Definition, criteria, and core concepts of guidelines for the management of obesity disease in Japan.

To identify those who might benefit from weight reduction within a large population of obese individuals, Japan Society for the Study of Obesity (JASSO) advocated the concept of "obesity disease." Here we summarize the definition, criteria, and core concepts for the management of obesity disease based on JASSO's latest guideline. JASSO defines obesity as excessive fat storage in adipose tissue associated with a BMI of ≥25 kg/m2. The threshold BMI of obesity is low as compared to Western countries given that Japanese individuals tend to develop obesity-related health disorders at lower BMI. Obesity with a BMI of ≥35 kg/m2 is referred to as "high-degree obesity" as treatment strategies vary based on the degree of obesity. Obesity is diagnosed as "obesity disease" if accompanied by any of the 11 specific obesity-related health disorders that weight reduction can prevent or alleviate, or if it meets the criteria for visceral fat obesity with a visceral fat area of ≥100 cm2. The initial weight reduction goals for high-degree obesity disease range from 5% to 10% of their current body weight, depending on the associated health disorders. That for those with obesity disease who do not qualify as high-degree is 3% or more. If these initial goals are not achieved, intensifying dietary therapy or introducing drug therapy (or both) may be necessary. While surgical treatment is primarily indicated for high-degree obesity disease, it might be appropriate for cases of obesity disease with a BMI <35 kg/m2, depending on the accompanying health disorders. Enhancing the quality of life for individuals with obesity or obesity disease necessitates a broader societal approach, emphasizing the resolution of related stigma.

Association between the lean nonalcoholic fatty liver disease and risk of incident type 2 diabetes in a healthy population of Northwest China: a retrospective cohort study with a 2-year follow-up period.

Aims: We aimed to explore the metabolic features of lean nonalcoholic fatty liver disease (Lean-NAFLD) and its association with the risk of incident type 2 diabetes in young and middle-aged people. Methods: We conducted a retrospective cohort study of 3001 participants who were enrolled in a health check-up program from January 2018 to December 2020 in the Health Management Center of Karamay People's Hospital. The age, sex, height, weight, body mass index (BMI), blood pressure, waist circumference (WC), fasting plasma glucose (FPG), lipid profiles, serum uric acid and alanine aminotransferase (ALT) of the subjects were collected. The cutoff point of BMI for lean nonalcoholic fatty liver disease is <25 kg/m2. A COX proportional hazard regression model was used to analyze the risk ratio of lean nonalcoholic fatty liver disease to type 2 diabetes mellitus. Results: Lean NAFLD participants had many metabolic abnormalities, such as overweight and obesity with nonalcoholic fatty liver disease. Compared with lean participants without nonalcoholic fatty liver disease, the fully adjusted hazard ratio (HR) for lean participants with nonalcoholic fatty liver disease was 3.83 (95% CI 2.02-7.24, p<0.01). In the normal waist circumference group (man<90cm, woman<80 cm), compared with lean participants without NAFLD, the adjusted hazard ratios (HRs) of incident type 2 diabetes for lean participants with NAFLD and overweight or obese participants with NAFLD were 1.93 (95% CI 0.70-5.35, p>0.05) and 4.20 (95% CI 1.44-12.22, p<0.05), respectively. For excess waist circumference (man≥90 cm, woman ≥80 cm) compared with lean participants without NAFLD, the adjusted hazard ratios (HRs) of incident type 2 diabetes for lean participants with NAFLD and overweight or obese participants with NAFLD were 3.88 (95% CI 1.56-9.66, p<0.05) and 3.30 (95% CI 1.52-7.14, p<0.05), respectively. Conclusion: Abdominal obesity is the strongest risk factor for type 2 diabetes in lean nonalcoholic fatty liver disease.

["Koshi-heso" (waist-umbilicus) test: A novel screening method for visceral fatty obesity].

OBJECTIVE: To evaluate the screening performance and validity of the "Koshi-heso" (waist-umbilicus) test for visceral fatty obesity in elderly diabetic patients. METHODS: Subjects were diabetic patients ≥65 years old visiting our outpatient clinic. As a "Koshi-heso" test, the distance between the umbilicus and the superior border of the iliac crest (waist) was measured with the patient's own finger. When the index finger reached the umbilicus and there was a gap between the finger and the abdominal wall, the patient was classified as "smaller"; when the index finger reached the umbilicus and there was no gap between the finger and the abdominal wall, the patient was classified as "just fit"; and when the index finger did not reach the umbilicus, the patient was classified as "bigger". Abdominal circumference was used to assess visceral fat obesity, with a cut-off value of ≥85 cm for men and ≥90 cm for women. Visceral fat mass and body fat percentage were evaluated by the multi-frequency bioelectrical impedance method. The sensitivity and specificity of the waist-umbilical test for visceral fat obesity were calculated. Pearson's correlation coefficients between the "Koshi-heso" test and visceral fat mass and body fat percentage were calculated to evaluate the validity of the test. Furthermore, the association between the "Koshi-heso" test and risk factors for vascular disease, microvascular complications and cardiovascular disease was assessed by a logistic analysis. RESULTS: A total of 221 patients were included in the analysis population of the study. The cut-off values of "just fit" in men (sensitivity 0.96, specificity 0.62) and "bigger" in women (sensitivity 0.76, specificity 0.78) were optimal. Furthermore, the "Koshi-heso" test was significantly correlated with abdominal visceral fat mass and body fat percentage as well as with vascular disease risk factors and microvascular complications. CONCLUSION: The "Koshi-heso" test was able to be used as a screening method for visceral fatty obesity in elderly diabetic patients.

Visceral Fat Obesity Correlates with Frailty in Middle-Aged and Older Adults.

Background: Frailty and obesity are associated with poor outcomes in older adults. Previous studies have shown that excessive visceral fat leads to frailty by promoting inflammation. However, the association between visceral fat obesity (VFO) and frailty has not been elucidated. We aimed to investigate the correlation between VFO and frailty in middle-aged and older adults. Methods: A total of 483 adults aged ≥45 years were recruited. Estimated visceral fat area (eVFA) and total fat (TF) were determined by bioimpedance analysis. Waist circumference, body mass index (BMI), and waist-to-hip ratio (WHR) were recorded. Frailty was assessed using the Fried frailty phenotype. Logistic regression analysis was used to analyze the association between frailty and other variables. Spearman correlation coefficients were calculated to assess the correlations between the frailty phenotype score, eVFA/TF, and other factors. Results: Frail adults were older and had higher waist circumference, eVFA metabolic indicators, and coronary artery disease incidence. Participants with frailty had a higher prevalence of VFO than those without. After adjusting for age, sex, and chronic diseases, frailty was associated with eVFA but not waist circumference, WHR, or BMI. Spearman correlation analysis showed that the frailty phenotype score was positively associated with eVFA and BMI in women but not men. After adjusting for age, frailty was not associated with BMI or WHR. The eVFA/TF ratio was negatively correlated with grip strength and walking speed and positively correlated with the clinical frailty scale score in middle-aged and older adults. Conclusion: Middle-aged and older adults with VFO had a higher risk of frailty. Frailty was associated with a higher eVFA but not with BMI or WHR. The frailty score was positively associated with eVFA and BMI in women, but not in men. A higher eVFA was correlated with worse physical function, even after adjusting for TF.

Visceral fat obesity is the key risk factor for the development of reflux erosive esophagitis in 40-69-years subjects.

BACKGROUND: Visceral fat obesity can be defined quantitatively by abdominal computed tomography, however, the usefulness of measuring visceral fat area to assess the etiology of gastrointestinal reflux disease has not been fully elucidated. METHODS: A total of 433 healthy subjects aged 40-69 years (234 men, 199 women) were included in the study. The relationship between obesity-related factors (total fat area, visceral fat area, subcutaneous fat area, waist circumference, and body mass index) and the incidence of reflux erosive esophagitis was investigated. Lifestyle factors and stomach conditions relevant to the onset of erosive esophagitis were also analyzed. RESULTS: The prevalence of reflux erosive esophagitis was 27.2% (118/433; 106 men, 12 women). Visceral fat area was higher in subjects with erosive esophagitis than in those without (116.6 cm2 vs. 64.9 cm2, respectively). The incidence of erosive esophagitis was higher in subjects with visceral fat obesity (visceral fat area ≥ 100 cm2) than in those without (61.2% vs. 12.8%, respectively). Visceral fat obesity had the highest odds ratio (OR) among obesity-related factors. Multivariate analysis showed that visceral fat area was associated with the incidence of erosive esophagitis (OR = 2.18), indicating that it is an independent risk factor for erosive esophagitis. In addition, daily alcohol intake (OR = 1.54), gastric atrophy open type (OR = 0.29), and never-smoking history (OR = 0.49) were also independently associated with the development of erosive esophagitis. CONCLUSIONS: Visceral fat obesity is the key risk factor for the development of reflux erosive esophagitis in subjects aged 40-69 years.

Inverse relationship between serum Metrnl levels and visceral fat obesity (VFO) in patients with type 2 diabetes.

AIM: The relationship between serum Metrnl levels and visceral fat obesity (VFO) remains unclear. This study aimed to investigate the association between serum Metrnl levels and VFO in Chinese patients with type 2 diabetes. METHODS: A total of 321 Chinese patients with type 2 diabetes (226 men and 95 postmenopausal women aged 61.4 ± 6.5 years, BMI 25.1 ± 3.2 kg/m2) were evaluated. Serum Metrnl levels were measured by enzyme linked-immunosorbent assay. Visceral fat area (VFA) was quantified via Dual Energy X-ray Absorptiometry (DXA). Correlation analyses were carried out for serum Metrnl levels and VFO. RESULTS: VFO groups (VFA ≧100 cm2) have lower serum Metrnl levels than non-VFO groups (VFA < 100 cm2) (578.9 ± 225.1 vs. 684.9 ± 263.8, P = 0.001). An increasing trend in serum Metrnl levels was found to accompany the decrease in VFA. Serum Metrnl levels were negatively correlated with VFA, total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C) and albumin (ALB), but positively correlated with age, height, blood urea nitrogen (BUN), creatinine (Cr) and uric acid (UA) (all P < 0.05). Binary logistic regression analysis showed that serum Metrnl was inversely associated with VFO even after adjusted age, gender, height, TC, TG, LDL-C, ALB, BUN, Cr, and UA (odds ration [OR], 0.846; confidence interval [CI], 0.745-0.961; P = 0.010). The optimal cut-off value of serum Metrnl levels that predicted VFO was 671.3 ng/ml (95%CI = 0.55-0.70, P = 0.001). CONCLUSIONS: Serum Metrnl levels were inversely correlated with VFO and may be a useful indicator of VFO in Chinese patients with type 2 diabetes.

Impaired Secretion of Glucagon-Like Peptide 1 in Patients with Colorectal Adenoma after an Oral Glucose Load.

BACKGROUND/AIMS: Obesity and insulin resistance are associated with an increased risk of colorectal adenoma (CRA). Glucagon-like peptide-1 (GLP-1) plays an important role in glucose homeostasis through its amplification of insulin secretion in response to oral nutrients; however, its role in human CRA remains unknown. We investigated oral glucose-mediated GLP-1 secretion in patients with adenoma. METHODS: We performed a case-control study of 15 nondiabetic patients with pathologically diagnosed CRA and 10 age-matched healthy controls without adenoma. Plasma concentrations of active GLP-1 were measured during a 75 g oral glucose tolerance test. RESULTS: Mean waist circumference (WC), homeostasis model assessment of insulin resistance (HOMA-IR) values, the total areas under the curve (AUC) of glucose and insulin were significantly higher in patients with CRA than in controls. The total AUC of GLP-1 (p = 0.01) was lower in patients with CRA than in controls. Moreover, the total AUC of GLP-1 showed a negative correlation with WC, total AUC of glucose, and HOMA-IR. Multiple linear regression analyses revealed that the total AUC of GLP-1 was independently correlated with the number and maximum size of CRAs. CONCLUSION: GLP-1 could actively participate in the development of CRA in humans, particularly in patients with metabolic syndrome.

Role of vitamin D in the development of obesity / Rol de la vitamina D en el desarrollo de la obesidad

SUMMARY: Antecedents in the literature suggest that vitamin D (VD) play a role in overweigh/obesity. The present study evaluated the effect of VD deficiency diet intake and fat hight on overweight/obesity about white adipose tissue (WAT) and body mass (BM) gain. Animals were divided into four experimental groups according to the lipid and VD content of their diets; G1: CVD+ (C: control diet with VD+; n=5), G2: CVD- (control diet without VD-; n=5), G3: HFVD+ (high fat diet, with VD+; n=5), G4: HFVD- (HF diet without VD-; n=5). The diets were administered for three months and BW was monitored weekly. At the end of this period all animals were euthanized. Epididymal (EFM), retroperitoneal (RFM) and subcutaneous (SFM) fat mass were removed, weighted. At 12 weeks the body mass of the animals that were fed without VD- diets; G2: 507.60±17.31 g, and G4: 528.50±13.50 g were significantly higher (p < 0.05), than the counterparts G1: 485.0±11.29 g and G3: 521.20±26.20 g respectively. Similarly, the animals fed with VDdiets had a greater EFM and SFM (p < 0.05) compared with the respective controls (VD+). Nevertheless, the animals fed with high fat diet had equal RFM (G3: 12.2±4.10 g, G4: 12.88±2.3 g, p > 0.05). The results demonstrate that the nutrition of rats with diet deficient in VD and high fat, promotes overweight by increasing fat deposits, suggestion a cause-effect relationship between VD deficiency and overweight. These results suggest that VD deficiency increases the risk of visceral fat obesity in males.

RESUMEN: Los antecedentes de la literatura sugieren una relación entre la vitamina D (VD) y el sobrepeso/obesidad, sin embargo, causalidad de la relación no está clara. El presente estudio evaluó el efecto de la ingesta dietética deficiente de VD y alta en grasa sobre el tejido adiposo (TA) y la masa corporal (MC). Los animales se dividieron en cuatro grupos experimentales de acuerdo con el contenido de VD y lípido en la dieta; G1: CVD+ (C: dieta control con VD+; n = 5), G2: CVD- (dieta control sin VD-; n = 5), G3: HFVD+ (dieta alta en grasa, con VD+; n = 5), G4: HFVD- (dieta HF sin VD-; n = 5). Las dietas se administraron durante tres meses y MC se controló semanalmente. Al final de este período, los animales fueron sacrificados. La masa grasa epididimaria (MGE), subcutánea abdominal (MGS) y retroperitoneal (MGR) fueron diseccionadas y pesadas individualmente. A las 12 semanas, la MC de los animales alimentados con dietas sin VD-; G2: 507,60 ± 17,31 g, y G4: 528,50 ± 13,50 g fue significativamente mayor (p < 0,05), que sus homólogos G1: 485,0 ± 11,29 g y G3: 521,20 ± 26,20 g respectivamente. De forma similar, los G2 y G4 tuvieron una mayor MGE y MGS (p < 0,05) en comparación con los controles respectivos (VD+). Sin embargo, los animales alimentados con dieta alta en grasas tuvieron igual MGR (G3: 12,2 ± 4,10 g; G4: 12,88 ± 2,3 g, p > 0,05). Los resultados demuestran que la nutrición de ratas con dieta deficiente en VD y alta en grasa, promueve el sobrepeso/obesidad al exacerbar la ganancia de masa grasa en los diferentes depósitos de grasa, sugiriendo una relación causa-efecto entre la deficiencia de VD y el sobrepeso/obesidad. Estos resultados sugieren que la deficiencia de VD aumenta el riesgo de obesidad de grasa visceral en machos.

Fruit vinegars attenuate cardiac injury via anti-inflammatory and anti-adiposity actions in high-fat diet-induced obese rats.

CONTEXT: Fruit vinegars (FVs) are used in Mediterranean folk medicine for their hypolipidemic and weight-reducing properties. OBJECTIVE: To investigate the preventive effects of three types of FV, commonly available in Algeria, namely prickly pear [Opuntia ficus-indica (L.) Mill (Cectaceae)], pomegranate [Punica granatum L. (Punicaceae)], and apple [Malus domestica Borkh. (Rosaceae)], against obesity-induced cardiomyopathy and its underlying mechanisms. MATERIALS AND METHODS: Seventy-two male Wistar rats were equally divided into 12 groups. The first group served as normal control (distilled water, 7 mL/kg bw), and the remaining groups were respectively treated with distilled water (7 mL/kg bw), acetic acid (0.5% w/v, 7 mL/kg bw) and vinegars of pomegranate, apple or prickly pear (at doses of 3.5, 7 and 14 mL/kg bw, acetic acid content as mentioned above) along with a high-fat diet (HFD). The effects of the oral administration of FV for 18 weeks on the body and visceral adipose tissue (VAT) weights, plasma inflammatory and cardiac enzymes biomarkers, and in heart tissue were evaluated. RESULTS: Vinegars treatments significantly (p < .05) attenuated the HFD-induced increase in bw (0.2-0.5-fold) and VAT mass (0.7-1.8-fold), as well as increase in plasma levels of CRP (0.1-0.3-fold), fibrinogen (0.2-0.3-fold), leptin (1.7-3.7-fold), TNF-α (0.1-0.6-fold), AST (0.9-1.4-fold), CK-MB (0.3-1.4-fold) and LDH (2.7-6.7-fold). Moreover, vinegar treatments preserved myocardial architecture and attenuated cardiac fibrosis. DISCUSSION AND CONCLUSION: These findings suggest that pomegranate, apple and prickly pear vinegars may prevent HFD-induced obesity and obesity-related cardiac complications, and that this prevention may result from the potent anti-inflammatory and anti-adiposity properties of these vinegars.

Higher visceral fat area increases the risk of vitamin D insufficiency and deficiency in Chinese adults.

BACKGROUND: Visceral fat area (VFA), a novel sex-specific index for visceral fat obesity (VFO) might play a major role in the development of vitamin D deficiency. However, the association between VFA and vitamin D insufficiency and deficiency in Chinese population is less clear. The aim of this study was to explore the population-level association between VFA and vitamin D insufficiency and deficiency among Chinese men and women. METHODS: This cross-sectional study involved 1105 adults aged 20-70 years living in Tianjin who were randomly selected and medically examined. All subjects underwent the bioelectrical impedance analysis (BIA) method to estimate the VFA. Serum 25-hydroxyvitamin D3 (25(OH) D3) level was assayed by the high-performance liquid chromatography (HPLC) method and defined insufficiency and deficiency following recommended cutoffs. The association between VFA and vitamin D insufficiency and deficiency was estimated using binary regression analysis. RESULTS: The total prevalence of vitamin D insufficiency (25(OH) D3: 20-29 µg/L) and deficiency (25(OH) D3 < 20 µg/L) were 26.60 % and 24.89 %, respectively. Significant negative association was observed for VFA with serum 25(OH) D3 levels in men and pre-menopausal women (P < 0.05), not in post-menopausal women (P > 0.05). Moreover, increased VFA was observed to be associated with higher vitamin D insufficiency or deficiency risk with a positive dose-response trend (P for trend < 0.001). As compared to individuals with the lowest VFA, those who had the highest VFA were at 4.9-fold risk of vitamin D insufficiency and deficiency [95 % confidence interval (95 % CI): 1.792-13.365] in men and 1.8-fold risk of vitamin D insufficiency and deficiency (95 % CI: 1.051-3.210) in pre-menopausal women, but not in post-menopausal women [odds ratio (OR) (95 % CI): 2.326(0.903-5.991)]. CONCLUSIONS: These results suggest that higher VFA increases the risk of vitamin D insufficiency and deficiency in men and pre-menopausal women, but not in post-menopausal women. VFA is a better and convenience surrogate marker for visceral adipose measurement and could be used in identifying the risk of vitamin D insufficiency and deficiency in routine health examination.

The Correlation Between Signs of Kampo Medicine and Visceral Fat Obesity / 日本東洋医学雑誌

Visceral fat obesity is closely associated with lifestyle-related diseases that include symptoms such as hypertension, diabetes mellitus, hyperlipidemia, etc. To examine the correlation between pulse, appearance of tongue, and abdominal palpation-diagnostic indicators according to Kampo medicine-and visceral fat obesity, we investigated 209 subjects who received health screenings, and obtained the following results. 1) The simply obese subjects, as determined by body mass index, showed symptoms of excess state, Kidepression, and stasis of body fluids according to the diagnostic techniques of Kampo medicine. 2) The visceral fat-rich subjects were diagnosed by means of abdominal ultrasonography and showed symptoms of pulsus maximum and Oketsu (blood stasis) state.

Effects of Boui-Ougi-To Treatment on Visceral Fat Obesity in Patients with Diabetes Mellitus / 日本東洋医学雑誌

Nineteen non-insulin dependent diabetes mellitus (NIDDM) patients with obesity were divided into two groups, and a group of eight patients who could try exercise was treated with walking over 160 Calories per day, and a group of eleven patients who could not try exercise was treated with Boui-ougi-to, for six months. Although exercise is known as the treatment of visceral fat obesity, no significant improvement was observed in body mass index, visceral fat/ somatic fat (V/S) ratio, blood sugar, serum cholesterol level in the patient group with exercise, whereas in the patient group treated with Boui-ougi-to, serum cholesterol significantly decreased from 197±31mg/dl to 180±19mg/dl (p<0.01), and V/S ratio improved significantly from 0.84±0.56 to 0.64±0.30 (p<0.05). These observations suggest that treatment with Boui-ougi-to is effective for visceral fat obesity and has potential for the prevention of atherosclerosis.