Body adiposity markers and insulin resistance in patients with type 1 diabetes

ABSTRACT Objectives: Body composition changes are associated with adverse effects such as increased insulin resistance (IR) in individuals with diabetes mellitus. This study aims to evaluate the association between different body adiposity markers and IR in adults with type 1 diabetes (T1D). Subjects and methods: The cross-sectional study included outpatient adults with T1D from a university public hospital in southern Brazil. The body adiposity markers studied were waist circumference (WC), waist-height ratio (WHtR), body mass index (BMI), conicity index (CI), lipid accumulation product (LAP) and body adiposity index (BAI). IR was calculated using an Estimated Glucose Disposal Rate (EGDR) equation (analyzed in tertiles), considering an inverse relation between EGDR and IR. Poisson regression models were used to estimate the odds ratio (OR) and 95% CIs of association of adiposity markers with IR. Results: A total of 128 patients were enrolled (51% women), with a median EGDR of 7.2 (4.4-8.7) mg.kg−1.min−1. EGDR was negatively correlated with WC (r = −0.36, p < 0.01), WHtR (r = −0.39, p < 0.01), CI (r = −0.44, p < 0.01), LAP (r = −0.41, p < 0.01) and BMI (r = −0.24, p < 0.01). After regression analyses, WC (OR = 2.07; CIs: 1.12-3.337; p = 0.003), WHtR (OR = 2.77; CIs: 1.59-4.79; p < 0.001), CI (OR = 2.59; CIs: 1.43-4.66; p = 0.002), LAP (OR = 2.27; CIs: 1.25-4.11; p = 0.007) and BMI (OR = 1.78; CIs: 1.09-2.91; p = 0.019) remained associated with IR. Conclusions: The authors suggest using the studied adiposity markers as a routine since they were shown to be suitable parameters in association with IR.

Maternal visceral adiposity and fetal biometry in women with obesity and diabetes

SUMMARY OBJECTIVE: The aim of this study was to compare the correlation of maternal visceral adiposity with sonographic variables related to fetal biometry in the second trimester of pregnancy in mothers who were previously obese versus nonobese and gestational diabetic versus nondiabetic. METHODS: This cross-sectional study included 583 pregnant women who received prenatal care between October 2011 and September 2013 at the Instituto de Medicina Integral Prof. Fernando Figueira, northeast of Brazil. Maternal visceral adiposity was measured by ultrasound examination at the same time as fetal biometry. Gestational age was 14.9±3.2 weeks. The correlation between maternal visceral adiposity and fetal biometric variables was evaluated using Pearson's correlation coefficient. Among the groups, the correlation coefficients were compared using Fisher's Z-test. This test was also used to evaluate the null hypothesis of correlation coefficients between pairs of variables. RESULTS: Maternal visceral adiposity positively correlated with fetal abdominal circumference, estimated fetal weight, head circumference, femur length, and biparietal diameter in pregnant women with obesity, nonobesity, gestational diabetes, and nondiabetes, but the correlation coefficients were statistically similar among the groups. CONCLUSION: Maternal visceral adiposity positively correlated with fetal biometry in the second trimester of pregnancy in the same manner in pregnant women previously obese and nonobese, as well as in pregnant women with gestational diabetes and nondiabetes.

Volume de Gordura Epicárdica está Associada com Disfunção Endotelial, mas Não com Calcificação Coronariana: Do ELSA-Brasil / Epicardial Fat Volume Is Associated with Endothelial Dysfunction, but not with Coronary Calcification: From the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

Resumo Fundamento O aumento no volume de gordura epicárdica (VGE) está relacionado com doença arterial coronariana (DAC), independentemente de gordura visceral ou subcutânea. O mecanismo dessa associação não é claro. O escore de cálcio coronariano (CC) e a disfunção endotelial estão relacionados com eventos coronarianos, mas não está bem esclarecido se o VGE está relacionado com esses marcadores. Objetivos Avaliar a associação entre VGE medido por método automatizado, fatores de risco cardiovasculares, escore de CC, e função endotelial. Métodos: Em 470 participantes do Estudo Longitudinal de Saúde do Adulto LSA-Brasil com medidas de VGE, escore de CC e função endotelial, realizamos modelos multivariados para avaliar a relação entre fatore de risco cardiovascular e VGE (variável resposta), e entre VGE (variável explicativa), e função endotelial ou escore de CC. Valor de p<0,05 bilateral foi considerado estatisticamente significativo. Resultados A idade média foi 55 ± 8 anos, e 52,3% dos pacientes eram homens. O VGE médio foi 111mL (86-144), e a prevalência de escore de CC igual a zero foi 55%. Nas análises multivariadas, um VGE mais alto relacionou-se com sexo feminino, idade mais avançada, circunferência da cintura, e triglicerídeos (p<0,001 para todos). Um VGE mais alto foi associado com pior função endotelial: em comparação ao primeiro quartil, os valores de odds ratio para a amplitude de pulso basal foram (q2=1,22; IC95% 1,07-1,40; q3=1,50, IC95% 1,30-1,74; q4=1,50, IC95% 1,28-1,79) e para a razão de tonometria arterial periférica foram (q2=0,87; IC95% 0,81-0,95; q3=0,86, IC95% 0,79-0,94; q4=0,80, IC95% 0,73-0,89), mas não com escore de CC maior que zero. Conclusão Um VGE mais alto associou-se com comprometimento da função endotelial, mas não com escore de CC. Os resultados sugerem que o VGE esteja relacionado ao desenvolvimento de DAC por uma via diferente da via do CC, possivelmente pela piora da disfunção endotelial e doença microvascular.

Abstract Background The increase in epicardial fat volume (EFV) is related to coronary artery disease (CAD), independent of visceral or subcutaneous fat. The mechanism underlying this association is unclear. Coronary artery calcium (CAC) score and endothelial dysfunction are related to coronary events, but whether EFV is related to these markers needs further clarification. Objectives To evaluate the association between automatically measured EFV, cardiovascular risk factors, CAC, and endothelial function. Methods In 470 participants from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) with measures of EFV, CAC score and endothelial function, we performed multivariable models to evaluate the relation between cardiovascular risk factors and EFV (response variable), and between EFV (explanatory variable) and endothelial function variables or CAC score. Two-sided p <0.05 was considered statistically significant. Results Mean age was 55 ± 8 years, 52.3% of patients were men. Mean EFV was 111mL (IQ 86-144), and the prevalence of CAC score=0 was 55%. In the multivariable analyses, increased EFV was related to female sex, older age, waist circumference, and triglycerides (p<0.001 for all). Higher EFV was associated with worse endothelial function: as compared with the first quartile, the odds ratio for basal pulse amplitude were (q2=1.22, 95%CI 1.07-1.40; q3=1.50, 95%CI 1.30-1.74; q4=1.50, 95%CI 1.28-1.79) and for peripheral arterial tonometry ratio were (q2=0.87, 95%CI 0.81-0.95; q3=0.86, 95%CI 0.79-0.94; q4=0.80, 95%CI 0.73-0.89), but not with CAC score>0. Conclusion Higher EFV was associated with impaired endothelial function, but not with CAC. The results suggest that EFV is related to the development of CAD through a pathway different from the CAC pathway, possibly through aggravation of endothelial dysfunction and microvascular disease.

Aerobic exercise attenuates the effects of ovariectomy and sedentarism on body composition and food intake in female rats / Exercício aeróbico atenua os efeitos da ovariectomia e do sedentarismo na composição corporal e no consumo alimentar em ratas

ABSTRACT Objective To evaluate the impact of low to moderate aerobic exercise and ovariectomy on body composition and food consumption in female rats. Methods Forty adult Wistar female rats (age: 23 weeks; body weight: 275.2±3.6g; mean±SEM) were divided into 4 groups (n=10): laparotomy-sedentary; laparotomy-exercised; ovariectomy-sedentary; and ovariectomy-exercised. The exercised groups were submitted to a treadmill running program (16m/min; 30min/day, 5 days/week), for 8 weeks. Body weight and food consumption were monitored during the experiment. Visceral fat and carcass water, protein, ash, fat and carbohydrate fractions were analyzed. Two-way ANOVA plus the Tukey's post hoc test was used for comparisons and p<0.05 was considered significant. Results The ovariectomized (ovariectomy-sedentary+ovariectomy-exercised) and sedentary (laparotomy-sedentary+ovariectomy-sedentary) animals showed higher (p<0.05) weight gain, food consumption, food efficiency ratio and weight gain/body weight ratio than laparotomy animals (laparotomy-sedentary+laparotomy-exercised) and exercised (exercised laparotomy+exercised ovariectomy), respectively. The ovariectomized and sedentary animals showed higher (p<0.05) carcass weight, fat percentage and visceral fat than laparotomy and exercised rats, respectively. Conclusion Ovariectomy and physical inactivity increase obesogenic indicators, whereas regular aerobic exercise of low to moderate intensity attenuates these unfavorable effects in female rats.

RESUMO Objetivo Avaliar o impacto do exercício aeróbico de intensidade baixa a moderada e da ovariectomia na composição corporal e no consumo alimentar em ratas. Métodos Quarenta ratas Wistar adultas (idade: 23 semanas; peso corporal: 275, 2±3, 6g; média±EPM) foram divididas em 4 grupos (n=10): laparotomia-sedentária, laparotomia-exercitada, ovariectomia-sedentária e ovariectomia-exercitada. Os grupos laparotomia-exercitada e ovariectomia-exercitada foram submetidos a um programa de corrida em esteira (16m/mim; 30min/dia, 5 dias/semana) durante 8 semanas. Foram monitorados o peso corporal e o consumo alimentar das ratas durante o experimento. Analisaram-se as frações de água, proteínas, cinzas, gordura e carboidrato da carcaça, bem como a gordura visceral. Empregou-se ANOVA Two-Way, seguida do teste post hoc de Tukey para as análises estatísticas. Adotou-se o nível de significância de p<0,05. Resultados As ratas ovariectomizadas (ovariectomia-sedentária+ovariectomia-exercitada) e sedentárias (laparotomia-sedentária+ ovariectomia-sedentária) exibiram maior (p<0,05) ganho de peso, consumo alimentar, coeficiente de eficácia alimentar e taxa de ganho de peso/peso corporal do que as ratas laparotomizadas (laparotomia-sedentária+laparotomia-exercitada) e exercitadas (laparotomia-exercitada+ovariectomia-exercitada), respectivamente. A carcaça das ratas ovariectomizadas e sedentárias apresentaram maior (p<0,05) peso, percentual de gordura e gordura visceral do que as ratas laparotomizadas e exercitadas, respectivamente. Conclusão A ovariectomia e o sedentarismo elevam indicadores obesogênicos, enquanto que o exercício aeróbico regular de intensidade baixa a moderada atenua esses efeitos desfavoráveis em ratas.

Effect of increased visceral fat on the perioperative period of laparoscopic-assisted distal gastric cancer radical resection / 国际外科学杂志

Objective:To explore the effect of excessive visceral fat area (VFA) on the intraoperative risk and postoperative outcome of laparoscopic-assisted distal gastric cancer surgery (LADG).Methods:A retrospective selection of 82 patients who underwent LADG at the Department of General Surgery, Beijing Friendship Hospital, Capital Medical University from June 2017 to March 2018 was selected. The patients were divided into two groups according to the VFA value calculated by preoperative CT: high VFA group ( n=31) and the low VFA group ( n=51). Patients in the high-VFA group had VFA≥100 cm 2, and those in the low-VFA group had VFA<100 cm 2. The differences in operation time, blood loss, number of lymph node dissections, and postoperative complications (including intestinal obstruction, anastomotic fistula, pancreatic fistula, and abdominal infection) were statistically compared between the two groups. Measurement data were expressed as mean±standard deviation ( Mean± SD), comparison between groups was by t-test; comparison of count data between groups was by Chi-square test. The factors related to pancreatic fistula were tested by one-way variance test, and the factors with differences were entered into the multivariate Logistic regression analysis as independent variables. Results:In terms of surgical bleeding ( P=0.061), lymph node dissection ( P=0.089), postoperative anastomotic leakage ( P=0.210), intestinal obstruction ( P=0.275) and abdominal infection ( P=0.130), the comparison between the two groups showed no significant statistical difference ( P>0.05), but compared with the low VFA group, the operation time of the high VFA group was prolonged [(258±91)min vs (230±82)min, P=0.018], and the onset of pancreatic fistula rate was significantly higher (11/31 vs 3/51, P=0.001), and there was statistical significance between the two groups ( P<0.05). The results of univariate analysis showed that gender and VFA were risk factors for pancreatic fistula; the results of multivariate analysis showed that VFA was a predictor of pancreatic fistula. Conclusion:Excessive VFA prolongs LADG operation time and is more valuable in predicting the occurrence of postoperative pancreatic fistula.

Research progress on fat aging and the occurrence and development of metabolic syndrome / 中华老年医学杂志

Obesity has become a major public health problem that threatens human health.Abdominal obesity, especially the increase in visceral adipose tissue(VAT), can in some cases lead to insulin resistance and other metabolism-related diseases such as diabetes, cardiovascular disease, thrombosis, and pro-inflammatory metabolic abnormalities.Metabolic syndrome is a group of clinical syndromes characterized by the co-occurrence of various metabolic diseases, including insulin resistance and inflammatory response.In a large extent, the occurrence and development of the metabolic syndrome are related to fat aging and visceral obesity related.Visceral obesity is an independent risk factor for cardiovascular events, and can be changed, so by setting realistic goals, by insisting on reasonable exercise and diet control can achieve control of visceral fat, prevention and control of the metabolic syndrome.This review reviews the concept and pathophysiology of metabolic syndrome and the relationship between visceral obesity and metabolic syndrome.

Visceral fat, physical fitness and biochemical markers of brazilian military personnel / Gordura visceral, aptidão física e marcadores bioquímicos de militares brasileiros / Grasa visceral, aptitud física y marcadores bioquímicos de militares brasileños

ABSTRACT Introduction: Adipocyte volume (fat accumulation) in different parts of the body may play different roles in the metabolism and in the appearance of cardiovascular risk factors. Most studies indicate that the regional distribution of body fat seems to be more important than excess adiposity per se. High levels of physical activity are associated with lower total and visceral body fat levels. Military physical training is of paramount importance for the health and performance of soldiers in the Brazilian Army. In this context, physical evaluation will provide data on the main physical benefits involved in military tasks. Objective: Verify the relationship between visceral fat (VF), physical performance and biochemical markers of soldiers in the Brazilian Army. Methods: The sample consisted of 41 (38.9 ± 2.2 years) Brazilian male military personnel. VF was obtained with a Dual Energy X-Ray Absorptiometry densitometry device. The biochemical analysis included fasting glycemia, triglycerides (TG) and HDL-C levels. Physical performance was evaluated through two tests (12-min run and pull-ups). The Shapiro-Wilk test confirmed the normality of the variables. Pearson's correlation test was then applied, with a p-value of <0.05. Results: Significant negative correlations of VF were found with the results of both physical tests (Pull-ups r = −0.59; 12-min r = −0.61). The only biochemical variable that had a significant positive correlation with VF was TG (r = 0.44). Conclusion: The results of this study showed a significant negative association between VF and physical tests. A significant positive association between VF and TG was also found. Level of Evidence I; Diagnostic studies - Investigation of a diagnostic test.

RESUMO Introdução: O acúmulo de adipócitos em diferentes regiões do corpo pode desempenhar diferentes papéis no metabolismo e no aparecimento de fatores de risco cardiovascular. A maioria dos estudos aponta que a distribuição regional da gordura corporal parece ser mais importante do que o excesso de adiposidade per se. Altos níveis de atividade física estão associados a níveis mais baixos de gordura corporal total e visceral. O treinamento físico militar é de fundamental importância para a saúde e desempenho dos militares do Exército Brasileiro, neste sentido a avaliação física fornecerá dados referentes aos principais benefícios físicos envolvidos nas tarefas militares. Objetivo: Verificar a relação entre a gordura visceral (GV), o desempenho físico e os marcadores bioquímicos de militares do Exército Brasileiro. Método: A amostra foi composta por 41(38,9± 2,2 anos) militares brasileiros, do sexo masculino. A GV foi obtida através de um aparelho de densitometria "Dual Energy X-Ray Absorptiometry". A análise bioquímica incluiu as dosagens em jejum da glicemia, de triglicerídeos (TG) e HDL-C. O desempenho físico foi avaliado por meio de dois testes (corrida de 12 min e flexão de braços na barra fixa). O teste de Shapiro-Wilk confirmou a normalidade das variáveis. Na sequência foi aplicado o teste de correlação de Pearson, com valor de p < 0,05. Resultados: Foram encontradas correlações negativas e significativas da GV, com o resultado dos dois testes físicos (Barra r = - 0,59; Teste de 12 min r = - 0,61). A única variável bioquímica que apresentou correlação positiva significativa com a GV foi TG (r = 0,44). Conclusão: Os resultados do presente estudo mostraram haver associação negativa significativa entre a GV e os testes físicos. Além disso, encontrou-se uma associação positiva significativa entre a GV e os TG. Nível de Evidência I; Estudos diagnósticos-Investigação de um exame para diagnóstico.

RESUMEN Introducción: La acumulación de adipocitos en diferentes regiones del cuerpo puede desempeñar papeles diferentes en el metabolismo y la aparición de factores de riesgo cardiovascular. La mayoría de los estudios indica que la distribución regional de la grasa corporal parece ser más importante que el exceso de adiposidad per se. Altos niveles de actividad física están asociados a niveles más bajos de grasa corporal total y visceral. El entrenamiento físico militar es de fundamental importancia para la salud y el desempeño de los militares del Ejército Brasileño, en este sentido la evaluación física proporcionará datos referentes a los principales beneficios físicos involucrados en las tareas militares. Objetivo: Verificar la relación entre la grasa visceral (GV), el desempeño físico y los marcadores bioquímicos de militares del Ejército Brasileño. Método: La muestra fue compuesta por 41 (38,9 ± 2,2 años) militares brasileños, del sexo masculino. La GV fue obtenida a través de un aparato de densitometría "Dual Energy X-Ray Absorptiometry". El análisis bioquímico incluyó las dosificaciones en ayuno de glucemia, de triglicéridos (TG) y del HDL-C. El desempeño físico fue evaluado por medio de dos tests (carrera de 12 minutos y flexión de brazos en la barra fija). El test de Shapiro-Wilk confirmó la normalidad de las variables. A continuación, fue aplicado el test de correlación de Pearson con valor de p <0,05. Resultados: Se encontraron correlaciones negativas y significativas de la GV, con el resultado de los dos tests físicos (Barra r = - 0,59; 12 min r = - 0,61). La única variable bioquímica que presentó una correlación positiva significativa con la GV fue TG (r = 0,44). Conclusión: Los resultados del presente estudio mostraron que hay una asociación negativa significativa entre la GV y los tests físicos. Además, se encontró una asociación positiva significativa entre GV y los TG. Nivel de evidencia I; Estudios diagnósticos-Investigación de un examen para diagnóstico.

Visceral-to-Subcutaneous Abdominal Fat Ratio Is Associated with Nonalcoholic Fatty Liver Disease and Liver Fibrosis

BACKGROUND: We evaluated the association of visceral-to-subcutaneous fat ratio (VSR) with nonalcoholic fatty liver disease (NAFLD) and advanced fibrosis degree based on noninvasive serum fibrosis markers in the general population with NAFLD.METHODS: This is a cross-sectional study, in 7,465 Korean adults who underwent health screening examinations. NAFLD was defined as fatty liver detected on ultrasonography, and visceral and subcutaneous abdominal fat was measured using computed tomography. We predicted fibrosis based on the fibrosis-4 (FIB-4) score and aspartate aminotransferase-to-platelet ratio index (APRI) and categorized the risk for advanced fibrosis as low, indeterminate, or high.RESULTS: The multivariable-adjusted prevalence ratios for indeterminate to high risk of advanced fibrosis based on FIB-4, determined by comparing the second, third, and fourth quartiles with the first quartile of VSR, were 3.38 (95% confidence interval [CI], 0.64 to 17.97), 9.41 (95% CI, 1.97 to 45.01), and 19.34 (95% CI, 4.06 to 92.18), respectively. The multivariable-adjusted prevalence ratios for intermediate to high degree of fibrosis according to APRI also increased across VSR quartiles (5.04 [95% CI, 2.65 to 9.59], 7.51 [95% CI, 3.91 to 14.42], and 19.55 [95% CI, 9.97 to 38.34], respectively). High VSR was more strongly associated with the prevalence of NAFLD in nonobese subjects than in obese subjects, and the associations between VSR and intermediate to high probability of advanced fibrosis in NAFLD were stronger in obese subjects than in nonobese subjects.CONCLUSION: High VSR values predicted increased NAFLD risk and advanced fibrosis risk with NAFLD, and the predictive value of VSR for indeterminate to high risk of advanced fibrosis was higher in obese subjects than in nonobese subjects.

Intra-abdominal fat measurement by ultrasonography: association with anthropometry and metabolic syndrome in adolescents / Gordura intra-abdominal medida por ultrassonografia: relação com antropometria e síndrome metabólica em adolescentes

Abstract Objective: To associate intra-abdominal fat thickness measured by ultrasonography to the factors related to metabolic syndrome and to determine cutoff points of intra-abdominal fat measurement associated with a greater chance of metabolic syndrome in adolescents. Methods: This was a cross-sectional study, with 423 adolescents from public schools. Intra-abdominal fat was measured by ultrasonography. Anthropometric data were collected, and biochemical analyses were performed. Results: Intra-abdominal fat was measured by ultrasonography, showing a statistically significant association with the diagnosis of metabolic syndrome (p = 0.037), body mass index (p < 0.001), elevated triglyceride levels (p = 0.012), decreased plasma HDL levels (p = 0.034), and increased systemic blood pressure values (p = 0.023). Cutoff values of intra-abdominal fat thickness measurements were calculated by ultrasound to estimate the individuals most likely to develop metabolic syndrome. In the logistic regression models, the cutoff values that showed the highest association with metabolic syndrome in males were 4.50, 5.35, 5.46, 6.24, and 6.50 cm for the ages of 14, 15, 16, 17, and 18/19 years, respectively. In the female gender, the cutoff values defined for the same age groups were 4.46, 4.55, 4.45, 4.90, and 6.46 cm. In an overall analysis using the ROC curve, without gender and age stratification, the cut-off of 3.67 cm showed good sensitivity, but low specificity. Conclusion: Ultrasonography is a useful method to estimate intra-abdominal adipose tissue in adolescents, which is associated with the main factors related to obesity and metabolic syndrome.

Resumo Objetivo: Relacionar a espessura da gordura intra-abdominal medida pela ultrassonografia aos fatores ligados à síndrome metabólica. Determinar pontos de corte da medida da gordura intra-abdominal associados a uma maior chance de síndrome metabólica em adolescentes. Métodos: Estudo seccional, com 423 adolescentes de escolas públicas. A gordura intra-abdominal foi medida pela ultrassonografia. Foram coletados dados antropométricos e feitas análises bioquímicas. Resultados: As medidas da gordura intra-abdominal por ultrassonografia apresentaram associação estatisticamente significativa com o diagnóstico de síndrome metabólica (p = 0,037), índice de massa corporal (p < 0,001), níveis elevados de triglicerídeos (p = 0,012), redução dos níveis plasmáticos de HDL (p = 0,034) e aumento da pressão arterial sistêmica (p = 0,023). Calcularam-se pontos de corte da medida da espessura da gordura intra-abdominal por ultrassom, para estimar os indivíduos com mais chance para o desenvolvimento de síndrome metabólica. Em modelos de regressão logística, os pontos de corte que apresentaram maior associação com a síndrome metabólica no sexo masculino foram de 4,50, 5,35, 5,46, 6,24 e 6,50 cm para as idades de 14, 15, 16, 17 e 18/19 anos, respectivamente. No sexo feminino, os pontos de corte definidos para as mesmas faixas etárias foram de 4,46, 4,55, 4,45, 4,90 e 6,46 cm. Em análise global por meio da curva ROC, sem estratificações por sexo e idade, o ponto de corte de 3,67 cm teve boa sensibilidade, porém apresentou baixa especificidade. Conclusão: A ultrassonografia é um método útil para a estimativa do tecido adiposo intra-abdominal em adolescentes, está associada com os principais fatores relacionados à obesidade e à síndrome metabólica.

Quantification of visceral adipose tissue by computed tomography and magnetic resonance imaging: reproducibility and accuracy / Quantificação do tecido adiposo visceral por tomografia computadorizada e ressonância magnética: reprodutibilidade e acurácia

Abstract Objective: To evaluate the feasibility of quantifying visceral adipose tissue (VAT) on computed tomography (CT) and magnetic resonance imaging (MRI) scans, using freeware, as well as calculating intraobserver and interobserver reproducibility. Materials and Methods: We quantified VAT in patients who underwent abdominal CT and MRI at our institution between 2010 and 2015, with a maximum of three months between the two examinations. A slice acquired at the level of the umbilicus was selected. Segmentation was performed with the region growing algorithm of the freeware employed. Intraobserver and interobserver reproducibility were evaluated, as was the accuracy of MRI in relation to that of CT. Results: Thirty-one patients (14 males and 17 females; mean age of 57 ± 15 years) underwent CT and MRI (mean interval between the examinations, 28 ± 12 days). The interobserver reproducibility was 82% for CT (bias = 1.52 cm2; p = 0.488), 86% for T1-weighted MRI (bias = −4.36 cm2; p = 0.006), and 88% for T2-weighted MRI (bias = −0.52 cm2; p = 0.735). The intraobserver reproducibility was 90% for CT (bias = 0.14 cm2; p = 0.912), 92% for T1-weighted MRI (bias = −3,4 cm2; p = 0.035), and 90% for T2-weighted MRI (bias = −0.30 cm2; p = 0.887). The reproducibility between T1-weighted MRI and T2-weighted MRI was 87% (bias = −0.11 cm2; p = 0.957). In comparison with the accuracy of CT, that of T1-weighted and T2-weighted MRI was 89% and 91%, respectively. Conclusion: The program employed can be used in order to quantify VAT on CT, T1-weighted MRI, and T2-weighted MRI scans. Overall, the accuracy of MRI (in comparison with that of CT) appears to be high, as do intraobserver and interobserver reproducibility. However, the quantification of VAT seems to be less reproducible in T1-weighted sequences.

Resumo Objetivo: Avaliar a viabilidade da quantificação do tecido adiposo visceral (TAV) pela tomografia computadorizada (TC) e ressonância magnética (RM) usando um software freeware, e também calcular a reprodutibilidade intraobservador e interobservador. Materiais e Métodos: Foi quantificado o TAV em pacientes submetidos a TC e RM de abdome em nossa instituição, entre 2010 e 2015, com um intervalo máximo de três meses entre os dois exames. Selecionou-se um corte adquirido ao nível da cicatriz umbilical. A segmentação foi realizada com o algoritmo de crescimento de região do freeware utilizado. As reprodutibilidades intraobservador e interobservador foram avaliadas, assim como a acurácia da RM em relação à TC. Resultados: Trinta e um pacientes (14 homens e 17 mulheres; média de idade: 57 ± 15 anos) realizaram TC e RM (intervalo médio entre os exames: 28 ± 12 dias). A reprodutibilidade interobservador foi 82% para TC (viés = 1,52 cm2; p = 0,488), 86% para RM ponderada em T1 (viés = −4,36 cm2; p = 0,006) e 88% para RM ponderada em T2 (viés = −0,52 cm2; p = 0,735). A reprodutibilidade intraobservador foi 90% para TC (viés = 0,14 cm2; p = 0,912), 92% para RM ponderada em T1 (viés = −3,4 cm2; p = 0,035) e 90% para RM ponderada em T2 (viés = −0,30 cm2, p = 0,887). A reprodutibilidade entre a RM ponderada em T1 e a RM ponderada em T2 foi 87% (viés = −0,11 cm2; p = 0,957). Em comparação com a TC, a acurácia da RM ponderada em T1 e T2 foi 89% e 91%, respectivamente. Conclusão: O programa utilizado pode ser usado para quantificar o TAV na TC, na RM ponderada em T1 e na RM ponderada em T2. No geral, a acurácia da RM (em comparação com a TC) parece ser alta, assim como a reprodutibilidade intraobservador e interobservador. No entanto, a quantificação do TAV parece ser menos reprodutível nas sequências ponderadas em T1.

Effect of Abdominal Visceral Fat Change on the Regression of Erosive Esophagitis: A Prospective Cohort Study

BACKGROUND/AIMS: Although abdominal visceral fat has been associated with erosive esophagitis in cross-sectional studies, there are few data on the longitudinal effect. We evaluated the effects of abdominal visceral fat change on the regression of erosive esophagitis in a prospective cohort study. METHODS: A total of 163 participants with erosive esophagitis at baseline were followed up at 34 months and underwent esophagogastroduodenoscopy and computed tomography at both baseline and follow-up. The longitudinal effects of abdominal visceral fat on the regression of erosive esophagitis were evaluated using relative risk (RR) and 95% confidence intervals (CIs). RESULTS: Regression was observed in approximately 49% of participants (n=80). The 3rd (RR, 0.13; 95% CI, 0.02 to 0.71) and 4th quartiles (RR, 0.07; 95% CI, 0.01 to 0.38) of visceral fat at follow-up were associated with decreased regression of erosive esophagitis. The highest quartile of visceral fat change reduced the probability of the regression of erosive esophagitis compared to the lowest quartile (RR, 0.10; 95% CI, 0.03 to 0.28). Each trend showed a dose-dependent pattern (p for trend < 0.001). The presence of baseline Helicobacter pylori increased the regression of erosive esophagitis (RR, 2.40; 95% CI, 1.05 to 5.48). CONCLUSIONS: Higher visceral fat at follow-up and a greater increase in visceral fat reduced the regression of erosive esophagitis in a dose-dependent manner.

Inter-relação de obesidade visceral, glúteo-femoral e doença periodontal em mulheres / Interrelationship of visceral, gluteofemoral obesity and periodontal disease in women

Este trabalho teve como objetivo avaliar a gravidade da Doença Periodontal (DP) em mulheres obesas, vivendo em uma uma mesma comunidade, com semelhantes hábitos e condições de vida e com amplo acesso à assistência médico-odontológica, considerando a distribuição de gordura corporal. Foram avaliadas 39 mulheres, 15 com obesidade visceral (OBV), 10 com obesidade glúteo-femoral (OBF) e 14 com peso normal (CON). Todas foram submetidas à avaliação periodontal e classificadas de acordo com o Índice Periodontal Comunitário (IPC). Medidas antropométricas e bioimpedanciometria foram realizadas para discriminar a regionalização da gordura corporal. Uma coleta de amostra sanguínea foi feita para dosagem glicemia de jejum e insulinemia a fim de se obter o cálculo do HOMA-IR (Homeostatic Model Assessment for Insulin Resistance) e quantificação laboratorial da resistência à insulina. Os três grupos foram comparados em relação à gravidade da DP. Foram realizadas análises de correlação entre o IPC e os seguintes parâmetros: Índice de Massa Corporal (IMC), circunferência da cintura (C), relação enter a circunferência da cintura/ e a circunferência do quadril (C/Q), percentual de gordura visceral em relação ao peso corporal (%GV) e HOMA -IR. O escore média do IPC foi significativamente maior (p = 0,0045) no grupo OBV do que no grupo CON. Não houve diferença no grupo OBF quando comparado ao grupo OBV e ao grupo CON. Houve correlação positivamente significativa entre o escore IPC (p = 0,0173), C/Q (p = 0,0004) e CC (p = 0,0082). Com esses resultados foi possível concluir que o presente estudo está de acordo com dados prévios da literatura que associam Obesidade à DP. Entretanto, o estudo fornece dados importantes, ainda não relatados, que sugerem que tal associação pode não ocorrer em todos os obesos, mas principalmente naqueles com acúmulo de gordura intra-abdominal(AU)

This study aim to evaluate the severity of Periodontal Disease (PD) in obese women from the same community, sharing the same life habits and life conditions and with broad access to dental-medical assistance, considering the distribution of body fat. 39 women were evaluated, 15 with visceral obesity (VOB), 10 with gluteofemoral obesity (FOB) and 14 with normal weight (CON). All were submitted to periodontal evaluation and scored according to the Community Periodontal Index (CPI). Anthropometric measurements and bioimpedanciometry were performed in order to discriminate the regionalization of body fat. A collect of blood sample was made for fasting dosage of glycemia and insulinemia for calculation of HOMA-IR determination and laboratory quantification of insulin resistance. The three groups were compared in relation to the severity of PD. Correlation analyzes were performed between CPI and the following parameters: Body Mass Index (BMI), waist circumference (WC), waist/hip circumference ratio (W/H), percentage of visceral fat in relation to body weight (%GV) and HOMA-IR. The mean CPI score was significantly higher (p = 0.0045) in the VOB group than in the CON group. There was no difference in the FOB group when compared to the VOB group and the CON group. There was a significant positive correlation between the CPI score (p = 0.0173), W/H (p = 0.0004), and WC (p = 0.0082). It was possible to conclude that the present study agrees with previous literature data associating Obesity with PD, however, the study provides an important data suggesting that such association may not occur in all obese individuals, but especially in those with accumulation of intra-abdominal fat(AU)

Effect of combination therapy with sitagliptin on abdominal visceral fat area in patients with type 2 diabetes mellitus / 中华全科医师杂志

The clinical data of 96 patients with type 2 diabetes mellitus (T2DM) treated in Department of endocrinology of our hospital from January 2016 to December 2017 were retrospectively analyzed. All patients had been treated with metformin ≥1 000 mg combined with sulfonylureas for>12 weeks and their glycosylated hemoglobin (HbA1c) was>7.5%. On the basis of the original scheme, 57 patients received oral sitagliptin (100 mg q.d, sitagliptin group) and 39 patients received insulin glargine injection (insulin group) for 26 weeks. The blood lipid, liver and kidney function were examined before and after treatment. The abdominal visceral fat area (VFA) was measured by CT scan. Results showed that the fasting plasma glucose (FPG) , 2-hour postprandial blood glucose (2 hPG) and HbA1c were significantly lower than baseline levels in both groups(P<0.05). The decrease of VFA in sitagliptin and insulin groups was by 9.6 (1.4,19.6)cm2 and by 8.3(-2.2,26.8) cm2, respectively; there was significant difference in variation of VFA before and after treatment between the two groups (P<0.05). There was no significant difference in blood pressure, liver function (ALT, AST) and estimated glomerular filtration rate (eGFR) before and after treatment in the sitagliptin group (P>0.05). Additional sitagliptin administration can effectively and safely reduce HbA1c and decrease the abdominal visceral fat content in T2DM patients who failed to metformin and sulfonylureas combined therapy.

Risk factors of nonalcoholic fatty liver disease with a normal visceral adipose tissue area / 临床肝胆病杂志

ObjectiveTo investigate the risk factors and insulin resistance (IR) of nonalcoholic fatty liver disease (NAFLD) with a normal visceral adipose tissue (VAT) area. MethodsA total of 45 NAFLD persons with a normal VAT area who were admitted to Quanzhou First Hospital Affiliated to Fujian Medical University from June 2017 to May 2018 were enrolled as observation group, and 27 non-NAFLD patients with a normal VAT area were enrolled as control group. VAT area, waist circumference, fasting blood glucose (FBG), and fasting insulin (FINS) were measured for both groups, homeostasis model assessment of insulin resistance (HOMA-IR) was calculated, and the correlation of IR with the indices including waist circumference was analyzed. The independent samples t-test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups; the chi-square test was used for comparison of categorical data between groups. Pearson correlation analysis and Spearman correlation analysis were used to investigate the correlation of normally and non-normally distributed continuous data. A forward logistic regression analysis was used to identify related risk factors. ResultsThe NAFLD group had a significantly higher level of IR than the control group, and there was a significant difference in HOMA-IR between the two groups (2.66(1.59-4.06) vs 1.84(125-2.47), Z=364.000, P=0005). IR was positively correlated with FBG (r=0.412, P=0.005), FINS (r=0.789, P＜0001), and TG (r=0.306, P=0041). IR was negatively correlated with HDL(r=-9398,P=0007). The multivariate regression analysis showed that waist circumference was an independent risk factor for NAFLD with a normal VAT area (regression coefficient = 0.181, odds ratio = 1.198, 95% confidence interval: 1.099-1.306, P＜0.001). ConclusionThere is a certain degree of IR in NAFLD patients with a normal VAT, and waist circumference is an independent risk for NAFLD with a normal VAT.

Perirenal and epicardial fat and their association with carotid intima-media thickness in children

Recent data suggest that subclinical atherosclerosis is more related to visceral adipose tissue distribution than to overall fat mass. Both perirenal fat and epicardial fat are visceral fat depots surrounding the kidneys and the myocardium, respectively, which can be easily assessed by ultrasound. Their clinical relevance in children is largely unknown. This review describes studies relating perirenal and epicardial fat to cardiovascular disease or carotid intima-media thickness (cIMT), a well-established surrogate for subclinical atherosclerosis, and discusses this in context with our own data from children. In adults, both perirenal and epicardial fat are useful biological markers of visceral obesity. The former has been related to hypertension in overweight subjects and with atherosclerosis in patients with human immunodeficiency virus. The latter was associated with several metabolic syndrome components and with calcification of the carotid artery. In healthy prepubertal children, both epicardial and perirenal fat thickness, rather than total body fat mass, were related to cIMT. Ultrasonography measures of perirenal and epicardial fat are related to atherosclerosis in adults and may be convenient tools for the assessment of cardiometabolic risk in children.

Association of visceral adiposity and insulin resistance with colorectal adenoma and colorectal cancer

BACKGROUND/AIMS: To examine whether visceral adiposity serves as a risk factor for colorectal cancer (CRC) and colorectal adenomas. METHODS: Two hundred healthy subjects, 200 patients with colorectal adenoma, and 151 patients with CRC (46 with early-stage and 105 with advanced-stage cancers) were enrolled at a tertiary referral hospital. All subjects underwent colonoscopy, and had laboratory data, and computed tomography (CT) scan available for abdominal fat measurement. An abdominal CT scan taken 1 to 4 years (mean interval, 20.6 months) before the diagnosis of CRC was also available in the 42 CRC patients. RESULTS: The mean areas of visceral adipose tissue (VAT) areas in the control, adenoma, early- and advanced-stage CRC groups were 94.6, 116.8, 110.4, and 99.7 cm², respectively (P0.05). The risk of both adenoma and CRC positively correlated with fasting plasma glucose levels (P for trend <0.05). In patients with early-stage cancer (n=17), VAT area decreased when the CT scan at diagnosis was compared with that taken before the diagnosis of CRC, but superficial adipose tissue area did not, so visceral-to-total fat ratio significantly decreased (46.6% vs. 50.7%, respectively, P=0.018) CONCLUSIONS: VAT area is related to the risk of colorectal adenoma. However, VAT decreases from the early stages of CRC. Impaired fasting glucose has a role in colorectal carcinogenesis.

Ultrasound as a method to evaluate the distribution of abdominal fat in obese prepubertal children and the relationship between abdominal fat and metabolic alterations / A ultrassonografia como método de avaliação da distribuição da gordura abdominal em crianças pré-púberes obesas e sua relação com alterações metabólicas

Abstract Objective: To evaluate, using ultrasound, the distribution of abdominal fat in obese prepubertal children, as well as its possible correlation with metabolic changes due to obesity. Materials and Methods: This was a cross-sectional study of prepubescent children: 77 obese children (33 girls and 44 boys), with a mean age of 7.31 years; and 31 normal-weight children (17 girls and 14 boys), with a mean age of 7.32 years. In all of the children, abdominal wall thickness (AWT) and abdominal fat thickness (AFT) were measured by ultrasound. For the evaluation of the associated metabolic alterations, serum levels of glycemia, HDL cholesterol, triglycerides, and insulin were determined. Results: The obese children presented with greater abdominal fat, predominantly greater AWT, without a significant gender-related difference in AWT or AFT. The homeostasis model assessment of insulin resistance (HOMA-IR) showed a significant direct correlation with AWT and AFT. Conclusion: In obese prepubertal children, the AWT, as measured by ultrasound, was shown to be more closely related to the HOMA-IR than to the lipid metabolism or glycemia.

Resumo Objetivo: Avaliar, em crianças pré-púberes obesas, a distribuição da gordura no abdome por meio da ultrassonografia e sua possível correlação com as alterações metabólicas decorrentes da obesidade. Materiais e Métodos: Estudo transversal em crianças pré-púberes, sendo 77 obesas (33 meninas e 44 meninos) com média de idade de 7,31 anos e 31 eutróficas (17 meninas e 14 meninos) com média de idade de 7,32 anos. Em todas as crianças foram medidas a espessura da parede abdominal (EPA) e a espessura da gordura intra-abdominal (EIA), pela ultrassonografia. Para a avaliação das alterações metabólicas associadas, foi realizada dosagem sérica de glicemia, HDL-colesterol, triglicerídeos e insulina. Resultados: Observou-se que as crianças obesas apresentaram aumento da gordura abdominal, com predomínio da EPA e sem diferença significativa da EIA e a EPA em relação ao gênero. Foi encontrada associação direta estatisticamente significante entre o índice homeostatic model assessment for insulin resistance (HOMA-IR) e EPA e EIA. Conclusão: A EPA em pré-púberes obesos, medida pela ultrassonografia, demonstrou ter maior relação com o HOMA-IR, determinante de resistência insulínica, em relação ao metabolismo lipídico e à glicemia.

Portadores de doença de Crohn apresentam maior acúmulo de gordura visceral: análise comparativa com controles saudáveis / Visceral fat is increased in individuals with crohn's disease: a comparative analysis with healthy controls

ABSTRACT BACKGROUND: It is known that obesity is associated with a chronic inflammatory state, but few studies have evaluated visceral fat (VF) content and its role in individuals with Crohn's disease (CD). OBJETIVE: To compare the nutritional status, body composition and proportion of VF between CD individuals and healthy volunteers. METHODS: Cross-sectional study that enrolled individuals with Crohn's disease and healthy controls. The stratification according to nutritional status was carried out by means of BMI. The percentage of body fat percentage (%BF) and VF were estimated by means of DEXA. VF proportion was evaluated by means of the VF/BMI and VF/%BF ratios. RESULTS: A total of 78 individuals were included. The control group was comprised of 28 healthy subjects aged 35.39±10 years old (60.7% women); mean BMI=23.94±3.34 kg/m2; mean VF=511.82±448.68 g; mean CRP=0.81±1.78 ng/mL. The CD group was comprised of 50 patients; 11 (22%) were underweight (BMI=18.20±1.97 kg/ m2; %BF=24.46±10.01; VF=217.18±218.95 g; CRP=4.12±4.84 ng/mL); 18 (36%) presented normal weight (BMI=22.43±1.48 kg/m2; %BF=30.92±6.63; VF=542.00±425.47 g and CRP=4.40±1.78 ng/mL); 21 (42%) were overweight or obese (BMI=29.48±3.78 kg/m2; %BF=39.91±7.33; VF=1525.23±672.7 g and CRP=1.33±2.06 ng/mL). The VF/BMI ratio was higher in the CD group when compared to controls (32.41±24.63 vs 20.01±16.23 g per BMI point; P=0.02). Likewise, the VF/%BF was also higher in the CD group (35.21±23.33 vs 15.60±12.55 g per percentage point; P<0.001). CONCLUSION: Among individuals with Crohn's disease, BMI presents a direct correlation with visceral fat content. These results indicate the presence of an adiposopathy in Crohn's disease subjects, which is evidenced by a higher visceral fat.

RESUMO CONTEXTO: Sabe-se que a obesidade associa-se a um estado de inflamação crônica, mas faltam estudos que avaliem o conteúdo de gordura visceral em indivíduos com doença de Crohn. OBJETIVO: Comparar o estado nutricional, a composição corporal e a proporção de gordura visceral entre indivíduos com doença de Crohn (DC) e controles saudáveis (CS). MÉTODOS: Estudo transversal com doença de Crohn e controles saudáveis. O estado nutricional foi estratificado de acordo com o índice de massa corpórea (IMC). O percentual de gordura corporal (%GC) e a mensuração da gordura visceral foram avaliados por DEXA. A proporção de gordura visceral (GV) foi avaliada pelas relações entre GV/IMC e GV/%GC. RESULTADOS: Foram incluídos 78 indivíduos no estudo. O grupo CS foi constituído por 28 indivíduos saudáveis, com idade média de 35,39±10 anos; 60,7% mulheres; IMC=23,94±3,34 kg/m2; %GC=32,7±7,89; GV=511,82±448,68 g e PCR=0,81±1,78 ng/mL. O grupo DC foi composto por 50 indivíduos, destes, 11 (22%) desnutridos (IMC=18,20±1,97 kg/m2; %GC 24,46±10,01; GV=217,18±218,95 g; PCR=4,12±4,84 ng/mL); 18 (36%) eutróficos (IMC=22,43±1,48 kg/m2; %GC=30,92±6,63; GV=542,00±425,47 g e PCR=4,40±1,78 ng/mL); 21 (42%); sobrepeso/obesidade (IMC=29,48±3,78 kg/m2; %GC=39,91±7,33; GV=1525,23±672,76 g e PCR=1,33±2,06 ng/mL). A relação GV/IMC foi maior no grupo DC quando comparado aos do grupo CS (32,41±24,63 vs 20,01±16,23 gramas por ponto do IMC; P=0,02), assim como a relação GV/%GC que também foi maior no grupo DC (23,33±33,33 vs 12,55±2,37 gramas por ponto percentual; P<0,001). CONCLUSÃO: Entre os indivíduos com doença de Crohn, o IMC apresentou correlação direta com o conteúdo de gordura visceral. Esses resultados sinalizam a ocorrência de adiposopatia nos pacientes com doença de Crohn, com maior volume de tecido adiposo visceral.

The relationship between subclinical hypothyroidism and visceral adipose tissue / 天津医药

@#Objective To investigate the relationship between subclinical hypothyroidism (SCH) and visceral adipose tissue. Methods A total of 68 SCH subjects from medical examination center and inpatient department of our hospital and 100 healthy controls matched for age and sex were enrolled in this study. The patient gender, blood pressure (SBP/DBP), anthropometric measurements, lipid profile, lipid accumulation product (LAP) and visceral adipose area (VA) were compared between two groups. The Sperman’s correlation was used to analyze the correlation between thyroid stimulating hormone (TSH) and variables, and the Binary logistic regression analysis was used to analyze the impact of variables on SCH. Results The waist circumference (WC), waist to hip ratio (WHR), non high density lipoprotein cholesterol (nonHDL-C), three acylglycerol (TG), TSH, LAP and VA were higher in SCH subjects than that in the healthy controls (P＜0.05), while HDL-C was lower in SCH subjects (P＜0.05). There were no significant differences in sex, age, body mass index (BMI), SBP, DBP, total cholesterol (TC) and low density lipoprotein cholesterol (LDL-C) between two groups (P<0.05). Correlation analysis showed that TSH was positively correlated with WC, TG, nonHDL-C, LAP and VA, and negatively correlated with HDL-C (P＜0.05). There was no significant correlation between TSH and age, BMI, WHR, TC and LDL-C (P> 0.05). Binary logistic regression analysis showed that female and low level of HDL-C were risk factors of SCH, while the effects of VA and LAP on SCH were not statistically significant. Conclusion Our findings show that the dyslipidemia and VA increase are more serious in subjects with SCH than those with normal thyroid function and healthy controls, which suggest that SCH is closely related to abdominal obesity.

Progress in research on the correlation of visceral adipose tissue and subcutaneous adipose tissue with cardiovascular disease / 中华健康管理学杂志

Mortality due to cardiovascular disease is increasing in developing countries and arteriosclerotic cardiovascular disease is the leading cause of death in developed countries. The main pathological change in cardiovascular disease is atherosclerosis, which is closely associated with obesity. This study reviewed progress in research on the correlation of visceral adipose tissue and subcutaneous adipose tissue with cardiovascular disease.