Journal of Endocrinology, Metabolism and Diabetes in South Africa - Volume 19, Issue 3, January 2014

It is with great sadness that the editorial team at JEMDSA learned of the passing of Dr Douw Greeff, owner of Medpharm Publications, on 11 November 2014. In spite of ill-health, Douw hosted a dinner party on 1 November in Pretoria, celebrating the 25 years of existence of Medpharm Publications, also JEMDSA's publisher for the past 6 years. For the event Douw invited the editors of all the journals in the Medpharm stable, along with their spouses. Douw entertained his guests with his typical charisma to a lovely evening of good food and music.

There is no doubt that there are considerably more challenges to a scholarly journal published in 2014 than simply preparing a paper copy that is timeously posted to its readership. We say this with great respect because not so long ago all our efforts were consolidated to achieve only that. However, printing a journal took much longer, and the publishing process was entirely streamlined in accordance with printing deadlines.

Weight loss to reduce cardiovascular risk is encouraged in both healthy overweight individuals and those at high cardiovascular risk, including patients with diabetes. However, a large body of studies suggest that, in comparison to overweight and even obese subjects, cardiovascular events may be more common among patients who lose weight or who fall into lower body mass index categories. In contrast, other studies confirm the traditional concept that weight loss and maintenance of a healthy body weight is not only associated with improvement in cardiovascular risk factors, such as blood pressure, lipid profile and blood glucose control, but also with a reduction in cardiovascular morbidity and mortality. Possible reasons for the difference in outcomes between these two groups of studies include differences in study design, bias and statistics, the health status of the study participants and differential treatment afforded to different patient groups. This article reviews studies supporting both points of view and describes potential explanations for the observed differences in outcomes according to body weight.

Age-related loss of muscle mass has received increased attention over the past two decades from both clinician and basic science researchers. Evans and Campbell labeled the age-related loss of muscle mass as sarcopaenia (Greek sarx=flesh and paenia=loss). The estimated relative annual rate of loss of muscle mass is 1% in men and 0.84% in women. The average age of onset of decline in muscle mass is approximately 40 years and progress in a linear fashion to reach approximately 50% by the 8^th decade.

Objectives : Waist circumference (WC) cut-off points specific to sub-Saharan Caucasians do not exist with which to identify metabolic syndrome. Neck circumference (NC), as an additional measure, was previously found to be a worthy identifier of metabolic syndrome. Therefore, the aim was to determine NC and WC cut-off points specific to our Caucasian cohort, to confirm baseline cut-off points and to determine whether or not WC cut-off points specific to this cohort differed from the Joint Interim Statement (JIS) WC guidelines.

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Design, subjects and setting : A target population study, nested in a prospective cohort, was assessed and included 90 and 96 Caucasian men and women aged 24-65 years from the Dr Kenneth Kaunda Municipality District, North West province.

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Outcomes measures : Anthropometric and fasting biological markers for metabolic syndrome, e.g. systolic and diastolic blood pressure, glucose, triglycerides and high-density lipoprotein, were obtained.

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Results : Cut-off points were determined with the use of a receiver operating characteristic. With the use of cohort-specific WC cut-offs, metabolic syndrome prevalence did not change. WC cut-off points were 96 cm for men and 88 cm for women. NC cut-off points were 42 cm and 35 cm, for men and women, respectively.

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Conclusion : WC cut-off points specific to these Caucasians differed to those from the JIS guidelines, but corresponded with the baseline findings of the prospective cohort. From a clinical perspective, we cautiously suggest the application of NC, rather than WC, as an anthropometric measure of metabolic syndrome in women as it was a stronger predictor of metabolic syndrome and is not influenced by menopausal status per se.