Exploring the Role of Adult Wrist Circumference as a Potential Indicator of Obesity.

OBJECTIVE: To explore the correlation of wrist circumference (WrC) with various obesity indices and to determine gender-specific optimal cut-off points of WrC for obesity. STUDY DESIGN: Cross-sectional study. Place and Duration of the Study: Dow University of Health Sciences, Karachi, Pakistan, from December 2021 to December 2022. METHODOLOGY: Two hundred and eighty residents of Karachi, aged 30-60 years, participated in this research. Established methods were used to measure body mass index (BMI), waist circumference, hip circumference, neck circumference, WrC, visceral fat level, waist-hip ratio, abdominal volume index, and body roundness index. Correlation of WrC with all obesity markers was done and scatterplots were obtained. Receiver Operating Characteristic curves were plotted to find the gender-specific cut-off value of WrC. RESULTS: Of the total 280 subjects, 191 (68%) were females and 89 (32%) were males. The overall mean age was 42.04 ± 9.12 years (range: 28-65 years). The mean WrC in males and females were 16.32 ± 1.01 cm and 14.82 ± 1.03 cm, respectively. The WrC correlated best with neck circumference in males (r = 0.758; p<0.001) and BMI in females (r=0.615; p<0.001). The scatterplots obtained showed positive linear relationships between WrC and anthropometric variables. The cut-off values of WrC for adult males and females when compared to waist circumference were 15.45 cm and 13.95 cm, respectively. CONCLUSION: Measurement of the WrC can be a helpful indicator to identify excess weight in the general population. Its ease of measurement makes it applicable in both routine clinical practice and extensive epidemiological research. KEY WORDS: Wrist circumference, BMI, Waist circumference, Obesity.

The relationship of 1,25-dihydroxyvitamin D and Vitamin D binding protein in periodontitis.

OBJECTIVE: This study was conducted to explore the relationship between 1,25-dihydroxy vitamin D (1,25(OH)2D) and Vitamin-D binding protein (DBP) in patients with periodontitis and healthy controls. METHODS: Seventy-five periodontitis cases were recruited from the dental OPD of Dow University of Health Sciences, Karachi. Diagnostic criteria of periodontitis were followed according to the probe pocket depth and clinical attachment loss. Seventy-five periodontal healthy controls were selected from the faculty and students of same university. Serum levels of 1,25(OH)2D and DBP were determined by ELISA. RESULTS: Significantly low levels of 1,25(OH)2D and high levels of serum DBP were observed in periodontitis patients compared to healthy controls (p<0.05), with levels of DBP increasing significantly with the severity of periodontitis (p=0.005). Concentrations of DBP correlated positively with 1,25(OH)2D, especially in cases with periodontitis (r =0.780; p<0.001). CONCLUSION: Within the limits of the study, we conclude that low 1,25(OH)2D levels and high DBP levels are associated with periodontitis.

Leptin as a predictor of anthropometric cutoff points for obesity.

This study was conducted to find the association between leptin and adiposity indices. Secondly, to identify optimal threshold of various anthropometric indices for obesity, as assessed by 75th percentile of leptin levels, within a clinic sample of non-diabetic and diabetic Pakistani adults. Fasting serum leptin levels were compared with anthropometric markers of obesity in 164 diabetic and non-diabetic subjects (90 male, 74 female), aged 35 to 65 years. Obesity was defined by body mass index (BMI) of 25 kg/m2 in either sex. The cutoff point of leptin was taken as the 75th percentile in non-obese subjects. Diagnostic accuracy for detecting excess fatness was evaluated through receiver operating characteristics (ROC) analyses with leptin taken as reference test against anthropometric indices as test variables. The 75th percentile of leptin in male and female was 7.0ng/mL and 17.9ng/mL, respectively. Leptin levels were significantly higher in females (p<0.001) and had strong positive correlation (p<0.001) with most anthropometric indices of obesity in both sexes; hip circumference (HC) being most prominent among these. Largest area under ROC curve (AUC) was between WC and leptin (AUC=0.844; CI=0.764, 0.925) in males and BMI and leptin (AUC=0.832; CI=0.740, 0.923) in females. The optimum thresholds for obesity indices in our study were: BMI, WC and HC as 25 kg/m2, 96.25cm, 99.25cm for males; 27 kg/m2, 95.50cm, 105.5cm for females, respectively. Leptin can be considered as a potential marker of obesity and may be used to identify obesity cutoffs in future demographic surveys. Longitudinal studies are required that include leptin in coronary artery disease risk assessment models.

Serum Interleukin-15 and its relationship with adiposity Indices before and after short-term endurance exercise.

OBJECTIVE: The myokine interleukin-15 (IL-15) is capable of modifying the metabolism of both skeletal and adipose tissue. This study compares the change in serum levels of IL-15 in obese and non-obese after a single session of submaximal exercise. METHODS: A cross-sectional study was carried out at Jinnah Medical and Dental College, Karachi, during Aug-Dec 2015, comprising of 133 medical students (aged 17-24 years). Cardiorespiratory fitness was evaluated by Queen's College Step Test. Blood was obtained both before and just after exercise and serum levels of IL-15 determined by enzyme-linked immunosorbent assay. RESULTS: Mean serum level of IL-15 was 3.64±1.59 pg/mL. Higher levels of IL-15 were seen in lean subjects compared to overweight/obese, both before and after three minutes of exercise (all Ptrend<.001). The percent increase in IL-15 upon exercise was 12.7% higher in lean. Significant negative association was seen between interleukin-15 and adiposity, especially visceral fat (r = -.288, p=.001). CONCLUSION: Interleukin-15 correlates negatively with adiposity indices, especially visceral fat. With the proven benefit of IL-15 in terms of adipose tissue stores and skeletal muscle mitochondrial biogenesis, endurance exercises, even of short duration, may possess therapeutic potential towards producing a healthier body.

Cardiorespiratory fitness and its association with adiposity indices in young adults.

OBJECTIVE: This study investigated the relationship between cardiorespiratory fitness (CRF) and adiposity in young adults. METHODS: Data was collected from 133 students of a medical college of Pakistan. The study was conducted on young adults, aged 17-24 years, recruited from Jinnah Medical & Dental College, Karachi, between Aug-Dec, 2015. Queen's College Step Test was conducted to measure CRF and maximal oxygen uptake (VO2max) evaluated. Anthropometric measurements (body mass index, body fat, visceral fat, waist circumference) were taken to assess adiposity. Associations of VO2max and adiposity were analyzed. RESULTS: The prevalence of overweight/obesity was 44% overall. The VO2max (ml/kg/min) of males and females was 55.41±9.45 and 39.91±3.14, respectively, the gender difference being highly significant (p<0.001). Quartiles of VO2max showed strong inverse relationship between adiposity and VO2max, obese individuals having low VO2max (1st quartile) and normal weight individuals having high VO2max (4th quartile). VO2max correlated greatest with body fat in males (r = -0.600; p<0.001), and waist circumference in females (r = -0.319; p=0.004). CONCLUSION: The results indicate low CRF in young females and a strong inverse relationship between fitness levels and adiposity in young adults of both genders. Improving these parameters in our young population may prevent development of chronic non-communicable disease in later life.

Neck circumference: A supplemental tool for the diagnosis of metabolic syndrome.

OBJECTIVE: To explore the usefulness of neck circumference as a supplemental tool for diagnosing metabolic syndrome while identifying its cut-off values. METHODS: This case-control study was conducted at Dr. Essa's Laboratory and Diagnostic Centre, Karachi, from December 2014 to April 2015, and comprised subjects with and without metabolic syndrome aged between 35 and 65 years regardless of their diabetic status. Evaluation was done for metabolic syndrome by measuring anthropometric, clinical and biochemical parameters according to the criteria proposed by the International Diabetes Federation. Variables in both cases and controls were correlated with neck circumference and its cut-off values were determined for diagnosing metabolic syndrome. SPSS 20 was used for statistical analysis. RESULTS: Of the 215 subjects enrolled, 164(76.28%) were selected. Of them, 83(50.61%) were cases and 81(49.39%) were controls. Moreover, 90(55%) of them were men and 74(45%) were women. The overall mean age was 51.15±10.36 years (range: 35 to 65 years).The mean neck circumference was 36.13±2.14 cm and 31.59±1.18 cm in normal-weight men and women, respectively, compared with 40.0±2.13 cm and 35.75 ± 2.74 cm among obese men and women. The neck circumference correlated best with waist circumference in men (p=0.001) and with body surface area in women (p=0.001). The area under the curve of neck circumference for metabolic syndrome was 0.760 for men (p<0.001) and 0.631 for women (p<0.05). Optimal neck circumference cut-off points to determine metabolic syndrome were >38 cm for men and >34 cm for women. The odds ratio for metabolic syndrome was 12.44 (95% confidence interval: 4.13-37.41) among male cases and controls compared to 3.34 (1.26-8.80) among women. CONCLUSIONS: Neck circumference strongly correlated with adiposity indices and had a definite cut-off point. It can therefore be used as a useful adjunct for clinical screening of metabolic syndrome.

Analysis of one-best MCQs: the difficulty index, discrimination index and distractor efficiency.

OBJECTIVE: To investigate the relationship of items having good difficulty and discrimination indices with their distractor efficiency to find how 'ideal questions' can be affected by non-functioning distractors (NF-Ds). METHODS: The cross-sectional study was conducted at Fatima Jinnah Dental College, Karachi, during Jan-Jun 2009, with 102 First Year dental students (17-20 years). Physiology paper of the first semester, given after 22 weeks of teaching general topics of physiology, was analysed. The paper consisted of 50 one-best MCQs, having 5 options each. The MCQs were analysed for difficulty index (p-value), discrimination index (DI), and distractor efficiency (DE). Items having p-value between 30-70 and DI > or = 0.25 were considered as having good difficulty and discrimination indices respectively. Effective distractors were considered as the ones selected by at least 5% of the students. RESULTS: The mean score was 27.31 +/- 5.75 (maximum 50 marks). Mean p-value and DI were 54.14 +/- 17.48 and 0.356 +/- 0.17, respectively. Seventy eight per cent items were of average (recommended) difficulty (mean p-value = 51.44 +/- 11.11) and having DE = 81.41%. Sixty two per cent items had excellent DI (0.465 +/- 0.083) with DE = 83.06%. Combining the two indices, 32 (64%) items could be called as 'ideal' (p-value = 30 to 70; DI > 0.24) and had DE = 85.15%. Overall 42% items had no Non-functioning Distractors (NF-D), while 12% had 3 NF-Ds. Excellent discrimination (DI = 0.427) was achieved with items having one NF-D, while items with 2 NF-D and no NF-D had nearly equal but lower DI (0.365 and 0.351 respectively). CONCLUSION: One-best MCQs having average difficulty and high discrimination with three functioning distractors should be incorporated into future tests to improve the test score and properly discriminate among the students. Items with two NF-Ds, though easier, are better discriminators than items with no NF-D.

Neck circumference as a useful marker of obesity: a comparison with body mass index and waist circumference.

OBJECTIVE: To evaluate the usefulness of neck circumference as an index of excess weight and obesity in young adults while identifying its appropriate cutoff points. METHODS: The study comprised 41 male and 109 female students, aged 18-20 years. Anthropometric markers of obesity were measured, including body mass index, waist circumference, hip circumference, waist-to-hip ratio, and compared with neck circumference of the same subjects. Overweight and obesity levels were defined by BMI > or = 23.0 and > or = 25.0 respectively. RESULTS: Overall 29.2% males and 25.6% females were found overweight/obese. The mean body mass index was 21.7 kg/m2 in males and 21.0 kg/m2 in females. The mean waist and neck circumferences were higher in males (80.6 cm, and 35.5 cm) than females (78.1 cm, and 31.5 cm). Neck circumference had a strong positive correlation (p<0.001) with other relevant indicators in all subjects, except the waist-to-hip ratio which was applicable on males only. At BMI of 23.0 and 25.0, males had neck circumference 35.7cm and 37.5cm, while females had it at of 32.2cm and 33.5cm respectively. CONCLUSION: Neck circumference is a potentially useful initial screening tool for overweight/obesity. A neck circumference > or = 35.5 cm in men and > or = 32 cm in women should be considered the cutoff point for overweight/obesity.

Overweight and obesity in students of a dental college of Karachi: lifestyle influence and measurement by an appropriate anthropometric index.

OBJECTIVE: To compare body mass index (BMI), waist circumference (WC), and body fat percentage (%BF), as index of overweight and obesity in young adults. We also intended to find an association between lifestyle behaviours and obesity. METHODS: A cross-sectional study was conducted at Fatima Jinnah Dental College, Karachi, during 2007 to 2008, with 192 first year dental students, (18-21years) of high socioeconomic class. All were questioned regarding lifestyle behaviours. Overweight and obesity were estimated by measuring %BF, BMI, and WC. For %BF, skinfold thickness was measured using skinfold calipers. BMI > or = 23.0-24.9 kg/m2 was taken as overweight and > or = 25.0 kg/m2 as obese (Asians criteria proposed by Western Pacific Regional Office of World Health Organization). WC using Asian cutoff values for overweight and obesity were: males > or = 78 cm and > or = 90 cm; females > or = 72 cm and > or = 80 cm, respectively. Body fat percentage used to define overweight and obesity was: males 22.1-27.0 and > 27.1; females 27.1-32.0 and > 32.1, respectively. Pearson's correlation was done between the BMI, WC and %BF with statistical significance taken at P < 0.01. RESULTS: BMI (Expressed as mean +/- SD) in males and females was 23.82 +/- 3.88 and 20.98 +/- 4.12 respectively. WC was 83.63 +/- 10.20 cm in males and 70.22 +/- 9.36 cm in females. %BF was 22.32 +/- 6.27 in males and 28.73 +/- 6.65 in females, with an overall 60.8% females and 44.4% males found to be overweight or obese. Obesity was underpredicted by BMI when compared to skinfold calipers method. The obese were seen to skip breakfast more often [odds ratio (OR): 2.39], take frequent snacks (OR: 1.58), watch television more (OR: 1.58), and were physically less active than their non-obese counterparts. CONCLUSION: Body fat percentage using skinfold caliper is a reliable index of obesity. Lack of sleep and skipping of breakfast, are prominent promoters of obesity, in addition to other lifestyle behaviours.

Anthropometric and metabolic indicators in hypertensive patients.

OBJECTIVE: To determine the relationship between anthropometric variables with blood glucose and lipid concentrations in different stages of hypertension and evaluate the risk factors involved in progression of pre-hypertension stage in to clinical hypertension stage-1. STUDY DESIGN: Case-control study. PLACE AND DURATION OF STUDY: National Institute of Cardiovascular Disease and General Practitioner's Clinics, Karachi, from 2005 to 2007. METHODOLOGY: The study was conducted on 276 participants aged 25-65 years and classified into four categories of control, prehypertension (pre-HTN), hypertension (HTN) stage I and II, according to 7th JNC report. Anthropometric measurements and blood chemistry were obtained. The relationship between obesity indices (Body Mass Index [BMI], Waist Circumference [WC], Waist Hip Ratio [WHpR], Waist Height Ratio [WHtR], Basal Metabolic Rate [BMR] and Cardiovascular Disease [CVD] risk factors [blood pressure, serum lipids and glucose levels]) were investigated. The analysis of variance and test of Pearson's coefficient correlation were applied to assess relationship of all the variables. RESULTS: The mean WHR had significant correlation with both systolic and diastolic BP in all groups of HTN, as well as with blood glucose level in control and pre-HTN groups. BMI was positively correlated with cholesterol (r=0.29) and triglyceride (r=0.25) in HTN stage-1. Impaired and high blood glucose levels were found in pre-HTN group; all lipid parameters except triglycerides were higher in HTN stage I. CONCLUSION: WHR was positively and independently related to occurrence of arterial hypertension. Elevated levels of WHR, BMI, fasting blood glucose, total cholesterol and triglycerides were responsible for progression of pre-HTN stage in to HTN stage-1.

Ehlers-danlos syndrome--clinical presentation.

Two cases of Ehlers-Danlos syndrome (EDS) diagnosed on the basis of their clinical presentation are presented. EDS is a rare genetic disorder involving connective tissue of skin and joints, having a variety of presenting signs and symptoms. There is no specific therapy for this disease but it is important to diagnose it as it may end up in fatal complications.

Role of exercise in osteoporosis prevention--current concepts.

Osteoporosis is a metabolic disorder of the bones due to loss of both bone mineral and bone matrix in equal proportions resulting in a bone that is weak and unable to support the body. This becomes a problem in the elderly who are then at risk of frequent fractures increasing the morbidity and mortality. Measures taken early in life in the form of calcium and exercise go far in preventing the development of this disorder. The primary purpose of this narrative review is to evaluate the current literature and to provide insight into the role of exercise relating to osteoporosis. Emphasis is given to the importance of the specific types of exercises needed to increase bone strength and muscle power, keeping in view the age and general physical condition of the person.

Presentation, staging and diagnosis of lymphoma: a clinical perspective.

BACKGROUND: Due to lack of awareness among health professionals, lymphoma is often misdiagnosed. This study was done to evaluate the clinical features and histopathologic subtypes of lymphoma. METHODS: Sixty diagnosed cases of lymphoma were selected (aged 12-65 years) from medical units of Civil Hospital Karachi, during 1993 to 1998. Clinical history, physical examination and basic laboratory investigations including imaging procedures were done in all the patients. The diagnosis of lymphoma was based on histology, following the International Working Formulation classification system. This included lymph node biopsy and in some cases, biopsy of the bone marrow. The Ann Arbor Staging Classification was used to classify the extent of disease. RESULTS: Out of 60 cases of lymphoma, 81.6% (49 cases) were diagnosed as non-Hodgkin's lymphoma and 18.3% (11 cases) as Hodgkin's disease, with an overall male predominance. Both categories exhibited a bimodal age distribution. Lymphadenopathy was the commonest presenting features in both the types of lymphomas; however, patients with Hodgkin's disease had a prominence of 'B' symptoms, whereas abdominal signs and symptoms were more common in non-Hodgkin's lymphoma. On histopathology, majority of non-Hodgkin's lymphomas (91.8%) showed a diffuse pattern, while mixed cellularity was the commonest type seen in Hodgkin's disease (81.8%). CONCLUSION: Non-Hodgkin's lymphoma was 4 times more common than Hodgkin's disease. The vast clinical spectrum of lymphoma sometimes delays its diagnosis, leading to its eventual presentation in late stages. A general awareness is hence required among the health professionals regarding its varied clinical presentations.

Current trends in type 1 diabetes mellitus--stem cells and beyond.

Search for a cure for type-1 diabetes mellitus has lead to many avenues of research, all having the same objective: to replace the lost beta cells and prevent their further destruction by the immune system. Transplantation of islets of Langerhans seems closer to achieving this goal with the recent introduction of new improved immunosuppressive protocols including monoclonal antibodies against the T-lymphocytes. But the need for acquiring beta cells in large numbers rather limits this approach. With the recent advancement in stem cell technology, it may be possible to gather enough stem cells for transplantation purposes. In this regard, embryonic stem cells have shown the greatest promise due to their capacity for unlimited proliferation and differentiation into any cell type. This review discusses the current direction of research regarding diabetes mellitus type-1, while explaining the progress being made in stem cell usage in finding a cure for the disease.