clinicians might choose to consult SORG-MLA instead of METSSS for survival estimation in patients with long-bone metastases presenting for evaluation of local treatment. Basing a treatment decision on the predictions of SORG-MLA could be beneficial when a patient's individualized risk threshold for opting to undergo a particular treatment strategy ranged from 0.2 to 0.9. Future studies might investigate relevant laboratory items when constructing or refining a survival estimation model because these data demonstrated prognostic value independent of the predictions of the METSSS model, and future studies might also seek to keep these models up to date using data from diverse, contemporary patients undergoing both modern operative and nonoperative treatments. Level III, diagnostic study.

Lee CC ，Chen CW ，Yen HK ，Lin YP ，Lai CY ，Wang JL ，Groot OQ ，Janssen SJ ，Schwab JH ，Hsu FM ，Lin WH ... -  《-》

The impact of a lifestyle promotion program on anthropometric and clinical manifestations in adolescents with polycystic ovarian syndrome: a randomized controlled trial.

Lifestyle modification can have beneficial effects on improving symptoms of ovary syndrome and anthropometric changes, particularly in obese individuals… However, it is not clear whether these affects in obese adolescents with PCOS are the same as non-PCOS adolescents. We had a study question" Can lifestyle promotion programs, which focus on changing behavioral habits, have an effect on anthropometric parameters and the manifestation of polycystic ovary syndrome (PCOS) in adolescents?" This was a cluster randomized trial (CRT) that started from January 2021 and follow-up ended in March 2022. 128 participants included adolescent girls (from 14 to 18 years old). The status of PCOS was determined for the participants, following which both the PCOS-afflicted and non-PCOS cohorts were subjected to randomization to either partake in a lifestyle promotion program or to proceed without it. This program included eight sessions that were designed to be implemented for two months. This intervention provides recommendations for a balanced diet and regular exercise, as well as advice on behavior change for adolescents, including those with PCOS, regardless of their weight. All participants were followed up for 12 months and were evaluated at three time points: baseline, 6 and 12 months. Outcomes included changes in the anthropometric indices (weight, hip and waist circumstance), regularity of menstrual cycle, hirsutism score by the modified-Ferriman-Gallwey scale, acne score by the Investigator's Global Assessment Scale, hair loss scores by the Sinclair Graphic Instrument and then physical activity by the Caspian tool and dietary intake status by the Food Frequency Questionnaire. Data was analyzed using the non-parametric Mann-Whitney test for variables with two-time point assessments and generalized estimation equations (GEE) for variables with three time point assessments. In the study, the intervention group of girls with PCOS exhibited a significant reduction in weight and waist circumference, with an average decrease of 3.14 kg and 4.68 cm, respectively (P < 0.001), compared to the PCOS control group. Similarly, the non-PCOS intervention group showed a decrease in these factors by 2.60 kg and 4.95 cm (P < 0.001) when compared to the non-PCOS control group. After 12 months of intervention, the odds ratio (OR) for menstrual regularity in the PCOS intervention group increased to 3.30 (95% CI: 2.06, 5.25), and the acne score significantly decreased with an OR of 0.46 (95% CI: 0.31, 0.70). In contrast, the non-PCOS intervention group experienced an increase in the OR for menstrual regularity to 2.45 (95% CI: 1.33, 4.25) and an improved in acne score with an OR of 0.44 (95% CI: 0.28, 0.69). No notable differences were observed in the nutritional status among all groups post-intervention. However, a significant increase in physical activity levels, measured in metabolic equivalent minutes per week (met/min/week), was recorded in both intervention groups (p < 0.05). Manifestations of PCOS in adolescents are improved by a lifestyle promotion program and high schools are considered an appropriate setting to identify those with PCOS and the implementation of a lifestyle modification program. This program was also shown to promote healthy lifestyles for non-PCOS adolescents. Trial registration number: irct.ir number: IRCT20200114046123N1.

Nahidi F ，Ramezani Tehrani F ，Ghodsi D ，Jafari M ，Majd HA ，Abdolahian S ... -  《BMC Womens Health》

Using different anthropometric indices of obesity as predictors for type 2 diabetes mellitus in older adults.

There is some evidence that anthropometric measurements can be associated with the risk of type 2 diabetes mellitus (T2DM). Nevertheless, there is no comprehensive consensus on which anthropometric index is the best for evaluating the risk and predicting T2DM, especially in older adults. For this reason, we compared the performance of six indices for detecting T2DM in a population of Colombian older adults. We conducted a cross-sectional study of 3453 older adults (≥60 years old; 2023 women), analysing demographic characteristics, biochemical markers, and anthropometric indices including body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR), adiposity index (VAI), conicity index (C-Index), and body roundness index (BRI). T2DM was defined as fasting plasma glucose ≥126 mg/dl (≥7.0 mmol/l). All the anthropometric indices correlated significantly with the presence of T2DM. An analysis of the receiver operating characteristic curve showed that for men the VAI (AUC = 0.71; moderate ES (0.78); OR = 4.13), BMI (AUC = 0.68; moderate ES (0.68); OR = 3.38), and WC (AUC = 0.68; moderate ES (0.68); OR = 3.38) are the best predictors for identifying T2DM. For women, however, the WC (AUC = 0.63; ES = 0.46; OR = 2.34) and C-Index (AUC = 0.63; ES = 0.46; OR = 2.34) were better indicators for predicting T2DM. Cut-off points for all the anthropometric indices were provided. In summary, the VAI, BMI, and WC in men, and WC and the C-Index in women have a moderate discriminating power for detecting T2DM in Colombian older adults, evidencing that these anthropometric indices are suitable screening tools for use in the elderly.

Ramírez-Vélez R ，Pérez-Sousa MA ，González-Jiménez E ，Correa-Rodríguez M ，Calderón-González JC ，Dávila-Grisales A ，Schmidt-RioValle J ... -  《-》