Systematic Review Critique Paper. “Beyond Body Mass Index: Advantages of Abdominal Measurements for Recognizing Cardiometabolic Disorders”

The Main Issue Researched

The article Beyond Body Mass Index: Advantages of abdominal measurements for recognizing cardiometabolic disorders by Kahn and Bullard (2016) is a systematic research aimed at identifying the effectiveness of the recognition of cardiometabolic disorders among nonelderly adults with several methods. They include sagittal abdominal diameter/ height ratio (SADHtR), waist circumference/height ratio (WHtR), or body mass index (BMI) calculated as weight/height2 (Kahn & Bullard, 2016). The main question asked in review is whether SADHtR or WHtR are better recognizers of cardiometabolic disorders than BMI. Therefore, the authors of the article have conducted an extensive analysis of the measures taken from adults and referred them to the possibilities of the development of cardiometabolic disorders.

Five cardiometabolic disorders were identified: dysglycemia, hyperNonHDLc, hypertension, hyperALT, and hyperGGT. Therefore, different measures were related to the development of the parallel between the physical measures of human body and the possibility of the cardiometabolic disorders development. The data for the review was obtained from the 2011-2012 National Health and Examination Survey (NHANES). Since the research results were focused on adults, not pregnant and without diabetes, the current systematic review imposed some specific selection criteria. They included the age of 20-60, excluded pregnant women and diabetics, and those, who did not provide the information on SAD, waist circumference, BMI and any other clinical data, which was needed in order to confirm the cardiometabolic disorders identified as the focus of the review.

The Elements of the Review

The systematic review under consideration is focused on understanding the relation of the SADHtR, WHtR, and BMI to the development of cardiometabolic disorders. Overall, many measures were reviewed in the study. Discussing the elements of the review, it is important to understand which measures have been taken to draw conclusions about the relation of SADHtR, WHtR, and BMI to the development of cardiometabolic disorders. The authors focused on five cardiometabolic disorders: dysglycemia, hyperNonHDLc, hypertension, hyperALT, and hyperGGT. The analysis of dysglycemia development was based on the assessment of glycated hemoglobin (HbA1c). In case its level was equal to or higher than 5.7%, the patient was referred to as the one who had developed dysglycemia. If the level of non-HDL-cholesterol was equal to 4.14 mmol/L or higher, or people were prescribed anticholesteremic medications, they were indicated as those with hyperNonHDLc (HDL – high-density lipoprotein) – one of the cardiometabolic disorders. Hypertension was measured by systolic blood pressure (?140 mm Hg) and diastolic blood pressure (?90 mm Hg). (Kahn & Bullard, 2016, p. 76) The consumption of antihypertensive medications was also a sign of hypertension. People with hyper alanine transaminase and hyper gamma-glutamyltransferase were also marked as those who had developed cardiometabolic disorders. The relation to people with hyper alanine transaminase was characterized by the inclusion of subjects whose alanine transaminase equaled or was higher than p75 (sex-specific 75th percentile). Those whose gamma-glutamyltransferase was equal to or higher than p75 (sex-specific 75th percentile) were referred to as those with hyper gamma-glutamyltransferase.

All the data was taken from NHANES and the measured were acquired basing on the pertinent laboratory and blood pressure measures. The authors stated that the 75th percentile (p75) thresholds for HyperALT were 33 U/L for men, 22 U/L for women; for HyperGGT they were 33 U/L for men, 21 U/L for women (Kahn & Bullard, 2016, p. 76). This information was important in understanding the measures and the reasons for considering them valid. The consumption of medication was considered in the questions. The subjects were asked: To lower your blood cholesterol, are you now following advice to take prescribed medicine? and Are you now taking prescribed medicine for your high blood pressure/hypertension? (Kahn & Bullard, 2016, p. 75). Therefore, the understanding of the development of the cardiometabolic disorders was based on the particular analysis of the measures taken from the replies of the respondents.

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Having gathered the information about the cardiometabolic disorders, the further data was required in relation to measuring SADHtR, WHtR, and BMI. The dimensions of weight, height, and waist circumference were taken from the subjects in standing position using the established methods. The measures were taken above the iliac crest. SAD data retrieval required a specific procedure which was followed entirely. Portable, sliding-beam caliper was used to measure SAD. The subjects were placed on a slightly padded examination table. The hips of the subjects were fixed as only in this way it was possible to mark the level of iliac crests. After these preparing measures were completed, the subjects were asked to breathe slowly. After a person relaxed, the measures were taken with 0.1 cm accuracy. According to NHANES, the mean of two measurements was taken for 94.4% of the subjects, while the rest 5.6% required up to four procedures to guarantee the ability to calculate the mean and to note the measurements.

The Validity of the Results of the Systematic Review

The assessment of the validity of the systematic review should start with the appraisal of the quality of the trial, its strategies, individual assessments, results consistency, and the data used. Ciliska, Cullum, & Marks (2001) have offered to use the following questions in defining the validity of the systematic review:

Are the results of this systematic review valid? Is this a systematic review of randomized trials? Does the systematic review include a description of the strategies used to find all relevant trials? Does the systematic review include a description of how the validity of individual studies was assessed? Were the results consistent from study to study? Were individual patient data or aggregate data used in the analysis? (p. 100)

The results of the systematic review under analysis can be considered valid since the randomized trials are referred to in the survey under consideration. The review has provided a detailed analysis of SAD measures, which are probably the most important dimensions that have influenced the research results greatly. Other measures were standard (weight, height and waist circumference) and did not require any special attention in the measuring procedures. The results can be considered valid since large scope of US population has been tested. All the peculiarities and specifics of data have been noted, which is important for further research and assessment. The surveys taken during 2011-2012 assessed not only the physical condition of the population but also involved the interviews that helped expand the knowledge about the health and nutritional status of adults and children (National Health and Nutrition Examination Survey, 2016).

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Schlesselman and Collins (2003) have identified systematic review validity by the quality of the individual studies, the rigor with which the systematic methods were applied, and the extent of heterogeneity (p. 95). The measures from the NHANES were taken several times and the mean was used for SAD, where the difference in the measures could be observed due to physical conditions. The measures were taken from an extended population in a strict manner to ensure the accuracy of results. The outcomes can also be considered valid since the population is described and selected from the overall data by the exclusion criteria to fit the study objectives. In addition, the interventions and the measures are discussed in thorough detail (Abalos, Carroli, Mackey, & Bergel, 2001). The information from NHANES has perfectly fit the research objectives set by Kahn and Bullard (2016), since the survey contained all the necessary data to refer to and the size of the sample allowed generalizing the research findings. Therefore, the systematic review can be considered valid despite the fact that no new evidence is collected and the data is used from the survey that has been conducted for other purposes.

Final Results

The research results of the systematic review have confirmed that the measurements of SADHtR and WHtR ratios among nonelderly adults allow recognizing cardiometabolic disorders faster and more effectively than BMI. This conclusion has been drawn from the research results obtained from the measurements and interviews based on the data from NHANES. Adjusted odds ratios appeared to be higher for SADHtR and lower for BMI, when helped predict hyperNonHDLc, hypertension, hyperALT, and hyperGGT in patients. WHtR was also effective in recognizing dysglycemia, hyperNonHDLc, and hyperGGT, in comparison to BMI, which showed no significance.

Application to Advanced Practice Nurses or Registered Nurses Practice

Buitrago-Lopez et al. (2011) have reported the increased rates of cardiometabolic disorders, which include cardiovascular diseases, metabolic syndrome, and diabetes. Moreover, the amplified rates of defining and diagnosing cardiometabolic disorders in children have also become a serious issue for concern among nurses and other healthcare staff (Andersen et al., 2015). For a long time, BMI has been considered as the identifier of the possible cardiometabolic disorders development (Vaccaro & Huffman, 2013; Hou et al., 2013; Millar, Perry, & Phillips, 2015). The research findings of the current systematic review can be applied by the nurses in practice for a more accurate prediction of cardiometabolic disorders, since the measures considered in the analysis can be easily obtained for a medical observation.

The authors of the review expressed their gratitude to the participants of the National Health and Nutrition Examination Survey, which took place in 2011-2012, and to the efforts of the NHANES staff. Since the original data used in the review is in the open access and can be easily obtained, no funding was required for the review. The research findings were fully accomplished since the authors managed to prove that SADHtR and WHtR recognized cardiometabolic disorders better than BMI. The major strength of the review is the fact that a better means for recognizing cardiometabolic disorders has been identified without additional costs for nurses and healthcare institutions. Only supine sagittal abdominal diameter measurement is required in addition to what is usually measured while diagnosing any disease. The absence of circumferences measured at the hip or thigh in 2011-2012 NHANES report prevented from including one more parameter is the review, which could influence the research findings negatively.

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Despite the fact that the research findings can be used in practice while identifying such cardiometabolic disorders as dysglycemia, hyperNonHDLc, hypertension, hyperALT, and hyperGGT with higher efficacy than body mass index, the latter still remains the faster and the most commonly used dimension. The measurement of sagittal abdominal diameter requires additional attention from the side of the patients. However, since this method is more effective, it can be useful to oblige nursing staff to refer to it when predicting the possibility of cardiometabolic disorder development. Since SAD/height ratio has appeared to be the best measure for hypertension, hyperALT, and hyperGGT identification, the review findings should be delivered to the managerial healthcare staff in order to improve the effectiveness of nursing performance. The systematic review under consideration contains a detailed analysis of the clinical application of the research findings, which is another advantage of the article. Overall, much work has been conducted with the purpose of improving the diagnosis recognition paradigm.

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