Methods of estimation of visceral fat: advantages of ultrasonography.

OBJECTIVE: To compare methods for the assessment of visceral fat with computed tomography (CT) and establish cutoffs to define visceral obesity based on such alternative methods. RESEARCH METHODS AND PROCEDURES: One hundred women (50.4 +/- 7.7 years; BMI 39.2 +/- 5.4 kg/m2 underwent anthropometric evaluation, bioelectrical impedance, DXA, abdominal ultrasonography (US), and CT scan. RESULTS: Waist circumference, waist-to-hip ratio (WHR), and US-determined visceral fat values showed the best correlation coefficients with visceral fat determined by CT (r = 0.55, 0.54, and 0.71, respectively; p < 0.01). Fat mass determined by DXA was inversely correlated with visceral-to-subcutaneous-fat ratio (r = -0.47, p < 0.01). Bioimpedance-determined fat mass and skinfolds were correlated with only subcutaneous abdominal fat quantified by CT. Linear regression indicated US visceral-fat distance and WHR as the main predictors of CT-determined visceral fat (adjusted r2 = 0.51, p < 0.01). A waist measurement of 107 cm (82.7% specificity, 60.6% sensitivity) and WHR of 0.97 (78.8% specificity, 63.8% sensitivity) were chosen as discriminator values corresponding with visceral obesity diagnosed by CT. A value of 6.90 cm for visceral fat US-determined diagnosed visceral obesity with a specificity of 82.8%, a sensitivity of 69.2%, and a diagnostic concordance of 74% with CT. DISCUSSION: US seemed to be the best alternative method for the assessment of intra-abdominal fat in obese women. Its diagnostic value could be optimized by an anthropometric measurement. Prospective studies are needed to establish CT and US cutoffs for defining visceral-fat levels related to elevated cardiovascular risk.

[Influence of body fat distribution on the prevalence of arterial hypertension and other cardiovascular risk factors in obese patients]. / Influência da distribuição da gordura corporal sobre a prevalência de hipertensão arterial e outros fatores de risco cardiovascular em indivíduos obesos.

INTRODUCTION: Obese people are at higher cardiovascular risk than people with normal body weight. The objective of this study was to establish the relationship between obesity, body fat distribution and cardiovascular risk factors. METHODS: Body mass index (BMI), waist-hip ratio (WHR) systolic (SBP) and diastolic blood pressure (DBP), plasma cholesterol, triglycerides and glucose levels were determined in a population of 499 overweight and obese patients (432F/67M; age 39 12.9y). RESULTS: High prevalence of abnormal glucose tolerance or diabetes (21.8%), hypercholesterolenemia (49.1%), hypertri glyceridemia (21.3%) and hypertension (43.8%) were found in this population. The prevalence of hypertension increased from 23% in patients with BMI 25-29.9 kg/m to 67.1% (p<0.05) in those with BMI > 40kg/m and also from 35.7% in patients with WHR between 0.73 and 0.88 to 66.6% in those with WHR >0.97 (p<0.05). In addition, a correlation was found between the waist circumference and SBP (r=0.35; p<0.0001). In the hypertensive group, but not in the normotensive, SBP increased with BMI, from 150 12 mmHg in the overweight group to 161 18mmHg in that with BMI > 40kg/m , (p<0.05). CONCLUSION: Our data reinforce the association between obesity and high cardiovascular risk. In addition, our findings suggested a role for body fat distribution in the development of hypertension in obese patients.

Influência da distribuiçäo da gordura corporal sobre a prevalência de hipertensäo arterial e outros fatores de risco cardiovascular em indivíduos obesos / Influence of body fat distribution on the prevalence of arterial hypertension and other cardiovascular risk factors in obese patients

OBJETIVOS: Indivíduos obesos säo mais predispostos à ocorrência de eventos cardiovasculares que indivíduos com peso normal. Para se avaliar o impacto da obesidade e da distribuiçäo de gordura corporal sobre o risco cardiovascular, avaliamos uma populaçäo de indivíduos com sobrepeso ou obesidade. MÉTODOS: Foram feitas medidas do índice de massa corporal (IMC), da relaçäo entre as medidas da cintura e do quadril (RCQ), da pressäo arterial sistólica (PAS) e diastólica (PAD) e dos níveis da glicemia de jejum, colesterol total e triglicérides. RESULTADOS: Altas prevalências de intolerância à glicose ou diabetes (21,8 por cento), hipercolesterolenemia (49,1 por cento), hipertrigliceridemia (21,3 por cento) e hipertensäo arterial (43,8 por cento) foram observadas nesta populaçäo. A prevalência de hipertensäo aumentou de 23 por cento no grupo com sobrepeso (IMC 25-29,9 kg/m²) para 67,1 por cento (p<0.05) em pacientes com obesidade grau 3 (IMC > 40kg/m²). Também a prevalência de hipertensäo aumentou de 35,7 por cento naqueles com RCQ entre 0,73 e 0,88 para 66,6 por cento naqueles com RCQ >0,97 (p<0,05), independente do IMC, e os valores da PAS se correlacionaram com as medidas da circunferência da cintura (r=0,35; p<0,0001). A PAS, entretanto, mostrou aumentos com o IMC apenas entre hipertensos, elevando-se de 150±12 mmHg naqueles com sobrepeso para 161±18mmHg naqueles com IMC > 40kg/m² (p<0,05). CONCLUSÄO: A obesidade favorece a ocorrência dos fatores de risco cardiovascular, sendo que a distribuiçäo central da gordura corporal se destaca especialmente como fator importante no desenvolvimento da hipertensäo arterial

Two-hour insulin determination improves the ability of abdominal fat measurement to identify risk for the metabolic syndrome.

OBJECTIVE: Visceral obesity is shown to be a predictor of morbidity and mortality. We evaluated the association of measurements of generalized adiposity and visceral fat area (VFA), with abnormalities of metabolic syndrome (MS). RESEARCH DESIGN AND METHODS: Seventy-six women (47.9 +/- 9.2 years) with BMI of 38.7 +/- 5.4 kg/m(2) underwent anthropometric measurements, laboratory procedures, bioeletrical impedance, and abdominal computed tomography (CT) scan. Diagnosis of MS was based on the presence of abdominal obesity and at least two of the following components: hypertension, dyslipidemia, and glucose intolerance and/or hyperinsulinemia. RESULTS: BMI was correlated with both components of adipose tissue--subcutaneous (r = 0.66, P < 0.01) and VFA (r = 0.33, P < 0.02)--and leptin levels (r = 0.38, P < 0.01). In contrast, VFA was correlated with 2-h glucose and insulin levels (r = 0.32 and 0.35, P < 0.05, respectively), triglyceride, HDL cholesterol, and uric acid (r = 0.33, -0.34 and 0.24, P < 0.05, respectively). Subjects with high VFA, matched for BMI, showed greater plasma glucose area under the curve (621 +/- 127 vs. 558 +/- 129 mg x h(-1) x dl(-1), P < 0.05), 2-h insulin (804 +/- 599 vs. 579 +/- 347 pmol/l, P < 0.05), and uric acid levels (0.33 +/- 0.07 vs. 0.26 +/- 0.06 mmol/l, P < 0.05) than subjects with low VFA. In logistic regression analysis, waist circumference, VFA, and 2-h insulin were identified as independent predictors of MS. Receiver operating characteristic curve analysis pointed out the values of 104 cm for waist circumference (58.1% specificity, 84.1% sensitivity), 158.5 cm(2) for VFA (78.1% specificity, 52.3% sensitivity), and 559.8 pmol/l for 2-h insulin (71.9% specificity, 69.8% sensitivity); the presence of at least two of the three variables resulted in a degree of concordance of 76%. CONCLUSIONS: While BMI was unable to differentiate between obese people and those at higher risk for MS, abdominal fat was shown to be associated with its metabolic abnormalities. The usefulness of abdominal fat in the identification of high-risk subjects may be improved when combined with 2-h insulin determination.

Binge eating disorder, anxiety, depression and body image in grade III obesity patients

INTRODUCTION: The objective of this study was to assess the frequency of Binge Eating Disorder (BED) or Binge Eating episodes (BINGE), anxiety, depression and body image disturbances in severely obese patients seeking treatment for obesity. METHOD: We assessed 50 patients (10M and 40F) with Body Mass Index (BMI) between 40 and 81.7 Kg/m² (mean 52.2±9.2 Kg/m²) and aging from 18 to 56 years (mean 38.5±9.7). Used instruments: Questionnaire on Eating and Weight Patterns ¾ Revised (QEWP-R) for BED or BINGE assessment, Beck Depression Inventory (BDI) for depressive symptoms, State - Trait Anxiety Inventory (STAI-TRAIT and STAI-STATE) for anxiety and Body Shape Questionnaire (BSQ) for body image assessments. RESULTS: In this population BED and BINGE frequencies were 36 percent and 54 percent, respectively. Symptoms of depression were detected in 100 percent while severe symptomatology was found in 84 percent of the cases. The frequency of anxiety as a trait was 70 percent, as a state, 54 percent and 76 percent of all patients reported discomfort regarding body image. The frequency of BED was higher in patients with higher anxiety scores as a personality trait (>40) but not as a state (46 percent vs. 13 percent; p<0,05). A high frequency of BINGE was found in those with higher scores (>140) in the BSQ assessment. CONCLUSION: Our results indicate a high frequency of binge eating episodes, severe depressive symptoms, anxiety and concern with body image in grade III obesity patients

Tratamento de diabetes e hipertensäo no paciente obeso / Treating diabetes and hypertension in the obese patient

A obesidade é um fator de risco independente para doença coronariana. A resistência à insulina associada à obesidade contribui para o desenvolvimento de dislipidemia, hipertensäo arterial e diabetes tipo 2. A coexistência de hipertensäo e diabetes aumenta o risco para complicaçöes micro e macrovasculares, predispondo os indivíduos à insuficiência cardíaca congestiva, doença coronariana e cerebrovascular, insuficiência arterial periférica, nefropatia e retinopatia. Em pacientes diabéticos obesos a reduçäo do peso, bem como o uso de metiformina, melhoram a sensibilidade à insulina, o controle da glicemia e da pressäo arterial. O tratamento anti-hipertensivo em diabéticos reduz a mortalidade cardiovascular e retarda o declínio da funçäo glomerular. Deve-se considerar os efeitos dos agentes anti-hipertensivos sobre a sensibilidade à insulina e o perfil lipídico. Diuréticos e b-bloqueadores podem reduzir a sensibilidade à insulina, enquanto bloqueadores de canais de cálcio säo metabolicamente neutros e os TECA aumentam a sensibilidade à insulina, além de conferir proteçäo adicional cardiovascular e renal para diabéticos. O bloqueio da angiotensina II tem mostrado benefícios semelhantes.

Obesidade, hipertensäo arterial e suas influências sobre a massa e funçäo do ventrículo esquerdo / Obesity, hypertension and your influence about the left ventricular function and mass

Para avaliar as influências da obesidade e da hipertensão sobre a massa de ventrículo esquerdo (MVE), estudamos 121 mulheres divididas em 4 grupos: não-obesas normotensas (n = 25), não-obesas hipertensas (n = 30), obesas normotensas (n = 24) e obesas hipertensas (n = 42) quanto a parâmetros antropométricos, ecocardiográficos e de monitorização ambulatorial da pressão arterial (MAPA). As pacientes obesas hiperten- sas apresentaram maior MVE que os outros grupos - não-obesas normotensas, não-obesas hipertensas e obesas normotensas (167 +/- 38,8 vs. 113 +/- 26,4; vs. 133 +/- 26,5; vs. 132 +/- 29,2g; p < 0,05, respectivamente) e maior diâmetro de átrio esquerdo (AE) quando comparadas aos grupos de não-obesas, tanto normotensas como hipertensas (36 +/- 4,3 vs. 33 +/- 5,1; vs. 35 +/- 3,9mm; p < 0,05, respectivamente). Obesas normotensas apresentaram MVE similar à do grupo não-obesas hipertensas (133 +/- 26,5 vs. 132 +/- 29,5g; NS) e aumento de AE quando comparadas às não-obesas normotensas (35 +/- 3,9 vs. 31 +/- 4,6mm; p < 0,05). Detectou-se correlação entre a circunferência da cintura e a razão cintura-quadril com os níveis pressóricos à MAPA, assim como entre estas medidas e parâmetros ecocardiográficos que avaliam a massa cardíaca; o índice de massa corporal só se correlacionou ao diâmetro do AE. A correção da MVE pela altura ao invés da superfície corpórea aumentou a prevalência de hipertrofia de VE nas obesas (10,6 vs. 36,7 por cento, p < 0,01), mas não nas não-obesas. Ausência de descenso noturno da pressão arterial sistólica à MAPA (non-dipper) foi mais prevalente nas pacientes obesas, hipertensas ou não; entretanto, as obesas hipertensas non-dippers não diferiram das dippers quanto à MVE. Nossos dados demonstram que a obesidade associada à hipertensão aumenta a MVE de modo mais importante do que as condições isoladamente. Concluímos, ainda, que pacientes obesas também apresentam alta freqüência de alterações do ritmo da pressão arterial de 24 horas, caracterizada por menor queda pressórica durante o sono.