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Genetic epidemiology and metabolism study

Final Activity Report Summary - GEMS (Genetic Epidemiology and Metabolism Study)

Obesity is considered the pandemic of the 21st century. It increases the risk of some type of cancers, cardiovascular diseases, and of type 2 diabetes. Its prevalence, and of the related metabolic syndrome, has increased in all western countries; Cyprus too has increased rates. Since obesity and the metabolic syndrome are multifactorial one needs to understand the interaction between hormonal, genetic, and environmental factors, lifestyle and diet to be able to help in their prevention and treatment - in an effort to shed some light in this complex problem and to set the basis for longitudinal studies the GEMS study was designed.

The study population is comprised of 18-year males performing their two-year mandatory service in the Cyprus Army. Exclusion criteria include health reasons for which a person can be found unable to join the army. The study eventually recruited 1056 volunteers who signed an informed consent and participated in the study, providing a representative sample of the 18-year old male population of Cyprus from all regions and socioeconomic levels.

Several measurements were done, in order to set-up a comprehensive database of baseline health information, including height, weight, circumferences of waist, neck, and hip, 5-site skin fold thickness, and body composition estimates, as well as resting heart rate, systolic and diastolic blood pressure, and lung function. Blood was also drawn and questionnaires were answered to collect information on lifestyle, dietary habits, personal and family medical history.

Through GEMS we were able to determine the prevalence of overweight and obesity in 18-year old Cypriots. We further determined the baseline distribution of blood pressure, anthropometric variables, fasting lipids, and fasting glucose; investigated the association between different measures of adiposity; and find out which measures of adiposity are most closely correlated with cardiovascular risk markers (theoretically, the measures that best estimates visceral adiposity will be most tightly associated with cardiovascular risk factors).

The mean height of the participants was 1.75 (0.1) m, the mean weight 72.3 (14.0) kg and the mean BMI 23.5 (4.1) kg/m2; we found 5.9% of the participants being underweight (BMI<18.5) 64.6% being of normal BMI (18.5 BMI<25), 21.7% being overweight (25 BMI<30), and 7.7% being obese (BMI 30). Also, 76.0% of the participants reported one or more of their parents being overweight / obese. More than five percent (5.5%) have waist >102 cm with mean waist 81.7 (10.7) cm, waist-to-hip ratio 0.8 (0.1) and waist-to-height ratio 0.5 (0.1). The mean body fat percentage was 12.9 (6.7) % with values ranging from 1.0 to 44.3 % and the mean sum of skinfolds measured (bicep + tricep + subscapular + suprailiac + calf) was 50.9 (24.2) mm.

Furthermore, 1.2% of the participants had triglycerides levels >150 mg/dl, 8.3% total cholesterol >200 mg/dl, 18.0% have HDL <40 mg/dl, and 36.9% have LDL >100 mg/dl but <130 mg/dl with an additional 14.0% having LDL >130 mg/dl. More than three percent (3.4%) could be classified as hypertensive with SBP>130 mmHg or DBP>85 mmHg and the mean heart rate was 70.1 (10.2). The mean fasting plasma glucose was 82.5 (7.9) mg/dl with 1.5% having fasting plasma glucose levels of at least 100 mg/dl indicating levels of pre-diabetes. In an analysis of variance comparison, the four BMI groups were found to have significantly different mean glucose values (p<.0001); the group with BMI>30 kg/m2 was found to have significantly different mean levels of glucose than both the group with BMI<18.5 kg/m2 and the group with BMI between 18.5 and 25 kg/m2; the same applies for the group with BMI between 25 and 30 kg/m2. Smoking prevalence is high with 41% of the participants reporting that they are smokers. Mean HDL levels are different between smokers and non-smokers (p<.0001). In the analyses of available 2-year follow-up data a lot of the measures worsened. For example weight increased by 4.4 kg, waist by 5.0 cm, and BMI by 1.5 kg/m2, on average. Also, triglycerides increased by 19.0 mg/dl, glucose by 9.2 mg/dl, and total cholesterol by 15.6 mg/dl, on average.