Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp ing this period. 8-10 Therefore, the association of obesity with CVD remains to be investigated, especially in terms of differences in the association by time period as well as how the association (if any) would be mediated by the established risk factors. 11 Also, there may be differences in the threshold of BMI where significant BMI would be observed, because significant differences exist in the prevalence of obesity by sex and ethnicity. Hence, we set 2 aims in this review. The first aim was to provide an overview of global trends of overweight and obesity according to the WHO regions and countries within each region by sex. The second aim was to provide upto-date information on cohort studies that have investigated the associations of BMI with coronary artery disease (CAD) and stroke in various parts of the world. Methods Overweight and Obesity TrendsThe review compiles the prevalence of overweight and obesity for every country in the WHO's 6 regions of the world (Africa, the Americas, Eastern Mediterranean, South-East Asia, Western Pacific, and Europe).besity is a state of excess fat accumulation that accompanies wide range of health disadvantages. The World Health Organization (WHO) defines a body mass index (BMI) of ≥25 kg/m 2 as overweight, and a BMI of ≥30 kg/m 2 as obesity. 1 The global prevalence of the overweight and obese is on the rise. 2 The Global Burden of Disease Study estimated that the proportion of overweight or obese adults in 2013 was 36% in men and 37% in women worldwide. 3 Globally, the epidemic has affected both developed and developing countries, men and women, and adults and children, although there are great variations in their prevalence and trends among regions or countries, and sexes.Because obesity is believed to cause a number of established risk factors for cardiovascular diseases (CVD) such as hypertension, dyslipidemia, and diabetes, 4 the growing prevalence of obesity is assumed to increase the global CVD burden. However, it is also known that other changes in diet and lifestyle have led to changes in the prevalence of these risk factors, and presumably in CVD incidence. 5, 6 An example of this would be a dramatic decrease in stroke mortality observed after World War 2 in Japan because of the decrease in severe hypertension, 7 although the average BMI also increased dur- Global Trend in Overweight and Obesity and Its Association With Cardiovascular Disease IncidenceHiroshi Yatsuya, MD, PhD; Yuanying Li, PhD; Esayas Haregot Hilawe, PhD; Atsuhiko Ota, MD, PhD; Chaochen Wang, BSc; Chifa Chiang, PhD; Yan Zhang, BSc; Mayu Uemura, BSc; Ayaka Osako, BSc; Yukio Ozaki, MD, PhD; Atsuko Aoyama, MD, PhDAlthough the global prevalence of both the overweight and obese is on the rise, there are variations among regions or countries, and sexes. Approximately half or more than half of the population are overweight/obese defined as body mass index ≥25 kg/m 2 in the Americas (61.1%), Europe (54.8%...

ObjectiveTo evaluate the associations between adiposity measures (body mass index, waist circumference, and waist-to-height ratio) with decline in glomerular filtration rate (GFR) and with all cause mortality.DesignIndividual participant data meta-analysis.SettingCohorts from 40 countries with data collected between 1970 and 2017.ParticipantsAdults in 39 general population cohorts (n=5 459 014), of which 21 (n=594 496) had data on waist circumference; six cohorts with high cardiovascular risk (n=84 417); and 18 cohorts with chronic kidney disease (n=91 607).Main outcome measuresGFR decline (estimated GFR decline ≥40%, initiation of kidney replacement therapy or estimated GFR <10 mL/min/1.73 m2) and all cause mortality.ResultsOver a mean follow-up of eight years, 246 607 (5.6%) individuals in the general population cohorts had GFR decline (18 118 (0.4%) end stage kidney disease events) and 782 329 (14.7%) died. Adjusting for age, sex, race, and current smoking, the hazard ratios for GFR decline comparing body mass indices 30, 35, and 40 with body mass index 25 were 1.18 (95% confidence interval 1.09 to 1.27), 1.69 (1.51 to 1.89), and 2.02 (1.80 to 2.27), respectively. Results were similar in all subgroups of estimated GFR. Associations weakened after adjustment for additional comorbidities, with respective hazard ratios of 1.03 (0.95 to 1.11), 1.28 (1.14 to 1.44), and 1.46 (1.28 to 1.67). The association between body mass index and death was J shaped, with the lowest risk at body mass index of 25. In the cohorts with high cardiovascular risk and chronic kidney disease (mean follow-up of six and four years, respectively), risk associations between higher body mass index and GFR decline were weaker than in the general population, and the association between body mass index and death was also J shaped, with the lowest risk between body mass index 25 and 30. In all cohort types, associations between higher waist circumference and higher waist-to-height ratio with GFR decline were similar to that of body mass index; however, increased risk of death was not associated with lower waist circumference or waist-to-height ratio, as was seen with body mass index.ConclusionsElevated body mass index, waist circumference, and waist-to-height ratio are independent risk factors for GFR decline and death in individuals who have normal or reduced levels of estimated GFR.

BackgroundSkipping breakfast has been suspected as a risk factor for type 2 diabetes (T2DM), but the associations are not entirely consistent across ethnicities or sexes, and the issue has not been adequately addressed in the Japanese population.MethodsWe followed 4631 participants (3600 men and 1031 women) in a work-site cohort of participants aged 35–66 years in 2002 through 2011 for T2DM development. Frequency of eating breakfast was self-reported and was subsequently dichotomized to breakfast skippers, who eat breakfast 3–5 times/week or less, and to eaters. Cox proportional hazards models were used to adjust for potential confounding factors, including dietary factors, smoking and other lifestyles, body mass index (BMI), and fasting blood glucose (FBG) at baseline.ResultsDuring 8.9 years of follow-up, 285 T2DM cases (231 men and 54 women) developed. Compared to participants who reported eating breakfast every day, maximally-adjusted hazard ratios and 95% confidence intervals (CI) of those with the frequency of almost every day and 3–5, 1–2, and 0 days/week were: 1.06 (95% CI, 0.73–1.53), 2.07 (95% CI, 1.20–3.56), 1.37 (95% CI, 0.82–2.29), and 2.12 (95% CI, 1.19–3.76), respectively. In a dichotomized analysis, breakfast skipping was positively associated with T2DM incidence (maximally-adjusted hazard ratio 1.73; 95% CI, 1.24–2.42). The positive associations were found in both men and women, current and non-current smokers, normal weight and overweight (BMI ≥25 kg/m2), and normal glycemic status and impaired fasting glycemic status (FBG 110 to <126 mg/dL) individuals at baseline (Ps for interaction all >0.05).ConclusionsThe present study in middle-aged Japanese men and women suggests that skipping breakfast may increase the risk of T2DM independent of lifestyles and baseline levels of BMI and FBG.

We report the light-driven isomerization mechanism of a fluorene-based light-driven rotary motor (corresponding to Feringa's 2nd generation rotary motor, [M. M. Pollard et al., Org. Biomol. Chem. 6, 507-512 (2008)]) at the complete active space self-consistent field (CASSCF) and spin-flip time-dependent density functional theory (TDDFT) (SFDFT) levels, combined with the complete active space second-order perturbation theory (CASPT2) single-point energy corrections. The good consistence between the SFDFT and CASSCF results confirms the capability of SFDFT in investigating the photoisomerization step of the light-driven molecular rotary motor, and proposes the CASPT2//SFDFT as a promising and effective approach in exploring photochemical processes. At the mechanistic aspect, for the fluorene-based motor, the S/S minimum-energy conical intersection (MECIs) caused by pyramidalization of a fluorene carbon have relatively low energies and are easily accessible by the reactive molecule evolution along the rotary reaction path; therefore, the fluorene-type MECIs play the dominant role in nonadiabatic decay, as supported by previous experimental and theoretical works. Comparably, the other type of MECIs that results from pyramidalization of an indene carbon, which has been acting as the dominant nonadiabatic decay channel in the stilbene motor, is energetically inaccessible, thus the indene-type MECIs are "missing" in previous mechanistic studies including molecular dynamic simulations. A correlation between the geometric and electronic factors of MECIs and that of the S energy profile along the C═C rotary coordinate was found. The findings in current study are expected to deepen the understanding of nonadiabatic transition in the light-driven molecular rotary motor and provide insights into mechanistic tuning of their performance.

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