NEW YORK (Reuters Health) – Adding calf circumference (CC) to other metabolic syndrome (MetS) assessments may help identify people at greater risk for cardiovascular mortality, researchers suggest.
Dr. Wei-Liang Chen of Tri-Service General Hospital in Taipei, Taiwan, and colleagues used data from the 1999-2002 NHANES dataset on 7,448 participants (52% women) with MetS who were followed until death or through 2006.
Participants had three or more of the following features: waist circumference of at least 102 cm in men and 88 cm in women; systolic blood pressure of 130 mmHg or higher and diastolic pressure of 85 mmHg or higher; triglyceride levels of 150 mg/dL or higher; high-density lipoprotein concentrations of less than 40 mg/dL in men and 50 mg/dL in women; and fasting glucose of 100 mg/dL or more.
From this cohort, the team defined and analyzed four types of MetS: WaistMetS (increased waist circumference), CalfMetS (decreased CC), WCRMetS (increased waist-to-calf ratio), and CC plus MetS (decreased CC and MetS components).
WaistMetS, CalfMetS and WCRMetS included the named measure plus two or more additional MetS components; CC plus MetS included the named measure plus three of five MetS components.
Analyses to identify optimal cutoff values for calf circumference showed the best values were 33.65 cm, with a sensitivity and specificity of 85% and 53%, respectively, in women; and 36.65 cm in men, with a sensitivity and specificity of 70% and 59%.
As reported online January 15 in the Journal of Clinical Endocrinology and Metabolism, for cardiovascular mortality, the adjusted hazard ratios for WaistMetS, CalfMetS, WCRMetS and CC plus MetS were 1.867, 1.871, 1.949, and 2.306, respectively. All of these aHRs were statistically significant.
“Notably, CalfMetS showed the strongest positive correlation with serum C-reactive protein, and WCRMetS had the strongest positive relationship with homeostasis model assessment of insulin resistance,” the authors note.
“Taken together,” they state, “these findings illustrated that the CC-incorporated definition of MetS tended to have a better predictive ability for cardiovascular mortality.”
In the survival analysis for all-cause mortality, aHRs were 1.614, 1.573, 1.728, and 1.854 for WaistMetS, CalfMetS, WCRMetS and CC plus MetS, respectively. Again, all were statistically significant.
“Collectively,” the authors note, “the findings suggested that this CC-incorporated definition of MetS might be another useful prediction tool for all-cause mortality, except for CalfMetS.”
Dr. Cherie Vaz, an assistant professor of medicine at the Lewis Katz School of Medicine at Temple University and a physician in the section of Metabolism, Diabetes and Endocrinology at Temple University Hospital in Philadelphia, commented, “These findings are intriguing as patients with metabolic syndrome have central adiposity, which can be associated with thinner extremities.”
“However,” she said in an email to Reuters Health, “it is important to note that not all patients with metabolic syndrome have this body habitus and severity of metabolic defects, age, and genetics can play a role.”
“Though measurement of calf circumference appears to add value, there are several caveats to be considered which prevent its clinical application to the general population,” she noted.
“While the sample size for this study was large,” she said, “it would not be considered the most robust form of evidence due to its retrospective study design.”
“Although easy to measure, only a few studies have looked at calf circumference as a disease marker,” Dr. Vaz continued. “It was previously shown to be highly correlating with BMI when assessing for undernutrition in elderly. Hence, it has typically been used as a marker for sarcopenia or age-related muscle loss.”
“However,” she said, “other studies have shown that regardless of BMI, using a larger calf circumference to identify non-sarcopenia is more useful than using a smaller calf circumference to identify sarcopenia.”
In addition, she noted, “the cutoff values used for calf circumference as a predictor of cardiovascular mortality were more sensitive in women than in men and were only around 50% specific in both genders.”
“Muscle mass and strength decline with age,” she stated. “Besides age, calf circumference may be affected by multiple factors such as genetics, ethnicity and type and amount of physical activity. Both in research and in clinical practice, we currently use ethnicity-specific cut-offs for BMI and waist circumference.”
“One would expect age and ethnicity-specific normal values to be more appropriate when interpreting calf circumference,” Dr. Vaz concluded. “Thus, the specificity of low calf circumference to predict cardiovascular risk in the metabolic syndrome needs to be further evaluated in prospective studies.”
Dr. Chen did not respond to requests for comment.
SOURCE: http://bit.ly/2EmD1sA
J Clin Endocrinol Metab 2018.
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