Introduction: The body roundness index (BRI) and a body shape index (ABSI) are novel anthropometric indices established to determine both the amount visceral adipose tissue and body fat. Objective: ...to investigate whether BRI and ABSI are better predictors of hypertension than body mass index (BMI), waist circumference (WC) or waist-to-height ratio (WHtR). Methods: A systematic search was conducted in the Scopus, PubMed and Web of Science databases up until 31 December 2020. Results: The estimated pooled area under curve AUC (95% CI) for BRI 0.67 (0.65–0.70) for the prediction of hypertension were superior to that of ABSI (0.58 (0.56–0.60)), similar to that of BMI 0.67 (0.64–0.69), and lower than those WC 0.68 (0.66–0.70) and WHtR 0.68 (0.66–0.71). Nevertheless, the difference of BRI compared to WC and WHtR in the context of predicting hypertension was non-significant. ABSI was significantly lower (p < 0.05) than BRI, BMI, WC and WHtR. Similar findings were observed with the summary receiver operating characteristic curve (AUC-SROC). There were no significant differences between subgroups according to type of population or diagnostic criteria of hypertension. The diagnostic odds ratio (dORs) proved that increased BRI and ABSI were related with an elevated hypertension risk. Conclusions: BRI and ABSI have discriminatory power for hypertension in adult women and men from different populations. Although, WHtR and WC provided the best performance when assessing hypertension, no significant differences were found for BRI. Finally, BRI was significantly better predictor of hypertension than ABSI.
Aims
To evaluate the effectiveness of a brief motivational intervention to increase the breastfeeding duration in the first 6 months postpartum in mothers who began breastfeeding in the first hour ...after birth and to explore the role of general and breastfeeding self‐efficacy in this relationship.
Design
A multi‐centre randomized controlled clinical trial.
Methods
Data were collected from February 2018 ‐ March 2019. Women were randomly assigned to an intervention group that received a brief motivational intervention (N = 44) or a control group that was offered standard education on breastfeeding (N = 44). Survival analysis techniques were carried out with a follow‐up of 6 months. In addition, the roles of breastfeeding and general self‐efficacy in the association between BMI and breastfeeding duration were explored through mediation/moderation analysis.
Results
Among 88 randomized patients (mean age, 32.82 years), 81 (92.04%) completed the trial. The survival analyses of exclusive breastfeeding and breastfeeding (exclusive and non‐exclusive) showed reductions in the risk of abandonment in the intervention group of 63% (aHR: 0.37 0.22–0.60 p < .001) and 61% (aHR: 0.39 0.20–0.78 p = .008), respectively. We found that self‐efficacy acted as a moderator of the effect of brief motivational intervention on breastfeeding self‐efficacy. A discrete indirect effect of brief motivational intervention through increased breastfeeding self‐efficacy was found on breastfeeding duration, with an index of moderated mediation of 0.08 (95% CI: 0.02–0.19). Greater positive variations in the breastfeeding self‐efficacy scores during follow‐up predicted exclusive and non‐exclusive breastfeeding duration.
Conclusion
A brief motivational intervention conducted in the immediate postpartum period increases breastfeeding and exclusive breastfeeding duration in the first 6 months. Although breastfeeding self‐efficacy seems to moderate the effect of brief motivational intervention on the increase in breastfeeding duration, other factors may influence its effectiveness. Further studies could focus on exploring how brief motivational intervention works and whether it also works for pregnant mothers who have not yet decided whether to breastfeed.
Impact
Brief motivational intervention could be introduced as part of routine care of women who begin breastfeeding to improve the low rates of exclusive breastfeeding at 6 months postpartum.
Trial registration
Unique Protocol ID: Moti003; https://ClinicalTrials.gov ID: NCT03357549.
目的
评价对产后1小时开始母乳喂养的产妇在产后前6个月进行短期激励性干预以延长母乳喂养时间的有效性,并探讨一般自我效能感和母乳喂养自我效能感在这一关系中的作用。
设计
多中心随机对照临床试验。
方法
收集了2018年2月至2019年3月期间的数据资料。经随机分配,将产妇分为两组,一组为接受短期激励性干预的干预组(N = 44),另一组为接受母乳喂养标准教育的对照组(N=44)。随访时间6个月,并进行生存分析。此外,通过调解/适度性分析,还探讨了母乳喂养自我效能感和一般自我效能感在体重指数与母乳喂养持续时间二者关系中的作用。
结果
88名随机患者中(平均年龄32.82岁)中有81例(92.04%)完成了试验。纯母乳喂养和母乳喂养(纯母乳喂养和非纯母乳喂养)的生存分析表明,干预组的放弃风险分别降低了63%(aHR: 0.37 【0.22–0.60】 p < .001)和61%(aHR: 0.39【0.20–0.78】 p = .008)。我们发现,自我效能感可调节短期励性干预对母乳喂养自我效能感的影响。通过提高母乳喂养自我效能感,短期励性干预对母乳喂养持续时间具有离散的间接影响,且适度调解指数为0.08(95% CI: 0.02–0.19)。在随访期间,母乳喂养自我效能感评分的正向变化较大,因此可用于预测纯母乳喂养和非纯母乳喂养的持续时间。
结论
产后立即进行短期激励性干预,可延长产后前6个月的母乳喂养和纯母乳喂养时间。虽然母乳喂养自我效能感似乎可调解短期激励性干预措施对增加母乳喂养持续时间的效果,但其他因素也可能会对其有效性产生影响。未来研究可侧重于探讨短期激励性干预的作用方式,以及其是否对尚未决定进行母乳喂养的孕妇有所影响。
影响
可实施短期激励性干预措施,作为开始进行母乳喂养的产妇的日常护理的一部分,以提高产后6个月的纯母乳喂养率。
试验注册
唯一协议编号:Moti003;北美临床试验中心编号:NCT 03357549。
Background and aims
Clinical trials have shown that intensive low‐density lipoprotein cholesterol (LDL‐C) lowering improves cardiovascular outcomes among patients with atherosclerotic cardiovascular ...disease (ASCVD), but data are limited in real clinical practice, particularly for patients with ASCVD informing different territories.
Methods
FRENA was a prospective registry of consecutive outpatients with coronary, cerebrovascular or peripheral artery disease. We compared the incidence of recurrent events in patients with sustained LDL‐C levels <70 mg/dl compared with those with ≥70 mg/dl.
Results
As of December 2018, 1182 patients were eligible for this study. Among them, 172 (14.5%) had mean LDL‐C levels ≤70 mg/dl, and 1010 (85.5%) had <70 mg/dl. Their clinical characteristics at baseline were similar. During 5 years of follow‐up, 252 patients (21%) suffered major adverse cardiovascular events (MACE). The incidence rates of MACE were 3.42 events per 100 patient‐years (95% confidence interval 95% CI 2.17–5.14) in patients with levels <70 mg/dl and 5.57 (95% CI, 4.87–6.34) in those with ≥70 mg/dl; the rate ratio was 0.61 (95% CI, 0.39–0.92), p = 0.019. On multivariable analysis, patients with LDL‐C levels <70 mg/dl were at lower risk for MACE (hazard ratio HR: 0.61 95% CI, 0.39–0.93 p < 0.05). MACE reduction was driven by a decrease in coronary and peripheral events with no significant effect on stroke.
Conclusions
Long‐term sustained LDL‐C <70 mg/dl in the clinical practice is associated with reduction in cardiovascular and peripheral vascular events with no apparent effect on stroke.
Summary
Body roundness index (BRI) is a new anthropometric index developed to predict both body fat and the percentage of visceral adipose tissue. Our aim was to investigate whether BRI is superior ...to traditional anthropometric indices in predicting metabolic syndrome (MetS). This systematic review and meta‐analysis was conducted using Pubmed, Scopus and Web of Sciences databases. The estimated pooled areas under curve (AUCs) for BRI predicting MetS was higher than body mass index (BMI), waist‐to‐hip ratio (WHR), body shape index (ABSI) and body adiposity index (BAI), similar to waist circumference (WC) and lower than waist‐to‐height ratio (WHtR). However, the difference between BRI and BMI, WC and WHtR predicting MetS was statistically non‐significant. Similar results were found with the summary receiver operating characteristic curve (AUC‐SROC). In addition, the non‐Chinese population had pooled AUCs greater than the Chinese population for all indices. Pooled ORs showed that BRI is associated with an increased MetS risk. In conclusion, BRI had good discriminatory power for MetS in adults of both sexes from diverse populations (AUC > 0.7; AUC‐SROC>0.7). However, WC and WHtR offer the best performance when screening for MetS, and non‐significant differences were found with BRI. In contrast, BRI was superior to BMI, WHR, ABSI and BAI in predicting MetS.
Background
The relationship between anticardiolipin (aCL) antibodies and cardiovascular events is uncertain and may vary according to arterial location.
Materials and methods
FRENA is an ongoing ...registry of stable outpatients with symptomatic coronary artery disease (CAD), cerebrovascular disease (CVD) or peripheral artery disease (PAD). The rate of subsequent ischaemic events was cross‐referenced with the presence of aCL antibodies (any isotype, IgG or IgM).
Results
As of June 2017, 1387 stable outpatients were recruited. Of these, 120 (8.7%) showed positive levels of aCL antibodies. Over an average follow‐up of 18 months, 250 patients developed subsequent events: 101 myocardial infarction, 57 ischaemic stroke and 92 critical leg events. Patients with positive aCL antibodies had a higher risk of distal artery events (a composite of ischaemic stroke or critical leg events) than patients with undetectable or low levels (rate ratio: 1.66; 95% CI: 1.07‐2.60). However, an association with central coronary events was not found. The multivariate Cox analysis after adjustment for relevant clinical covariates showed that positivity of aCL antibodies is an independent risk factor for distal events (hazard ratio: 1.60; 95% CI: 1.01‐2.55; P < .05).
Conclusions
Positivity of aCL antibodies is associated with an increased risk of subsequent distal artery ischaemic events (cerebral or leg arteries) but not coronary artery events. Anticardiolipin antibodies appear to have a different relationship on the localisation of ischaemic events in patients with symptomatic artery disease.
Introduction: New anthropometric indices have been developed as an alternative to body mass index (BMI) and waist circumference (WC) to assess body mass and visceral fat. Asymptomatic hyperuricemia ...is considered an independent cardiovascular risk factor. Currently, little is known about the relationship between asymptomatic hyperuricemia and several new anthropometric indices. This study aimed to assess the association between the presence of asymptomatic hyperuricemia and anthropometric indices, both novel and traditional. Methods: This study analyzed 1094 Spanish subjects who consecutively visited the cardiovascular risk consultation of the University Hospital San Pedro de Alcántara of Cáceres, Spain, between June 2021 and September 2022. Anthropometric measures, including traditional and novel indices, were determined. The asymptomatic hyperuricemia group was defined according to serum uric acid levels. Results: All the anthropometric indices studied, including new and traditional, were significantly greater among patients with asymptomatic hyperuricemia, except for WWI. In multiple linear regression analysis, serum uric acid levels were significantly correlated with BMI, WHR, WHtR, AVI, BAI, BRI, CUN-BAE, and WWI but not ABSI or CI. In the univariate analysis, all indices were associated with asymptomatic hyperuricemia (p < 0.05); however, only WHtR (adjusted OR: 2.93; 95% CI: 1.03–8.37; p = 0.044), AVI (adjusted OR: 1.46; 95% CI: 1.04–2.04; p = 0.026), and BRI (adjusted OR: 1.66; 95% CI: 1.19–2.32; p = 0.003) were significantly associated in multivariate analysis. Finally, WHtR, AVI, and BRI provided the largest AUCs. Conclusions: Our findings showed that WHtR, AVI, and BRI were independently positively associated with asymptomatic hyperuricemia and could be good predictors.
IntroductionCardio‐ankle vascular index (CAVI) is a new marker of arterial stiffness (AS) that can assess vascular wall stiffness in the aorta, femoral artery and tibial artery. CAVI is less affected ...by blood pressure at the time of measurement than the gold standard method (carotid-femoral pulse wave velocity (PWV)). Our group has developed a device called VOPITB (Velocidad Onda de Pulso Índice Tobillo Brazo) that uses the oscillometric method and easily and accurately measures the PWV in the arms and legs separately, allowing new AS indices to be studied. This article describes the research protocol to determine CAVI using VOPITB and to validate the device against a reference device (VaSera VS-1500) and assess its clinical utility.Methods and analysesA cross-sectional, descriptive and observational study will be conducted. In all, 120 subjects (a minimum of 40% of subjects from any one gender) will be evaluated. CAVI will be determined from the measurement by VOPITB and VaSera VS-1500. For each subject, the average of the three readings taken with each device will be calculated. The Bland-Altman plot will be used to determine whether any bias exists in the data—that is, a tendency of the size of the difference to vary with the mean. The participants will be divided roughly equally between the following age bands: <30, 30–60 and >60 years.Ethics and disseminationThe study has been approved by the ethics committee of the Hospital San Pedro de Alcántara, Cáceres, Spain. The participants will be required to sign an informed consent form before inclusion in the study, in accordance with the Declaration of Helsinki and WHO standards for observational studies. The dissemination plan of the research study results will be through presentations in relevant national and international conferences and scientific publications in peer-reviewed journals.Trial registration numberNCT04303546.
Novel anthropometric indices have been proposed as an alternative to body mass index (BMI) and waist circumference (WC) to determine visceral adipose tissue and body mass. Little is known about the ...relationship of these new anthropometric indices to subclinical carotid atherosclerosis. The objective of this study was to assess the association of anthropometric indices, both new and traditional, with the presence of subclinical carotid artery arteriosclerosis (SCAA) estimated by Doppler ultrasound. This cross-sectional study analyzed 788 Spanish patients who consecutively attended a vascular risk consultation between June 2021 and September 2022. Traditional anthropometric indices (BMI, WHR and WHtR) and novel indices (ABSI, AVI, BAI, BRI, CI, CUNBAE and WWI) were calculated, and Doppler ultrasound in the carotid artery (cIMT and atherosclerosis plaque) was performed to detect SCAA. All analyzed anthropometric indices, except BMI, BAI and CUNBAE, were significantly higher in patients with SCAA. ABSI, BRI, CI, WHR, WHtR and WWI and were associated with SCAA in the univariate analysis (p<0.05); however, only ABSI (adjusted OR: 1.15; 95% CI: 1.10-2.38; p= 0.042) was significantly associated with SCAA in the multivariate analysis. In conclusion, only ABSI was significantly positively associated with SCAA, independent of other confounders.
Recent meta-analysis studies have reported that metabolic comorbidities such as diabetes, obesity, dyslipidaemia and hypertension are associated with higher risk of severe acute respiratory syndrome ...(SARS) and mortality in patients with COVID-19. This meta-analysis aims to investigate the relationship between metabolic syndrome (MetS) and its components with SARS and mortality in COVID-19 patients.
A systematic search was conducted in the several databases up until 1 September 2021. Primary observational longitudinal studies published in peer review journals were selected. Two independent reviewers performed title and abstract screening, extracted data and assessed the risk of bias using the Newcastle-Ottawa Scale.
The random effects meta-analysis showed that MetS was significantly associated with SARS with a pooled OR (95% CI) of 3.21 (2.88-3.58) and mortality with a pooled OR (95% CI) of 2.32 (1.16-4.63). According to SARS, the pooled OR for MetS was 2.19 (1.71-2.67),
< 0.001; significantly higher than the hypertension component. With regard to mortality, although the pooled OR for MetS was greater than for its individual components, no significant differences were observed.
this meta-analysis of cohort studies, showed that MetS is better associated to SARS and mortality in COVID-19 patients than its individual components.
The effects of maintaining all classical, vascular risk factors on target among patients with stabilized atherosclerotic cardiovascular disease (ASCVD) are uncertain. Factores de Riesgo y ENfermedad ...Arterial (FRENA) was a prospective registry of consecutive outpatients with coronary, cerebrovascular, or peripheral artery disease. We analyzed the incidence of recurrent events and mortality according to sustained, optimal control of principal risk factors including the following: LDL cholesterol, glucose, blood pressure, and smoking. As of December 2018, 4285 stable outpatients were eligible for this study. Over a median follow-up of 21 months, 664 (15%) maintained all risk factors on target (Group 1), while 3621 (85%) did not (Group 2). During follow-up, no differences in recurrent major adverse cardiovascular events (MACEs) or death were observed between groups. On multivariable analysis, patients with previous known dyslipidemia (hazard ratio HR: 95% confidence interval (95% CI): (HR: 1.20 95% CI, 1.03-1.40), polyvascular disease (HR: 1.98 95% CI, 1.69-2.32), insulin therapy (HR: 1.56 95% CI, 1.24-1.95) and associated conditions (HR: 1.47 95% CI, 1.24-1.74) were associated with a higher risk for subsequent MACE. The presence of associated medical conditions was also strongly associated with all-cause death (HR: 3.49 95% CI, 2.35-5.19). Only a minority of patients with atherosclerotic cardiovascular disease achieved sustained optimal control for all principal risk factors although without discernible clinical, therapeutic benefit. The findings of the present study provide some insights into what factors may be used to guide physicians in adapting intensive, multifactorial therapy to the individual patient in clinical practice.
PDF
