Joint Associations of Oxidative Stress, Central Obesity, and Cardiorespiratory Fitness with Diabetes and Pre-Diabetes: NHANES 1999-2004 Open Access

Abstract

PURPOSE: Obesity and central adiposity are well-known risk factors for cardiometabolic conditions including diabetes (DM), but little is known about the contribution of oxidative stress (OS) and cardiorespiratory fitness (CRF). This study will assess the individual and joint associations of central obesity, OS, and CRF with glycemic status using data from the National Health and Nutrition Examination Survey (NHANES) 1999-2004.

METHODS: This analysis was restricted to adults 20 years of age and older (n=12,662). We used polytomous logistic regression to assess the associations between waist-to-height ratio (WHtR) and oxidative stress score (OSS) with glycemic status outcomes (DM and pre-DM), adjusting for sociodemographics, family history of DM, modifiable risk factors, and co-morbidities. We conducted a sub-analysis (n=3,141; ages 20-49) of these associations with the addition of CRF as our third main exposure. Glycemic status was defined using self-reported diagnoses, use of insulin or other glucose-lowering medications, measured HbA1c, or fasting plasma glucose. OSS was calculated for each participant and divided into quartiles for the analyses using seven equally weighted biomarkers. WHtR ≥ 0.65 was used as a measure of central obesity. CRF was measured using submaximal treadmill testing, where the lowest 20^th percentile of estimated VO2max represented low fitness.

RESULTS: 43.1% and 28.2% of adults with DM and pre-DM, respectively, had a WHtR ≥ 0.65. The mean OSS for those with DM and pre-DM was 1.01 and 0.45, respectively. An increased WHtR was significantly associated with pre-DM (OR=1.79, 95% CI: 1.52, 2.12) and DM (OR=3.42, 95% CI: 2.73, 4.29). The highest quartile of OSS was significantly associated with pre-DM (OR=2.34, 95% CI: 1.78, 3.07) and DM (OR=2.15, 95% CI: 1.53, 3.03). The sub-analysis showed that low CRF was significantly associated with pre-DM (OR=1.27, 95% CI: 1.07, 1.51) and DM (OR=2.86, 95% CI: 1.73, 4.70). The highest risk group (high central obesity, high OS, low CRF) had the strongest associations with pre-DM (OR=2.84; 95% CI: 2.51, 3.22) and DM (OR=7.57; 95% CI: 6.24, 9.19).

CONCLUSIONS: This study highlights the importance of central obesity, elevated OS, and low CRF in hyperglycemic individuals. These risk factors are all significantly associated with the odds of DM and pre-DM.

Table of Contents

CHAPTER I: BACKGROUND .........................................1 

Diabetes Mellitus ..........................................................1 

Oxidative Stress and Diabetes ......................................2 

Waist‐to‐height ratio and Diabetes .............................5 

Cardiorespiratory Fitness ..............................................6 

Problem Statement .......................................................9 

Study Hypotheses ..........................................................9 

Specific Aims .................................................................9 

CHAPTER II: METHODS ...............................................10 

Study Design ................................................................10 

Study Population ..........................................................11

 Outcome Measures ......................................................11 

Main Exposures ............................................................12 

Covariates .....................................................................15 

Analytic Sample ............................................................17 

Statistical Analysis .......................................................18 

CHAPTER III: RESULTS .................................................21 

CHAPTER IV: DISCUSSION ..........................................25 

Future Directions ..........................................................29 

REFERENCES ................................................................31 

TABLES .........................................................................38  

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Epidemiology
Keyword	United States Oxidative Stress Central Obesity Cardiorespiratory Fitness Diabetes NHANES
Committee Chair / Thesis Advisor	Lobelo, Roberto L, Emory University Ali, Mohammed K, Emory University

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