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Li X, Ren H, Xu H, Han X, Lu J, Yang Z. Behind BMI: The Potential Indicative Role of Abdominal Ectopic Fat on Glucose Metabolism. Obes Facts 2024; 17:158-168. [PMID: 38246158 PMCID: PMC10987183 DOI: 10.1159/000536160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 01/04/2024] [Indexed: 01/23/2024] Open
Abstract
INTRODUCTION The purpose of this study was to compare the difference in abdominal fat distribution between different metabolic groups and find the ectopic fat with the most risk significance. METHODS A total of 98 subjects were enrolled; there were 53 cases in the normal glucose metabolism group and 45 cases in the abnormal glucose metabolism group. Chemical shift-encoded magnetic resonance imaging was applied for quantification of pancreatic fat fraction (PFF) and hepatic fat fraction (HFF), subcutaneous adipose tissue (SAT), and visceral adipose tissue (VAT). The correlation and the difference of fat distribution between different metabolism groups were analyzed. The receiver operating characteristic (ROC) curve was used to analyze the suggestive effect of different body fat fraction. RESULTS Correlation analysis showed that body mass index (BMI) had the strongest correlation with fasting insulin (r = 0.473, p < 0.001), HOMA-IR (r = 0.363, p < 0.001), and C-reactive protein (r = 0.245, p < 0.05). Pancreatic fat has a good correlation with fasting blood glucose (r = 0.247, p < 0.05) and HbA1c (r = 0.363, p < 0.001). With the increase of BMI, PFF, VAT, and SAT showed a clear upward trend, but liver fat was distributed relatively more randomly. The pancreatic fat content in the abnormal glucose metabolism group is significantly higher than that in the normal group, and pancreatic fat is also a reliable indicator of abnormal glucose metabolism, especially in the normal and overweight groups (the area under the curve was 0.859 and 0.864, respectively). CONCLUSION MR-based fat quantification techniques can provide additional information on fat distribution. There are differences in fat distribution among people with different metabolic status. People with more severe pancreatic fat deposition have a higher risk of glucose metabolism disorders.
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Affiliation(s)
- Xiaoyang Li
- Beijing Friendship Hospital, Capital Medical University, Beijing, China,
| | - Hao Ren
- Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Hui Xu
- Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xinjun Han
- Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jun Lu
- Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zhenghan Yang
- Beijing Friendship Hospital, Capital Medical University, Beijing, China
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Xu Z, Yang D, Luo J, Xu H, Jia J, Yang Z. Diagnosis of Sarcopenia Using the L3 Skeletal Muscle Index Estimated From the L1 Skeletal Muscle Index on MR Images in Patients With Cirrhosis. J Magn Reson Imaging 2023; 58:1569-1578. [PMID: 36932680 DOI: 10.1002/jmri.28690] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 03/07/2023] [Accepted: 03/08/2023] [Indexed: 03/19/2023] Open
Abstract
BACKGROUND Cirrhotic patients with sarcopenia have poor prognoses and higher mortality. The third lumbar vertebra (L3) skeletal muscle index (SMI) is widely used to assess sarcopenia. However, L3 is generally outside the scanning volume on standard liver MRI. PURPOSE To investigate SMIs change between slices in cirrhotic patients and the relationships between SMI at the 12th thoracic vertebra (T12), the first lumbar vertebra (L1) and the second lumbar vertebra (L2) levels and L3-SMI and assess the accuracy of the estimated L3-SMIs in diagnosing sarcopenia. STUDY TYPE Prospective. SUBJECTS A total of 155 cirrhotic patients (109 with sarcopenia, 67 male; 46 without sarcopenia, 18 male). FIELD STRENGTH/SEQUENCE A 3.0 T, 3D dual-echo T1-weighted gradient echo sequence (T1WI). ASSESSMENT Two observers analyzed T12 to L3 skeletal muscle area (SMA) in each patient based on T1W water images and calculated the SMI (SMA/height2 ). Reference standard was L3-SMI. STATISTICAL TESTS Intraclass correlation coefficient (ICC), Pearson correlation coefficients (r), and Bland-Altman plots. Models relating L3-SMI to the SMI at T12, L1, and L2 levels were constructed using 10-fold cross-validation. Accuracy, sensitivity, and specificity were calculated for the estimated L3-SMIs for diagnosing sarcopenia. P < 0.05 was considered statistically significant. RESULTS Intraobserver and interobserver ICCs were 0.998-0.999. The L3-SMA/L3-SMI were correlated with the T12 to L2 SMA/SMI (r = 0.852-0.977). T12-L2 models had mean-adjusted R2 values of 0.75-0.95. The estimated L3-SMI from T12 to L2 levels to diagnose sarcopenia had good accuracy (81.4%-95.3%), sensitivity (88.1%-97.0%), and specificity (71.4%-92.9%). The recommended L1-SMI threshold of 43.24 cm2 /m2 in males and 33.73 cm2 /m2 in females. DATA CONCLUSION The estimated L3-SMI from T12, L1 and L2 levels had good diagnostic accuracy in assessing sarcopenia in cirrhotic patients. Although L2 was best associated with L3-SMI, L2 is generally not included in standard liver MRI. L3-SMI estimate from L1 may therefore be most clinically applicable. EVIDENCE LEVEL 1. TECHNICAL EFFICACY Stage 2.
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Affiliation(s)
- Zhengyu Xu
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- Department of Medical Technology, Shaanxi University of Chinese Medicine, Middle section of Century Avenue, Xianyang, Shaanxi, China
| | - Dawei Yang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jia Luo
- Department of Geriatrics, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Hui Xu
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jidong Jia
- Beijing Key Laboratory of Translational Medicine On Liver Cirrhosis, Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Zhenghan Yang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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Wang L, Pan Y, Ye X, Zhu Y, Lian Y, Zhang H, Xu M, Liu M, Ruan X. Perirenal fat thickness and liver fat fraction are independent predictors of MetS in adults with overweight and obesity suspected with NAFLD: a retrospective study. Diabetol Metab Syndr 2023; 15:56. [PMID: 36949492 PMCID: PMC10035216 DOI: 10.1186/s13098-023-01033-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 03/15/2023] [Indexed: 03/24/2023] Open
Abstract
BACKGROUND Nonalcoholic fatty liver disease (NAFLD) has a multidirectional relationship with metabolic syndrome (MetS) and used to be considered a hepatic manifestation of MetS. Perirenal fat, as a part of visceral adipose tissue (VAT), was reported to be correlated with MetS components, but data for intraorgan fat are lacking. This study was undertaken to assess the value of peripheral and intraorgan fat to predict MetS in adults with overweight and obesity with suspected NAFLD. METHODS We studied 134 sequential adults (mean age, 31.5 years; 47% female) with overweight and obesity with suspected NAFLD. All participants underwent abdominal magnetic resonance imaging (MRI) examination. Anthropometric and metabolic parameters and perirenal fat thickness (PRFT), subcutaneous adipose tissue thickness (SATT), liver fat fraction (LFF), pancreas fat fraction (PFF), and lumbar spine fat fraction (LSFF) were collected. MetS was defined according to the International Diabetes Federation (IDF) criteria. Statistical analyses included basic statistics, linear correlation and logistic regression analysis. RESULTS A total of 63 adults with MetS and 71 adults with advanced liver steatosis (grades 2 and 3) were included in our study. Patients with MetS had greater PRFT (p = 0.026) and LFF (p < 0.001), as well as greater homeostasis model assessment of insulin resistance (HOMA-IR), alanine transaminase (ALT), aspartate transaminase (AST), and decreased SATT. MetS patients had a higher proportion of advanced steatosis than those without MetS (P < 0.001). The MetS score was associated with PRFT and LFF. Logistic regression analysis showed that the PRFT and LFF were independent predictors of MetS after adjusting for age and sex. A cutoff of 9.15 mm for PRFT and 14.68% for LFF could be predictive of MetS. CONCLUSIONS This study shows that the absolute cutoff level of 9.15 mm for PRFT and 14.68% for LFF may be clinically important markers for identifying patients who are at high risk of MetS among adults with overweight and obesity with suspected NAFLD, irrespective of sex and age. Moreover, ectopic fat levels in pancreas and lumbar spine are positively associated with PRFT. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Li Wang
- Department of Radiology, Ningbo First Hospital, No. 59, Liuting Street, Haishu District, Ningbo, Zhejiang 315010 China
| | - Yuning Pan
- Department of Radiology, Ningbo First Hospital, No. 59, Liuting Street, Haishu District, Ningbo, Zhejiang 315010 China
| | - Xianwang Ye
- Department of Radiology, Ningbo First Hospital, No. 59, Liuting Street, Haishu District, Ningbo, Zhejiang 315010 China
| | - Yongmeng Zhu
- Department of Radiology, Ningbo First Hospital, No. 59, Liuting Street, Haishu District, Ningbo, Zhejiang 315010 China
| | - Yandong Lian
- Department of Radiology, Ningbo First Hospital, No. 59, Liuting Street, Haishu District, Ningbo, Zhejiang 315010 China
| | - Hui Zhang
- Department of Radiology, Ningbo First Hospital, No. 59, Liuting Street, Haishu District, Ningbo, Zhejiang 315010 China
| | - Miao Xu
- Department of Endocrinology, Ningbo First Hospital, No. 59, Liuting Street, Haishu District, Ningbo, Zhejiang 315010 China
| | - Mengxiao Liu
- MR Collaborations, Siemens healthineers, No.278, Zhouzhu Road, Pudong New District, Shanghai, 200090 China
| | - Xinzhong Ruan
- Department of Radiology, Ningbo First Hospital, No. 59, Liuting Street, Haishu District, Ningbo, Zhejiang 315010 China
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Clinical practice guideline for body composition assessment based on upper abdominal magnetic resonance images annotated using artificial intelligence. Chin Med J (Engl) 2022; 135:631-633. [PMID: 35471478 PMCID: PMC9276375 DOI: 10.1097/cm9.0000000000002002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Indexed: 11/26/2022] Open
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Sun J, Lv H, Li M, Zhao L, Liu Y, Zeng N, Wei X, Chen Q, Ren P, Liu Y, Zhang P, Yang Z, Zhang Z, Wang Z. How much abdominal fat do obese patients lose short term after laparoscopic sleeve gastrectomy? A quantitative study evaluated with MRI. Quant Imaging Med Surg 2021; 11:4569-4582. [PMID: 34737924 DOI: 10.21037/qims-20-1380] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 05/28/2021] [Indexed: 11/06/2022]
Abstract
Background This study aimed to elucidate the changes in the amount of abdominal adipose tissue after laparoscopic sleeve gastrectomy in obese Chinese patients over a relatively short follow-up period and to analyze the differences in the effects of surgery between genders. Methods Ninety-one patients were enrolled in the study, including 18 males and 73 females. These patients underwent laparoscopic sleeve gastrectomy between November 2017 and November 2019. Before and short term after surgery, the areas of subcutaneous/visceral adipose tissue and the liver proton density fat fraction were calculated with upper abdominal magnetic resonance (MR) examinations. Results Approximately 100 days after surgery, the median values of weight loss and body mass index reduction were 23.1 kg and 8.1 kg/m2, respectively. The patients achieved a greater absolute loss of subcutaneous adipose tissue index than of visceral adipose tissue index (3.2×10-3 vs. 1.6×10-3, P<0.001). The amount of weight loss, body mass index loss and absolute/relative reduction in visceral adipose tissue index were much greater in males than in females (31.7 vs. 21.7 kg, P<0.001; 9.8 vs. 7.9 kg/m2, P=0.016; 2.5×10-3 vs. 1.3×10-3, P=0.007; 28.2% vs. 20.9%, P=0.029). There was a correlation between decreased amounts in subcutaneous and visceral adipose tissue in sum and weight loss (r=0.282, P=0.032). The absolute/relative reduction in visceral adipose tissue index was also correlated with absolute/relative reduction in liver proton density fat fraction (r=0.283, P=0.013; r=0.372, P=0.001). Conclusions The reductions in body weight and visceral fat were more significant in male patients. The sum of absolute reduction in subcutaneous and visceral fat deposits was correlated with weight loss, in all patients enrolled. For severely obese patients, an upper abdominal MR examination could assess the body tissue composition and how it changes after bariatric surgery.
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Affiliation(s)
- Jing Sun
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Han Lv
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Mengyi Li
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University & National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Lei Zhao
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yawen Liu
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Na Zeng
- National Clinical Research Center for Digestive Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xuan Wei
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Qian Chen
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Pengling Ren
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yang Liu
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University & National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Peng Zhang
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University & National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Zhenghan Yang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zhongtao Zhang
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University & National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Zhenchang Wang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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Liu X, Wang L, Gao M, Wang G, Tang K, Yang J, Song W, Yang J, Lyu L, Cheng X. Comparison of Muscle Density in Middle-Aged and Older Chinese Adults Between a High-Altitude Area (Kunming) and a Low-Altitude Area (Beijing). Front Endocrinol (Lausanne) 2021; 12:811770. [PMID: 35002981 PMCID: PMC8740240 DOI: 10.3389/fendo.2021.811770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 12/06/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND AND PURPOSE A high-altitude environment was known to have a negative effect on bone and lead to a higher incidence of hip fracture. However, the dependence of muscle composition on altitude is unclear. Thus, we aimed to compare muscle density and area in plateau and low altitude area and to determine the effect of the altitude on these outcomes. METHODS Community dwelling adults over 60 years old living in Beijing (elevation 50 m; 300 subjects,107 men and 193 women) or Kunming (elevation 2000 m; 218 subjects,83 men and 135 women) for more than 10 years were enrolled. Quantitative CT was performed in all subjects and cross-sectional area and attenuation measured in Hounsfield units (HU) were determined for the trunk, gluteus, and mid-thigh muscles. RESULTS Compared to Beijing, Kunming adults were slimmer (Beijing men vs Kunming men: 25.08 ± 2.62 vs 23.94 ± 3.10kg/m2, P=0.013; Beijing women vs Kunming women: 25.31 ± 3.1 vs 23.98 ± 3.54 kg/m2, P= 0.001) and had higher muscle density in the L2-trunk and gluteus maximus muscles after adjustment for age and BMI (L2-trunk muscles: Beijing men 29.99 ± 4.17 HU vs Kunming men 37.35 ± 4.25 HU, P< 0.0001; Beijing women 27.37 ± 3.76 HU vs Kunming women 31.51 ± 5.12 HU, P< 0.0001; Gluteus maximus muscle: Beijing men 35.11 ± 6.54 HU vs Kunming men 39.36 ± 4.39 HU, P= 0.0009; Beijing women 31.47 ± 6.26 HU vs Kunming women 34.20 ± 5.87 HU P=0.0375). Age was similar in both cohorts and no differences were observed in the gluteus medius and minimus muscle or the mid-thigh muscle, either in the area or density. CONCLUSIONS Compared with Beijing, the adults in Kunming had higher muscle density of the gluteus maximus and L2 trunk muscles, showing that living at a higher altitude might be beneficial to muscle quality.
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Affiliation(s)
- Xingli Liu
- Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, China
- Medical School, Kunming University of Science and Technology, Kunming, China
- Department of Radiology, The First People’s Hospital of Yunnan Province, Kunming, China
- Department of Radiology, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Ling Wang
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China
| | - Meng Gao
- Department of Radiology, The First People’s Hospital of Yunnan Province, Kunming, China
- Department of Radiology, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Gang Wang
- Department of Radiology, The First People’s Hospital of Yunnan Province, Kunming, China
- Department of Radiology, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Kai Tang
- Medical School, Kunming University of Science and Technology, Kunming, China
| | - Jin Yang
- Medical School, Kunming University of Science and Technology, Kunming, China
| | - Wei Song
- Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, China
- Medical School, Kunming University of Science and Technology, Kunming, China
- Department of Radiology, The First People’s Hospital of Yunnan Province, Kunming, China
- Department of Radiology, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Jingsong Yang
- Department of Radiology, The First People’s Hospital of Yunnan Province, Kunming, China
- Department of Radiology, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Liang Lyu
- Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, China
- Medical School, Kunming University of Science and Technology, Kunming, China
- Department of Radiology, The First People’s Hospital of Yunnan Province, Kunming, China
- Department of Radiology, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
- *Correspondence: Liang Lyu, ; Xiaoguang Cheng,
| | - Xiaoguang Cheng
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China
- *Correspondence: Liang Lyu, ; Xiaoguang Cheng,
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Sun J, Lv H, Zhang M, Li M, Zhao L, Zeng N, Liu Y, Wei X, Chen Q, Ren P, Liu Y, Zhang P, Yang Z, Zhang Z, Wang Z. The Appropriateness Criteria of Abdominal Fat Measurement at the Level of the L1-L2 Intervertebral Disc in Patients With Obesity. Front Endocrinol (Lausanne) 2021; 12:784056. [PMID: 34970225 PMCID: PMC8712928 DOI: 10.3389/fendo.2021.784056] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 11/19/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND In this study, we proposed to use MR images at L1-L2 (lumbar) intervertebral disc level to measure abdominal fat area in patients with obesity. The quantitative results would provide evidence for the individualized assessment of the severity of obesity. METHODS All patients in the IRB-approved database of Beijing Friendship Hospital who underwent bariatric surgery between November 2017 and November 2019 were recruited. We retrospectively reviewed upper abdominal magnetic resonance (MR) data before surgery. We analyzed the correlation and consistency of the area of abdominal subcutaneous adipose tissue (ASAT) and visceral adipose tissue (VAT) measured at the L1-L2 and L2-L3 levels on MR images. We randomly distributed the cases into prediction model training data and testing data at a ratio of 7:3. RESULTS Two hundred and forty-five subjects were included. The ASAT and VAT results within the L1-L2 and L2-L3 levels were very similar and highly correlated (maleASAT: r=0.98, femaleASAT: r=0.93; maleVAT: r=0.91, femaleVAT: r=0.88). There was no substantial systematic deviation among the results at the two levels, except for the ASAT results in males. The intraclass correlation coefficients (ICCs) were 0.91 and 0.93 for maleASAT and femaleASAT, and 0.88 and 0.87 for maleVAT and femaleVAT, respectively. The ASAT/VAT area at the L2-L3 level was well predicted. The coefficient β of linear regression that predicted L2-L3 ASAT from L1-L2 ASAT was 1.11 for males and 0.99 for females. The R-squares were 0.97 and 0.91, respectively. For VAT prediction, the coefficient β was 1.02 for males and 0.96 for females. The R-squares were 0.82 and 0.77, respectively. CONCLUSION For patients with obesity, the L1-L2 intervertebral disc level can be used as the substitution of L2-L3 level in abdominal fat measurement.
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Affiliation(s)
- Jing Sun
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Han Lv
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- *Correspondence: Zhenchang Wang, ; Han Lv,
| | - Meng Zhang
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University & National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Mengyi Li
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University & National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Lei Zhao
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Na Zeng
- National Clinical Research Center for Digestive Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yawen Liu
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Xuan Wei
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Qian Chen
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Pengling Ren
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yang Liu
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University & National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Peng Zhang
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University & National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Zhenghan Yang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zhongtao Zhang
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University & National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Zhenchang Wang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- *Correspondence: Zhenchang Wang, ; Han Lv,
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