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Maskarinec G, Shvetsov Y, Wong MC, Cataldi D, Bennett J, Garber AK, Buchthal SD, Heymsfield SB, Shepherd JA. Predictors of visceral and subcutaneous adipose tissue and muscle density: The ShapeUp! Kids study. Nutr Metab Cardiovasc Dis 2024; 34:799-806. [PMID: 38218711 PMCID: PMC10922397 DOI: 10.1016/j.numecd.2023.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 12/02/2023] [Accepted: 12/14/2023] [Indexed: 01/15/2024]
Abstract
BACKGROUND AND AIMS Body fat distribution, i.e., visceral (VAT), subcutaneous adipose tissue (SAT) and intramuscular fat, is important for disease prevention, but sex and ethnic differences are not well understood. Our aim was to identify anthropometric, demographic, and lifestyle predictors for these outcomes. METHODS AND RESULTS The cross-sectional ShapeUp!Kids study was conducted among five ethnic groups aged 5-18 years. All participants completed questionnaires, anthropometric measurements, and abdominal MRI scans. VAT and SAT areas at four lumbar levels and muscle density were assessed manually. General linear models were applied to estimate coefficients of determination (R2) and to compare the fit of VAT and SAT prediction models. After exclusions, the study population had 133 male and 170 female participants. Girls had higher BMI-z scores, waist circumference (WC), and SAT than boys but lower VAT/SAT and muscle density. SAT, VAT, and VAT/SAT but not muscle density differed significantly by ethnicity. R2 values were higher for SAT than VAT across groups and improved slightly after adding WC. For SAT, R2 increased from 0.85 to 0.88 (girls) and 0.62 to 0.71 (boys) when WC was added while VAT models improved from 0.62 to 0.65 (girls) and 0.57 to 0.62 (boys). VAT values were significantly lower among Blacks than Whites with little difference for the other groups. CONCLUSION This analysis in a multiethnic population identified BMI-z scores and WC as the major predictors of MRI-derived SAT and VAT and highlights the important ethnic differences that need to be considered in diverse populations.
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Affiliation(s)
| | | | | | - Devon Cataldi
- University of Hawaii Cancer Center, Honolulu, HI, USA
| | | | - Andrea K Garber
- University of California at San Francisco, San Francisco, CA, USA
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Kway YM, Thirumurugan K, Michael N, Tan KH, Godfrey KM, Gluckman P, Chong YS, Venkataraman K, Khoo EYH, Khoo CM, Leow MKS, Tai ES, Chan JK, Chan SY, Eriksson JG, Fortier MV, Lee YS, Velan SS, Feng M, Sadananthan SA. A fully convolutional neural network for comprehensive compartmentalization of abdominal adipose tissue compartments in MRI. Comput Biol Med 2023; 167:107608. [PMID: 37897959 DOI: 10.1016/j.compbiomed.2023.107608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 09/18/2023] [Accepted: 10/17/2023] [Indexed: 10/30/2023]
Abstract
BACKGROUND Existing literature has highlighted structural, physiological, and pathological disparities among abdominal adipose tissue (AAT) sub-depots. Accurate separation and quantification of these sub-depots are crucial for advancing our understanding of obesity and its comorbidities. However, the absence of clear boundaries between the sub-depots in medical imaging data has challenged their separation, particularly for internal adipose tissue (IAT) sub-depots. To date, the quantification of AAT sub-depots remains challenging, marked by a time-consuming, costly, and complex process. PURPOSE To implement and evaluate a convolutional neural network to enable granular assessment of AAT by compartmentalization of subcutaneous adipose tissue (SAT) into superficial subcutaneous (SSAT) and deep subcutaneous (DSAT) adipose tissue, and IAT into intraperitoneal (IPAT), retroperitoneal (RPAT), and paraspinal (PSAT) adipose tissue. MATERIAL AND METHODS MRI datasets were retrospectively collected from Singapore Preconception Study for Long-Term Maternal and Child Outcomes (S-PRESTO: 389 women aged 31.4 ± 3.9 years) and Singapore Adult Metabolism Study (SAMS: 50 men aged 28.7 ± 5.7 years). For all datasets, ground truth segmentation masks were created through manual segmentation. A Res-Net based 3D-UNet was trained and evaluated via 5-fold cross-validation on S-PRESTO data (N = 300). The model's final performance was assessed on a hold-out (N = 89) and an external test set (N = 50, SAMS). RESULTS The proposed method enabled reliable segmentation of individual AAT sub-depots in 3D MRI volumes with high mean Dice similarity scores of 98.3%, 97.2%, 96.5%, 96.3%, and 95.9% for SSAT, DSAT, IPAT, RPAT, and PSAT respectively. CONCLUSION Convolutional neural networks can accurately sub-divide abdominal SAT into SSAT and DSAT, and abdominal IAT into IPAT, RPAT, and PSAT with high accuracy. The presented method has the potential to significantly contribute to advancements in the field of obesity imaging and precision medicine.
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Affiliation(s)
- Yeshe M Kway
- Singapore Institute for Clinical Sciences, Agency for Science Technology, and Research, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kashthuri Thirumurugan
- Singapore Institute for Clinical Sciences, Agency for Science Technology, and Research, Singapore
| | - Navin Michael
- Singapore Institute for Clinical Sciences, Agency for Science Technology, and Research, Singapore
| | - Kok Hian Tan
- Duke-National University of Singapore Graduate Medical School, Singapore; Department of Maternal Fetal Medicine, KK Women's and Children's Hospital, Singapore
| | - Keith M Godfrey
- MRC Lifecourse Epidemiology Centre & NIHR Southampton Biomedical Research Centre, University of Southampton & University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Peter Gluckman
- Singapore Institute for Clinical Sciences, Agency for Science Technology, and Research, Singapore
| | - Yap Seng Chong
- Singapore Institute for Clinical Sciences, Agency for Science Technology, and Research, Singapore; Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kavita Venkataraman
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore
| | - Eric Yin Hao Khoo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Chin Meng Khoo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Medicine, National University Health System, Singapore
| | - Melvin Khee-Shing Leow
- Singapore Institute for Clinical Sciences, Agency for Science Technology, and Research, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University (NTU), Singapore; Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Endocrinology, Division of Medicine, Tan Tock Seng Hospital (TTSH), Singapore
| | - E Shyong Tai
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Endocrinology, University Medicine Cluster, National University Health System, Singapore
| | - Jerry Ky Chan
- Department of Reproductive Medicine, KK Women's and Children's Hospital, Singapore; Experimental Fetal Medicine Group, Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University Health System, Singapore
| | - Shiao-Yng Chan
- Singapore Institute for Clinical Sciences, Agency for Science Technology, and Research, Singapore; Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Johan G Eriksson
- Singapore Institute for Clinical Sciences, Agency for Science Technology, and Research, Singapore; Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Folkhälsan Research Center, Helsinki, Finland
| | - Marielle V Fortier
- Singapore Institute for Clinical Sciences, Agency for Science Technology, and Research, Singapore; Department of Diagnostic and Interventional Imaging, KK Women's and Children's Hospital, Singapore
| | - Yung Seng Lee
- Singapore Institute for Clinical Sciences, Agency for Science Technology, and Research, Singapore; Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Paediatric Endocrinology, Department of Paediatrics, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore
| | - S Sendhil Velan
- Singapore Institute for Clinical Sciences, Agency for Science Technology, and Research, Singapore
| | - Mengling Feng
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore; Institute of Data Science, National University of Singapore, Singapore
| | - Suresh Anand Sadananthan
- Singapore Institute for Clinical Sciences, Agency for Science Technology, and Research, Singapore.
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Samouda H, Lee S, Arslanian S, Han M, Kuk JL. Anthropometric Equations to Predict Visceral Adipose Tissue in European and American Youth. J Pediatr 2023; 253:33-39.e3. [PMID: 36115621 DOI: 10.1016/j.jpeds.2022.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 09/06/2022] [Accepted: 09/09/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To investigate whether prediction equations including a limited but selected number of anthropometrics that consider differences in subcutaneous abdominal adipose tissue may improve prediction of the visceral adipose tissue (VAT) in youth. STUDY DESIGN Anthropometrics and abdominal adipose tissue by MRI were available in 7-18 years old youth with overweight or obesity: 181 White Europeans and 186 White and Black Americans. Multivariable regressions were performed to develop and validate the VAT anthropometric predictive equations in a cross-sectional study. RESULTS A model with both waist circumference (WaistC) and hip circumference (HipC) (VAT = [1.594 × WaistC] - [0.681 × HipC] + [1.74 × Age] - 48.95) more strongly predicted VAT in girls of White European ethnicity (R2 = 50.8%; standard error of the estimate [SEE] = 13.47 cm2), White American ethnicity (R2 = 41.9%; SEE, 15.63 cm2), and Black American ethnicity (R2 = 25.1%; SEE, 16.34 cm2) (P < .001), than WaistC or BMI. In boys, WaistC was the strongest predictor of VAT; HipC did not significantly improve VAT prediction. CONCLUSIONS A model including both WaistC and HipC that considers differences in subcutaneous abdominal adipose tissue more accurately predicts VAT in girls and is superior to commonly measured anthropometrics used individually. In boys, other anthropometric measures did not significantly contribute to the prediction of VAT beyond WaistC alone. This demonstrates that selected anthropometric predictive equations for VAT can be an accessible, cost-effective alternative to imaging methods that can be used in both clinics and research.
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Affiliation(s)
- Hanen Samouda
- Precision Health Department, Luxembourg Institute of Health, Strassen, Luxembourg.
| | - SoJung Lee
- Division of Sports Medicine, Graduate School of Physical Education, Kyung Hee University, Yongin, Republic of Korea
| | - Silva Arslanian
- Center for Pediatric Research in Obesity and Metabolism, University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Minsub Han
- Division of Sports Medicine, Graduate School of Physical Education, Kyung Hee University, Yongin, Republic of Korea
| | - Jennifer L Kuk
- School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
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Staiano AE, Katzmarzyk PT. Visceral, subcutaneous, and total fat mass accumulation in a prospective cohort of adolescents. Am J Clin Nutr 2022; 116:780-785. [PMID: 35544287 PMCID: PMC9437989 DOI: 10.1093/ajcn/nqac129] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 05/06/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Race and sex differences in adolescents' body fat are demonstrated in cross-sectional cohorts, yet a longitudinal design would better identify patterns of fat distribution over time. OBJECTIVES The aim was to examine race and sex differences in adiposity between black and white adolescents over 2 y. METHODS A cohort of adolescents aged 10-16 y (38% black; 52% girls; 15% overweight, 34% with obesity) underwent body composition measurements at baseline (n = 309) and 2 y later (n = 236), using DXA to quantify whole-body fat mass (FM) and MRI for abdominal subcutaneous (SAT) and visceral adipose tissue (VAT) volumes. General linear models were used to examine race and sex differences in log-transformed FM, SAT, and VAT, adjusting for age, sexual maturation, extended BMI percentile, and race-by-sex interaction. SAT and VAT models in addition controlled for baseline FM and change in FM (for change models). RESULTS Mean (95% CI) baseline FM (kg) was higher among white [18.5 (17.9, 19.2) than among black adolescents [17.4 (16.6, 18.2), P = 0.03] and girls [19.5 (18.8, 20.3) than boys [16.5 (15.8, 17.2), P < 0.0001]. Mean (95% CI) baseline SAT (L) was higher among girls [4.4 (4.2, 4.6)] than among boys [3.9 (3.7, 4.1), P < 0.0001]. Mean (95% CI) baseline VAT (L) was higher among white [0.5 (0.5, 0.6)] than among black [0.3 (0.3, 0.4)] adolescents (P < 0.0001) and boys [0.5 (0.4, 0.5)] than girls [0.4 (0.4, 0.4), P = 0.04]. Over 2 y mean (95% CI) FM change (kg) was higher among white [3.7 (2.9, 4.5)] than among black adolescents [2.3 (1.3, 3.3), P = 0.04] and girls [4.0 (3.0, 4.9)] than boys [2.0 (1.1, 3.0), P = 0.007], but SAT change (L) did not differ by race or sex. VAT change (L) was higher among white [0.1 (0.1, 0.1)] than among black adolescents [0.0 (0.0, 0.1), P = 0.003] and boys [0.1 (0.1, 0.1)] than girls [0.0 (0.0, 0.1), P = 0.034]. CONCLUSIONS Sex and race differences in the deposition and accumulation of excess fat are important considerations for understanding obesity prevalence and obesity-related disease risk among adolescents.This trial was registered at clinicaltrials.gov as NCT02784509.
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Gebara NY, Kim JY, Bacha F, Lee S, Arslanian S. Metabolic inflexibility in youth with obesity: Is it a feature of obesity or distinctive of youth who are metabolically unhealthy? Clin Obes 2022; 12:e12501. [PMID: 34851557 PMCID: PMC8904284 DOI: 10.1111/cob.12501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 10/26/2021] [Accepted: 11/17/2021] [Indexed: 11/28/2022]
Abstract
Individuals with obesity have metabolic inflexibility with diminished fasting fat oxidation and blunted increase in respiratory quotient (RQ) in insulin-stimulated states. However, it is unclear if metabolic inflexibility is a characteristic of obesity per se or is unique to youth who have metabolically unhealthy obesity (MUO) compared with metabolically healthy obesity (MHO). We investigated metabolic flexibility in youth with MUO, MHO and normal weight (NW) and compared their metabolic characteristics. Youth (n = 188) were divided, based on cut-off points for in vivo insulin sensitivity (IS) of adolescents with NW, into 137 with MUO and 51 with MHO. Fasting hepatic IS (HIS) from hepatic glucose production by [6,6-2 H2 ]glucose, adipose tissue IS (ATIS) from whole-body lipolysis by [2 H5 ]glycerol, RQ (indirect calorimetry) during fasting and a hyperinsulinemic (80 mU/m2 /min)-euglycemic clamp were measured. Youth with MUO versus MHO had blunted ΔRQ (p = .035) and lower HIS and ATIS (both p < .0001), while ΔRQ, HIS and ATIS were not different between youth with MHO and NW. In a pair-matched sub-analyses of 30 MUO and 30 MHO the results were similar to the total cohort. Metabolic inflexibility, does not appear to be a feature of obesity per se rather distinctive of youth with MUO, who also have worse HIS and ATIS compared with youth with MHO.
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Affiliation(s)
- Nour Y. Gebara
- Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Joon Young Kim
- Department of Exercise Science, David B. Falk College of Sport and Human Dynamics, Syracuse University, Syracuse, New York
| | - Fida Bacha
- Children's Nutrition Research Center, Baylor College of Medicine, Houston, Texas
| | - SoJung Lee
- Division of Sports Medicine, Graduate School of Physical Education, Kyung Hee University, Yongin, Republic of Korea
| | - Silva Arslanian
- Center for Pediatric Research in Obesity and Metabolism, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
- Division of Pediatric Endocrinology, Metabolism and Diabetes Mellitus, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
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Tirandi A, Carbone F, Montecucco F, Liberale L. The role of metabolic syndrome in sudden cardiac death risk: Recent evidence and future directions. Eur J Clin Invest 2022; 52:e13693. [PMID: 34714544 PMCID: PMC9286662 DOI: 10.1111/eci.13693] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 08/23/2021] [Accepted: 09/28/2021] [Indexed: 12/14/2022]
Abstract
Metabolic syndrome (MetS) is a frequent condition whose deleterious effects on the cardiovascular system are often underestimated. MetS is nowadays considered a real pandemic with an estimated prevalence of 25% in general population. Individuals with MetS are at high risk of sudden cardiac death (SCD) as this condition accounts for 50% of all cardiac deaths in such a population. Of interest, recent studies demonstrated that individuals with MetS show 70% increased risk of SCD even without previous history of coronary heart disease (CHD). However, little is known about the interplay between the two conditions. MetS is a complex disease determined by genetic predisposition, unhealthy lifestyle and ageing with deleterious effects on different organs. MetS components trigger a systemic chronic low-grade pro-inflammatory state, associated with excess of sympathetic activity, cardiac hypertrophy, arrhythmias and atherosclerosis. Thus, MetS has an important burden on the cardiovascular system as demonstrated by both preclinical and clinical evidence. The aim of this review is to summarize recent evidence concerning the association between MetS and SCD, showing possible common aetiological processes, and to indicate prospective for future studies and therapeutic targets.
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Affiliation(s)
- Amedeo Tirandi
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Federico Carbone
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino Genoa - Italian Cardiovascular Network, Genoa, Italy
| | - Fabrizio Montecucco
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino Genoa - Italian Cardiovascular Network, Genoa, Italy
| | - Luca Liberale
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy.,Center for Molecular Cardiology, University of Zürich, Schlieren, Switzerland
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Marunowski K, Świętoń D, Bzyl W, Grzywińska M, Kaszubowski M, Bandosz P, Khrichenko D, Piskunowicz M. MRI-Derived Subcutaneous and Visceral Adipose Tissue Reference Values for Children Aged 6 to Under 18 Years. Front Nutr 2021; 8:757274. [PMID: 34660672 PMCID: PMC8517194 DOI: 10.3389/fnut.2021.757274] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 09/03/2021] [Indexed: 11/20/2022] Open
Abstract
The assessment of body composition in pediatric population is essential for proper nutritional support during hospitalization. However, currently available methods have limitations. This study aims to propose a novel approach for nutrition status assessment and introduce magnetic resonance imaging (MRI)-derived subcutaneous and visceral fat normative reference values. A total of 262 healthy subjects aged from 6 to 18 years underwent MRI examinations and anthropometric measurements. MRI images at the second lumbar vertebrae were used by two radiologists to perform the semi-automatic tissue segmentation. Based on obtained adipose tissue surface areas and body mass index (BMI) scores sex-specific standard percentile curves (3rd, 10th, 25th, 50th, 75th, 90th, 97th) and z-scores were constructed using LMS method. Additionally, 85th and 95th centiles of subcutaneous and visceral adipose tissue were proposed as equivalents of overweight and obesity. Bland-Altman plots revealed an excellent intra-observer reproducibility and inter-observer agreement. In conclusion, our findings demonstrate highly reproducible method and suggest that MRI-derived reference values can be implemented in clinical practice.
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Affiliation(s)
- Kacper Marunowski
- Department of Radiology, Medical University of Gdańsk, Gdańsk, Poland
| | - Dominik Świętoń
- Department of Radiology, Medical University of Gdańsk, Gdańsk, Poland
| | - Włodzimierz Bzyl
- Faculty of Mathematics, Physics and Informatics, University of Gdańsk, Gdańsk, Poland
| | | | - Mariusz Kaszubowski
- Department of Economic Sciences, Faculty of Management and Economics, Institute of Statistics, Gdansk University of Technology, Gdańsk, Poland
| | - Piotr Bandosz
- Department of Public Health and Policy, University of Liverpool, Liverpool, United Kingdom
- Department of Prevention and Medical Education, Medical University of Gdańsk, Gdańsk, Poland
| | - Dmitry Khrichenko
- Division of Body Imaging, Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, PA, United States
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Lee LW, Hsieh CJ, Wu YH, Liao YS. Added values of DXA-derived visceral adipose tissue to discriminate cardiometabolic risks in pre-pubertal children. PLoS One 2020; 15:e0233053. [PMID: 32401808 PMCID: PMC7219764 DOI: 10.1371/journal.pone.0233053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 04/27/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The new generation of dual energy X-ray absorptiometry (DXA) scanners provide visceral adipose tissue (VAT) estimates by applying different algorithms to the conventional DXA-derived fat parameters such as total fat, trunk fat and android fat for the same image data. OBJECTIVE This cross-sectional study aimed to investigate whether VAT estimates from Hologic scanners are better predictors of VAT than conventional DXA parameters in pre-pubertal children, and to explore the discrimination ability of these VAT methods for cardiometabolic risks. METHODS Healthy pre-pubertal children aged 7-10 years were recruited for basic anthropometric, DXA and magnetic resonance imaging (MRI) measurements. Laboratory tests included lipid profile, glycaemic tests and blood pressure. RESULTS All VAT methods had acceptable to excellent performance for the diagnosis of dyslipidaemia (area under the curve [AUC] = 0.753-0.837) and hypertensive risk (AUC = 0.710-0.821) in boys, but suboptimal performance for these risks in girls, except for VAT by MRI in the diagnosis of dyslipidaemia. In both sexes, all VAT methods had no or poor discrimination ability for diabetes risk. CONCLUSIONS DXA-derived VAT estimates are very highly correlated with standard methods but has equivalent discrimination abilities compared to the existing DXA-derived fat estimates.
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Affiliation(s)
- Li-Wen Lee
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Puzi City, Chiayi, Taiwan
- Department of Nursing, Chang Gung University of Science and Technology, Puzi City, Chiayi, Taiwan
| | - Chu-Jung Hsieh
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Puzi City, Chiayi, Taiwan
| | - Yun-Hsuan Wu
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Puzi City, Chiayi, Taiwan
| | - Yu-San Liao
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Puzi City, Chiayi, Taiwan
- Department of Nursing, Chang Gung University of Science and Technology, Puzi City, Chiayi, Taiwan
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Yunlin, Taiwan
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Cunha GM, Correa de Mello LL, Hasenstab KA, Spina L, Bussade I, Prata Mesiano JM, Coutinho W, Guzman G, Sajoux I. MRI estimated changes in visceral adipose tissue and liver fat fraction in patients with obesity during a very low-calorie-ketogenic diet compared to a standard low-calorie diet. Clin Radiol 2020; 75:526-532. [PMID: 32204895 DOI: 10.1016/j.crad.2020.02.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 02/20/2020] [Indexed: 02/07/2023]
Abstract
AIM To compare the changes in visceral adipose tissue (VAT), liver fat fraction, and liver stiffness using quantitative magnetic resonance imaging (MRI) during a very-low-calorie ketogenic (VLCK) diet and a standard low-calorie diet (LC). MATERIALS AND METHODS The study involved secondary analysis of prospective collected clinical data. Patients undergoing weight loss interventions were randomised to either a LC or a VLCK diet. VAT, liver fat fraction, and stiffness were measured at baseline and after 2 months. RESULTS Forty-six patients were included; 39 patients were evaluated at baseline and at 2 months follow-up. Mean weight loss was -9.7±3.8 kg (interquartile range [IQR]: -12.3; -7 kg) in the VLCK group and -1.67±2.2 kg (IQR: -3.3, -0.1 kg) in the LC group (p<0.0001). Mean VAT reductions were -39.3±40 cm2 (IQR: -52, -10 cm2) and -12.5±38.3 cm2 (IQR: -29, 5 cm2; p=0.0398), and mean liver proton density fat fraction (PDFF) reductions were -4.77±4.2% (IQR: -7.3, -1.7%) and -0.79±1.7%, (IQR: -1.8, -0.4%; p<0.005) in the VLCK group and in the LC group, respectively. No significant changes in liver stiffness occurred from baseline to follow-up. CONCLUSION A VLCK diet resulted in greater weight loss than a standard low-calorie diet and in significantly greater reduction in liver PDFF. As anthropometric measurements may not correlate with liver fat changes, it may be advantageous to include quantitative MRI to the monitoring strategies of patients undergoing weight-loss programmes.
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Affiliation(s)
- G M Cunha
- Liver Imaging Group, Radiology, University of California San Diego, California, USA; MRI Department, Clínica de Diagnóstico por Imagem - CDPI/DASA, Rio de Janeiro, Brazil.
| | - L Lugarino Correa de Mello
- Serviço de Obesidade, Transtornos Alimentares e Metabologia (SOTAM), Instituto Estadual de Endocrinologia (IEDE), Rio de Janeiro, Brazil
| | - K A Hasenstab
- Liver Imaging Group, Radiology, University of California San Diego, California, USA
| | - L Spina
- CliniCoop, Rio de Janeiro, Brazil
| | - I Bussade
- Departamento de Pós-Graduação Em Clínica Médica, Pontifícia Universidade Católica (PUC), Rio de Janeiro, Brazil
| | | | - W Coutinho
- Serviço de Obesidade, Transtornos Alimentares e Metabologia (SOTAM), Instituto Estadual de Endocrinologia (IEDE), Rio de Janeiro, Brazil
| | - G Guzman
- Medical Department Pronokal, Barcelona, Spain
| | - I Sajoux
- Medical Department Pronokal, Barcelona, Spain
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10
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Kim JY, Tfayli H, Bacha F, Lee S, Michaliszyn SF, Yousuf S, Gebara N, Arslanian S. β-cell function, incretin response, and insulin sensitivity of glucose and fat metabolism in obese youth: Relationship to OGTT-time-to-glucose-peak. Pediatr Diabetes 2020; 21:18-27. [PMID: 31677208 DOI: 10.1111/pedi.12940] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 10/04/2019] [Accepted: 10/26/2019] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND In adults, the time-to-glucose-peak at or after 30 minutes during an oral glucose tolerance test (OGTT) identifies physiologically distinct groups with differences in insulin sensitivity, β-cell function and risk for type 2 diabetes. In obese non-diabetic adolescents, we investigated if the OGTT-time-to-glucose-peak also reflects incretin and free fatty acid (FFA) responses besides insulin sensitivity and β-cell function, measured by the clamp. METHODS Obese adolescents (n = 278) were categorized according to their OGTT-time-to-glucose-peak by Early-peak (at 30 minutes) vs Late-peak (>30 minutes) groups. Body composition, visceral adipose tissue, oral disposition index and OGTT-area under the curve (AUC) were examined. A subset of 102 participants had both hyperinsulinemic-euglycemic and hyperglycemic clamps to measure in vivo insulin sensitivity, insulin secretion, and β-cell function relative to insulin sensitivity. RESULTS Compared with the Early-peak group, the Late-peak group had impaired β-cell function relative to insulin sensitivity, lower glucose-dependent insulinotropic polypeptide-AUC, and higher FFA-AUC despite higher insulin- and C-peptide-AUC. They also had lower hepatic and peripheral insulin sensitivity despite similar percent body fat and visceral adipose tissue, and had higher prevalence of impaired glucose tolerance (all P < .05). CONCLUSIONS In obese non-diabetic youth, those with a Late-peak vs an Early-peak glucose during an OGTT showed diminished β-cell function, blunted incretin secretion, and lower insulin sensitivity of glucose and FFA metabolism. It remains to be determined if Late-peak glucose predicts the future development of type 2 diabetes in these high-risk youth.
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Affiliation(s)
- Joon Young Kim
- Department of Exercise Science, Syracuse University, Syracuse, New York
| | - Hala Tfayli
- Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Fida Bacha
- Children's Nutrition Research Center, Baylor College of Medicine, Houston, Texas
| | - SoJung Lee
- Division of Sports Medicine, Graduate School of Physical Education, Kyung Hee University, Yongin, Republic of Korea
| | - Sara F Michaliszyn
- Kinesiology and Sport Science, Youngstown State University, Youngstown, Ohio
| | - Shahwar Yousuf
- Center for Pediatric Research in Obesity and Metabolism, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Nour Gebara
- Center for Pediatric Research in Obesity and Metabolism, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Silva Arslanian
- Center for Pediatric Research in Obesity and Metabolism, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania.,Division of Pediatric Endocrinology, Metabolism and Diabetes Mellitus, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
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Cunha GM, Guzman G, Correa De Mello LL, Trein B, Spina L, Bussade I, Marques Prata J, Sajoux I, Countinho W. Efficacy of a 2-Month Very Low-Calorie Ketogenic Diet (VLCKD) Compared to a Standard Low-Calorie Diet in Reducing Visceral and Liver Fat Accumulation in Patients With Obesity. Front Endocrinol (Lausanne) 2020; 11:607. [PMID: 33042004 PMCID: PMC7521128 DOI: 10.3389/fendo.2020.00607] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 07/27/2020] [Indexed: 12/11/2022] Open
Abstract
Background: Currently the treatment of non-alcoholic fatty liver disease (NAFLD) is based on weight loss through lifestyle changes, such as exercise combined with calorie-restricted dieting. Objectives: To assess the effects of a commercially available weight loss program based on a very low-calorie ketogenic diet (VLCKD) on visceral adipose tissue (VAT) and liver fat content compared to a standard low-calorie (LC) diet. As a secondary aim, we evaluated the effect on liver stiffness measurements. Methods: Open, randomized controlled, prospective pilot study. Patients were randomized and treated either with an LC or a VLCKD and received orientation and encouragement to physical activity equally for both groups. VAT, liver fat fraction, and liver stiffness were measured at baseline and after 2 months of treatment using magnetic resonance imaging. Paired t-tests were used for comparison of continuous variables between visits and unpaired test between groups. Categorical variables were compared using the χ2-test. Pearson correlation was used to assess the association between VAT, anthropometric measures, and hepatic fat fraction. A significance level of the results was established at p < 0.05. Results: Thirty-nine patients (20 with VLCKD and 19 with LC) were evaluated at baseline and 2 months of intervention. Relative weight loss at 2 months was -9.59 ± 2.87% in the VLCKD group and -1.87 ± 2.4% in the LC group (p < 0.001). Mean reductions in VAT were -32.0 cm2 for VLCKD group and -12.58 cm2 for LC group (p < 0.05). Reductions in liver fat fraction were significantly more pronounced in the VLCKD group than in the LC group (4.77 vs. 0.79%; p < 0.005). Conclusion: Patients undergoing a VLCKD achieved superior weight loss, with significant VAT and liver fat fraction reductions when compared to the standard LC diet. The weight loss and rapid mobilization of liver fat demonstrated with VLCKD could serve as an effective alternative for the treatment of NAFLD. Clinical Trial Registration: ClinicalTrials.gov, identifier: NCT04322110.
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Affiliation(s)
- Guilherme Moura Cunha
- Department of Radiology, University of California, San Diego, La Jolla, CA, United States
| | - German Guzman
- Pronokal Group, Barcelona, Spain
- *Correspondence: German Guzman
| | | | - Barbara Trein
- Instituto Estadual de Diabetes e Endocrinologia Luiz Capriglione, Rio de Janeiro, Brazil
| | | | | | | | | | - Walmir Countinho
- Instituto Estadual de Diabetes e Endocrinologia Luiz Capriglione, Rio de Janeiro, Brazil
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12
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Kim JY, Bacha F, Tfayli H, Michaliszyn SF, Yousuf S, Arslanian S. Adipose Tissue Insulin Resistance in Youth on the Spectrum From Normal Weight to Obese and From Normal Glucose Tolerance to Impaired Glucose Tolerance to Type 2 Diabetes. Diabetes Care 2019; 42:265-272. [PMID: 30455334 PMCID: PMC6341282 DOI: 10.2337/dc18-1178] [Citation(s) in RCA: 75] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 10/25/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Adipose tissue insulin resistance is one of the pathophysiological components of type 2 diabetes. Herein we investigated: 1) adipose insulin resistance index (Adipose-IR) (calculated as fasting insulin × free fatty acids [FFAs]) in youth across the spectrum of adiposity from normal weight to obese and the spectrum from normal glucose tolerance (NGT) to impaired glucose tolerance (IGT) to type 2 diabetes, 2) the relationship of Adipose-IR with physical and metabolic characteristics, and 3) the predictive power of Adipose-IR for determining dysglycemia in youth. RESEARCH DESIGN AND METHODS A total of 205 youth had fasting glucose, insulin, FFA, Adipose-IR, body composition, visceral adipose tissue (VAT), leptin, and adiponectin evaluated. RESULTS Adipose-IR was 2.2-fold higher in obese NGT, 4.3-fold higher in IGT, and 4.6-fold higher in type 2 diabetes compared with that in normal-weight peers (all P < 0.05). Females with dysglycemia (IGT and type 2 diabetes) had higher Adipose-IR than their male counterparts (P < 0.001). Adipose-IR correlated positively with total body and visceral adiposity, fasting glucose, HOMA-IR, and leptin and negatively with adiponectin. Receiver operating characteristic curve analysis yielded an optimal cutoff for Adipose-IR of 9.3 μU/mL × mmol/L for determining dysglycemia with 80% predictive power. CONCLUSIONS Adipose-IR is a simple surrogate estimate that reflects pathophysiological alterations in adipose tissue insulin sensitivity in youth, with progressive deterioration from normal weight to obese and from NGT to IGT to type 2 diabetes. Adipose-IR can be applied in large-scale epidemiological/observational studies of the natural history of youth-onset type 2 diabetes and its progression or reversal with intervention strategies.
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Affiliation(s)
- Joon Young Kim
- Center for Pediatric Research in Obesity and Metabolism, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA
- Division of Endocrinology and Metabolism, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Fida Bacha
- Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX
| | - Hala Tfayli
- Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Sara F Michaliszyn
- Department of Kinesiology and Sport Science, Youngstown State University, Youngstown, OH
| | - Shahwar Yousuf
- Center for Pediatric Research in Obesity and Metabolism, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Silva Arslanian
- Center for Pediatric Research in Obesity and Metabolism, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA
- Division of Pediatric Endocrinology, Diabetes, and Metabolism, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA
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Heckman KM, Otemuyiwa B, Chenevert TL, Malyarenko D, Derstine BA, Wang SC, Davenport MS. Validation of a DIXON-based fat quantification technique for the measurement of visceral fat using a CT-based reference standard. Abdom Radiol (NY) 2019; 44:346-354. [PMID: 29946923 DOI: 10.1007/s00261-018-1678-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE The purpose of the study is to determine whether a novel semi-automated DIXON-based fat quantification algorithm can reliably quantify visceral fat using a CT-based reference standard. METHODS This was an IRB-approved retrospective cohort study of 27 subjects who underwent abdominopelvic CT within 7 days of proton density fat fraction (PDFF) mapping on a 1.5T MRI. Cross-sectional visceral fat area per slice (cm2) was measured in blinded fashion in each modality at intervertebral disc levels from T12 to L4. CT estimates were obtained using a previously published semi-automated computational image processing system that sums pixels with attenuation - 205 to - 51 HU. MR estimates were obtained using two novel semi-automated DIXON-based fat quantification algorithms that measure visceral fat area by spatially regularizing non-uniform fat-only signal intensity or de-speckling PDFF 2D images and summing pixels with PDFF ≥ 50%. Pearson's correlations and Bland-Altman analyses were performed. RESULTS Visceral fat area per slice ranged from 9.2 to 429.8 cm2 for MR and from 1.6 to 405.5 cm2 for CT. There was a strong correlation between CT and MR methods in measured visceral fat area across all studied vertebral body levels (r = 0.97; n = 101 observations); the least (r = 0.93) correlation was at T12. Bland-Altman analysis revealed a bias of 31.7 cm2 (95% CI [- 27.1]-90.4 cm2), indicating modestly higher visceral fat assessed by MR. CONCLUSION MR- and CT-based visceral fat quantification are highly correlated and have good cross-modality reliability, indicating that visceral fat quantification by either method can yield a stable and reliable biomarker.
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Ramírez-Vélez R, Correa-Rodríguez M, Izquierdo M, Schmidt-RioValle J, González-Jiménez E. Muscle Fitness to Visceral Fat Ratio, Metabolic Syndrome and Ideal Cardiovascular Health Metrics. Nutrients 2018; 11:E24. [PMID: 30583491 PMCID: PMC6356414 DOI: 10.3390/nu11010024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 12/14/2018] [Accepted: 12/20/2018] [Indexed: 12/15/2022] Open
Abstract
This study aimed to investigate the association between the muscle fitness to visceral fat level (MVF) ratio and the prevalence of metabolic syndrome (MetS) and ideal cardiovascular health (CVH) metrics among college students. A total of 1467 young adults recruited from the FUPRECOL study (Asociación de la Fuerza Prensil con Manifestaciones Tempranas de Riesgo Cardiovascular en Jóvenes y Adultos Colombianos), were categorized into four quartiles based on their MVF ratio. Muscular fitness was assessed using a digital handgrip dynamometer and visceral fat level was determined through bioelectrical impedance analysis. Ideal CVH was assessed, including lifestyle characteristics, anthropometry, blood pressure, and biochemical parameters. The body weight, waist circumference, body mass index (BMI), fat mass, fat mass index, and visceral fat level were significantly higher in subjects in Q1 (lower MVF ratio) than those in Q2, Q3, or Q4 (p < 0.001). The muscle fitness (handgrip and normalized grip strength (NGS)) of the subjects in Q4 was significantly greater than that of those in Q1 to Q2 (p < 0.001). Subjects with a medium-high MVF ratio (i.e., 3⁻4th quartiles) had an odds ratio of 2.103 of ideal CVH metrics after adjusting for age, gender, university, and alcohol intake (95% confidence interval (CI) 1.832 to 2.414; p < 0.001). A lower MVF ratio is associated with worse CVH metrics and a higher prevalence of MetS in early adulthood, supporting the hypothesis that the MVF ratio could be used as a complementary screening tool that could help clinicians identify young adults with unfavorable levels of CVH and metabolic risk.
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Affiliation(s)
- Robinson Ramírez-Vélez
- Centro de Estudios para la Medición de la Actividad Física CEMA, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá 111221, Colombia.
- GICAEDS Group, Faculty of Physical Culture, Sport and Recreation, Universidad Santo Tomás, Bogotá 110311, Colombia.
| | - María Correa-Rodríguez
- Departamento de Enfermería, Facultad de Ciencias de la Salud, Avda. De la Ilustración, 60, University of Granada, Granada 18016, Spain.
| | - Mikel Izquierdo
- Department of Health Sciences, Public University of Navarre, Navarrabiomed, IdiSNA, CIBER de Fragilidad y Envejecimiento Saludable (CB16/10/00315), Navarre 31006, Spain.
| | - Jacqueline Schmidt-RioValle
- Departamento de Enfermería, Facultad de Ciencias de la Salud, Avda. De la Ilustración, 60, University of Granada, Granada 18016, Spain.
| | - Emilio González-Jiménez
- Departamento de Enfermería, Facultad de Ciencias de la Salud, Avda. De la Ilustración, 60, University of Granada, Granada 18016, Spain.
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15
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Muscle mass to visceral fat ratio is an important predictor of the metabolic syndrome in college students. Br J Nutr 2018; 121:330-339. [DOI: 10.1017/s0007114518003392] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
AbstractThis study aimed to evaluate the associations between the muscle mass to visceral fat (MVF) ratio and cardiometabolic risk factors in a large population of college students in Colombia and to propose cut-off points of this index for the metabolic syndrome (MetS). A total of 1464 young adults recruited from the FUPRECOL (Asociación de la Fuerza Prensil con Manifestaciones Tempranas de Riesgo Cardiovascular en Jóvenes y Adultos Colombianos) study were categorised into four groups based on their MVF ratio. Muscle mass and visceral fat level of the participants were measured using a bioelectrical impedance analysis. Cardiometabolic risk factors including lifestyle characteristics, anthropometry, blood pressure and biochemical parameters were assessed. The prevalence of moderate to severe obesity, hypertension and the MetS was higher in subjects in quartile (Q)1 (lower MVF ratio) (P <0·001). ANCOVA revealed that the subjects in Q1 had higher cardiometabolic disturbances, including altered anthropometry, blood pressure, muscle strength and biochemical parameters after adjusting for age and sex compared with young adults in higher MVF ratio quartiles (P <0·001). Muscular mass and physical activity levels were significantly lower in subjects with a lower MVF ratio (P <0·001). The receiver operating characteristic curve analyses indicated that in men the best MVF ratio cut-off point for detecting the MetS was 18·0 (AUC 0·83, sensitivity 78 % and specificity 77 %) and for women, the MVF ratio cut-off point was 13·7 (AUC 0·85, sensitivity 76 % and specificity 87 %). A lower MVF ratio is associated with a higher risk cardiometabolic profile in early adulthood, supporting that the MVF ratio could be used as a complementary screening tool that may help clinicians identify young adults at high cardiometabolic risk.
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16
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Cunha GM, Villela-Nogueira CA, Bergman A, Lobo Lopes FPP. Abbreviated mpMRI protocol for diffuse liver disease: a practical approach for evaluation and follow-up of NAFLD. Abdom Radiol (NY) 2018; 43:2340-2350. [PMID: 29450605 DOI: 10.1007/s00261-018-1504-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
AIM Multiparametric magnetic resonance imaging (mpMRI) may help determine the metabolic profile of patients with obesity and metabolic syndrome in addition to their clinical and laboratory biomarkers for diagnosis and monitoring. An abbreviated mpMRI protocol may be a faster, less-costly, and easier to perform alternative for the diagnosis, treatment, and follow-up of patients with NAFLD and for use in clinical trials. OBJECTIVE To evaluate an abbreviated mpMRI protocol tailored to analyze quantitative imaging features of patients with obesity and NAFLD and assess its use during treatment. METHODS This prospective study included patients with obesity and NAFLD to perform a quantitative analysis of liver fat and iron content, stiffness, as well as the visceral adipose tissue (VAT) during the course of a physical exercise-based treatment regimen. RESULTS Longitudinal improvements in imaging features were observed in patients with good response to treatment, in accordance with improvements in biochemical and anthropometric biomarkers. CONCLUSION An abbreviated mpMRI protocol consisting of liver fat and iron quantification, MR elastography, and VAT measurements is a feasible, less-costly, and accessible option for screening and monitoring of patients with obesity, NAFLD, and metabolic syndrome.
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Affiliation(s)
- Guilherme Moura Cunha
- Clínica de Diagnóstico por Imagem - CDPI/DASA, Av. Ataulfo de Paiva, 669, Leblon, Rio de Janeiro, 22440-032, Brazil.
| | - Cristiane A Villela-Nogueira
- Faculdade de Medicina, Departamento de Clínica Médica, Serviço de Hepatologia, Universidade Federal do Rio De Janeiro, UFRJ R. Prof. Rodolpho Paulo Rocco, 255 sala 9E16 - Cidade Universitária, Rio de Janeiro, 22440-032, Brazil
| | - Anke Bergman
- Instituto Nacional de Câncer (INCA), Rua André Cavalcanti, 37, Rio de Janeiro, 20231-050, Brazil
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Effects of Exercise Training Alone on Depot-Specific Body Fat Stores in Youth: Review of Recent Literature. Pediatr Exerc Sci 2018; 30:58-68. [PMID: 28556755 DOI: 10.1123/pes.2016-0275] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The prevalence of childhood obesity has increased at an alarming rate. The increased obesity rate in pediatrics parallels the increased risks for developing metabolic abnormalities, such as insulin resistance, type 2 diabetes, and nonalcoholic fatty liver disease. In particular, the strong relationship between obesity and such health consequences is well explained by the excessive accumulation of depot-specific body adiposity, such as visceral adipose tissue, intrahepatic lipid content, intermuscular adipose tissue, and/or intramyocellular lipid content. Limited evidence suggests that both aerobic and resistance exercise alone, independent of weight loss, can be an effective therapeutic strategy for improving risk markers of metabolic abnormalities as well as inducing positive changes in depot-specific body adiposity in obese children and adolescents. However, the independent role of exercise alone (without calorie restriction) in body fat distribution is still unclear, and the results are less conclusive in pediatrics. In this brief review, the effects of aerobic and resistance exercise on depot-specific body adiposity changes in children and adolescents are discussed.
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18
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Stodden D, Sacko R, Nesbitt D. A Review of the Promotion of Fitness Measures and Health Outcomes in Youth. Am J Lifestyle Med 2017; 11:232-242. [PMID: 30202338 PMCID: PMC6125085 DOI: 10.1177/1559827615619577] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 10/23/2015] [Accepted: 11/06/2015] [Indexed: 11/16/2022] Open
Abstract
The relationship between physical fitness and health in adults is well established, yet until recently, empirical support for the impact of physical fitness levels on health markers in children has not been thoroughly documented. The aim of this review was to provide a summary of current literature that has examined the linkage between measures of health-related physical fitness (ie, cardiorespiratory fitness, musculoskeletal fitness, flexibility, and body composition) and health markers in youth. Specifically, this review focused on the findings from the recent 2012 Institutes of Medicine report on Fitness Measures in Youth as well as other subsequent review articles related to the topic. In addition, recommendations for health-related fitness assessments in youth populations are presented.
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Affiliation(s)
| | | | - Danielle Nesbitt
- Department of Physical Education and Athletic Training, University of South Carolina, Columbia, South Carolina
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19
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Kim JY, Tfayli H, Michaliszyn SF, Lee S, Nasr A, Arslanian S. Anti-Müllerian Hormone in Obese Adolescent Girls With Polycystic Ovary Syndrome. J Adolesc Health 2017; 60:333-339. [PMID: 27998701 PMCID: PMC5326592 DOI: 10.1016/j.jadohealth.2016.10.015] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 09/10/2016] [Accepted: 10/21/2016] [Indexed: 02/06/2023]
Abstract
PURPOSE Anti-Müllerian hormone (AMH) is proposed as a biomarker of polycystic ovary syndrome (PCOS). This study investigated: (1) AMH concentrations in obese adolescents with PCOS versus without PCOS; (2) the relationship of AMH to sex steroid hormones, adiposity, and insulin resistance; and (3) the optimal AMH value and the multivariable prediction model to determine PCOS in obese adolescents. METHODS AMH levels were measured in 46 obese PCOS girls and 43 obese non-PCOS girls. Sex steroid hormones, clamp-measured insulin sensitivity and secretion, body composition, and abdominal adiposity were evaluated. Logistic regression and receiver-operating characteristic curve analyses were used, and multivariate prediction models were developed to test the utility of AMH for the diagnosis of PCOS. RESULTS AMH levels were higher in obese PCOS versus non-PCOS girls (8.3 ± .6 vs. 4.3 ± .4 ng/mL, p < .0001), of comparable age and puberty. AMH concentrations correlated positively with age in both groups, total and free testosterone in PCOS girls only, abdominal adipose tissue in non-PCOS girls, with no correlation to in vivo insulin sensitivity and secretion in either groups. A multivariate model including AMH (cutoff 6.26 ng/mL, area under the curve .788) together with sex hormone-binding globulin and total testosterone exhibited 93.4% predictive power for diagnosing PCOS. CONCLUSIONS AMH may be a useful biomarker for the diagnosis of PCOS in obese adolescent girls.
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Affiliation(s)
- Joon Young Kim
- Division of Weight Management and Wellness, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Hala Tfayli
- Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Sara F Michaliszyn
- Human Performance and Exercise Science, Youngstown State University, Youngstown, Ohio
| | - SoJung Lee
- Division of Weight Management and Wellness, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Alexis Nasr
- Division of Weight Management and Wellness, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Silva Arslanian
- Division of Weight Management and Wellness, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Division of Pediatric Endocrinology, Metabolism and Diabetes Mellitus, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania.
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20
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Michaliszyn SF, Lee S, Bacha F, Tfayli H, Farchoukh L, Mari A, Ferrannini E, Arslanian S. Differences in β-cell function and insulin secretion in Black vs. White obese adolescents: do incretin hormones play a role? Pediatr Diabetes 2017; 18:143-151. [PMID: 26799689 PMCID: PMC4958038 DOI: 10.1111/pedi.12364] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 12/21/2015] [Accepted: 12/22/2015] [Indexed: 12/27/2022] Open
Abstract
Black youth are at higher risk for type 2 diabetes (T2D) than their White peers. Previously we demonstrated that for the same degree of insulin sensitivity, Black youth have an upregulated β-cell function and insulin hypersecretion, in response to intravenous (iv) glucose, compared with Whites. To investigate if the same holds true during an oral glucose challenge and because of the important role of glucagon-like peptide 1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) in augmenting insulin secretion, we examined β-cell function and incretin hormones in 85 Black and 78 White obese adolescents, with normal glucose tolerance (NGT), during a 2-h oral glucose tolerance test (OGTT) with mathematical modeling of plasma glucose and C-peptide concentrations to assess β-cell glucose sensitivity (βCGS), rate sensitivity, potentiation factor, and insulin sensitivity. Incretin, pancreatic polypeptide, and glucagon concentrations were measured during the OGTT. Black obese youth had a heightened early insulin secretion together with significantly greater βCGS, rate sensitivity, and potentiation factor compared with Whites, with no differences in incretin and glucagon concentrations. Basal and stimulated insulin clearance was lower (p = 0.001) in Black vs. White youth. In conclusion, during an OGTT Black obese youth with NGT demonstrate a pronounced early insulin secretion jointly with heightened β-cell glucose sensitivity, rate sensitivity, and potentiation factor. These racial disparities in β-cell function and the pathophysiological components of T2D are unlikely to be attributed to incretin hormones and remain to be investigated further to explain the metabolic basis for the enhanced risk of T2D in back youth.
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Affiliation(s)
- Sara F Michaliszyn
- Human Performance and Exercise Science, Youngstown State University, Youngstown, OH 44555
| | - SoJung Lee
- Division of Weight Management, Children’s Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA 15224
| | - Fida Bacha
- Children’s Nutrition Research Center, Baylor College of Medicine, Houston, TX 77030
| | - Hala Tfayli
- Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Lama Farchoukh
- Division of Weight Management, Children’s Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA 15224
| | - Andrea Mari
- CNR Institute of Neuroscience, Padova, Italy
| | - Ele Ferrannini
- Department of Clinical & Experimental Medicine, University of Pisa School of Medicine, Pisa, Italy
| | - Silva Arslanian
- Division of Weight Management, Children’s Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA 15224,Division of Pediatric Endocrinology, Metabolism & Diabetes Mellitus, Children’s Hospital of Pittsburgh, Pittsburgh, PA 15224
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Cho SA, Joo HJ, Cho JY, Lee SH, Park JH, Hong SJ, Yu CW, Lim DS. Visceral Fat Area and Serum Adiponectin Level Predict the Development of Metabolic Syndrome in a Community-Based Asymptomatic Population. PLoS One 2017; 12:e0169289. [PMID: 28046037 PMCID: PMC5207404 DOI: 10.1371/journal.pone.0169289] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 12/14/2016] [Indexed: 12/21/2022] Open
Abstract
Background Although it has been demonstrated that visceral adipose tissue content and serum levels of adiponectin are associated with metabolic syndrome, their predictive potential for the development of metabolic syndrome remains to be elucidated. Methods We studied 1,130 participants of the Seoul Metabolic Syndrome cohort. A total of 337 subjects without metabolic syndrome underwent the follow-up evaluation and finally analyzed. Visceral fat area (VFA) was measured using dual bioelectrical impedance analysis. We compared the 1-year incidence rate of metabolic syndrome among four different groups: Group 1 (high adiponectin level and low VFA), Group 2 (low adiponectin level and low VFA), Group 3 (high adiponectin level and high VFA) and Group 4 (low adiponectin level and high VFA). Results Median follow-up duration was 17 months. Cut-off points of adiponectin level and VFA for metabolic syndrome were 7.34 ng/ml and 84 cm2 for men, and 12.55 and 58 cm2 ng/ml for women, respectively. The incidence of metabolic syndrome was the highest in Group 4 (Group 1; 16.47%, Group 2; 22.08%, Group 3; 25%, and Group 4; 46.15%, p<0.001). Adjusted logistic regression analyses for metabolic syndrome prediction demonstrated that Group 4 exhibited the highest odds ratio compared with Group 1 (4.918 [2.05–11.795]), which was predominantly affected by waist circumference and serum triglyceride levels. Notably, triglyceride/high-density lipoprotein cholesterol (TG/HDL) ratio was significantly higher in Group 4 (p = 0.017). Conclusion Incidence rate of metabolic syndrome was the highest in subjects with low serum adiponectin levels and high visceral fat area. Higher TG/HDL ratio in these subjects suggested insulin resistance may contribute to the development of metabolic syndrome.
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Affiliation(s)
- Sang-A Cho
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Seoul, Korea
| | - Hyung Joon Joo
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Seoul, Korea
| | - Jae-Young Cho
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Seoul, Korea
| | - Seung Hun Lee
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Seoul, Korea
| | - Jae Hyoung Park
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Seoul, Korea
| | - Soon Jun Hong
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Seoul, Korea
| | - Cheol Woong Yu
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Seoul, Korea
| | - Do-Sun Lim
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Seoul, Korea
- * E-mail:
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Kim JY, Michaliszyn SF, Nasr A, Lee S, Tfayli H, Hannon T, Hughan KS, Bacha F, Arslanian S. The Shape of the Glucose Response Curve During an Oral Glucose Tolerance Test Heralds Biomarkers of Type 2 Diabetes Risk in Obese Youth. Diabetes Care 2016; 39:1431-9. [PMID: 27293201 PMCID: PMC4955931 DOI: 10.2337/dc16-0352] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 05/10/2016] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The shape of the glucose response curve during an oral glucose tolerance test (OGTT), monophasic versus biphasic, identifies physiologically distinct groups of individuals with differences in insulin secretion and sensitivity. We aimed to verify the value of the OGTT-glucose response curve against more sensitive clamp-measured biomarkers of type 2 diabetes risk, and to examine incretin/pancreatic hormones and free fatty acid associations in these curve phenotypes in obese adolescents without diabetes. RESEARCH DESIGN AND METHODS A total of 277 obese adolescents without diabetes completed a 2-h OGTT and were categorized to either a monophasic or a biphasic group. Body composition, abdominal adipose tissue, OGTT-based metabolic parameters, and incretin/pancreatic hormone levels were examined. A subset of 106 participants had both hyperinsulinemic-euglycemic and hyperglycemic clamps to measure in vivo insulin sensitivity, insulin secretion, and β-cell function relative to insulin sensitivity. RESULTS Despite similar fasting and 2-h glucose and insulin concentrations, the monophasic group had significantly higher glucose, insulin, C-peptide, and free fatty acid OGTT areas under the curve compared with the biphasic group, with no differences in levels of glucagon, total glucagon-like peptide 1, glucose-dependent insulinotropic polypeptide, and pancreatic polypeptide. Furthermore, the monophasic group had significantly lower in vivo hepatic and peripheral insulin sensitivity, lack of compensatory first and second phase insulin secretion, and impaired β-cell function relative to insulin sensitivity. CONCLUSIONS In obese youth without diabetes, the risk imparted by the monophasic glucose curve compared with biphasic glucose curve, independent of fasting and 2-h glucose and insulin concentrations, is reflected in lower insulin sensitivity and poorer β-cell function, which are two major pathophysiological biomarkers of type 2 diabetes in youth.
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Affiliation(s)
- Joon Young Kim
- Division of Weight Management and Wellness, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Sara F Michaliszyn
- Human Performance and Exercise Science, Youngstown State University, Youngstown, OH
| | - Alexis Nasr
- Division of Weight Management and Wellness, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - SoJung Lee
- Division of Weight Management and Wellness, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Hala Tfayli
- Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Tamara Hannon
- Sections of Pediatric Endocrinology and Diabetology, and Pediatric Comparative Effectiveness Research, Department of Pediatrics, School of Medicine, Indiana University, Indianapolis, IN
| | - Kara S Hughan
- Division of Weight Management and Wellness, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA Division of Pediatric Endocrinology, Metabolism and Diabetes Mellitus, Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Fida Bacha
- Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX
| | - Silva Arslanian
- Division of Weight Management and Wellness, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA Division of Pediatric Endocrinology, Metabolism and Diabetes Mellitus, Children's Hospital of Pittsburgh, Pittsburgh, PA
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Brown RE, Kuk JL, Libman I, Rivera-Vega M, Lee S. Associations between visceral fat and liver fat with insulin sensitivity and metabolic risk in obese adolescents. Biochem Cell Biol 2015; 93:466-71. [DOI: 10.1139/bcb-2014-0064] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
We examined the joint and independent associations between VAT and LF with insulin sensitivity (IS) and lipids in seventy-one obese adolescents (BMI ≥ 95th, 14.9 ± 1.8 years). VAT was assessed by magnetic resonance imaging, and LF was quantified by proton magnetic resonance spectroscopy. IS was evaluated by a 3 -h hyperinsulinemic (80 mU·m−2·min−1) euglycemic clamp. Independent associations between VAT and LF on metabolic variables were assessed in mutually adjusted multivariate models. The joint association between VAT and LF on metabolic variables was assessed by categorizing participants into a low VAT + low LF group (n = 35), high VAT + low LF group (n = 26), or high VAT + high LF group (n = 10), based on a VAT median split (1.17 kg) and high (≥5%) and low (<5%) LF. Both VAT and LF were independently associated with fasting insulin, 2 h insulin, insulin AUC, IS, and triglycerides (P < 0.05). Adolescents with high VAT + high LF had higher 2 h glucose, glucose AUC, 2 h insulin, triglycerides, and lower insulin sensitivity compared to adolescents with high VAT only (P < 0.025 for all). In obese adolescents, VAT and LF were independently associated with insulin sensitivity and dyslipidemia, and the concomitant presence of VAT and LF is strongly associated with metabolic risk factors.
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Affiliation(s)
- Ruth E. Brown
- School of Kinesiology and Health Science, York University, Toronto, ON M3J 1P3, Canada
| | - Jennifer L. Kuk
- School of Kinesiology and Health Science, York University, Toronto, ON M3J 1P3, Canada
| | - Ingrid Libman
- Division of Pediatric Endocrinology, Metabolism and Diabetes Mellitus, Children’s Hospital of Pittsburgh of UPMC; Pittsburgh, PA 15224, USA
- Division of Weight Management and Wellness, Children’s Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, 4401 Penn Ave., Faculty Pavilion (6102), Pittsburgh, PA 15224, USA
| | - Michelle Rivera-Vega
- Division of Pediatric Endocrinology, Metabolism and Diabetes Mellitus, Children’s Hospital of Pittsburgh of UPMC; Pittsburgh, PA 15224, USA
- Division of Weight Management and Wellness, Children’s Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, 4401 Penn Ave., Faculty Pavilion (6102), Pittsburgh, PA 15224, USA
| | - SoJung Lee
- Division of Weight Management and Wellness, Children’s Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, 4401 Penn Ave., Faculty Pavilion (6102), Pittsburgh, PA 15224, USA
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O'Connor M, Ryan J, Foley S. Best single-slice location to measure visceral adipose tissue on paediatric CT scans and the relationship between anthropometric measurements, gender and VAT volume in children. Br J Radiol 2015; 88:20140711. [PMID: 26317895 DOI: 10.1259/bjr.20140711] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Visceral adipose tissue (VAT) is a significant risk factor for obesity-related metabolic diseases. This study investigates (1) the best single CT slice location for predicting total abdominal VAT volume in paediatrics and (2) the relationship between waist circumference (WC), sagittal diameter (SD), gender and VAT volume. METHODS A random sample of 130 paediatric abdomen CT scans, stratified according to age and gender, was collected. Three readers measured VAT area at each intervertebral level between T12 and S1 using ImageJ analysis (National Institute of Health, Bethesda, MD) software by thresholding -190 to -30 HU and manually segmenting VAT. Single-slice VAT measurements were correlated with total VAT volume to identify the most representative slice. WC and SD were measured at L3-L4 and L4-L5 slices, respectively. Regression analysis was used to evaluate WC, SD and gender as VAT volume predictors. RESULTS Interviewer and intraviewer reliability were excellent (intraclass correlation coefficient = 0.99). Although VAT measured at multiple slices correlated strongly with abdominal VAT, only one slice in females at L2-L3 and two slices in males at L1-L2 and L5-S1 were strongly correlated across all age groups. Linear regression analysis showed that WC was strongly correlated with VAT volume (beta = 0.970, p < 0.001). CONCLUSION Single-slice VAT measurements are highly reproducible. Measurements performed at L2-L3 in females and L1-L2 or L5-S1 in males were most representative of VAT. WC is indicative of VAT. ADVANCES IN KNOWLEDGE VAT should be measured at L2-L3 in female children and at either L1-L2 or L5-S1 in males. WC is a strong indicator of VAT in children.
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Affiliation(s)
- Michelle O'Connor
- School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
| | - John Ryan
- School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
| | - Shane Foley
- School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
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25
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Brown RE, Kuk JL, Lee S. Measurement site influences abdominal subcutaneous and visceral adipose tissue in obese adolescents before and after exercise. Pediatr Obes 2015; 10:98-104. [PMID: 24729534 PMCID: PMC4197119 DOI: 10.1111/j.2047-6310.2014.224.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Revised: 01/15/2014] [Accepted: 01/31/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND/OBJECTIVES The objective of this study was to determine if abdominal adipose tissue (AT) measurement site influences the association between baseline and change in abdominal subcutaneous (ASAT) and visceral AT (VAT), and metabolic risk factors in obese adolescents. METHODS Fifty-five obese adolescents (14.9 ± 1.7 years; 51% male; 42% white) participated in an aerobic or resistance exercise intervention three times/week for 3 months. We compared the association between changes in abdominal AT area (spanning 5 cm below to 15 cm above L4-L5) and volume measured by magnetic resonance imaging with concomitant changes in metabolic risk. RESULTS All AT areas were significantly (p < 0.05) correlated with the respective volume at baseline and follow-up. Baseline VAT areas at 5 and 10 cm above L4-L5 were more strongly associated with VAT volume than VAT area at L4-L5 (p < 0.05). After the intervention, changes in the area at 5 and 10 cm above L4-L5 were more strongly associated with changes in AT volumes than changes in L4-L5 (p < 0.05). Changes in abdominal AT volumes were more strongly associated with insulin area under the curve than any single-slice abdominal AT area. CONCLUSIONS The measurement site for abdominal AT has significant influence on the relationships with total VAT or ASAT and metabolic risk factors in obese adolescents before and after an exercise intervention.
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Affiliation(s)
- Ruth E. Brown
- School of Kinesiology and Health Science, York University, Toronto, ON, Canada
| | - Jennifer L. Kuk
- School of Kinesiology and Health Science, York University, Toronto, ON, Canada
| | - SoJung Lee
- Division of Weight Management and Wellness, Children’s Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, PA
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Michaliszyn SF, Mari A, Lee S, Bacha F, Tfayli H, Farchoukh L, Ferrannini E, Arslanian S. β-cell function, incretin effect, and incretin hormones in obese youth along the span of glucose tolerance from normal to prediabetes to type 2 diabetes. Diabetes 2014; 63:3846-55. [PMID: 24947360 PMCID: PMC4207396 DOI: 10.2337/db13-1951] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Accepted: 05/30/2014] [Indexed: 12/22/2022]
Abstract
Using the hyperglycemic and euglycemic clamp, we demonstrated impaired β-cell function in obese youth with increasing dysglycemia. Herein we describe oral glucose tolerance test (OGTT)-modeled β-cell function and incretin effect in obese adolescents spanning the range of glucose tolerance. β-Cell function parameters were derived from established mathematical models yielding β-cell glucose sensitivity (βCGS), rate sensitivity, and insulin sensitivity in 255 obese adolescents (173 with normal glucose tolerance [NGT], 48 with impaired glucose tolerance [IGT], and 34 with type 2 diabetes [T2D]). The incretin effect was calculated as the ratio of the OGTT-βCGS to the 2-h hyperglycemic clamp-βCGS. Incretin and glucagon concentrations were measured during the OGTT. Compared with NGT, βCGS was 30 and 65% lower in youth with IGT and T2D, respectively; rate sensitivity was 40% lower in T2D. Youth with IGT or T2D had 32 and 38% reduced incretin effect compared with NGT in the face of similar changes in GLP-1 and glucose-dependent insulinotropic polypeptide (GIP) in response to oral glucose. We conclude that glucose sensitivity deteriorates progressively in obese youth across the spectrum of glucose tolerance in association with impairment in incretin effect without reduction in GLP-1 or GIP, similar to that seen in adult dysglycemia.
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Affiliation(s)
- Sara F Michaliszyn
- Division of Weight Management, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Andrea Mari
- CNR Institute of Biomedical Engineering, Padova, Italy
| | - SoJung Lee
- Division of Weight Management, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Fida Bacha
- Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX
| | - Hala Tfayli
- Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Lama Farchoukh
- Division of Weight Management, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Ele Ferrannini
- Department of Clinical and Experimental Medicine, University of Pisa School of Medicine, Pisa, Italy
| | - Silva Arslanian
- Division of Weight Management, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA Division of Pediatric Endocrinology, Diabetes and Metabolism, Children's Hospital of Pittsburgh, Pittsburgh, PA
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27
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Sabin MA, Wong N, Campbell P, Lee KJ, McCallum Z, Werther GA. Where should we measure waist circumference in clinically overweight and obese youth? J Paediatr Child Health 2014; 50:519-24. [PMID: 24909833 DOI: 10.1111/jpc.12626] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/05/2014] [Indexed: 11/29/2022]
Abstract
AIMS Waist circumference (WC) measurement is a useful tool in the assessment of overweight/obese individuals, but standard measures may miss an apron of 'overhanging' fat (termed 'panniculus'). The objective of this study was to assess whether, in clinically overweight/obese youth, 'pannicular' WC better correlates with fat mass than a standard WC measurement. METHODS Standard and pannicular WC, alongside body composition (BC) measures, were collected from 181 consultations on 127 overweight and obese children/adolescents (52% male; mean (standard deviation) age 12.5 (3.4) years). Correlation coefficients describe associations between WC and measures of BC, and between ΔWC and ΔBC, while linear regression models assessed which of the WC measures explained more of the variability in BC and ΔBC over time. RESULTS Standard and pannicular WC were highly correlated (r = 0.95). Correlation coefficients with measures of BC were generally greater for pannicular than standard WC, with greatest correlations seen for whole body (r = 0.94 vs. 0.85, respectively) and truncal (r = 0.86 vs. 0.77) fat mass. Furthermore, pannicular and Δpannicular WC explained more variability in truncal fat and Δtruncal fat than the standard measure of WC. CONCLUSIONS These data show that pannicular, rather than standard, WC measurements better correlate with absolute measures of fat mass, and their change over time, in clinically overweight/obese youth.
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Affiliation(s)
- Matthew A Sabin
- Department of Physiology, Monash University, Melbourne, Victoria, Australia; Murdoch Childrens Research Institute, The Royal Children's Hospital, Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
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28
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Sadananthan SA, Prakash B, Leow MKS, Khoo CM, Chou H, Venkataraman K, Khoo EY, Lee YS, Gluckman PD, Tai ES, Velan SS. Automated segmentation of visceral and subcutaneous (deep and superficial) adipose tissues in normal and overweight men. J Magn Reson Imaging 2014; 41:924-34. [DOI: 10.1002/jmri.24655] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 04/17/2014] [Accepted: 04/17/2014] [Indexed: 01/26/2023] Open
Affiliation(s)
- Suresh Anand Sadananthan
- Singapore Institute for Clinical Sciences, Agency for Science, Technology & Research (A*STAR); Singapore
- Department of Obstetrics & Gynaecology; Yong Loo Lin School of Medicine, National University of Singapore and National University Health System; Singapore
| | - Bhanu Prakash
- Singapore Bioimaging Consortium, Agency for Science, Technology & Research (A*STAR); Singapore
| | - Melvin Khee-Shing Leow
- Singapore Institute for Clinical Sciences, Agency for Science, Technology & Research (A*STAR); Singapore
- Department of Endocrinology; Tan Tock Seng Hospital; Singapore
| | - Chin Meng Khoo
- Department of Medicine; Yong Loo Lin School of Medicine, National University of Singapore and National University Health System; Singapore
| | - Hong Chou
- Department of Diagnostic Radiology; Khoo Teck Puat Hospital; Singapore
| | - Kavita Venkataraman
- Department of Obstetrics & Gynaecology; Yong Loo Lin School of Medicine, National University of Singapore and National University Health System; Singapore
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System; Singapore
| | - Eric Y.H. Khoo
- Department of Medicine; Yong Loo Lin School of Medicine, National University of Singapore and National University Health System; Singapore
| | - Yung Seng Lee
- Singapore Institute for Clinical Sciences, Agency for Science, Technology & Research (A*STAR); Singapore
- Department of Pediatrics; Yong Loo Lin School of Medicine, National University of Singapore and National University Health System; Singapore
| | - Peter D. Gluckman
- Singapore Institute for Clinical Sciences, Agency for Science, Technology & Research (A*STAR); Singapore
| | - E. Shyong Tai
- Singapore Institute for Clinical Sciences, Agency for Science, Technology & Research (A*STAR); Singapore
- Department of Medicine; Yong Loo Lin School of Medicine, National University of Singapore and National University Health System; Singapore
| | - S. Sendhil Velan
- Singapore Institute for Clinical Sciences, Agency for Science, Technology & Research (A*STAR); Singapore
- Singapore Bioimaging Consortium, Agency for Science, Technology & Research (A*STAR); Singapore
- Clinical Imaging Research Centre, Agency for Science, Technology & Research (A*STAR); Singapore
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Kelly AS, Dengel DR, Hodges J, Zhang L, Moran A, Chow L, Sinaiko AR, Steinberger J. The relative contributions of the abdominal visceral and subcutaneous fat depots to cardiometabolic risk in youth. Clin Obes 2014; 4:101-7. [PMID: 24683420 PMCID: PMC3964618 DOI: 10.1111/cob.12044] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The aim of this study was to evaluate the association of abdominal visceral and subcutaneous fat, independent of total body fat, with cardiometabolic risk factors and insulin resistance among youth. Visceral and subcutaneous fat, percentage total body fat, insulin resistance (adjusted for lean body mass: Mlbm), blood pressure, glucose, insulin and lipids were obtained in 472 youth ages 6-18 years. Linear regression, adjusted for age, sex, race, Tanner stage and percentage total body fat, was used to evaluate associations of visceral and subcutaneous fat with cardiometabolic risk factors. Visceral fat was associated inversely with Mlbm (P = 0.003) and positively with fasting insulin (P = 0.002) and triglycerides (P = 0.002). Visceral fat levels above the mean were associated inversely with high-density lipoprotein (HDL) cholesterol (P = 0.002), and positively with systolic blood pressure (P < 0.0001) and non-HDL cholesterol (P < 0.0001). Subcutaneous fat was associated inversely with Mlbm (P = 0.003) and HDL cholesterol (P < 0.05), and positively with fasting glucose (P < 0.05), fasting insulin (P = 0.0003), systolic blood pressure (P = 0.005) and triglycerides (P = 0.003). Subcutaneous fat levels above the mean were associated with non-HDL cholesterol (P = 0.0002). These findings suggest that there may be a threshold level of visceral and subcutaneous fat (regardless of total body fat), that when exceeded in childhood, is more likely to be associated with many cardiometabolic risk factors. Triglycerides and insulin resistance appear to be associated with these fat depots at even lower thresholds of abdominal adiposity.
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Affiliation(s)
- Aaron S. Kelly
- Department of Pediatrics, University of Minnesota Medical School, and University of Minnesota Amplatz Children’s Hospital, Minneapolis, MN
| | - Donald R. Dengel
- Department of Pediatrics, University of Minnesota Medical School, and University of Minnesota Amplatz Children’s Hospital, Minneapolis, MN
- School of Kinesiology, University of Minnesota Medical School, Minneapolis, MN
| | - James Hodges
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Lei Zhang
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Antoinette Moran
- Department of Pediatrics, University of Minnesota Medical School, and University of Minnesota Amplatz Children’s Hospital, Minneapolis, MN
| | - Lisa Chow
- Department of Medicine, University of Minnesota Medical School, Minneapolis, MN
| | - Alan R. Sinaiko
- Department of Pediatrics, University of Minnesota Medical School, and University of Minnesota Amplatz Children’s Hospital, Minneapolis, MN
| | - Julia Steinberger
- Department of Pediatrics, University of Minnesota Medical School, and University of Minnesota Amplatz Children’s Hospital, Minneapolis, MN
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30
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Michaliszyn SF, Bonadonna RC, Sjaarda LA, Lee S, Farchoukh L, Arslanian SA. β-Cell lipotoxicity in response to free fatty acid elevation in prepubertal youth: African American versus Caucasian contrast. Diabetes 2013; 62:2917-22. [PMID: 23557704 PMCID: PMC3717834 DOI: 10.2337/db12-1664] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Prepubertal African American (AA) youth compared with their Caucasian (C) peers have higher insulin secretion, which correlates positively with free fatty acid (FFA) concentration. In our continued efforts to explain the racial disparity in insulinemia, and because FFAs modulate insulin secretion, we hypothesized that AA youth would have a greater response to FFA-induced β-cell insulin secretion than C youth. We compared the short-term effects of FFA elevation on fasting and glucose-stimulated C-peptide-modeled insulin secretion in prepubertal normal-weight AA versus C peers during a 2-h hyperglycemic clamp (12.5 mmol/L) on two occasions: 1) infusion of normal saline and 2) infusion of 20% intralipid (IL). During IL infusion, insulin sensitivity (IS) declined comparably in AA and C youth. Glucose sensitivity of first- and second-phase insulin secretion showed a significant condition × race interaction being higher in AA youth. Disposition index, β-cell function relative to IS, declined with IL infusion in AA and C youth, with a significantly greater decrease in Cs compared with AAs. In conclusion, AA and C prepubertal youth both demonstrated a decline in β-cell function relative to IS during IL infusion, indicative of acute lipotoxicity. The greater decline in C youth compared with AAs may suggest that C youth are more susceptible to β-cell lipotoxicity than AA youth, or alternatively, that AA youth are hypersensitive to FFA stimulation of β-cell insulin secretion, consistent with our theory.
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Affiliation(s)
- Sara F. Michaliszyn
- Division of Weight Management, Children’s Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Riccardo C. Bonadonna
- Division of Endocrinology and Metabolic Disease, University of Verona School of Medicine, and Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Lindsey A. Sjaarda
- Eunice Kennedy Shriver National Institute of Child Health & Human Development, National Institutes of Health, Bethesda, Maryland
| | - SoJung Lee
- Division of Weight Management, Children’s Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Lama Farchoukh
- Division of Weight Management, Children’s Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Silva A. Arslanian
- Division of Weight Management, Children’s Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
- Division of Pediatric Endocrinology, Metabolism & Diabetes Mellitus, Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
- Corresponding author: Silva A. Arslanian,
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31
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Lee HO, Yim JE, Lee JS, Kim YS, Choue R. The association between measurement sites of visceral adipose tissue and cardiovascular risk factors after caloric restriction in obese Korean women. Nutr Res Pract 2013; 7:43-8. [PMID: 23424007 PMCID: PMC3572225 DOI: 10.4162/nrp.2013.7.1.43] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Revised: 10/25/2012] [Accepted: 11/12/2012] [Indexed: 12/28/2022] Open
Abstract
Quantities as well as distributions of adipose tissue (AT) are significantly related to cardiovascular disease (CVD) risk factors and can be altered with caloric restriction. This study investigated which cross-sectional slice location of AT is most strongly correlated with changes in CVD risk factors after caloric restriction in obese Korean women. Thirty-three obese pre-menopausal Korean women (32.4 ± 8.5 yrs, BMI 27.1 ± 2.3 kg/m(2)) participated in a 12 weeks caloric restriction program. Subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT) were measured using computed tomography (CT) scans at the sites of L2-L3, L3-L4, and L4-L5. Fasting serum levels of glucose, insulin, triglyceride, total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), leptin and homeostasis model assessment-insulin resistance (HOMA-IR) were observed. Pearson's partial correlation coefficients were used to assess the relationship between AT measurement sites and changes in CVD risk factors after calorie restriction. When calories were reduced by 350 kcal/day for 12 weeks, body weight (-2.7%), body fat mass (-8.2%), and waist circumference (-5.8%) all decreased (P < 0.05). In addition, following caloric restriction, serum levels of glucose (-4.6%), TC (-6.2%), LDL-C (-5.3%), leptin (-17.6%) and HOMA-IR (-18.2%) decreased significantly (P < 0.05) as well. Changes in VAT at the level of L3-L4 were significantly greater than those at other abdominal sites, and these changes were correlated with changes in TC (P < 0.05), LDL-C (P < 0.001), SBP (P < 0.001) and HOMA-IR (P < 0.01). These results show that VAT at L3-L4 had a stronger correlation with CVD risk factors than with other AT measurement sites after caloric restriction.
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Affiliation(s)
- Hye-Ok Lee
- Department of Medical Nutrition, Graduate School of East-West Medical Science, Kyung Hee University, 26 Kyungheedae-ro, Dongdaemun-gu, Seoul 130-701, Korea
- Department of Nutrition, Kyung Hee University Hospital at Gangdong, Seoul 134-727, Korea
| | - Jung-Eun Yim
- Department of Food and Nutrition, Changwon National University, Changwon 641-773, Korea
| | - Jeong-Sook Lee
- Department of Nutrition, Kyung Hee University Hospital at Gangdong, Seoul 134-727, Korea
| | - Young-Seol Kim
- Department of Endocrine and Metabolism, Kyung Hee Medical Center, Seoul 130-702, Korea
| | - Ryowon Choue
- Department of Medical Nutrition, Graduate School of East-West Medical Science, Kyung Hee University, 26 Kyungheedae-ro, Dongdaemun-gu, Seoul 130-701, Korea
- Research Institute of Medical Nutrition, Kyung Hee University, Seoul 130-701, Korea
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Shen W, Chen J, Gantz M, Velasquez G, Punyanitya M, Heymsfield SB. A single MRI slice does not accurately predict visceral and subcutaneous adipose tissue changes during weight loss. Obesity (Silver Spring) 2012; 20:2458-63. [PMID: 22728693 PMCID: PMC3466347 DOI: 10.1038/oby.2012.168] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Earlier cross-sectional studies found that a single magnetic resonance imaging (MRI) slice predicts total visceral and subcutaneous adipose tissue (VAT and SAT) volumes well. We sought to investigate the accuracy of trunk single slice imaging in estimating changes of total VAT and SAT volume in 123 overweight and obese subjects who were enrolled in a 24-week CB-1R inverse agonist clinical trial (weight change, -7.7 ± 5.3 kg; SAT change, -5.4 ± 4.9 l, VAT change, -0.8 ± 1.0 l). VAT and SAT volumes at baseline and 24 weeks were derived from whole-body MRI images. The VAT area 5-10 cm above L(4)-L(5) (A(+5-10)) (R(2) = 0.59-0.70, P < 0.001) best predicted changes in VAT volume but the strength of these correlations was significantly lower than those at baseline (R(2) = 0.85-0.90, P < 0.001). Furthermore, the L(4)-L(5) slice poorly predicted VAT volume changes (R(2) = 0.24-0.29, P < 0.001). Studies will require 44-69% more subjects if (A(+5-10)) is used and 243-320% more subjects if the L(4)-L(5) slice is used for equivalent power of multislice total volume measurements of VAT changes. Similarly, single slice imaging predicts SAT loss less well than cross-sectional SAT (R(2) = 0.31-0.49 vs. R(2) = 0.52-0.68, P < 0.05). Results were the same when examined in men and women separately. A single MRI slice 5-10 cm above L(4)-L(5) is more powerful than the traditionally used L(4)-L(5) slice in detecting VAT changes, but in general single slice imaging poorly predicts VAT and SAT changes during weight loss. For certain study designs, multislice imaging may be more cost-effective than single slice imaging in detecting changes for VAT and SAT.
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Affiliation(s)
- Wei Shen
- New York Obesity Nutrition Research Center, St. Luke's-Roosevelt Hospital and Institute of Human Nutrition, Columbia University, New York, New York, USA.
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Katzmarzyk PT, Shen W, Baxter-Jones A, Bell JD, Butte NF, Demerath EW, Gilsanz V, Goran MI, Hirschler V, Hu HH, Maffeis C, Malina RM, Müller MJ, Pietrobelli A, Wells JCK. Adiposity in children and adolescents: correlates and clinical consequences of fat stored in specific body depots. Pediatr Obes 2012; 7:e42-61. [PMID: 22911903 DOI: 10.1111/j.2047-6310.2012.00073.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2012] [Accepted: 05/22/2012] [Indexed: 12/11/2022]
Abstract
The 2011 Pennington Biomedical Research Center's Scientific Symposium focused on adiposity in children and adolescents. The symposium was attended by 15 speakers and other invited experts. The specific objectives of the symposium were to (i) integrate the latest published and unpublished findings on the laboratory and clinical assessment of depot-specific adiposity in children and adolescents, (ii) understand the variation in depot-specific adiposity and related health outcomes associated with age, sex, maturation, ethnicity and other factors and (iii) identify opportunities for incorporating new markers of abdominal obesity into clinical practice guidelines for obesity in children and adolescents. This symposium provided an overview of important new advances in the field and identified directions for future research. The long-term goal of the symposium is to aid in the early identification of children and adolescents who are at increased health risk because of obesity and obesity-related conditions.
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Affiliation(s)
- P T Katzmarzyk
- Pennington Biomedical Research Center, Baton Rouge, LA 70808-4124, USA.
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Samara A, Ventura EE, Alfadda AA, Goran MI. Use of MRI and CT for fat imaging in children and youth: what have we learned about obesity, fat distribution and metabolic disease risk? Obes Rev 2012; 13:723-32. [PMID: 22520361 DOI: 10.1111/j.1467-789x.2012.00994.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Childhood obesity is a matter of great concern for public health. Efforts have been made to understand its impact on health through advanced imaging techniques. An increasing number of studies focus on fat distribution and its associations with metabolic risk, in interaction with genetics, environment and ethnicity, in children. The present review is a qualitative synthesis of the existing literature on visceral and subcutaneous abdominal, intrahepatic and intramuscular fat. Our search revealed 80 original articles. Abdominal as well as ectopic fat depots are prevalent already in childhood and contribute to abnormal metabolic parameters, starting early in life. Visceral, hepatic and intramuscular fat seem to be interrelated but their patterns as well as their independent contribution on metabolic risk are not clear. Some ethnic-specific characteristics are also prevalent. These results encourage further research in childhood obesity by using imaging techniques such as magnetic resonance imaging and computed tomography. These imaging methods can provide a better understanding of fat distribution and its relationships with metabolic risk, compared to less detailed fat and obesity assessment. However, studies on bigger samples and with a prospective character are warranted.
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Affiliation(s)
- A Samara
- Obesity Research Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
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Ethnic and sex differences in body fat and visceral and subcutaneous adiposity in children and adolescents. Int J Obes (Lond) 2012; 36:1261-9. [PMID: 22710928 DOI: 10.1038/ijo.2012.95] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Body fat and the specific depot where adipose tissue (AT) is stored can contribute to cardiometabolic health risks in children and adolescents. Imaging procedures including magnetic resonance imaging and computed tomography allow for the exploration of individual and group differences in pediatric adiposity. This review examines the variation in pediatric total body fat (TBF), visceral AT (VAT) and subcutaneous AT (SAT) due to age, sex, maturational status and ethnicity. TBF, VAT and SAT typically increase as a child ages, though different trends emerge. Girls tend to accumulate more TBF and SAT during and after puberty, depositing fat preferentially in the gynoid and extremity regions. In contrast, pubertal and postpubertal boys tend to deposit more fat in the abdominal region, particularly in the VAT depot. Sexual maturation significantly influences TBF, VAT and SAT. Ethnic differences in TBF are mixed. VAT tends to be higher in white and Hispanic youth, whereas SAT is typically higher in African American youth. Asian youth typically have less gynoid fat but more VAT than whites. Obesity per se may attenuate sex and ethnic differences. Particular health risks are associated with high amounts of TBF, VAT and SAT, including insulin resistance, hepatic steatosis, metabolic syndrome and hypertension. These risks are affected by genetic, biological and lifestyle factors including physical activity, nutrition and stress. Synthesizing evidence is difficult as there is no consistent methodology or definition to estimate and define depot-specific adiposity, and many analyses compare SAT and VAT without controlling for TBF. Future research should include longitudinal examinations of adiposity changes over time in representative samples of youth to make generalizations to the entire pediatric population and examine variation in organ-specific body fat.
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[Identification and quantification of fat compartments with CT and MRI and their importance]. Radiologe 2011; 51:372-8. [PMID: 21487800 DOI: 10.1007/s00117-010-2088-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
In addition to being overweight, as defined by the BMI, the distribution, composition and biological activity of adipose tissue are key elements in the cardiovascular risk stratification of patients. Several non-invasive techniques have been developed to quantify local fat depots, whereby computed tomography (CT) and magnetic resonance imaging (MRI) are the most important. In general adipose tissue is subdivided into subcutaneous and visceral compartments and although both are associated with cardiovascular risk factors and disease, visceral fat has on average a stronger association and a clearly higher biological activity independent of traditional risk factors. This maybe explained by the higher endocrine activity and secretion of pro-inflammatory cytokines by visceral fat. Especially pericardial adipose tissue, a local visceral fat depot surrounding the coronary arteries, is associated with the presence, extent and severity of coronary artery disease. However, several other local fat depots have been identified and associations with various diseases have been established. This article gives an overview over the current methods for the identification and quantification of local fat depots and summarizes the hypothesized and known associations. Furthermore, it gives an overview of the potential significance of individual local fat depots for cardiovascular risk stratification.
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