Gestational diabetes mellitus early prediction by maternal body fat index: A cohort study.

OBJECTIVES: To compare the performance of maternal body fat index (BFI) assessed during the first 20+6 weeks among 138 pregnant women in an ultrasound outpatient clinic as a predictor of gestational diabetes mellitus (GDM) later in pregnancy. METHOD: Maternal visceral and subcutaneous fat was measured with a convex ultrasound probe placed in two locations on the maternal abdominal surface: the first in the mid-sagittal epigastric region, visualising epigastric fat, and the second 2cm above the maternal umbilical scar, visualising periumbilical fat. Ultrasound callipers measured the distance from dermal edge to the linea alba and after from the linea alba to the anterior hepatic surface (epigastric fat). Periumbilical fat was measured from the dermal edge to the linea alba and after from the linea alba to the anterior aortic surface. The BFI formula was [visceral adipose tissue (mm)×subcutaneous adipose tissue (mm)]/maternal height (cm). RESULTS: The best thresholds for predicting GDM outcome for epigastric and periumbilical BFI were 1.2 and 4.8, respectively. Odds ratio, sensitivity and specificity were 5.88 (95% CI 1.86-18.6), 80.9%, 58.0% for the epigastric site and 6.31 (95% CI 1.73-22.94), 84.2%, 54.2% for the periumbilical site. Pre-pregnancy body mass index compatible with adult obesity shows inadequate predictive performance for GDM outcome. Only epigastric BFI above 1.2 maintained statistical significance for GDM in the logistic regression analysis, when compared to periumbilical BFI above 4.8. CONCLUSION: Epigastric BFI above 1.2 during the first half of pregnancy may help identify women at risk of developing GDM later in pregnancy.

Effect of Brassica rapa var. rapifera on Insulin Resistance and Inflammatory Analysis of Visceral Adipose Tissue of Obese Wistar Rats Under Glucolipotoxicity Condition / Efecto de Brassica rapa var. rapifera sobre la Resistencia a la Insulina y el Análisis Inflamatorio del Tejido Adiposo Visceral de Ratas Wistar Obesas en Condiciones de Glucolipotoxicidad

SUMMARY: Obesity-related pathophysiologies such as insulin resistance and the metabolic syndrome show a markedly increased risk for type 2 diabetes and atherosclerotic cardiovascular disease. This risk appears to be linked to alterations in adipose tissue function, leading to chronic inflammation and the dysregulation of adipocyte-derived factors. Brassica rapa have been used in traditional medicine for the treatment of several diseases, including diabetes. This study aimed to investigate the effect of nutritional stress induced by a high-fat and high-sucrose diet on the pathophysiology of visceral adipose tissue and the therapeutic effect of Brassica rapa in male Wistar rats. We subjected experimental rats to a high-fat (10 %) high-sucrose (20 %)/per day for 11 months and treated them for 20 days with aqueous extract Br (AEBr) at 200 mg/kg at the end of the experiment. At the time of sacrifice, we monitored plasma and tissue biochemical parameters as well as the morpho-histopathology of visceral adipose tissue. We found AEBr corrected metabolic parameters and inflammatory markers in homogenized visceral adipose tissue and reduced hypertrophy, hyperplasia, and lipid droplets. These results suggest that AEBr enhances anti-diabetic, anti-inflammatory and a protective effect on adipose tissue morphology in type 2 diabetes and obesity.

La fisiopatología relacionadas con la obesidad, como la resistencia a la insulina y el síndrome metabólico, muestran un riesgo notablemente mayor de diabetes tipo 2 y enfermedad cardiovascular aterosclerótica. Este riesgo parece estar relacionado con alteraciones en la función del tejido adiposo, lo que lleva a una inflamación crónica y a la desregulación de los factores derivados de los adipocitos. Brassica rapa se ha utilizado en la medicina tradicional para el tratamiento de varias enfermedades, incluida la diabetes. Este estudio tuvo como objetivo investigar el efecto del estrés nutricional inducido por una dieta rica en grasas y sacarosa sobre la fisiopatología del tejido adiposo visceral y el efecto terapéutico de Brassica rapa en ratas Wistar macho. Sometimos a ratas experimentales a una dieta rica en grasas (10 %) y alta en sacarosa (20 %)/por día durante 11 meses y las tratamos durante 20 días con extracto acuoso de Br (AEBr) a 200 mg/kg al final del experimento. En el momento del sacrificio, monitoreamos los parámetros bioquímicos plasmáticos y tisulares, así como la morfohistopatología del tejido adiposo visceral. Encontramos parámetros metabólicos corregidos por AEBr y marcadores inflamatorios en tejido adiposo visceral homogeneizado y reducción de hipertrofia, hiperplasia y gotitas de lípidos. Estos resultados sugieren que AEBr mejora el efecto antidiabético, antiinflamatorio y protector sobre la morfología del tejido adiposo en la diabetes tipo 2 y la obesidad.

¿Es la actividad metabólica del tejido adiposo un predictor de respuesta histopatológica al tratamiento neoadyuvante en el cáncer de mama? / Is adipose tissue metabolic activity a predictor of pathological responses to neoadjuvant treatment in breast cancer?

Objetivo La respuesta histopatológica a la quimioterapia neoadyuvante (NAC) es esencial en pacientes con cáncer de mama. La predicción de la respuesta histopatológica a la NAC en pacientes con cáncer de mama localmente avanzado es esencial para una estrategia de tratamiento óptima. El enfoque actual del tratamiento adyuvante o neoadyuvante se basa en el subtipo molecular. La obesidad puede afectar la respuesta a la quimioterapia. El objetivo de este estudio es evaluar la relación entre la actividad metabólica del tejido adiposo (AT) y la respuesta histopatológica de la NAC. Definir, la asociación del índice de masa corporal (IMC) y el valor del «Standard Uptake Value» (SUV) de AT medido por tomografía por emisión de positrones (PET/TC) con la respuesta a la quimioterapia neoadyuvante. Material y métodos Hemos incluido 116 pacientes consecutivos con cáncer de mama, estadio II y III, que acudieron para la realización de un PET/TC previo a NAC entre 2016 y 2020. Hemos calculado los parámetros metabólicos del tejido adiposo visceral (SUV del VAT), del tejido adiposo subcutáneo (SUV del SAT) y la relación entre ambos (relación V/S). Todos estos biomarcadores los hemos relacionado con la respuesta histopatológica de los pacientes. Resultados El análisis univariante muestra una correlación significativa entre la respuesta histopatológica con el estadio clínico (p<0,001), HER2 positivo (p<0,001), SUV del VAT (p=0,037), densidad del VAT (p=0,043) y la relación V/S (p=0,003). El análisis multivariante muestra una significación estadística entre HER2 positivo y la relación V/S con la respuesta histopatológica. Se evidencia una correlación positiva del IMC con el volumen del IVA (p<0,001), SUV del IVA (p<0,016), volumen del SAT (p<0,001) y el SUV del SAT (p<0,001). Se evidencia una correlación negativa del IMC con la relación V/S (p=0,039) y la densidad del SAT (p=0,003) (AU)

Introduction and objective Prediction of the pathologic response to neoadjuvant chemotherapy (NAC) in patients with locally advanced breast cancer is essential for optimal treatment strategy. The current approach of adjuvant or neoadjuvant treatment is based on the molecular subtype. Obesity may have affected chemotherapy response. This study aims to evaluate the relationship between metabolic activity of adipose tissue (AT) and pathological responses to NAC. And to define the association with body mass index (BMI) and metabolic parameters of standardized uptake value (SUV) of adipose tissue measured by positron emission computed tomography (PET/CT). Material and methods One-hundred and sixteen consecutive patients with stage II and III breast cancer who underwent PET/CT before receiving NAC, were evaluated in the study. Metabolic parameters of visceral adipose tissue (VAT-SUV), subcutaneous adipose tissue (SAT-SUV), and calculated SUV of visceral-to-subcutaneous ratio (V/S-ratio) were regarded. The relationship between SUV of AT and pathologic response was evaluated from medical records retrospectively. Results Univariate-analysis revealed that good pathological response was significantly associated with clinical stage (p<0.001), HER-2 positivity (p<0.001), VAT-SUV (p=0.037), VAT-density (p=0.043) and V/S-ratio (p=0.003). In multivariate-analysis clinical stage, HER-2 positivity and V/S-ratio were found to have statistically effect on pathological response. VAT-volume (p<0.001), VAT-SUV (p=0.016), SAT-volume (p<0.001) and SAT-SUV (p<0.001) has positive correlation with BMI value. On the other hand, V/S-ratio (p=0.039) and SAT-density (p=0.003) has negative correlation with BMI. Conclusion Metabolic activity of AT is associated with BMI and effected chemotherapy responses. Low V/S ratio was associated with high BMI and poor pathological response to NAC. V/S ratio may be a useful marker for the prediction of NAC responses (AU)

Is adipose tissue metabolic activity a predictor of pathological responses to neoadjuvant treatment in breast cancer.

INTRODUCTION AND OBJECTIVE: Prediction of the pathologic response to neoadjuvant chemotherapy (NAC) in patients with locally advanced breast cancer is essential for optimal treatment strategy. The current approach of adjuvant or neoadjuvant treatment is based on the molecular subtype. Obesity may have affected chemotherapy response. This study aims to evaluate the relationship between metabolic activity of adipose tissue (AT) and pathological responses to NAC. And to define the association with body mass index (BMI) and metabolic parameters of standardized uptake value (SUV) of adipose tissue measured by positron emission computed tomography (PET/CT). MATERIAL AND METHODS: One-hundred and sixteen consecutive patients with stage II and III breast cancer who underwent PET/CT before receiving NAC, were evaluated in the study. Metabolic parameters of visceral adipose tissue (VAT-SUV), subcutaneous adipose tissue (SAT-SUV), and calculated SUV of visceral-to-subcutaneous ratio (V/S-ratio) were regarded. The relationship between SUV of AT and pathologic response was evaluated from medical records retrospectively. RESULTS: Univariate-analysis revealed that good pathological response was significantly associated with clinical stage (P<.001), HER-2 positivity (P<.001), VAT-SUV (P=.037), VAT-density (P=.043) and V/S-ratio (P=.003). In multivariate-analysis clinical stage, HER-2 positivity and V/S-ratio were found to have statistically effect on pathological response. VAT-volume (P<.001), VAT-SUV (P=.016), SAT-volume (P<.001) and SAT-SUV (P<.001) has positive correlation with BMI value. On the other hand, V/S-ratio (P=.039) and SAT-density (P=.003) has negative correlation with BMI. CONCLUSION: Metabolic activity of AT is associated with BMI and effected chemotherapy responses. LowV/S ratio was associated with high BMI and poor pathological response to NAC. V/S ratio may be a useful marker for the prediction of NAC responses.

Development and validation of equations to estimate visceral adipose tissue in military men / Desenvolvimento e validação de equações de estimar o tecido adiposo visceral em militares / Desarrollo y validación de ecuaciones para estimar el tejido adiposo visceral en militares

ABSTRACT Introduction It has been suggested that visceral adipose tissue (VAT) is associated with several non-communicable chronic diseases, but measuring it is difficult. Thus, anthropometry could be used because is easily applied in clinical practice. Objectives The present study aimed to develop and validate VAT estimation equations (Eq) in military men. Methods The sample consisted of 409 (mean age, 36.5 ± 6.7 years) military men in the Brazilian Army (BA) divided into an equation group (EG) ( n = 270; mean age, 37.0 ± 6.3 years) and a validation group (VG) ( n =139; mean age, 36.0 ± 7.2 years). Anthropometric, hemodynamic and DXA body composition evaluations ( GE iLunar ) were performed. The Student's t test, Pearson's correlation, and stepwise general linear regression were applied. Bland-Altman graphics were used to assess the concordance between VAT by Eq and by DXA. The level of significance was 95% ( p < 0.05). Results Age, waist circumference (WC), hip circumference and body mass index presented the main significant positive correlations with the VAT-DXA. Four Eq were created Eq1 ( r 2 = 0.793), Eq2 ( r 2 = 0.810), Eq3 ( r 2 = 0.817), and Eq 4 ( r 2 = 0.823) ( p < 0.05). No differences were observed between VAT by DXA and VAT by Eq ( p = 0.982, p = 0.970, p = 0.495 and p = 0.698). Bland-Altman analysis also presented good concordance as the bias was close to zero and was not statistically significant. Conclusion Eq2 (age*13.0 + WC*60.0 - 4975,.5) was more suitable because it is easier to apply, has a higher predictive power (81.0%), less bias (1.86) and validation yielded average VAT values close to those found in DXA. It may still be considered a valuable tool for other extensive epidemiological studies in military men in the BA and can be used in adult men. Evidence Level I: Development of diagnostic criteria on consecutive patients (with universally applied reference ''gold'' standard).

RESUMO Introdução A literatura científica tem sugerido que o tecido adiposo visceral (TAV) está associado a doenças crônicas não transmissíveis, mas é difícil fazer sua mensuração. Assim, a antropometria pode ser empregada por ser de fácil aplicação na prática clínica. Objetivos Este estudo teve como objetivo desenvolver e validar equações de estimativa (Eq) do TAV em militares. Métodos A amostra consistiu em 409 (média de idade 36,5 ± 6,7 anos) militares do Exército Brasileiro (EB) divididos em Grupo equação (GE) (n = 270; média de idade 37,0 ± 6,3 anos) e Grupo validação (GV) (n = 139; média de idade 36,0 ± 7,2 anos). Foram realizadas avaliações antropométricas, hemodinâmicas e de composição corporal por DXA (GE iLunar). O teste t de Student, a correlação de Pearson e a regressão linear geral Stepwise foram aplicados. Os gráficos de Bland-Altman foram usados para avaliar a concordância entre os resultados de TAV pela Eq e por DXA. O nível de significância adotado foi de 95% (p <0,05). Resultados Idade, circunferência da cintura (CC), circunferência do quadril e o índice de massa corporal apresentaram as principais correlações positivas e significativas com TAV-DXA. Foram criadas quatro equações: Eq1 (r2 = 0,793), Eq2 (r2 = 0,810), Eq3 (r2 = 0,817) e Eq 4 (r2 = 0,823), p < 0,05. Não foram observadas diferenças entre o TAV por DXA pelas Eq (p = 0,982, p = 0,970, p = 0,495 e p = 0,698). A análise de Bland-Altman também apresentou boa concordância, porque o viés foi próximo de zero e não estatisticamente significativo. Conclusões A Eq2 (idade*13,0 + CC*60,0 - 4975,5) foi mais adequada, porque é mais fácil de aplicar, tem maior poder preditivo (81,0%), menor viés (1,86) e a validação forneceu valores médios de TAV próximos aos encontrados no DXA. Além disso, pode ser considerada uma ferramenta valiosa para outros estudos epidemiológicos extensos em militares do EB e pode ser usada em homens adultos. Nível de Evidência I; Teste de critérios diagnósticos desenvolvidos anteriormente em pacientes consecutivos (com padrão de referência "ouro" aplicado).

RESUMEN Introducción La literatura científica ha sugerido que el tejido adiposo visceral (TAV) está asociado a enfermedades crónicas no transmisibles, pero es difícil hacer su medición. Así, la antropometría puede ser empleada por ser de fácil aplicación en la práctica clínica. Objetivos Este estudio tuvo como objetivo desarrollar y validar ecuaciones de estimativa (Ec) del TAV en militares. Métodos La muestra consistió en 409 (promedio de edad 36,5 ± 6,7 años) militares del Ejército Brasileño (EB) divididos en Grupo de ecuación (GE) (n = 270; promedio de edad 37,0 ± 6,3 años) y Grupo validación (GV) (n = 139; promedio de edad 36,0 ± 7,2 años). Fueron realizados análisis antropométricos, hemodinámicos y de composición corporal por DXA (GE iLunar). Fueron aplicados el teste t de Student, la correlación de Pearson y la regresión linear general Stepwise. Los gráficos de Bland-Altman fueron usados para evaluar la concordancia entre los resultados de TAV por la Ec y por DXA. El nivel de significancia fue de 95% (p <0,05). Resultados Edad, circunferencia de cintura (CC), circunferencia de la cadera y el índice de masa corporal presentaron las principales correlaciones positivas y significativas con TAV-DXA. Fueron creadas cuatro ecuaciones: Ec1 (r2 = 0,793), Ec2 (r2 = 0,810), Ec3 (r2 = 0,817) y Ec4 (r2 = 0,823), p <0,05. No fueron observadas diferencias entre el TAV por DXA por las Ec (p = 0,982, p = 0,970, p = 0,495 y p = 0,698). El análisis de Bland-Altman también presentó buena concordancia, porque el sesgo fue próximo de cero y no estadísticamente significativo. Conclusiones La Ec2 (edad*13,0 + CC*60,0 - 4975.5) fue más adecuada, porque que es más fácil de aplicar, tiene mayor poder predictivo (81,0%), menor sesgo (1,86) y la validación suministró valores promedio de TAV próximos a los encontrados en el DXA. Además, puede ser considerada una herramienta valiosa para otros estudios epidemiológicos extensos en militares del EB y puede ser usada en hombres adultos. Nivel de Evidencia I: Test de criterios diagnósticos desarrollados anteriormente en pacientes consecutivos (con patrón de referencia "oro" aplicado).

Visceral obesity, skeletal muscle mass and resistin in metabolic syndrome development.

INTRODUCTION: Background: obesity implies an increase in the visceral adipose tissue (VAT), which is a risk factor for various metabolic diseases. VAT releases proinflammatory mediators, like resistin. In addition, it has been noted that the skeletal muscle mass (SMM) is involved in the development of metabolic syndrome (MS). Objective: this study was designed to determine the relationship of body components (VAT and SMM) with MS and resistin in patients with obesity. Methods: body composition and anthropometric and biochemical measurements to assess MS, and ELISA tests for resistin were carried out in 40 patients aged 18-40 years. Results: overweight and obesity were observed in 72% of patients; visceral obesity was found in 53% and 35% had MS. A positive correlation between VAT and SMM in patients with MS was detected. In the entire population, an increase of 1 kg of SMM was found to be associated with an increase of 3 cm2 of VAT, and an increase of 4 cm2 of VAT was observed in individuals with MS. According to resistin, people with increased VAT had higher concentration than persons with normal VAT. Furthermore, an increase of 1 cm2 of VAT accounted for a person entertaining a 3.3 fold greater risk of MS for different values of SMM and resistin. Conclusion: the transcendence and significance of VAT as a main factor in triggering the chronic inflammatory process and MS, the SMM and resistin were also related.

INTRODUCCIÓN: Introducción: la obesidad implica un aumento del tejido adiposo visceral (TAV), el cual es un factor de riesgo para varias enfermedades metabólicas. El VAT se relaciona con mediadores proinflamatorios, como la resistina. Además, se ha observado que la masa musculoesquelética (MME) interviene en el desarrollo del síndrome metabólico (SM). Objetivo: este estudio fue diseñado para determinar la relación de la composición corporal (TAV y MME) con el SM y la resistina en pacientes con obesidad. Métodos: se realizaron medidas antropométricas, de composición corporal y bioquímica para determinar el SM y prueba de ELISA para resistina en 40 pacientes de 18 a 40 años de edad. Resultados: se observó sobrepeso y obesidad en el 72% de los participantes, obesidad visceral en el 53% y el 35% presentó SM. Se detectó una correlación positiva entre el TAV y la MME en pacientes con SM. En el grupo de estudio encontramos que un aumento de un 1 kg de MME se asociaba con un incremento de 3 cm2 de TAV y en individuos con SM, con un incremento de 4 cm2 de TAV. En relación con la resistina, las personas con TAV incrementado presentan concentraciones más altas que las personas con TAV normal. Además, se observó que un aumento de 1 cm2 de TAV representa un riesgo 3,3 veces mayor que para las personas de padecer SM para diferentes valores de MME y de resistina. Conclusión: además de la trascendencia y la importancia del TAV como factor principal para desencadenar el proceso inflamatorio crónico y el SM, se observó que la MME y la resistina también están relacionadas.

Mecanismos inmunológicos involucrados en la obesidad / Immune mechanisms involved in obesity

La obesidad es un problema de salud pública creciente a nivel mundial. Se ha clasificado como una enfermedad ocasionada por acumulación excesiva de triglicéridos en el tejido adiposo (TA). El TA visceral (TAV), se considera un factor importante en el desarrollo de enfermedades crónicas no transmisibles. Esto principalmente porque el adipocito aumenta en tamaño y número, lo cual lleva a hipoxia, liberación de ácidos grasos, movilización y activación de subpoblaciones leucocitarias (linfocitos T, B, macrófagos, neutrófilos y eosinófilos), liberación de mediadores proinflamatorios (factor de necrosis tumoral- α (TNF-α), interleucina (IL)-6, resistina) y disminución en la secreción de antiinflamatorios (adiponectina, IL-10, IL-4 e IL-13). Estos cambios en el TAV generan un estado de inflamación crónica de baja intensidad, que se ha relacionado con resistencia a la insulina (RI). La RI es el signo fundamental para el desarrollo del Síndrome Metabólico (SM), que inicialmente se presenta localmente en el TAV y después se vuelve sistémica. En la investigación de la obesidad y el desarrollo de sus comorbilidades, la trascendencia del TAV en la interacción entre células adiposas e inmunitarias, así como de liberación de mediadores para desencadenar el proceso inflamatorio crónico, es clave para el desarrollo de RI y SM; sin embargo, se ha observado que la masa músculo-esquelética está implicada en este proceso, aparte de las células y mediadores de los que se sabe su participación. De esta manera a los linfocitos T CD4 y T CD8 se les señala como proinflamatorios, en cambio a los eosinófilos y a la adiponectina se les clasifica como protectores del proceso.

Obesity is a widespread public health problem worldwide. This disease has been classified as a condition caused by excessive accumulation of triglycerides in adipose tissue (TA). Visceral TA is an important factor in the development of several chronic diseases, since the adipocyte increases in size and number, leading to hypoxia, fatty acid release, mo-bilization and activation of leukocyte subpopulations (macrophages, neutrophils, eosinophils, NK cells, T lymphocytes and B); release of pro-inflammatory mediators (TNF-á, IL-6, PAI-1, resistin and visfatin), and decreased secretion of anti-inflammatory cytokines (adiponectin, IL-10, IL-4 and IL-13). These changes in TAV generate a chronic inflammation state of low inten-sity, that has been linked to insulin resistance (IR), initially local and then becomes systemic, which represents the determining factor for the development of metabolic syndrome (SM). The transcendence of TAV in the interaction between adipose and immune cells, as well as the release of mediators that trigger the chronic inflammatory process, is key for the development of IR and SM. However, in the investigation of obesity and the development of its comorbidities, it has been observed that the skeletal-muscle mass is involved in this process, apart from the cells and mediators of which their participation is known. In this way, TCD4 and TCD8 lymphocytes are recognized as pro-inflammatory. In contrast, eosinophils and adiponectin are considered as protective of the process.

The Ratio Between Visceral and Subcutaneous Abdominal Fat Assessed by Computed Tomography Is an Independent Predictor of Mortality and Cardiac Events.

INTRODUCTION AND OBJECTIVES: Obesity is an important cardiovascular risk factor and the location of fat deposits seems to be an important determinant of its metabolic impact. Visceral adipose tissue (VAT) exerts a harmful effect on metabolic homeostasis, but few longitudinal studies have evaluated the prognostic impact of the ratio of VAT to subcutaneous adipose tissue (SAT). This study aimed to evaluate whether the VAT/SAT ratio was associated with all-cause mortality and cardiac events. METHODS: Registry-based retrospective cohort study. Eligible patients consisted of those without known heart disease referred to cardiac computed tomography (CT) angiography to evaluate suspected coronary artery disease (CAD). We included all patients with available information on VAT and SAT areas and coronary artery calcium (CAC) score. We assessed the combined endpoint of all-cause mortality, myocardial infarction or revascularization procedure at least 1 month after cardiac CT. RESULTS: The final population consisted of 713 participants (61% male; mean age, 57.7±10.2 years) followed up for a median of 1.3 years. The combined endpoint occurred in 66 patients; these patients showed a higher VAT/SAT ratio (1.06±0.74 vs 0.80±0.52, P=.0001). The VAT/SAT ratio was an independent predictor of death and cardiac events (HR = 1.43; 95%CI, 1.03-1.99), irrespective of cardiovascular risk factors, CAC, and the presence of CAD. CONCLUSIONS: The ratio between abdominal VAT/SAT was an independent predictor of death and coronary events, irrespective of cardiovascular risk factors, CAC, and the presence of CAD. This ratio is a CT-derived metric that may help to better identify patients with increased risk of death or cardiac events.

Obesidad y enfermedad inflamatoria intestinal / Obesity and inflammatory bowel disease

Incidence of obesity is rising worldwide, Chile is no exception with obese patients representing up to one third of general population. This parallels with increasing prevalence of inflammatory bowel disease (IBD). Contrary to conventional belief, comorbidity is high (15-40%), where both diseases present with chronic inflammation and dysbiosis which alters intestinal barrier. Causality between obesity and IBD is difficult to stablish and evidence is scarce to determine association. Obesity would be a risk factor for IBD, particularly in Crohn´s Disease (CD), females and obesity at young age. Other than body mass index (BMI), visceral adipose tissue (VAT) has been recently determined as the best indicator of metabolic and endocrine consequences of obesity. Increasing values of VAT have been related to complicated IBD and worst prognosis. On IBD-related therapy, increasing BMI has been related to suboptimal doses and in biologic therapy, obesity raises the probability of flares, loss of response and therapy optimization. Obese patients require IBD-related surgery before non-obese patients and present more postoperative complications. Similarly, VAT is an independent risk factor for postoperative recurrence in CD. Altogether this evidence suggests that obesity does have an influence on IBD, therefore, multidisciplinary healthcare providers should prevent, educate and intervene actively in obesity in order to improve results in intestinal disease

La obesidad ha ido aumentando progresivamente a nivel mundial. Chile no es la excepción, donde un tercio de la población es obesa. Así mismo, la incidencia y prevalencia de la enfermedad inflamatoria intestinal (EII) también ha ido en aumento. La comorbilidad entre obesidad y EII es alta (15-40%) donde ambas presentan inflamación crónica y dentro de su patogenia tienen en común la disbiosis, que altera la función de barrera intestinal. Establecer una asociación de causalidad es difícil y la evidencia es escasa en relación a su asociación. La obesidad puede ser considerada como factor de riesgo para EII, particularmente en pacientes con Enfermedad de Crohn (EC), mujeres y obesidad temprana. Además, se ha establecido que el tejido adiposo visceral (TAV) es mejor indicador de las consecuencias metabólicas de la obesidad en comparación al índice de masa corporal (IMC) y se ha asociado a EII más complicada y peor evolución natural. Con respecto a la terapia, los pacientes con mayor IMC tienen con mayor frecuencia, dosis subóptima de los fármacos, y en terapia biológica, la obesidad aumenta la probabilidad de crisis, pérdida de respuesta al fármaco u optimización de la terapia. Los pacientes obesos requieren cirugía relacionada a EII antes que los pacientes no obesos, presentan más complicaciones postoperatorias y el TAV es un factor de riesgo independiente para recurrencia postoperatoria en EC. Todos estos resultados sugieren que la obesidad influye en la EII, por lo que una intervención activa y multidisciplinaria pudiese mejorar también los resultados en la enfermedad intestinal.

El sobrepeso y la obesidad como un problema de salud / Overweight and obesity as an universal health problem

Se destaca al sobrepeso y obesidad como el principal condicionante actual de patología crónica no transmisible. Se identifican y discuten las principales comorbilidades asociadas al sobrepeso y obesidad, analizando las evidencias que las apoyan. Se destaca el rol de la adiposidad en la etiopatogenia del síndrome metabólico y en forma muy especial de la DM. Se analiza la asociación entre indicadores de masa corporal y tejido adiposo y tasas de mortalidad, destacando un significativo incremento de la mortalidad a medida que la masa corporal o grasa se incrementa. Se destacan los rangos asociados a la menor mortalidad, nadires que fundamentan los rangos de peso normal. Se discute en forma separada la asociación entre sobrepeso yobesidad en la infancia y adolescencia y salud, en especial su posible rol en la incidencia de patologías crónicas al alcanzar la adultez.

The article highlights overweight and obesity as the main factor in some current chronic diseases. Also it identifies and discusses major co-morbidities associated with overweight and obesity, analyzing the evidence that support them. The role of adiposity in the pathogenesis of metabolic syndrome especially in the development of mellitus diabetes 2 is discussed. We analyze the association between indicators of body mass and adipose tissue and mortality, highlighting a significant increase in mortality as the fat body mass increases and shows the range associated with lower mortality, basing the normal weight ranges. Will be discussing separately the association between overweight and obesity in childhood and adolescence health, especially its possible role in the incidence of chronic diseases that will develop at adulthood.

Medición volumétrica de grasa visceral abdominal con RM y su relación con elastografía hepática en una población diabética / Volumetric measurement of abdominal visceral fat by MRI and its relation to transient elastography in a diabetic population

Background. Increase in visceral fat is associated to the development of fatty liver and liver fibrosis. Hepatic elastography is a novel noninvasive method for assessing liver fibrosis. Objective. To evaluate the relationship between visceral adipose tissue volume (VAT), subcutaneous adipose tissue volume (SAT) as measured by Magnetic Resonance Imaging (MRI) and transient elastography (TrE) values using ARFI (Acoustic Radiation Force Impulse) in type 2 Diabetic Mellitus patients (DM2). Methods. We included 20 DM2 patients (mean age: 62 years, range: 55-75, mean weight: 77.8 kg, range: 61.5-97). Patients underwent an MRI study in a Philips Intera 1.5T scanner. MR imaging protocol included a spectral excitation sequence centered on the fat peak. The sequence included 32 cross sections, 7mm thick, from the diaphragmatic cupula to the inferior border of the kidney. VAT was measured by using the semiautomatic Image J software. Each patient underwent a hepatic elastograpy (HE); 10 ARFI measurements were performed in the right hepatic lobe. Finally, a statistical analysis was performed by applying Pearson correlation between abdominal fat volumes and ARFI scores Results. Mean VAT was 2472 +/- 861 cc, (1173-4020 cc), whilst the mean ARFI was 1.62 ± 0.8 m/s, (0.8-3.4 m/s). Correlations obtained were r=0.08 between VAT and ARFI (p=0.72); 0.13 between SAT and ARFI (p=0.57), and -0.06 between (VAT+SAT) and ARFI (p=0.77). By subdividing the sample universe, we observed that the group with ARFI scores greater than 1.6 m/s (7 patients) had a correlation of 0.63 between VAT and ARFI (p=0.12); of 0.66 between SAT and ARFI (p=0.10), and of 0.94 between VAT+SAT and ARFI (p=0.001). In the subgroup with ARFI values inferior to 1.6 m/s (13 patients), the correlation was of 0.11 between VAT and ARFI (p=0.71); of 0.26 between SAT and ARFI (p=0.38), and of 0.32 between ( VAT+SAT) and ARFI (p=0.28). When adjusted for gender, ARFI scores greater than.

Introducción. La acumulación de grasa visceral se asocia al desarrollo de enfermedad hepática. La elastografía hepática es un método novedoso no invasivo para evaluar fibrosis hepática. Objetivo. Evaluar la relación entre el volumen de tejido adiposo visceral (VAT), volumen de tejido adiposo subcutáneo (SAT) medido por resonancia magnética (RM), con índices de elastografía hepática (EH) utilizando ARFI (fuerza de impulso de radiación acústica) en pacientes con Diabetes Mellitus tipo 2 (DM2). Métodos. Fueron incluidos 20 pacientes (edad promedio: 62 años, rango: 55-75 años, peso promedio: 77,8 kg, rango: 61,5-97 kg) con DM2. Los pacientes se sometieron a un examen de RM en un resonador Philips Intera 1.5T. Al protocolo de RM se agregó una secuencia de excitación espectral centrada en el peak de grasa. La secuencia incluyó 32 cortes transversales, grosor 7mm, desde la cúpula diafragmática hasta el borde inferior renal. En las imágenes se midió VAT utilizando el software Image J (freeware). En cada paciente se realizó una EH, utilizando ARFI con 10 medidas en lóbulo hepático derecho. Finalmente, se realizó un análisis estadístico a través de la correlación de Pearson entre los volúmenes de grasa abdominal y ARFI. Resultados. El promedio de VAT fue 2472 +/- 861 cc, (1173-4020 cc), el promedio de ARFI fue 1,62 ± 0,8 m/s, (0,8-3,4 m/s). Se obtuvieron correlaciones de r=-0,08 entre VAT y ARFI (p=0,72), de 0,13 entre SAT y ARFI (p=0,57), y de -0,06 entre (VAT+SAT) con ARFI (p=0,77). Subdividiendo el universo muestral, se encontró que el grupo con ARFI mayor que 1,6 m/s (7 pacientes) obtuvo una correlación de 0,63 entre VAT y ARFI (p=0,12), de 0,66 entre SAT y ARFI (p=0,10), y de 0,94 entre (VAT+SAT) con ARFI (p=0,001). En el subgrupo con ARFI inferior a 1,6 m/s (13 pacientes) la correlación fue 0,11 entre VAT y ARFI (p=0,71), de 0,26 entre SAT y ARFI (p=0,38), y de 0,32 entre (VAT+SAT) y ARFI (p=0,28).