Renal cell carcinoma and visceral adipose index: a new risk parameter

ABSTRACT Purpose: The aim of this study was to evaluate the relationship between tumor size and grade with visceral adipose index (VAI) levels in patients with renal cell carcinoma. Materials and methods: We retrospectively reviewed the records of 310 consecutive patients with RCC who underwent radical nephrectomy at our institution between January 2007 and May 2014. VAI was calculates for males and females seperately as this formula like previous study. The relationship between tumor size and nuclear grade with VAI levels were evaluated statisticaly. Analyses were completed using Chi-square tests and Logistic regression analysis. Results: Among the 310 total patients analyzed in our study, there were 176 males (56.8%) and 134 females (43.2%). VAI levels were statistically higher in men and women with high tumor size (p<0.001). VAI levels were statistically higher in men and women with high fuhrman grade (p<0.001). Conclusions: The components of VAI may have effect on tumor carcinogenesis in similar pathways. In our study patients with high VAI levels were found to have statistically significant higher nuclear grade and tumor size. VAI can be a useful index for the evaluation and calculation of renal cell cancer aggressiviness. Further studies with more patients are needed to confirm our study.

Serum Chemerin Levels Are Associated with Abdominal Visceral Fat in Type 2 Diabetes

Chemerin is a recently identified adipokine suggested to play a role in obesity and its metabolic complications. The relationship between visceral obesity and serum chemerin levels in type 2 diabetes (T2DM) is unknown and may differ from that of subjects without diabetes. Therefore, we evaluated whether serum chemerin was associated with visceral abdominal obesity in patients with T2DM. A total of 218 Korean patients with T2DM were enrolled and metabolic parameters, abdominal visceral and subcutaneous fat areas, and serum chemerin levels were measured. Serum chemerin level showed positive correlation with fasting insulin, HOMA-IR, serum triglyceride, serum creatinine, urine albumin/creatinine ratio, high-sensitivity C-reactive protein (hsCRP), fibrinogen, abdominal visceral fat area, visceral to subcutaneous fat area ratio, and negatively correlation with high density lipoprotein cholesterol and creatinine clearance (CCr) after adjusting for age, gender and body mass index. Multiple linear stepwise regression analysis showed that abdominal visceral fat area (β = 0.001, P < 0.001), serum triglyceride (β = 0.001, P < 0.001), CCr (β = -0.003, P = 0.001), hsCRP (β = 0.157, P = 0.001), fibrinogen (β = 0.001, P < 0.001) and BMI (β = 0.02, P = 0.008) independently affected log transformed serum chemerin levels. Higher serum chemerin level was associated with higher level of abdominal visceral fat area, serum triglyceride, hsCRP and fibrinogen and lower level of CCr in patients with T2DM. Serum chemerin may be used as a biomarker of visceral adiposity and chemerin may play a role in inflammation, decreased renal function, and increased cardiovascular risk in T2DM.

Esteatosis hepática, grasa visceral y alteraciones metabólicas, en individuos con sobrepeso/obesidad aparentemente sanos / Hepatic steatosis, visceral fat and metabolic alterations in apparently healthy overweight/obese individuals

La observación clínica indica que muchos obesos no presentan alteraciones metabólicas importantes, por lo que el objetivo del presente estudio fue comprobar si el sobrepeso/obesidad (SP/OB) simple, no asociado a otros factores de riesgo, se acompañaba de alteraciones metabólicas; o si estaba presente el fenómeno conocido como “paradoja de la obesidad”. A 30 individuos aparentemente sanos de Maracaibo, Venezuela, entre 20 y 59 años de edad, e índice de masa corporal (IMC) superior a 25 kg/m², y a un grupo control de 11 individuos con IMC inferior a 25 kg/m², se les realizó una historia clínica, medida de parámetros antropométricos, determinaciones basales de glicemia, insulina y lípidos, medición ultrasonográfica para esteatosis hepática y ultrasonografía e impedancia bioeléctrica para estimar la grasa visceral. El estudio demostró que solo en un tercio de los individuos con SP/OB, con elevado IMC y circunferencia de cintura (CC), se encontraron concentraciones elevadas de insulina, HOMA-IR y triglicéridos. A pesar de ello, la presencia de esteatosis hepática fue muy elevada (91%) en el grupo SP/OB, si se compara con 9% en el grupo control. La grasa visceral, en el grupo control, estuvo asociada a la CC y a la glicemia; sin embargo, no se relacionó con el IMC, insulina, HOMA-IR o HDLc; mientras que en el grupo SP/OB, aunque estadísticamente elevada en relación al grupo control, reveló una pérdida de estas asociaciones. Los resultados resaltan la importancia de investigar más la presencia de esteatosis hepática en los individuos con SP/OB, que la estimación de la grasa visceral, para identificar sujetos con alto riesgo cardiometabólico.

Clinical observation indicates that many obese individuals do not display important metabolic alterations. Consequently, the objective of this study was to establish whether simple obesity, non concurrent with other important risk factors, was associated with metabolic alterations; or if the phenomenon known as “obesity paradox” was present. A clinical history, measurements of anthropometric and metabolic parameters and estimation of hepatic steatosis and visceral fat, were determined in 30, apparently healthy, individuals from Maracaibo, Venezuela, between 20 and 59 years of age and a body mass index (BMI) above 25 kg/m²,and compared to a lean control group of 11 individuals with BMI less than 25 kg/m². The study demonstrated that only one third of overweight/obese individuals (OW/OB), with high body mass index (BMI) and waist circumference (WC), presented elevated values of insulin, HOMA-IR and triglycerides. Nevertheless, the presence of hepatic steatosis was elevated in the OW/OB group (91%) vs. 9% in the control group. The visceral fat in the lean control group was associated with both, WC and glycemia; however, it was not related to the BMI or insulin, HOMA-IR and HDLc. The visceral fat in the OW/OB group, although elevated in relation to the lean group, revealed a loss of these associations. In the OW/OB it was the BMI that was associated with insulin and HOMA-IR. The results emphasize the importance of investigating for the presence of hepatic steatosis, rather than visceral fat, in individuals with OW/OB, to identify subjects with high cardiometabolic risk.

Medición volumétrica de grasa visceral abdominal con resonancia magnética y su relación con antropometría, en una población diabética / Quantification of visceral adipose tissue using magnetic resonance imaging compared with anthropometry, in type 2 diabetic patients

Background: Visceral fat accumulation is associated with the development of metabolic diseases. Anthropometry is one of the methods used to quantify it. aim: to evaluate the relationship between visceral adipose tissue volume (VAT), measured with magnetic resonance imaging (MRI), and anthropometric indexes, such as body mass index (BMI) and waist circumference (WC), in type 2 diabetic patients (DM2). Patients and Methods: Twenty four type 2 diabetic patients aged 55 to 78 years (15 females) and weighting 61.5 to 97 kg, were included. The patients underwent MRI examination on a Philips Intera® 1.5T MR scanner. The MRI protocol included a spectral excitation sequence centered at the fat peak. The field of view included from L4-L5 to the diaphragmatic border. VAT was measured using the software Image J®. Weight, height, BMI, WC and body fat percentage (BF%), derived from the measurement offour skinfolds with the equation of Durnin and Womersley, were also measured. The association between MRIVAT measurement and anthropometry was evaluated using the Pearson's correlation coefficient. Results: Mean VAT was 2478 ± 758 ml, mean BMI29.5 ± 4.7 kg/m², and mean WC was 100 ± 9.7 cm. There was a poor correlation between VAT, BMI (r = 0.18) and WC (r = 0.56). Conclusions: BMI and WC are inaccurate predictors of VAT volume in type 2 diabetic patients.

Cut-Off Values of Visceral Fat Area and Waist-to-Height Ratio: Diagnostic Criteria for Obesity-Related Disorders in Korean Children and Adolescents

PURPOSE: The aim of this study was to study the appropriate cut-off value of visceral fat area (VFA) and waist-to-height ratio (WTHR) which increase the risk of obesity-related disorders and to validate the diagnostic criteria of abdominal obesity and metabolic syndrome in Korean children and adolescents. MATERIALS AND METHODS: A total 314 subjects (131 boys and 183 girls) were included in this study. The subjects were selected from Korean children and adolescents who visited three University hospitals in Seoul and Uijeongbu from January 1999 to December 2009. All patients underwent computed tomography to measure VFA. RESULTS: The cut-off value of VFA associated with an increase risk of obesity-related disorder, according to the receiver operating characteristics curve, was 68.57 cm2 (sensitivity 59.8%, specificity 76.6%, p=0.01) for age between 10 to 15 years, and 71.10 cm2 (sensitivity 72.3%, specificity 76.5%, p<0.001) for age between 16 to 18 years. By simple regression analysis, the WTHR corresponding to a VFA of 68.57 cm2 was 0.54 for boys and 0.61 for girls, and the WTHR corresponding to a VFA of 71.10 cm2 was 0.51 for boys and 0.56 for girls (p=0.004 for boys, p<0.001 for girls). CONCLUSION: Based on the results of this study, VFA which increases the risk of obesity-related disorders was 68.57 cm2 and the WTHR corresponding to this VFA was 0.54 for boys and 0.61 for girls age between 10-15 years, 71.70 cm2 and the WTHR 0.51 for boys and 0.56 for girls age between 16-18 years. For appropriate diagnostic criteria of abdominal obesity and obesity-related disorders in Korean children and adolescents, further studies are required.

Avaliação por imagem da área de gordura visceral e suas correlações com alterações metabólicas / Imaging assessment of visceral adipose tissue area and its correlations with metabolic alterations / Evaluación por imagen del área de grasa visceral y sus correlaciones con alteraciones metabólicas

FUNDAMENTO: A obesidade androgênica está associada a um risco maior de distúrbios metabólicos, favorecendo assim a ocorrência de doenças cardiovasculares e outras morbidades. OBJETIVO: Verificar a influência da área de tecido adiposo visceral (ATAV), medida pela tomografia computadorizada, sobre alterações metabólicas em adultos e idosos. MÉTODOS: Tomografias computadorizadas e valores de lipoproteínas: o colesterol total e frações, os triglicérides, a glicemia e o ácido úrico foram obtidos de 194 indivíduos estratificados por sexo, grupo etário e massa corporal, e analisados utilizando os testes de correlação e de média. RESULTADOS: Os idosos apresentaram maiores valores da ATAV, glicemia, ácido úrico e colesterol total. As maiores correlações foram encontradas entre a ATAV, os triglicérides e o VLDL-c (r > 0,5; p < 0,01), em ambos os grupos etários. A média da área de tecido adiposo visceral mostrou-se sempre mais elevada quando os valores de triglicérides e de glicemia estavam alterados, em ambos os grupos etários. CONCLUSÃO: A maioria dos exames apresentou forte correlação com a ATAV considerada de risco para alterações metabólicas. Em idosos, a área de tecido adiposo visceral de risco parece ser superior a de adultos.

BACKGROUND: Androgenic obesity is associated with a higher risk of metabolic disorders, thus favoring the occurrence of cardiovascular diseases and other morbidities. OBJECTIVE: To verify the influence of the visceral adipose tissue (VAT) area, measured by computed tomography (CT), on the metabolic alterations in adult and elderly individuals. METHODS: CT results and lipoprotein levels, total cholesterol and fractions, triglycerides, glycemia and uric acid levels, were obtained from 194 individuals stratified by sex, age group and body mass and analyzed using the tests of correlation and means. RESULTS: The elderly individuals presented higher VAT area, glycemia, uric acid and total cholesterol levels. The most important correlations were observed between VAT area, triglycerides (TG) and VLDL-c (r > 0.5; p < 0.01), in both age groups. The mean VAT area was always higher when TG and glycemia levels were altered, in both age groups. CONCLUSION: Most tests showed a strong correlation with VAT area, which was considered as risk for metabolic alterations. In elderly individuals, the risk VAT area seems to be higher than that of adult individuals.

FUNDAMENTO: La obesidad androgénica está asociada a un riesgo mayor de disturbios metabólicos, favoreciendo así la ocurrencia de enfermedades cardiovasculares y otras morbilidades. OBJETIVOS: Verificar la influencia del área de tejido adiposo visceral (ATAV), medida por la tomografía computarizada, sobre alteraciones metabólicas en adultos y adultos mayores. MÉTODOS: Tomografías computarizadas y valores de lipoproteínas: el colesterol total y fracciones, los triglicéridos, la glucemia y el ácido úrico se obtuvieron de 194 individuos estratificados por sexo, grupo de edad y masa corporal, y se analizaron utilizando las pruebas de correlación y de promedio. RESULTADOS: Los adultos mayores presentaron mayores valores de la ATAV, glucemia, ácido úrico y colesterol total. Las mayores correlaciones se encontraron entre la ATAV, los triglicéridos y el VLDL-c (r > 0,5; p < 0,01), en ambos grupos de edad. La media del área de tejido adiposo visceral se evidenció siempre más elevada cuando los valores de triglicéridos y de glucemia estaban alterados, en ambos grupos de edad. CONCLUSIÓN: La mayoría de los exámenes presentó fuerte correlación con la ATAV considerada de riesgo para alteraciones metabólicas. En adultos mayores, el área de tejido adiposo visceral de riesgo parece ser superior a la de adultos.

Metabólitos séricos da vitamina D não se correlacionam com pressão arterial em adolescentes / There are no association between vitamin D metabolites and blood pressure in adolescents

OBJETIVO: O objetivo deste estudo foi avaliar a associação entre o estado nutricional da vitamina D, a adiposidade e a pressão arterial (PA) em adolescentes. MÉTODOS: Foi realizada avaliação antropométrica, da composição corporal, da ingestão alimentar, de medidas bioquímicas e aferição da PA de 205 adolescentes, com média de idade de 18,2 anos. RESULTADOS: Destes, 12,19% apresentaram PA elevada. O nível sérico médio da 25OHD foi 29,2(0,8) ng/mL, e 62% dos adolescentes apresentaram insuficiência de vitamina D. Não foi encontrada correlação significativa entre a PAS e a PAD com a 25OHD e a 1,25(OH)2D. Houve correlação negativa entre a PAD com os níveis séricos de adiponectina, e tanto a PAS quanto a PAD apresentaram correlação positiva com a circunferência da cintura em ambos os sexos. CONCLUSÃO: Não houve relação entre os níveis séricos de vitamina D e a PA. Porém, a gordura visceral apresenta risco potencial para elevação da PA em adolescentes.

OBJETIVES: The purpose of this study was to evaluate the relationships between serum levels of vitamin D and blood pressure (BP) in adolescents. METHODS: The anthropometric measurements, body composition, dietary intake, blood pressure and biochemical measurements was undertaken. RESULTS: Two hundred and five adolescents, 106 boys and 99 girls, mean aged 18.2 years old, participate of the study. Elevated BP was observed in 12.19% of the adolescents. Mean 25OHD concentration was 29.2(0.8) ng/mL. Vitamin D insufficiency was observed in 62% of adolescents. There were no correlation between systolic and diastolic BP with 25OHD and 1,25(OH)2D concentration. An inverse correlation between adiponectin and diastolic BP was observed and positive significant correlation was observed between waist circumference with systolic and diastolic BP in both boys and in girls. In conclusion, no relationships between vitamin D levels and blood pressure were observed. CONCLUSION: However, the intra-abdominal adiposity offers potential risk to BP elevation in adolescents.

Ultrassonografia e ressonância magnética: estudo comparativo no diagnóstico da esteatose em obesos grau III / Abdominal ultrasound and magnetic resonance imaging: a comparative study on the non-alcoholic fatty liver disease diagnosis in morbidly obese patients

OBJETIVOS: Avaliar a concordância entre a ressonância magnética (RM) e a ultrassonografia abdominal (USG) no diagnóstico da doença hepática gordurosa não-alcoólica (DHGNA), bem como a concordância entre cada método com o exame padrão-ouro histopatológico. MÉTODOS: A população estudada foi constituída por 145 pacientes com obesidade grau III (IMC > 40 Kg/m²), de ambos os sexos. O diagnóstico da DHGNA foi realizado por ultrassonografia e ressonância magnética. Em uma subamostra foi realizado o diagnóstico por biópsia hepática (n=40). Para avaliar a concordância entre os diagnósticos por USG e RM, utilizou-se o coeficiente Kappa. RESULTADOS: Observou-se uma concordância fraca entre os dois métodos (Kappa ajustado= 0,27; IC 95 por cento= 0,07-0,39). Foi encontrada uma concordância moderada entre o diagnóstico da doença por USG e biópsia hepática, com 83,3 por cento de resultados concordantes e Kappa ajustado de 0,67. Já a concordância entre o diagnóstico por RM e histopatológico foi ausente, com 53,6 por cento de resultados concordantes e Kappa ajustado de 0,07. CONCLUSÃO: A boa concordância encontrada entre o diagnóstico realizado pela USG e a biópsia hepática reforça a necessidade de condução de mais estudos como os que vêm recomendando uma padronização da avaliação diagnóstica por USG como forma de minimizar a necessidade da realização da biópsia hepática para diagnóstico de formas mais graves da doença.

OBJECTIVES: To evaluate the concordance between abdominal ultrasound and an MRI (Magnetic Resonance Imaging) in the diagnosis of non-alcoholic fatty liver disease (NAFLD), and concordance of these two methods with the histopathological exam. METHODS: The population studied was comprised of 145 patients with morbid obesity (BMI > 40 Kg/m²), of both genders. NAFLD diagnosis was performed by MRI and Ultrasound. Liver biopsy was performed in a sub-sample (n=40). To evaluate the concordance of these two methods, the kappa coefficient was used. RESULTS: Concordance between both methods (MRI and Ultrasound) was poor and not significant (Kappa adjusted= 0.27; CI 95 percent= 0.07-0.39.) Nevertheless a slight concordance was found between diagnosis of NAFLD by ultrasound and the hepatic biopsy, with 83.,3 percent of concordant results and Kappa adjusted= 0.67.Results of an MRI and the histopathological exam were compared and results showed 53.6 percent of concordant results and kappa adjusted= 0.07. CONCLUSION: The concordance found in the diagnosis performed using the ultrasound method and the hepatic biopsy, shows a need to implement and perform more research on the use of ultrasound to validate and reconsider these methods. This would minimize the need to perform biopsies to detect and diagnose such disease.

Body fat distribution in childhood obesity: association with metabolic risk factors.

OBJECTIVES: To evaluate the clinical significance of body fat distribution in childhood obesity, we investigated the associations of subcutaneous and intraabdominal (preperitoneal and visceral) fat, estimated by ultrasonography, with metabolic risk factors. SUBJECTS: Fifty-one obese (age 11.5+/- 2.6 years) and 33 non-obese (age 12.2+/- 2.7 years) children. STUDY DESIGN: Case control study. METHODS: Ultrasonographic measurements of fat thickness [maximum and minimum preperitoneal fat thicknesses (Pmax, Pmin), maximum and minimum subcutaneous fat thicknesses (Smax, Smin), visceral fat thickness (V), triceps (Tr) and subscapular (Ss) skin fold thicknesses] were documented. Blood pressures, lipid profiles, fasting insulin levels, glucose/insulin ratio and HOMA IR (homeostasis model assessment for insulin resistance) were evaluated in both groups and these parameters were correlated with body fat distribution. RESULTS: In the obese group, fasting insulin level was correlated to Smin, Smax, and Pmin. HOMA, accordingly, was also correlated to Smin, Smax, and Pmin. Fasting insulin level and HOMA showed no correlation with either Pmax or visceral fat thickness. ANALYSIS: Abdominal subcutaneous fat thickness measurements were the best predictors of hyperinsulinemia (R2: 0.32). CONCLUSION: We did not observe a significant correlation between blood pressure, lipid parameters and body fat distribution in obese group. Abdominal subcutaneous fat thickness might be a better predictor of the risk for hyperinsulinemia in childhood obesity.

Visceral Fat Thickness Predicts Fatty Liver in Koreans with Type 2 Diabetes Mellitus

Our aim was to study whether visceral adiposity is a predictor of diabetic fatty liver in Korean type 2 diabetes mellitus. In this study, abdominal ultrasonography was used to assess the presence of fatty liver in 1,898 patients with type 2 diabetes. We measured visceral fat thickness by high-resolutional ultrasonography and insulin resistance by Kitt. Half of the cohort had a fatty liver (50.2%). High visceral fat thickness had the highest odds ratio for developing fatty liver in both sexes (odds ratio [S.D]: 3.14 [2.24-4.69], p<0.00 in male, 2.84 [2.04-3.93], p<0.00 in female). In addition, visceral fat thickness of 42.45 and 37.7 mm in men and women, respectively, were chosen as the discriminating value to predict the presence of fatty liver with a sensitivity of 71% and 73% and a specificity of 70% and 70% in men and women, respectively. The area under the receiver-operating characteristics curve was 0.759 in men and 0.764 in women. Therefore we could conclude that the degree of visceral adiposity predicts the presence of fatty liver type 2 diabetes mellitus, whether centrally obese or not, suggesting that hepatic fat accumulation in a diabetic fatty liver may be influenced by visceral fat accumulation regardless of waist circumference.

Validity and reliability of the sagittal abdominal diameter as a predictor of visceral abdominal fat

OBJECTIVES: To evaluate the reliability of the sagittal abdominal diameter and its validity as a predictor of visceral abdominal fat, as well as to identify the most appropriate cut-off points to identify the area of visceral fat that is known to represent a risk factor for cardiovascular disease. DESIGN: Validation study. SUBJECTS: 92 healthy volunteers (57 women, 35 men), age: 20-83 y, body mass index: 19.3 to 35.9 kg/m². MEASUREMENTS: Sagittal abdominal diameter (SAD), weight, height, circumferences (waist, hip, and thigh), sub-scapular skinfold thickness, abdominal diameter index, and waist-hip ratio (WHR). METHOD OF CHOICE: Computed tomography (CT). STATISTIC: Receiver operating characteristic (ROC) curve. RESULTS: The reliability for SAD measurement was very high (Inter-class coefficient = 0.99). Visceral fat as measured by VAF through CT was highly correlated with SAD (women r = 0.80; men r = 0.64, p < 0.001), waist circumference (women r = 0.77; men r = 0.73, p < 0.001), and WHR (women r = 0.72; men r = 0.58, p < 0.001). The ROC curve indicated 19.3 cm and 20.5 cm as the threshold values for abdominal sagittal diameter in women and men (sensitivity 85 percent and 83 percent, specificity 77 percent and 82 percent, respectively). CONCLUSIONS: There was a high correlation between SAD and VAF. The cut-off values identified for SAD presented a sensitivity and specificity that were considered adequate.

OBJETIVOS: Avaliar a confiabilidade do diâmetro abdominal sagital e a sua validade enquanto preditor de gordura abdominal visceral, assim como identificar os pontos de corte mais apropriados para identificar a área de gordura visceral que é conhecida por representar fator de risco para doença cardiovascular. MÉTODOS: Desenho: Estudo de validação. Amostra: 92 voluntários saudáveis (57 mulheres, 35 homens), idade: 20-83 anos, índice de massa corporal: 19,3 a 35,9 kg/m². Medidas: Diâmetro abdominal sagital (DAS), peso, altura, circunferências (cintura, quadril e coxa), pregas cutâneas tricipital e subescapular, índice diâmetro abdominal e razão cintura-quadril (RCQ). MÉTODO DE ESCOLHA: Tomografia computadorizada (TC). ESTATíSTICA: Curva ROC (receiver operating characteristic). RESULTADOS: A confiabilidade do DAS foi muito alta (coeficiente inter-classe = 0,99). A área de gordura visceral medida pela TC teve uma alta correlação com o DAS (mulheres r = 0,80, homens r = 0,64, p < 0,001), circunferência da cintura (mulheres r = 0,77, homens r = 0,73, p < 0,001) e com a RCQ (mulheres r = 0,72, homens r = 0,58, p < 0,001). A curva ROC indicou 19,3 cm e 20,5 cm como valores limites para o diâmetro abdominal sagital em mulheres e homens (sensibilidade de 85 por cento e 83 por cento, especificidade de 77 por cento e 82 por cento, respectivamente). CONCLUSÕES: Observou-se alta correlação entre o DAS e a área de gordura abdominal visceral. Os pontos de corte identificados para o DAS apresentaram sensibilidade e especificidade adequadas.