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.

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

Objective: 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. Conclusion: The authors suggest using the studied adiposity markers as a routine since they were shown to be suitable parameters in association with IR.

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.

Ultrasound evaluation of subcutaneous and visceral abdominal fat as a predictor of gestational diabetes mellitus: a systematic review.

OBJECTIVE: Studies of subcutaneous and visceral abdominal fat thickness evaluated by ultrasound as a predictor of gestational diabetes mellitus (GDM) have been published, but the best technique and standardization are unknown. To identify, critically evaluate, and analyze studies using subcutaneous and visceral abdominal fat as a model for predicting GDM in the first and second trimesters of pregnancy and evaluate their methodological quality. METHODS: PubMed, Scopus, and Web of Science databases were searched from May to July 2019. We included studies of any sample size performed for any duration and in any configuration. Model development and validation studies were eligible for inclusion. Two authors independently performed the eligibility assessment of the studies by reviewing the titles and abstracts. Data on study design, gestational age, diagnostic criteria for GDM, device, ultrasound fat measurement technique, and cutoff point for GDM prediction were extracted. RESULTS: The electronic search resulted in 1331 articles, of which 14 were eligible for systematic review. Different criteria for diagnosing GDM and fat measurement techniques were used. The cutoff point for subcutaneous, visceral, and total abdominal fat for predicting GDM in the first and second trimesters varied between the studies. CONCLUSION: No study validated the model for predicting GDM using subcutaneous and visceral abdominal fat measurements. External validation studies are recommended to improve the generalization of this GDM predictor in clinical practice.

Reductions of cardiovascular and metabolic risk factors after a 14-week periodized training model in patients with knee osteoarthritis: a randomized controlled trial.

INTRODUCTION/OBJECTIVE: To evaluate the effects of a periodized circuit training (CT) compared with a conventional strength training (ST) and an educational protocol (EP) on body composition, metabolic parameters, muscle strength, pain, and physical performance in patients with knee osteoarthritis (KOA). METHOD: This study followed a randomized controlled trial design. A sample of sixty-one patients with KOA, 40-65 years old and BMI < 30 kg/m2, were randomly divided into three 14-week protocols: CT, ST, or EP. The CT performed whole body exercises organized in circuit, 3 times a week. The ST performed conventional resistance exercises also 3 times a week, and the EP joined in educational meetings twice a month. Body composition (dual-energy X-ray absorptiometry (DXA)); metabolic parameters (abdominal obesity, triglyceride, HDL, blood pressure and fasting glucose), knee maximal isometric voluntary contraction (MIVC) extension and flexion, performance-based tests (40-m walk test, 30-s chair test, and stair climb test), self-reported pain, stiffness, and physical function (WOMAC) and pain catastrophism were evaluated at baseline and follow-up. Repeated measures ANOVA were used to compare differences between groups (CTxSTxEP) at the different times of assessment (baseline × follow-up). When group-time interaction was found, a one-way ANOVA, followed by a Bonferroni post hoc test, was used to compare groups in each time point; while a paired t test was used to verify the time effect in each group. Additionally, the training effect was analyzed in terms of the percent change (Δ%). Effect size was calculated for post intervention (week 14) between groups. For all analyses a significance level of 5% was adopted (p < 0.05). RESULTS: The CT was the only protocol that presented significant lower body mass (p = 0.018; Δ% = - 1.4), fat mass (p = 0.017; Δ% = - 10.3), %fat mass (p < 0.001; Δ% = - 13.9), adipose indices (%fat trunk/%fat legs p = 0.031; Δ% = 7.8; fat mass/height2 p = 0.011; Δ% = - 15.1; trunk/limb fat mass p = 0.012; Δ% = - 8.2; visceral adipose tissue (VAT) volume (cm3) p = 0.039; Δ% = - 11.6; VAT area (cm2) p = 0.044; Δ% = - 12.2), blood pressure levels (SBP p = 0.042; Δ% = - 3.4 and DBP p = 0.001; Δ% = - 4.9), higher lean mass and HDL (p < 0.001; Δ% = 5.9) compared to baseline. CT and ST presented lower WOMAC pain, stiffness and physical function (p < 0.001; Δ% = - 64.0 for CT and p < 0.001; Δ% = 0.001; Δ% = - 46.4 for ST in WOMAC total score, pain catastrophizing (p < 0.001; Δ% = - 66.7 for CT and p < 0.001; Δ% = - 61.5 for ST) a higher functional performance (30 s chair test: p < 0.001; Δ% = 45.7 for CT and p < 0.001; Δ% = 26.9 for ST; 40 m walk test: p < 0.001; Δ% = 26.7 for CT and p < 0.001; Δ% = 12.5 for ST; stair climb test: p = 0.002; Δ% = - 33.9 for CT and p < 0.001; Δ% = - 18.8 for ST) and knee extension MIVC (p < 0.001; Δ% = 21.92 for CT and p < 0.001; Δ% = 30.25 for ST). CONCLUSION: A periodized CT model reduces visceral adipose tissue, SBP and DBP, and improves HDL, important cardiovascular and metabolic risk factors, in patients with KOA. Both trained groups (CT and ST) improve self-reported clinical symptoms, muscle strength, and physical performance in this sample. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov , NCT02761590 (registered on May 4, 2016). KEY POINTS: • A 14-week periodized circuit training reduces visceral adipose tissue, systolic and diastolic blood pressure, and improves HDL blood levels in patients with knee osteoarthritis. • Both periodized circuit training and conventional strength training improve clinical symptoms, functional performance and muscle strength in this sample.

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.

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.

High-Protein Diet Associated with Bocaiuva Supplementation Decreases Body Fat and Improves Glucose Tolerance in Resistance-Trained Rats.

High-protein diets (HPDs) are widely used for health and performance. However, the combination of whey protein and natural foods (i.e., fruits) is still unclear. Thus, we evaluated the role of supplemental HPD with Bocaiuva (Acrocomia sp.) in metabolic and body composition parameters of rats submitted to resistance training (RT). Wistar rats (203.3 ± 30 g) were randomly allocated to five groups: normoproteic control (CON, n = 5), sedentary high-protein (SH, n = 5), RT + H (trained high-protein [TH], n = 5), sedentary+Bocaiuva (SH+B, n = 4), and RT+Bocaiuva (TH+B, n = 4) diet groups. After 12 weeks of RT, the maximal strength increased in both trained groups (P < .05). The TH + B group had lower values of adiposity index (AI) (3.8 ± 0.7% vs. 6.8 ± 1.3%) and visceral fat (0.038 ± 0.004 g/g vs. 0.067 ± 0.012 g/g) compared with the SH group, respectively (P < .05). The other groups did not show differences in values of AI (CON, 5.4 ± 1.6%, TH, 5.4 ± 1.3%, and SH+B, 5.5 ± 1.2%). In addition, the fasting glucose of trained groups (TH, 106.0 ± 4.5, and TH+B, 100.4 ± 13.5 dL/mg) was significantly lower when compared with controls (SH, 120.0 ± 14.4, and SH+B, 119 ± 6.4 dL/mg) (P < .05). Bocaiuva combined with an HPD reduced visceral fat and AI in addition to improving glucose tolerance of rats submitted to RT.

Metabolic Score for Visceral Fat (METS-VF), a novel estimator of intra-abdominal fat content and cardio-metabolic health.

BACKGROUND & AIMS: Intra-abdominal and visceral fat (VAT) are risk factors for the development of cardio-metabolic comorbidities; however its clinical assessment is limited by technology and required expertise for its assessment. We aimed to develop a novel score (METS-VF) to estimate VAT by combining the non-insulin-based METS-IR index, waist-height ratio (WHtr), age and sex. METHODS: We developed METS-VF in a sample of 366 individuals with Dual X-ray absorptiometry (DXA). METS-VF was modeled using non-linear regression and validated in two replication cohorts with DXA (n = 184, with n = 118 who also had MRI) and bio-electrical impedance (n = 991). We also assessed METS-VF to predict incident type 2 diabetes (T2D) and arterial hypertension independent of body-mass index (BMI) in our Metabolic Syndrome Cohort (n = 6144). RESULTS: We defined METS-VF as: 4.466 + 0.011*(Ln(METS-IR))3 + 3.239*(Ln(WHtr))3 + 0.319*(Sex) + 0.594*(Ln(Age)). METS-VF showed better performance compared to other VAT surrogates using either DXA (AUC 0.896 95% CI 0.847-0.945) or MRI (AUC 0.842 95% CI 0.771-0.913) as gold standards. We identified a METS-VF cut-off point >7.18 in healthy patients which has 100% sensitivity (95% CI 76.8-100) and 87.2% specificity (95% CI 79.1-93.0) to identify increased VAT (>100 cm2). METS-VF also had adequate performance in subjects with metabolically-healthy obesity. Finally, in our metabolic syndrome cohort, subjects in the upper quintiles of METS-VF (>7.2) had 3.8 and 2.0-fold higher risk of incident T2D and hypertension, respectively (p < 0.001). This effect was independent of BMI for both outcomes. CONCLUSION: METS-VF is a novel surrogate to estimate VAT, which has better performance compared to other surrogate VAT indexes and is predictive of incident T2D and hypertension. METS-VF could be a useful tool to assess cardio-metabolic risk in primary care practice and research settings.

Healthy Obese Subjects Differ in Chronotype, Sleep Habits, and Adipose Tissue Fatty Acid Composition from Their Non-Healthy Counterparts.

Obesity is not the same in all individuals and two different phenotypes have been described: metabolically healthy obesity (MHO) and metabolically unhealthy obesity (MUO). The aim of this study was to identify factors that explain metabolic health status in a rigorously matched Spanish population. Subcutaneous and visceral fat, adipocyte size and fatty acid composition, cardiometabolic markers in serum, and lifestyle habits were assessed. Higher physical activity in the mornings (Odds Ratio (95% Confidence Interval) (OR (95% CI) = 1.54 (1.09-2.18), p = 0.01)), earlier bedtimes (8:30-10:30 pm) (OR = 2.11 (1.02-4.36), p = 0.04), a complete breakfast (OR = 1.59 (1.07-2.36), p = 0.02), and a greater number of meals per day (4.10 ± 0.05 vs. 3.93 ± 0.05, p < 0.01), were associated with the MHO phenotype. Concentrations of 20:5 n-3 eicosapentaenoic acid (0.26 ± 0.46 vs. 0.10% ± 0.11%, p = 0.04) and 18:3 n-6 gamma-linolenic acid (0.37 ± 0.24 vs. 0.23% ± 0.22%, p = 0.04) in subcutaneous adipocytes were higher and omental adipocyte size (187 094 ± 224 059 µm3 vs. 490 953 ± 229 049 µm3, p = 0.02) was lower in MHO subjects than in those with MUO. Visceral fat area differed between MHO and MUO subjects (135 ± 60 cm2 vs. 178 ± 85 cm2, p = 0.04, respectively). The study highlights specific lifestyle habits that could form part of obesity therapies, not only involving healthier eating habits but also earlier sleeping and exercise patterns.

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.

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.

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.

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.

Intra-abdominal fat measurement by ultrasonography: association with anthropometry and metabolic syndrome in adolescents.

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 6.50cm 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 6.46cm. In an overall analysis using the ROC curve, without gender and age stratification, the cut-off of 3.67cm 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.

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)

Ultrasound as a method to evaluate the distribution of abdominal fat in obese prepubertal children and the relationship between abdominal fat and metabolic alterations.

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.

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.

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.

Increased brain cortical thickness associated with visceral fat in adolescents.

BACKGROUND: There has been a growing amount of evidence indicating that excess visceral fat is associated with alterations in brain structure and function, including brain cortical thinning in adults. OBJECTIVES: This study aims to investigate the relationship between brain cortical thickness with obesity assessments, in adolescents. METHODS: In this study, we measured three different obesity assessments within an adolescent population (aged 15 - 18 years): body mass index (BMI), visceral fat ratio measured with an MRI and hepatorenal gradient measured with an ultrasound. Volunteers also underwent an MRI scan to measure brain structure. RESULTS: Results indicated that there was no relationship of BMI or hepatorenal gradient with brain cortical dimensions. However, there was a significant association between visceral fat ratio and an increase of cortical thickness throughout the brain. CONCLUSIONS: These results suggest that visceral fat, but not BMI, is correlated with cortical thickening in adolescence.