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Published in: BMC Endocrine Disorders 1/2020

01-12-2020 | Obesity | Research article

Large mid-upper arm circumference is associated with metabolic syndrome in middle-aged and elderly individuals: a community-based study

Authors: Jie Shi, Zhen Yang, Yixin Niu, Weiwei Zhang, Xiaoyong Li, Hongmei Zhang, Ning Lin, Hongxia Gu, Jie Wen, Guang Ning, Li Qin, Qing Su

Published in: BMC Endocrine Disorders | Issue 1/2020

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Abstract

Background

The mid-upper arm circumference (MUAC) is a proxy for subcutaneous fat in the upper body and is a reliable screening measure for identifying individuals with abnormal regional fat distribution. The purpose of this study was to evaluate the association between MUAC and metabolic syndrome (MetS) in middle-aged and elderly individuals.

Methods

We measured the MUAC in a cross-sectional sample with a total of 9787 subjects aged 40 years and older. The measurement of MUAC is performed on the right arm using a non-elastic tape held midway between the acromion and the olecranon processes in duplicate, with the arm hanging loosely at the side of the body. The MetS was defined according to the Joint Statement of the International Diabetes Federation Task Force on Epidemiology and Prevention.

Results

MUAC was positively correlated with waist circumference (r = 0.437, P < 0.001), BMI (r = 0.334, P < 0.001), fasting insulin (r = 0.348, P < 0.001), HOMA-IR (r = 0.134, P < 0.001), triglycerides (r = 0.138, P < 0.001), SBP (r = 0.124, P < 0.001), and DBP (r = 0.123, P < 0.001), and inversely correlated with adiponectin (r = − 0.147, P < 0.001) and HDL-cholesterol (r = − 0.176, P < 0.001) after adjusting for age and gender. Compared with the lowest quartile group, the odds ratios were substantially higher for MetS (OR 1.77; 95% CI 1.51–2.09, P for trend< 0.001) in the highest MUAC quartile group after adjustment for potential cofounder.

Conclusion

Large mid-upper arm circumference is significantly associated with metabolic syndrome in middle-aged and elderly individuals.
Literature
1.
go back to reference Alberti KG, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA, Fruchart JC, James WP, Loria CM, Smith SC Jr. Harmonizing the metabolic syndrome: a joint interim statement of the international diabetes federation task force on epidemiology and prevention; National Heart, Lung, and Blood Institute; American Heart Association; world heart federation; international atherosclerosis society; and International Association for the Study of obesity. Circulation. 2009;120(16):1640–5.CrossRef Alberti KG, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA, Fruchart JC, James WP, Loria CM, Smith SC Jr. Harmonizing the metabolic syndrome: a joint interim statement of the international diabetes federation task force on epidemiology and prevention; National Heart, Lung, and Blood Institute; American Heart Association; world heart federation; international atherosclerosis society; and International Association for the Study of obesity. Circulation. 2009;120(16):1640–5.CrossRef
2.
go back to reference Gu D, Reynolds K, Wu X, Chen J, Duan X, Reynolds RF, Whelton PK, He J. Prevalence of the metabolic syndrome and overweight among adults in China. Lancet. 2005;365(9468):1398–405.CrossRef Gu D, Reynolds K, Wu X, Chen J, Duan X, Reynolds RF, Whelton PK, He J. Prevalence of the metabolic syndrome and overweight among adults in China. Lancet. 2005;365(9468):1398–405.CrossRef
3.
go back to reference He Y, Jiang B, Wang J, Feng K, Chang Q, Fan L, Li X, Hu FB. Prevalence of the metabolic syndrome and its relation to cardiovascular disease in an elderly Chinese population. J Am Coll Cardiol. 2006;47(8):1588–94.CrossRef He Y, Jiang B, Wang J, Feng K, Chang Q, Fan L, Li X, Hu FB. Prevalence of the metabolic syndrome and its relation to cardiovascular disease in an elderly Chinese population. J Am Coll Cardiol. 2006;47(8):1588–94.CrossRef
4.
go back to reference Koutsari C, Ali AH, Mundi MS, Jensen MD. Storage of circulating free fatty acid in adipose tissue of postabsorptive humans: quantitative measures and implications for body fat distribution. Diabetes. 2011;60(8):2032–40.CrossRef Koutsari C, Ali AH, Mundi MS, Jensen MD. Storage of circulating free fatty acid in adipose tissue of postabsorptive humans: quantitative measures and implications for body fat distribution. Diabetes. 2011;60(8):2032–40.CrossRef
5.
go back to reference Nielsen S, Guo Z, Johnson CM, Hensrud DD, Jensen MD. Splanchnic lipolysis in human obesity. J Clin Invest. 2004;113(11):1582–8.CrossRef Nielsen S, Guo Z, Johnson CM, Hensrud DD, Jensen MD. Splanchnic lipolysis in human obesity. J Clin Invest. 2004;113(11):1582–8.CrossRef
6.
go back to reference Basu A, Basu R, Shah P, Vella A, Rizza RA, Jensen MD. Systemic and regional free fatty acid metabolism in type 2 diabetes. Am J Physiol Endocrinol Metab. 2001;280(6):E1000–6.CrossRef Basu A, Basu R, Shah P, Vella A, Rizza RA, Jensen MD. Systemic and regional free fatty acid metabolism in type 2 diabetes. Am J Physiol Endocrinol Metab. 2001;280(6):E1000–6.CrossRef
7.
go back to reference Liang J, Teng F, Li Y, Liu X, Zou C, Wang Y, Li H. Qi L: neck circumference and insulin resistance in Chinese adults: the Cardiometabolic risk in Chinese (CRC) study. Diabetes Care. 2013;36(9):e145–6.CrossRef Liang J, Teng F, Li Y, Liu X, Zou C, Wang Y, Li H. Qi L: neck circumference and insulin resistance in Chinese adults: the Cardiometabolic risk in Chinese (CRC) study. Diabetes Care. 2013;36(9):e145–6.CrossRef
8.
go back to reference Yang G-R, Yuan S-Y, Fu H-J, Wan G, Zhu L-X, Bu X-L, Zhang J-D, Du X-P, Li Y-L, Ji Y, et al. Neck circumference positively related with central obesity, overweight, and metabolic syndrome in Chinese subjects with type 2 diabetes: Beijing community diabetes study 4. Diabetes Care. 2010;33(11):2465–7.CrossRef Yang G-R, Yuan S-Y, Fu H-J, Wan G, Zhu L-X, Bu X-L, Zhang J-D, Du X-P, Li Y-L, Ji Y, et al. Neck circumference positively related with central obesity, overweight, and metabolic syndrome in Chinese subjects with type 2 diabetes: Beijing community diabetes study 4. Diabetes Care. 2010;33(11):2465–7.CrossRef
9.
go back to reference Jensen MD. Role of body fat distribution and the metabolic complications of obesity. J Clin Endocrinol Metab. 2008;93(11 Suppl 1):S57–63.CrossRef Jensen MD. Role of body fat distribution and the metabolic complications of obesity. J Clin Endocrinol Metab. 2008;93(11 Suppl 1):S57–63.CrossRef
10.
go back to reference Boden G. Fatty acid-induced inflammation and insulin resistance in skeletal muscle and liver. Curr Diab Rep. 2006;6(3):177–81.CrossRef Boden G. Fatty acid-induced inflammation and insulin resistance in skeletal muscle and liver. Curr Diab Rep. 2006;6(3):177–81.CrossRef
11.
go back to reference Berk PD. Regulatable fatty acid transport mechanisms are central to the pathophysiology of obesity, fatty liver, and metabolic syndrome. Hepatology. 2008;48(5):1362–76.CrossRef Berk PD. Regulatable fatty acid transport mechanisms are central to the pathophysiology of obesity, fatty liver, and metabolic syndrome. Hepatology. 2008;48(5):1362–76.CrossRef
12.
go back to reference Hou Y, Jia X, Xuan L, Zhu W, Deng C, Wang L, Zhao Z, Li M, Lu J, Xu Y, et al. Association between mid-upper arm circumference and cardiometabolic risk in Chinese population: a cross-sectional study. BMJ Open. 2019;9(9):e028904.CrossRef Hou Y, Jia X, Xuan L, Zhu W, Deng C, Wang L, Zhao Z, Li M, Lu J, Xu Y, et al. Association between mid-upper arm circumference and cardiometabolic risk in Chinese population: a cross-sectional study. BMJ Open. 2019;9(9):e028904.CrossRef
13.
go back to reference Ning G. Risk evaluation of cAncers in Chinese diabeTic individuals: a lONgitudinal (REACTION) study. J Diabetes. 2012;4(2):172–3.CrossRef Ning G. Risk evaluation of cAncers in Chinese diabeTic individuals: a lONgitudinal (REACTION) study. J Diabetes. 2012;4(2):172–3.CrossRef
14.
go back to reference Yang Z, Yan C, Liu G, Niu Y, Zhang W, Lu S, Li X, Zhang H, Ning G, Fan J, et al. Plasma selenium levels and nonalcoholic fatty liver disease in Chinese adults: a cross-sectional analysis. Sci Rep. 2016;6:37288.CrossRef Yang Z, Yan C, Liu G, Niu Y, Zhang W, Lu S, Li X, Zhang H, Ning G, Fan J, et al. Plasma selenium levels and nonalcoholic fatty liver disease in Chinese adults: a cross-sectional analysis. Sci Rep. 2016;6:37288.CrossRef
15.
go back to reference Qin L, Yang Z, Gu H, Lu S, Shi Q, Xing Y, Li X, Li R, Ning G, Su Q. Association between serum uric acid levels and cardiovascular disease in middle-aged and elderly Chinese individuals. BMC Cardiovasc Disord. 2014;14:26.CrossRef Qin L, Yang Z, Gu H, Lu S, Shi Q, Xing Y, Li X, Li R, Ning G, Su Q. Association between serum uric acid levels and cardiovascular disease in middle-aged and elderly Chinese individuals. BMC Cardiovasc Disord. 2014;14:26.CrossRef
16.
17.
go back to reference Berkley J, Mwangi I, Griffiths K, Ahmed I, Mithwani S, English M, Newton C, Maitland K. Assessment of severe malnutrition among hospitalized children in rural Kenya: comparison of weight for height and mid upper arm circumference. Jama. 2005;294(5):591–7.CrossRef Berkley J, Mwangi I, Griffiths K, Ahmed I, Mithwani S, English M, Newton C, Maitland K. Assessment of severe malnutrition among hospitalized children in rural Kenya: comparison of weight for height and mid upper arm circumference. Jama. 2005;294(5):591–7.CrossRef
18.
go back to reference Schaap LA, Quirke T, Wijnhoven HAH, Visser M: Changes in body mass index and mid-upper arm circumference in relation to all-cause mortality in older adults. Clin Nutr 2018, 37(6 Pt A):2252–2259. Schaap LA, Quirke T, Wijnhoven HAH, Visser M: Changes in body mass index and mid-upper arm circumference in relation to all-cause mortality in older adults. Clin Nutr 2018, 37(6 Pt A):2252–2259.
19.
go back to reference Wijnhoven HA, van Bokhorst-de van der Schueren MA, Heymans MW, de Vet HC, Kruizenga HM, Twisk JW, Visser M. Low mid-upper arm circumference, calf circumference, and body mass index and mortality in older persons. J Gerontol A Biol Sci Med Sci. 2010;65(10):1107–14.CrossRef Wijnhoven HA, van Bokhorst-de van der Schueren MA, Heymans MW, de Vet HC, Kruizenga HM, Twisk JW, Visser M. Low mid-upper arm circumference, calf circumference, and body mass index and mortality in older persons. J Gerontol A Biol Sci Med Sci. 2010;65(10):1107–14.CrossRef
20.
go back to reference Talma H, van Dommelen P, Schweizer JJ, Bakker B, Kist-van Holthe JE, Chinapaw JMM, Hirasing RA. Is mid-upper arm circumference in Dutch children useful in identifying obesity? Arch Dis Child. 2019;104(2):159–65.CrossRef Talma H, van Dommelen P, Schweizer JJ, Bakker B, Kist-van Holthe JE, Chinapaw JMM, Hirasing RA. Is mid-upper arm circumference in Dutch children useful in identifying obesity? Arch Dis Child. 2019;104(2):159–65.CrossRef
21.
go back to reference Chaput JP, Katzmarzyk PT, Barnes JD, Fogelholm M, Hu G, Kuriyan R, Kurpad A, Lambert EV, Maher C, Maia J, et al. Mid-upper arm circumference as a screening tool for identifying children with obesity: a 12-country study. Pediatr Obes. 2017;12(6):439–45.CrossRef Chaput JP, Katzmarzyk PT, Barnes JD, Fogelholm M, Hu G, Kuriyan R, Kurpad A, Lambert EV, Maher C, Maia J, et al. Mid-upper arm circumference as a screening tool for identifying children with obesity: a 12-country study. Pediatr Obes. 2017;12(6):439–45.CrossRef
22.
go back to reference Weisberg SP, McCann D, Desai M, Rosenbaum M, Leibel RL, Ferrante AW Jr. Obesity is associated with macrophage accumulation in adipose tissue. J Clin Invest. 2003;112(12):1796–808.CrossRef Weisberg SP, McCann D, Desai M, Rosenbaum M, Leibel RL, Ferrante AW Jr. Obesity is associated with macrophage accumulation in adipose tissue. J Clin Invest. 2003;112(12):1796–808.CrossRef
23.
go back to reference Arner P, Langin D. Lipolysis in lipid turnover, cancer cachexia, and obesity-induced insulin resistance. Trends Endocrinol Metab. 2014;25(5):255–62.CrossRef Arner P, Langin D. Lipolysis in lipid turnover, cancer cachexia, and obesity-induced insulin resistance. Trends Endocrinol Metab. 2014;25(5):255–62.CrossRef
24.
go back to reference Saltiel AR, Kahn CR. Insulin signalling and the regulation of glucose and lipid metabolism. Nature. 2001;414(6865):799–806.CrossRef Saltiel AR, Kahn CR. Insulin signalling and the regulation of glucose and lipid metabolism. Nature. 2001;414(6865):799–806.CrossRef
25.
go back to reference Guo Z, Hensrud DD, Johnson CM, Jensen MD. Regional postprandial fatty acid metabolism in different obesity phenotypes. Diabetes. 1999;48(8):1586–92.CrossRef Guo Z, Hensrud DD, Johnson CM, Jensen MD. Regional postprandial fatty acid metabolism in different obesity phenotypes. Diabetes. 1999;48(8):1586–92.CrossRef
26.
go back to reference Martin ML, Jensen MD. Effects of body fat distribution on regional lipolysis in obesity. J Clin Invest. 1991;88(2):609–13.CrossRef Martin ML, Jensen MD. Effects of body fat distribution on regional lipolysis in obesity. J Clin Invest. 1991;88(2):609–13.CrossRef
27.
go back to reference Boden G. Obesity, insulin resistance and free fatty acids. Curr Opin Endocrinol Diabetes Obes. 2011;18(2):139–43.CrossRef Boden G. Obesity, insulin resistance and free fatty acids. Curr Opin Endocrinol Diabetes Obes. 2011;18(2):139–43.CrossRef
28.
go back to reference Kim F, Pham M, Luttrell I, Bannerman DD, Tupper J, Thaler J, Hawn TR, Raines EW, Schwartz MW. Toll-like receptor-4 mediates vascular inflammation and insulin resistance in diet-induced obesity. Circ Res. 2007;100(11):1589–96.CrossRef Kim F, Pham M, Luttrell I, Bannerman DD, Tupper J, Thaler J, Hawn TR, Raines EW, Schwartz MW. Toll-like receptor-4 mediates vascular inflammation and insulin resistance in diet-induced obesity. Circ Res. 2007;100(11):1589–96.CrossRef
29.
go back to reference Shi H, Kokoeva MV, Inouye K, Tzameli I, Yin H, Flier JS. TLR4 links innate immunity and fatty acid-induced insulin resistance. J Clin Invest. 2006;116(11):3015–25.CrossRef Shi H, Kokoeva MV, Inouye K, Tzameli I, Yin H, Flier JS. TLR4 links innate immunity and fatty acid-induced insulin resistance. J Clin Invest. 2006;116(11):3015–25.CrossRef
30.
go back to reference Morino K, Petersen KF, Shulman GI. Molecular mechanisms of insulin resistance in humans and their potential links with mitochondrial dysfunction. Diabetes. 2006;55(Suppl 2):S9–s15.CrossRef Morino K, Petersen KF, Shulman GI. Molecular mechanisms of insulin resistance in humans and their potential links with mitochondrial dysfunction. Diabetes. 2006;55(Suppl 2):S9–s15.CrossRef
31.
go back to reference Hotamisligil GS. Inflammation, metaflammation and immunometabolic disorders. Nature. 2017;542(7640):177–85.CrossRef Hotamisligil GS. Inflammation, metaflammation and immunometabolic disorders. Nature. 2017;542(7640):177–85.CrossRef
32.
go back to reference Bergman RN, Ader M. Free fatty acids and pathogenesis of type 2 diabetes mellitus. Trends Endocrinol Metab. 2000;11(9):351–6.CrossRef Bergman RN, Ader M. Free fatty acids and pathogenesis of type 2 diabetes mellitus. Trends Endocrinol Metab. 2000;11(9):351–6.CrossRef
33.
go back to reference Furukawa S, Fujita T, Shimabukuro M, Iwaki M, Yamada Y, Nakajima Y, Nakayama O, Makishima M, Matsuda M, Shimomura I. Increased oxidative stress in obesity and its impact on metabolic syndrome. J Clin Invest. 2004;114(12):1752–61.CrossRef Furukawa S, Fujita T, Shimabukuro M, Iwaki M, Yamada Y, Nakajima Y, Nakayama O, Makishima M, Matsuda M, Shimomura I. Increased oxidative stress in obesity and its impact on metabolic syndrome. J Clin Invest. 2004;114(12):1752–61.CrossRef
34.
go back to reference Guo W, Wong S, Xie W, Lei T, Luo Z. Palmitate modulates intracellular signaling, induces endoplasmic reticulum stress, and causes apoptosis in mouse 3T3-L1 and rat primary preadipocytes. Am J Physiol Endocrinol Metab. 2007;293(2):E576–86.CrossRef Guo W, Wong S, Xie W, Lei T, Luo Z. Palmitate modulates intracellular signaling, induces endoplasmic reticulum stress, and causes apoptosis in mouse 3T3-L1 and rat primary preadipocytes. Am J Physiol Endocrinol Metab. 2007;293(2):E576–86.CrossRef
35.
go back to reference Ozcan U, Cao Q, Yilmaz E, Lee AH, Iwakoshi NN, Ozdelen E, Tuncman G, Gorgun C, Glimcher LH, Hotamisligil GS. Endoplasmic reticulum stress links obesity, insulin action, and type 2 diabetes. Science. 2004;306(5695):457–61.CrossRef Ozcan U, Cao Q, Yilmaz E, Lee AH, Iwakoshi NN, Ozdelen E, Tuncman G, Gorgun C, Glimcher LH, Hotamisligil GS. Endoplasmic reticulum stress links obesity, insulin action, and type 2 diabetes. Science. 2004;306(5695):457–61.CrossRef
36.
go back to reference Hotamisligil GS. Endoplasmic reticulum stress and the inflammatory basis of metabolic disease. Cell. 2010;140(6):900–17.CrossRef Hotamisligil GS. Endoplasmic reticulum stress and the inflammatory basis of metabolic disease. Cell. 2010;140(6):900–17.CrossRef
37.
go back to reference Kershaw EE, Flier JS. Adipose tissue as an endocrine organ. J Clin Endocrinol Metab. 2004;89(6):2548–56.CrossRef Kershaw EE, Flier JS. Adipose tissue as an endocrine organ. J Clin Endocrinol Metab. 2004;89(6):2548–56.CrossRef
38.
go back to reference Bremer AA, Devaraj S, Afify A, Jialal I. Adipose tissue dysregulation in patients with metabolic syndrome. J Clin Endocrinol Metab. 2011;96(11):E1782–8.CrossRef Bremer AA, Devaraj S, Afify A, Jialal I. Adipose tissue dysregulation in patients with metabolic syndrome. J Clin Endocrinol Metab. 2011;96(11):E1782–8.CrossRef
39.
go back to reference Guilherme A, Virbasius JV, Puri V, Czech MP. Adipocyte dysfunctions linking obesity to insulin resistance and type 2 diabetes. Nat Rev Mol Cell Biol. 2008;9(5):367–77.CrossRef Guilherme A, Virbasius JV, Puri V, Czech MP. Adipocyte dysfunctions linking obesity to insulin resistance and type 2 diabetes. Nat Rev Mol Cell Biol. 2008;9(5):367–77.CrossRef
40.
go back to reference Cancello R, Henegar C, Viguerie N, Taleb S, Poitou C, Rouault C, Coupaye M, Pelloux V, Hugol D, Bouillot JL, et al. Reduction of macrophage infiltration and chemoattractant gene expression changes in white adipose tissue of morbidly obese subjects after surgery-induced weight loss. Diabetes. 2005;54(8):2277–86.CrossRef Cancello R, Henegar C, Viguerie N, Taleb S, Poitou C, Rouault C, Coupaye M, Pelloux V, Hugol D, Bouillot JL, et al. Reduction of macrophage infiltration and chemoattractant gene expression changes in white adipose tissue of morbidly obese subjects after surgery-induced weight loss. Diabetes. 2005;54(8):2277–86.CrossRef
Metadata
Title
Large mid-upper arm circumference is associated with metabolic syndrome in middle-aged and elderly individuals: a community-based study
Authors
Jie Shi
Zhen Yang
Yixin Niu
Weiwei Zhang
Xiaoyong Li
Hongmei Zhang
Ning Lin
Hongxia Gu
Jie Wen
Guang Ning
Li Qin
Qing Su
Publication date
01-12-2020
Publisher
BioMed Central
Published in
BMC Endocrine Disorders / Issue 1/2020
Electronic ISSN: 1472-6823
DOI
https://doi.org/10.1186/s12902-020-00559-8

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