OBJECTIVE: Obesity and type 2 diabetes (T2D) have been associated with low adherence to the 2017 French food-based dietary guidelines, as assessed by the Programme National Nutrition Santé - guidelines score 2 (PNNS-GS2). Whether the association between T2D and PNNS-GS2 is direct or mediated by obesity has been little investigated.
METHODS: The study included 71,450 women from the E3N-EPIC cohort, mean age of 52.9 y (SD 6.7). The simplified PNNS-GS2 was derived via food history questionnaire. Multivariable Cox regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of T2D. Causal mediation analyses were used to decompose the total effect of sPNNS-GS2 on T2D into a direct effect and indirect effect mediated by body mass index (BMI) or the waist-hip ratio (WHR).
RESULTS: During a mean follow-up of 19 y, 3679 incident T2D cases were identified and validated. There was a linear association between adherence to sPNNS-GS2 and T2D (P-nonlinearity = 0.92). In the fully adjusted model, each 1-SD increase in the sPNNS-GS2 was associated with a lower T2D risk [HR (95% CI), 0.92 (0.89, 0.95)]. The overall associations were mainly explained by sPNNS-GS2-associated excess weight, with BMI and WHR mediating 52% and 58% of the associations, respectively.
CONCLUSIONS: Higher adherence to French food-based dietary guidelines was associated with a lower risk of T2D in women, and a significant portion of this effect could be attributed to excess weight measured by BMI or WHR. This finding helps better understand the mechanisms underlying the diet-T2D association.

BACKGROUND: Many studies have reported alteration in autonomic activity in obesity. However, there is paucity of literature comparing autonomic reactivity using different guidelines of obesity. As Indian guidelines were revised recently and WHO states that countries should use all categories of BMI for reporting purposes, it is prudent to compare physiological state in different categories of BMI.
OBJECTIVE: The aim of the present study was to compare the autonomic alteration in young adults using revised Indian and WHO guidelines for obesity.
METHODS: A battery of autonomic tests (Valsalva Manoeuvre (VM), Deep Breathing Test (DBT), Lying to Standing Test (LST) and Hand Grip isometric exercise Test (HGT) was conducted on 34 overweight and obese and 30 normal weight volunteers categorised using revised Indian guidelines of body mass index. Same participants were regrouped and analysed using WHO guidelines of BMI and waist hip ratio (WHR).
RESULTS: For analysis, participants were grouped into 3 categories of normal, overweight and obese using revised Indian guidelines for obesity. Same participants were regrouped according to WHO guidelines. E:I ratio during DBT, 30:15 ratio during LST, Valsalva ratio during VM and increase in DBP during HGT were compared in different subgroups. There was no difference in sympathetic and parasympathetic activities in participants classified according to revised Indian guidelines. In participants classified using WHO criteria, sympathetic reactivity in overweight subjects was significantly less as compared to normal subjects (p<0.05).
CONCLUSIONS: Autonomic alterations might be more related to body fat percent rather than BMI. Indian guidelines are based on the observation that Asian population has more adipose tissue in WHO range of BMI. As the guidelines of BMI are applicable to all age groups and do not consider physical activity profile, they might still not be a good predictor of body fat.

The long-term adherence to the dietary guidelines has not been evaluated against emergence of cardiometabolic risks in adolescents with increasing rates of obesity. The present study aimed to (1) determine the level of adherence to the guidelines using the Australian Dietary Guideline Index for Children and Adolescents (DGI-CA) in adolescents of age 14 and 17 years and to (2) examine the relationship between their assessed diet quality and concurrently measured cardiometabolic risk factors over time. Data were analysed from the Western Australian Pregnancy Cohort (Raine) Study. The DGI-CA was determined from a FFQ. Anthropometry and fasting biochemical measures were taken using standard procedures. Hierarchical linear mixed models examined associations between cardiometabolic risk factors and DGI-CA, adjusting for socio-economic status, physical activity, BMI, and sex, and examining for interactions. The mean DGI-CA scores were 47·1 (SD 10·2) at 14 years (n 1419) and 47·7 (SD 11·0) at 17 years (n 843), and were not different between sex. There was a significant inverse association between DGI-CA and insulin, homeostasis model assessment score and heart rate. The DGI-CA was positively associated with BMI (P= 0·029) but negatively with waist:hip ratio (P= 0·026). It was not associated with lipids or blood pressure, with the exception of a negative association with TAG (P= 0·011). The degree of adherence in the Raine Study adolescents was suboptimal but similar to the Australian Children\'s Nutrition and Physical Activity Survey. The present study shows that, at any particular time, better diet quality was associated with better insulin sensitivity and TAG levels and decreased abdominal fatness.

The long-term effects of dietary strategies designed to combat the metabolic syndrome (MetS) remain unknown. The present study evaluated the effectiveness of a new dietary strategy based on macronutrient distribution, antioxidant capacity and meal frequency (MEtabolic Syndrome REduction in NAvarra (RESMENA) diet) for the treatment of the MetS when compared with the American Heart Association guidelines, used as Control. Subjects with the MetS (fifty-two men and forty-one women, age 49 (se 1) years, BMI 36·11 (se 0·5) kg/m²) were randomly assigned to one of two dietary groups. After a 2-month nutritional-learning intervention period, during which a nutritional assessment was made for the participants every 15 d, a 4-month self-control period began. No significant differences were found between the groups concerning anthropometry, but only the RESMENA group exhibited a significant decrease in body weight ( - 1·7%; P= 0·018), BMI ( - 1·7%; P= 0·019), waist circumference ( - 1·8%; P= 0·021), waist:hip ratio ( - 1·4%; P= 0·035) and android fat mass ( - 6·9%; P= 0·008). The RESMENA group exhibited a significant decrease in alanine aminotransferase and aspartate aminotransferase (AST) concentrations ( - 26·8%; P= 0·008 and - 14·0%; P= 0·018, respectively), while the Control group exhibited a significant increase in glucose (7·9%; P= 0·011), AST (11·3%; P= 0·045) and uric acid (9·0%; P< 0·001) concentrations. LDL-cholesterol (LDL-C) concentrations were increased (Control group: 34·4%; P< 0·001 and RESMENA group: 33·8%; P< 0·001), but interestingly so were the LDL-C:apoB ratio (Control group: 28·7%; P< 0·001, RESMENA group: 17·1%; P= 0·009) and HDL-cholesterol concentrations (Control group: 21·1%; P< 0·001, RESMENA group: 8·7; P= 0·001). Fibre was the dietary component that most contributed to the improvement of anthropometry, while body-weight loss explained changes in some biochemical markers. In conclusion, the RESMENA diet is a good long-term dietary treatment for the MetS.

The aim of this study was to investigate the association between volume and frequency of moderate-intensity PA and step-based recommendations and individual body composition variables. Our cohort included 167 healthy ambulatory women (mean age 62.8 ± 4.8 years; body mass index [BMI] 27.3 ± 4.2 kg/m(2)) who carried out daily activities while wearing the ActiGraph GT1M accelerometer over a seven day period. Measurements of BMI, body fat mass index (BFMI), fat-free mass index (FFMI), waist-hip ratio (WHR) and visceral fat area (VFA) were obtained by the InBody 720 multifrequency bioelectrical impedance analysis (MFBIA) device. The significant relationship (r(s)=0.66; p<0.05) was found between moderate PA and steps per day. Moderate PA (r(2)=0.03-0.06) and steps per day (r(2)=0.05-0.20) were significantly associated with observed body composition parameters. Women spending > 300 min/week in moderate PA showed significantly lower values of BFMI (p=0.02) than those who spent 150-300 min/week. Carrying out moderate PA for 30 min 5 days a week was significantly associated with lower BMI (p=0.04; η(2)=0.02), BFMI (p=0.02; η(2)=0.03) and VFA (p=0.03; η(2)=0.03). In addition, higher amounts of daily steps were significantly associated with lower BMI (p=0.00; η(2)=0.16), BFMI (p=0.00; η(2)=0.21), VFA (p=0.00; η(2)=0.20) and WHR (p=0.00; η(2)=0.13). A clear association was found between the generally recommended PA guidelines and body composition variables for the women examined in this study. However, the concept of 10,000 steps/day appears to be the strongest predictor of health-related body composition values.

BACKGROUND: The report submitted is a detailed analysis of the happenings and outcomes of a two day deliberation that was organized in Trivandrum, India on the 9th and 10th August 2009.
METHODS: Asian Consensus Meeting on Metabolic Surgery (ACMOMS) was the first ever meeting of its kind in Asia where 52 professionals involved in the field of bariatric surgery, metabolic surgery, diabetes, and medical research from countries across Asia and the GCC met at Trivandrum, India to vote for and create a new set of guidelines for the Asian genotype, which were different from the NIH guidelines set for bariatric surgery. The aim was to set culturally, geographically, and genetically relevant standards for the management of obesity and metabolic syndrome.
RESULTS: It is known that Asians have a higher adiposity for a given level of obesity, and this is visceral obesity as compared to other populations. Currently, all over the world and in Asia as well, guidelines set by NIH in 1991 are being followed. Surgeons believe that NIH guidelines need to be revisited and modified. It is in light of these observations that the genesis of ACMOMS took place. At ACMOMS, it was recommended that the NIH guidelines are not suitable for Asians, and the BMI guidelines should be lowered for indication of surgery. Waist or waist-hip ratio must gain significance as compared to BMI alone in Asia.
CONCLUSIONS: The collective recommendations were submitted as a report to the executive committee for approval. As the Asia Pacific region consists of more than half of the world\'s population, the dire health and economic consequences of this epidemic demand urgent action from the medical fraternity in this region, and we hope that the recommendations will help to review the currently accepted guidelines.

OBJECTIVE: Women with polycystic ovary syndrome (PCOS) often have cardiovascular disease (CVD) risk factors. The Androgen Excess and Polycystic Ovary Syndrome (AE-PCOS) Society created a panel to provide evidence-based reviews of studies assessing PCOS-CVD risk relationships and to develop guidelines for preventing CVD.
METHODS: An expert panel in PCOS and CVD reviewed literature and presented recommendations.
METHODS: Only studies comparing PCOS with control patients were included. All electronic databases were searched; reviews included individual studies/databases, systematic reviews, abstracts, and expert data. Articles were excluded if other hyperandrogenic disorders were not excluded, PCOS diagnosis was unclear, controls were not described, or methodology precluded evaluation. Inclusion/exclusion criteria were confirmed by at least two reviewers and arbitrated by a third.
METHODS: Systematic reviews of CVD risk factors were compiled and submitted for approval to the AE-PCOS Society Board.
CONCLUSIONS: Women with PCOS with obesity, cigarette smoking, dyslipidemia, hypertension, impaired glucose tolerance, and subclinical vascular disease are at risk, whereas those with metabolic syndrome and/or type 2 diabetes mellitus are at high risk for CVD. Body mass index, waist circumference, serum lipid/glucose, and blood pressure determinations are recommended for all women with PCOS, as is oral glucose tolerance testing in those with obesity, advanced age, personal history of gestational diabetes, or family history of type 2 diabetes mellitus. Mood disorder assessment is suggested in all PCOS patients. Lifestyle management is recommended for primary CVD prevention, targeting low-density and non-high-density lipoprotein cholesterol and adding insulin-sensitizing and other drugs if dyslipidemia or other risk factors persist.

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The aim of this study was to evaluate the relationship between the diagnosis of metabolic syndrome (MetS) or its components and the prevalence of microvascular and macrovascular complications in 130 Japanese type 2 diabetic patients. Out of the 130 patients, 58.5% satisfied the criteria of the MetS as defined by the IDF guideline. The results of logistic regression analysis with adjustment for three variables (age, gender and duration of diabetes) revealed that the presence of MetS as defined by the IDF guideline was not independently related to the presence of proliferative retinopathy, proteinuria, neuropathy, or macrovascular disease in the diabetic patients. The waist circumference per se was not associated with diabetic neuropathy, retinopathy, nephropathy, or macrovascular diseases. These results suggest that neither the presence of MetS, as defined by the IDF guideline, nor the waist circumference was associated with the presence of either microvascular or macrovascular complications in Japanese type 2 diabetic patients.

BACKGROUND: The 2005 Dietary Guidelines for Americans Index (DGAI) was created to assess adherence to the dietary recommendations of the 2005 Dietary Guidelines for Americans (DGA) in relation to chronic disease risk.
OBJECTIVE: The objective was to assess the relation between dietary patterns consistent with the 2005 DGA as measured by the DGAI and both the prevalence of the metabolic syndrome (MetS) and individual MetS risk factors.
METHODS: DGAI scores and metabolic risk factors for MetS were assessed in a cross-sectional study of 3177 participants from the Framingham Heart Study Offspring Cohort. MetS was defined on the basis of the National Cholesterol Education Program Adult Treatment Panel III criteria.
RESULTS: After adjustment for potential confounders, the DGAI score was inversely related to waist circumference (P for trend < 0.001), triacylglycerol concentration (P for trend = 0.005), both diastolic (P for trend = 0.002) and systolic (P for trend = 0.01) blood pressure, the prevalence of abdominal adiposity (P for trend < 0.001), and hyperglycemia (P for trend = 0.03). The prevalence of MetS was significantly lower in individuals in the highest DGAI quintile category than in those in the lowest category (odds ratio: 0.64; 95% CI: 0.47, 0.88; P for trend = 0.005) when those being treated for any of the risk factors were excluded. There was a significant interaction between DGAI score and age; the association between the DGAI score and MetS was confined largely to adults younger than 55 y (odds ratio: 0.57; 95% CI: 0.36, 0.92; P for trend < 0.01).
CONCLUSIONS: A dietary pattern consistent with the 2005 DGA was associated with a lower prevalence of MetS-a potential risk factor for CVD.