Visceral fat and liver fat are independent predictors of metabolic risk factors in men

A Novel TGFβ Receptor Inhibitor, IPW-5371, Prevents Diet-induced Hepatic Steatosis and Insulin Resistance in Irradiated Mice

As the number of cancer survivors increases and the risk of accidental radiation exposure rises, there is a pressing need to characterize the delayed effects of radiation exposure and develop medical countermeasures. Radiation has been shown to damage adipose progenitor cells and increase liver fibrosis, such that it predisposes patients to developing metabolic-associated fatty liver disease (MAFLD) and insulin resistance. The risk of developing these conditions is compounded by the global rise of diets rich in carbohydrates and fats. Radiation persistently increases the signaling cascade of transforming growth factor β (TGFβ), leading to heightened fibrosis as characteristic of the delayed effects of radiation exposure. We investigate here a potential radiation medical countermeasure, IPW-5371, a small molecule inhibitor of TGFβRI kinase (ALK5). We found that mice exposed to sub-lethal whole-body irradiation and chronic Western diet consumption but treated with IPW-5371 had a similar body weight, food consumption, and fat mass compared to control mice exposed to radiation. The IPW-5371 treated mice maintained lower fibrosis and fat accumulation in the liver, were more responsive to insulin and had lower circulating triglycerides and better muscle endurance. Future studies are needed to verify the improvement by IPW-5371 on the structure and function of other metabolically active tissues such as adipose and skeletal muscle, but these data demonstrate that IPW-5371 protects liver and whole-body health in rodents exposed to radiation and a Western diet, and there may be promise in using IPW-5371 to prevent the development of MAFLD.

Does Elevated High-Density Lipoprotein Cholesterol Protect Against Cardiovascular Disease?

High-density lipoprotein (HDL) contributes to reverse cholesterol transport, which is 1 of the main explanations for the described inverse association between HDL-cholesterol (HDL-C) and atherosclerotic cardiovascular disease (ASCVD) risk. However, efforts to therapeutically raise HDL-C levels with niacin, fibrates, or cholesteryl ester transfer protein inhibitors have not demonstrated a reduction in ASCVD events when compared with placebo among individuals treated with statins. Furthermore, mendelian randomization studies suggest that HDL-C is unlikely to be a direct biologic variable impacting ASCVD risk. More recently, observations from well-conducted epidemiologic studies have indicated a nonlinear U-shaped relationship between HDL-C and subclinical atherosclerosis, and that very high HDL-C (≥80 mg/dL in men, ≥100 mg/dL in women) is paradoxically associated with higher all-cause and ASCVD-related mortality. These observations suggest that HDL-C is not a universal protective factor for atherosclerosis. Thus, there are several opportunities for reframing the contribution of HDL-C to ASCVD risk and related clinical calculators. Here, we examine our growing understanding of HDL-C and its role in ASCVD risk assessment, treatment, and prevention. We discuss the biological functions of HDL-C and its normative values in relation to demographics and lifestyle markers. We then summarize original studies that observed a protective association between HDL-C and ASCVD risk and more recent evidence indicating an elevated ASCVD risk at very high HDL-C levels. Through this process, we advance the discussion regarding the future role of HDL-C in ASCVD risk assessment and identify knowledge gaps pertaining to the precise role of HDL-C in atherosclerosis and clinical ASCVD.

Exercise-induced effects on asprosin and indices of atherogenicity and insulin resistance in males with metabolic syndrome: a randomized controlled trial

Metabolic syndrome (MetS) development is associated with insulin resistance and obesity, with the progression of visceral adipose tissue playing a crucial role. Excessive adipose tissue is accompanied by an increase in the asprosin (ASP), which is responsible for carbohydrate metabolism and the regulation of hunger and satiety. Exercise affects the release of ASP, which may regulate metabolism accordingly. Due to the inconclusive results of the effect of exercise on ASP concentration in men with MetS, 12-week interventions were carried out in the following groups: EG1-aerobic training (n = 21, age: 34.21 ± 6.06, WC; waist circumference: 114.7 ± 10.93) and EG2-a combination of aerobic and resistance training (n = 21, age: 37.37 ± 7.08, WC: 114.8 ± 11.64) and compared with a control group (CG) of men with MetS without any intervention (n = 20, age: 38.26 ± 7.43, WC: 115.3 ± 10.54). Body composition, indicators of carbohydrate-lipid metabolism, and ASP were assessed four times: before the intervention, at 6 and 12 weeks of training, and 4 weeks after the training sessions. A comparison of the intervention influence on changes in the analyzed variables between the groups was performed using ANOVA test for dependent groups with post-hoc comparison. The effect size (ES) was also assessed using squared eta (η2). The implementation of aerobic training resulted in a decrease in ASP concentration (p = 0.03) within 6 weeks of the intervention, while in the CG a gradual increase in ASP was confirmed (p < 0.001). Aerobic-resistance training did not induce significant changes in ASP concentration but resulted in an increase in fat-free mass/fat mass (FFM/FM) ratio (p < 0.001), and a decrease (p = 0.04) in Homeostasis Model Assessment of Insulin Resistance (HOMA-IR). Changes in the visceral adipose tissue level indicate a gradual decrease in both the EG1 (p = 0.01) and EG2 (p = 0.04) groups. Both aerobic and aerobic-resistance exercises may have a regulatory effect, mainly by reducing visceral adipose tissue, on the improvement of metabolic disorders.

Associations of renal sinus fat with blood pressure and ectopic fat in a diverse cohort of adults

Background

Renal sinus fat (RSF) is an ectopic fat depot shown to be associated with visceral adiposity and hypertension in predominantly white populations. The purpose of this analysis is to investigate RSF and associations between RSF and blood pressure in a cohort of African American (AA) and European American (EA) adults. A secondary purpose was to explore risk factors associated with RSF.

Methods

Participants were 116 A A and EA adult men and women. Ectopic fat depots were assessed with MRI: RSF, intraabdominal adipose tissue (IAAT), intermuscular adipose tissue (IMAT), perimuscular adipose tissue (PMAT), and liver fat. Cardiovascular measures included diastolic blood pressure (DBP), systolic blood pressure (SBP), pulse pressure, mean arterial pressure, and flow mediated dilation. Matsuda index was calculated for insulin sensitivity. Pearson correlations were used to investigate associations of RSF with cardiovascular measures. Multiple linear regression was used to evaluate contributions of RSF on SBP and DBP and to explore factors associated with RSF.

Results

No difference was observed in RSF between AA and EA participants. RSF was positively associated with DBP in AA participants, but this was not independent of age and sex. Age, male sex, and total body fat were positively associated with RSF in AA participants. Insulin sensitivity was inversely and IAAT and PMAT were positively associated with RSF in EA participants.

Conclusions

Differential associations of RSF with age, insulin sensitivity, and adipose depots among AA and EA adults suggest unique pathophysiological mechanisms influence RSF deposition, which may contribute to chronic disease etiology and progression.

Magnetic Resonance Imaging to Assess Body Composition Change in Adolescents With Obesity After Sleeve Gastrectomy

OBJECTIVES

Metabolic and bariatric surgery is the most effective weight loss treatment for severe obesity. The number of adolescents undergoing sleeve gastrectomy is increasing. We investigated changes in body composition in adolescents undergoing sleeve gastrectomy 12-26 weeks post-operatively using whole-body magnetic resonance imaging (WB-MRI).

METHODS

This prospective cohort study assessed changes in adipose tissue compartments (ie, visceral, subcutaneous, and intermuscular) and muscle in 18 obese adolescents, ages 14-19, 89% female, with body mass index z -score of 2.6 ± 0.25 (range 2.16-3.2). All underwent WB-MRI 1.5-17 weeks pre-operatively and 12-26 weeks post-operatively.

RESULTS

Pre- and post-operative WB-MRI showed decreases in all adipose tissue compartments, as well as decreased skeletal muscle and liver fat fraction ( P < 0.0001). The post-operative percentage loss of adipose tissue in subcutaneous, visceral, and intermuscular compartments (89.0%, 5.8%, 5.2%, respectively) was similar to the pre-operative percentages of corresponding adipose tissue compartments (90.5%, 5.0%, 4.5%, respectively). Of note, participants with obstructive sleep apnea had significantly higher pre-operative volume of subcutaneous and intermuscular adipose tissue than participants without obstructive sleep apnea ( P = 0.003).

CONCLUSIONS

We found, contrary to what is reported to occur in adults, that pre-operative percentage loss of adipose tissue in subcutaneous, visceral, and intermuscular compartments was similar to the post-operative percentage loss of corresponding adipose tissue compartments in adolescents 12-26 weeks after sleeve gastrectomy.

Utility of Human Relevant Preclinical Animal Models in Navigating NAFLD to MAFLD Paradigm

Fatty liver disease is an emerging contributor to disease burden worldwide. The past decades of work established the heterogeneous nature of non-alcoholic fatty liver disease (NAFLD) etiology and systemic contributions to the pathogenesis of the disease. This called for the proposal of a redefinition in 2020 to that of metabolic dysfunction-associated fatty liver disease (MAFLD) to better reflect the current understanding of the disease. To date, several clinical cohort studies comparing NAFLD and MAFLD hint at the relevancy of the new nomenclature in enriching for patients with more severe hepatic injury and extrahepatic comorbidities. However, the underlying systemic pathogenesis is still not fully understood. Preclinical animal models have been imperative in elucidating key biological mechanisms in various contexts, including intrahepatic disease progression, interorgan crosstalk and systemic dysregulation. Furthermore, they are integral in developing novel therapeutics against MAFLD. However, substantial contextual variabilities exist across different models due to the lack of standardization in several aspects. As such, it is crucial to understand the strengths and weaknesses of existing models to better align them to the human condition. In this review, we consolidate the implications arising from the change in nomenclature and summarize MAFLD pathogenesis. Subsequently, we provide an updated evaluation of existing MAFLD preclinical models in alignment with the new definitions and perspectives to improve their translational relevance.

Triglyceride affects the association between estimated glomerular filtration rate and the onset of non-alcoholic fatty liver disease: A second analysis of a Chinese cohort study

Objective

The role of triglyceride (TG) and estimated glomerular filtration rate (eGFR) effect modifiers on the risk of non-alcoholic fatty liver disease (NAFLD) is unknown. This study examined whether TG modifies the relationship between eGFR and incident NAFLD.

Methods

In a Chinese hospital from January 2010 to December 2014, 15,555 non-obese subjects were collected systematically for this retrospective cohort study. The target-independent and dependent variables were eGFR measured at baseline and NAFLD appearing during follow-up. The modified variable was TG measured at baseline. The multivariate Cox proportional hazards model was used to explore eGFR and TG’s association with NAFLD risk. We explored a priori interaction between eGFR and TG, and performed subgroup analyses to further assess whether the relationship between eGFR and incident NAFLD was modified by TG. We also explored the effect of TG and eGFR interaction on the risk of NAFLD.

Results

The mean age was 43.09 ± 14.92 years, and 8,131 (52.27%) were males. During a median follow-up time of 35.8 months, 2,077 (13.35%) individuals developed NAFLD. In the adjusted model, eGFR was negatively associated with incident NAFLD (HR = 0.984, 95% CI: 0.982, 0.987), while TG was positively related to NAFLD (HR = 1.582, 95% CI: 1.490, 1.681). TG could modify the relationship between eGFR and incident NAFLD. A stronger association between eGFR and NAFLD could be found in the participants without hypertriglyceridemia (HTG) (HR = 0.981, 95% CI: 0.978–0.984, P for interaction = 0.0139). In contrast, the weaker association was probed in the population with HTG (HR = 0.986, 95% CI: 0.983–0.989). At the same time, we also found an interaction between eGFR and TG in influencing NAFLD risk. In participants with decreased eGFR and HTG, the risk of NAFLD was significantly increased. Further, compared to non-HTG subjects with eGFR ≥ 116.56 ml/min/1.73 m², participants with HTG and eGFR < 82.88 ml/min/1.73 m² had about a fourfold increase in the risk (HR = 4.852 95% CI: 3.943–5.970) of NAFLD.

Conclusion

eGFR and TG is independently associated with NAFLD risk. The association of eGFR with incident NAFLD is likely to be modified by TG in the Chinese non-obese population. There was an interactive effect between eGFR and TG in affecting NAFLD risk. In participants with decreased eGFR and hypertriglyceridemia, the risk of NAFLD is significantly increased.

Visceral Adipose Tissue Inflammation and Radiographic Visceral-to-Subcutaneous Adipose Tissue Ratio in Patients with Cirrhosis

BACKGROUND AND AIMS

Accumulation of visceral adipose tissue is associated with hepatic inflammation and fibrosis, suggestive of its metabolic and inflammatory properties. We aimed to examine the histologic findings of visceral and subcutaneous adipose tissue and to associate these findings with clinical and radiologic characteristics in patients with cirrhosis.

METHODS

Included were 55 adults with cirrhosis who underwent liver transplantation from 3/2017-12/2018 and had an abdominal computed tomography (CT) scan within 6 months prior to transplant. Visceral-to-subcutaneous adipose tissue ratio (VSR) was calculated using visceral (VATI) and subcutaneous adipose tissue index (SATI) quantified by CT at the L3-vertebral level and normalized for height (cm²/m²). VAT (greater omentum), SAT (abdominal wall), and skeletal muscle (rectus abdominis) biopsies were collected at transplant.

RESULTS

Majority of patients had VAT inflammation (71%); only one patient (2%) had SAT inflammation. Patients with VAT inflammation had similar median VATI (42 vs 41 cm²/m²), lower median SATI (64 vs 97 cm²/m²), and higher median VSR (0.63 vs 0.37, p = 0.002) than patients without inflammation. In univariable logistic regression, VSR was associated with VAT inflammation (OR 1.47, 95%CI 1.11-1.96); this association remained significant even after adjusting for age, sex, BMI, HCC, or MELD-Na on bivariable analyses.

CONCLUSION

In patients with cirrhosis undergoing liver transplantation, histologic VAT inflammation was common, but SAT inflammation was not. Increased VSR was independently associated with VAT inflammation. Given the emerging data demonstrating the prognostic value of VSR, our findings support the value of CT-quantified VSR as a prognostic marker for adverse outcomes in the liver transplant setting.

Metabolik sendromda visseral ve subkutan yağ miktari ve hepatosteatozun bilgisayarli tomografi ile kantitatif değerlendirilmesi

Purpose: We aimed to evaluate visceral and subcutaneous fat tissue and its association with hepatosteatosis on computed tomography (CT) scans to determine cut-off criteria for metabolic syndrome, measure abdominal obesity directly based on the visceral fat tissue area (VFTA) rather than indirectly based on waist circumference and obtain supportive findings by density measurements in addition to the VFTA measurements.Materials and Methods: The Hounsfield unit (HU) values, visceral, subcutaneous fat areas and HU values of 108 patients diagnosed with metabolic syndrome (MS) were determined according to the National Cholesterol Education Program Adult Treatment Panel III 2001 Criteria by retrospectively analyzing their abdominal CT images taken for various reasons. The relationships of the obtained values with each other and to MS were evaluated.Results: The strongest predictor of MS was VFTA, and 156.47 cm² was the most significant value with 74.1% sensitivity and 58.6% specificity. An HU value of -102.99 for visceral fat tissue density (VFTD) was found as the second most significant finding with 75% sensitivity and 57.6% specificity. The VFTA values of the patients with hepatosteatosis were higher, and increased VFTA values were associated with lower VFTD values.Conclusion: The most important supportive finding was the demonstration of the possibility of measuring abdominal obesity, which has an important place among criteria, directly by measuring VFTA, rather than indirectly based on waist circumference. 

Anthropometric Assessment of General and Central Obesity in Urban Moroccan Women

In the last few decades, North African countries have faced the nutrition transition, leading to an increase in obesity, exacerbated by an extremely low rate of physical activity (PA). Particular attention must be paid to abdominal obesity (one of the metabolic syndrome criteria), which has been linked to several health problems. The present study aims to investigate the prevalence of overweight/obesity, particularly abdominal obesity, in a sample of urban Moroccan women and to analyze the anthropometric indicators of metabolic syndrome risk among subsamples with different PA and socio-demographic characteristics. Urban Moroccan women living in Casablanca (n = 304; mean age 37.4 ± 15.6 years) were recruited for this cross-sectional study. Data concerning socio-demographic variables, PA behavior, and anthropometric measures (height, weight, waist, and hip circumferences) were directly collected. Body mass index, waist-to-hip ratio, waist-to-height ratio, and relative fat mass were computed. Comparisons between women with different socio-demographic characteristics were performed through ANCOVA adjusted for age. The results reveal that 39.4% of the women did not practice any PA. The percentage of women above the cutoffs of risk for general and central obesity was more than half for all the indexes, except for waist-to-hip ratio (WHR), and 19.6% were at a very high risk of health issues. Moreover, being female unmarried, childless, graduates, and students were found to be protective against obesity. In conclusion, Moroccan women have a high level of obesity, especially abdominal, and preventive interventions are needed to reduce the health impact of obesity in this population.

Pre-sleep Protein Supplementation Affects Energy Metabolism and Appetite in Sedentary Healthy Adults

Purpose

To assess the acute effect of pre-sleep protein supplementation combined with resistance exercise on energy metabolism (including 24-h total energy expenditure (TEE), sleep energy expenditure (SEE), basal energy expenditure (BEE), glycolipid oxidation, and appetite of sedentary adults.

Methods

A total of thirty-one sedentary participants completed this randomized, double-blind, crossover study. Participants completed the following 24-h experimental conditions in random order in the Human Calorimeter chamber: (1) 40-g protein supplementation with dinner before a nighttime resistance exercise, and followed by pre-sleep placebo intake (PRO-PLA); (2) placebo intake with dinner before a nighttime resistance exercise, and followed by pre-sleep 40-g protein supplementation (PLA-PRO); and (3) placebo supplementation both with dinner and pre-sleep combined with a nighttime resistance exercise (PLA). Subjective appetite score before breakfast the next day was evaluated using the visual analog scale.

Results

The SEE values were significantly higher by a mean of 21.7 kcal and 33.3 kcal in PRO-PLA (318.3 ± 44.3 kcal) and PLA-PRO (329.9 ± 45.2 kcal), respectively, than in PLA (296.6 ± 46.6 kcal). In addition, the SEE values for PLA-PRO was also significantly higher by 11.6 kcal than that for PRO-PLA. Further, the fullness the next morning was significantly higher by 30.8% in PLA-PRO (43.9 ± 23.5 mm) than in PLA (33.5 ± 26.6 mm). These effects remained after adjustment for 24-h energy intake.

Conclusion

Pre-sleep protein supplementation combined with resistance exercise can significantly increase the SEE and fullness in the next morning, indicating a possible strategy to improve sleep energy metabolism in the sedentary population.

Genetic and phenotypic links between obesity and extracellular vesicles

Obesity has a highly complex genetic architecture, making it difficult to understand the genetic mechanisms, despite the large number of discovered loci via genome-wide association studies (GWAS). Omics techniques have provided a better resolution to view this problem. As a proxy of cell-level biology, extracellular vesicles (EVs) are useful for studying cellular regulation of complex phenotypes such as obesity. Here, in a well-established Scottish cohort, we utilized a novel technology to detect surface proteins across millions of single EVs in each individual's plasma sample. Integrating the results with established obesity GWAS, we inferred 78 types of EVs carrying one or two of 12 surface proteins to be associated with adiposity-related traits such as waist circumference. We then verified that particular EVs' abundance is negatively correlated with body adiposity, while no association with lean body mass. We also revealed that genetic variants associated with protein-specific EVs capture 2-4-fold heritability enrichment for blood cholesterol levels. Our findings provide evidence that EVs with specific surface proteins have phenotypic and genetic links to obesity and blood lipids, respectively, guiding future EV biomarker research.

Body composition and risk of non-alcoholic fatty liver disease: A case control study

BACKGROUND: While evidence has been a highlight that obesity may be associated with the increased incidence of Nonalcoholic fatty liver disease (NAFLD), these data have depended on defective measures of obesity such as body mass index (BMI), and usually have not the well-known relationship between body composition with NAFLD. METHODS: In a case-control study of people aged 20– 65 years, we directly measured body composition (using bioelectrical impedance analysis), height, weight, and waist and hip circumferences who referred to radiology clinics in Kermanshah, Iran. Dietary intake was assessed by the food frequency questionnaire (FFQ). RESULTS: Among 221 people examined, 103 cases with NAFLD and 119 as control were established. The risk of NAFLD was positively associated with higher BMI and the components of the body composition. These associations were strengthened after adjusting for potential confounders including gender, age, marital status, education, smoking, alcohol consumption, and physical activity CONCLUSION: An increasing prevalence of obesity may be associated with the increasing incidence of NAFLD as observed in many populations. We observed an increased risk of NAFLD associated with increased BMI, central adiposity, and the fat component of weight, but found no association with nonfat mass.

Association of abdominal muscle area and density with glucose regulation: The multi-ethnic study of atherosclerosis (MESA)

AIMS

Previous characterisation of body composition as a type 2 diabetes mellitus (T2DM) risk factor has largely focused on adiposity, but less is known about the independent role of skeletal muscle. We examined associations between abdominal muscle and measures of glucose regulation.

MATERIALS AND METHODS

Cross-sectional analysis of 1,891 adults enrolled in the Multi-Ethnic Study of Atherosclerosis. Multivariable regression assessed associations between abdominal muscle area and density (measured by computed tomography) with fasting glucose, homeostasis model assessment of insulin resistance (HOMA-IR), and prevalent T2DM (fasting glucose ≥126 mg/dL or medication use).

RESULTS

In minimally adjusted models (age, sex, race/ethnicity, income), a 1-SD increment in abdominal muscle area was associated with higher HOMA-IR (β = 0.20 ± SE 0.03; 95%CI: 0.15, 0.25; P < 0.01) and odds of T2DM (OR = 1.47; 95%CI: 1.18, 1.84; P < 0.01), while higher density was associated with lower fasting glucose (-4.49 ± 0.90; -6.26, -2.72; P < 0.01), HOMA-IR (-0.16 ± 0.02; -0.20, -0.12; P < 0.01), and odds of T2DM (0.64; 0.52, 0.77; P < 0.01). All associations persisted after adjustment for comorbidities and health behaviours. However, after controlling for height, BMI, and visceral adiposity, increasing muscle area became negatively associated with fasting glucose (-2.23 ± 1.01; -4.22, -0.24; P = 0.03), while density became positively associated with HOMA-IR (0.09 ± 0.02; 0.05, 0.13; P < 0.01).

CONCLUSIONS

Increasing muscle density was associated with salutary markers of glucose regulation, but associations inverted with further adjustment for body size and visceral adiposity. Conversely, after full adjustment, increasing muscle area was associated with lower fasting glucose, suggesting some patients may benefit from muscle-building interventions.

Epicardial Fat Thickness: A Cardiometabolic Risk Marker in Rheumatoid Arthritis

Background: Rheumatoid arthritis (RA) is a chronic, systemic, inflammatory disorder of unknown etiology which mainly involves synovial joints. However, the corresponding systemic inflammation may result in disorders of multiple other organ systems. Several organs and organ systems are potentially involved in RA, particularly in severe diseases. The organs most involved are the lung, heart, eyes, and nervous system. Extra-articular manifestations of RA may develop even before the onset of arthritis. Emerging epidemiological evidence shows that cardiovascular disease (CVD) accounts for near about 50% of RA-associated death. Epicardial fat thickness (EFT) has recently emerged as a new marker of cardiometabolic risk. Although Epicardial fat (EF) is needed for heart muscle function, given its intrinsic inflammatory status, EFT displays the potential to serve as a therapeutic target in patients with RA.

Objectives: To evaluate EFT using echocardiography in RA patients compared to age and sex-matched control and to find the factors associated with EFT in RA patients.

Materials and methods: This current study was conducted in the Department of Medicine, Postgraduate Institute of Medical Education & Research. The study was conducted from November 2016 to March 2018. Patients with BMI ≥ 30 kg/m², diabetes mellitus, primary hyperlipidemia, and uncontrolled hypertension were particularly excluded. Thirty patients of age and sex-matched controls were also taken for the study. All the patients and controls selected for the study were subjected to detailed history taking and clinical examination. They were subjected to lab investigations and echocardiography. The 30 RA patients included in the study were diagnosed according to the 2010 ACR-EULAR criteria. Disease activity was measured by the disease activity score (DAS28) index.

Results: Group 1 included 30 patients with RA and group 2 included 30 age and sex-matched controls. Pearson correlation analysis was done between EFT and other variables. Only HDL, erythrocyte sedimentation rate (ESR), high-sensitivity C-reactive protein (hS-CRP), rheumatoid factor (RF), anti-cyclic citrullinated peptide (anti-CCP), DAS28, and disease duration were found to have a significant correlation with EFT.

Conclusion: In patients with RA, EFT, left ventricular mass, and diastolic dysfunction are increased in RA patients compared to healthy controls. Out of the conventional CVD risk factors, only HDL was associated with increased EFT in RA patients. In RA patients, DAS28, disease duration, RF, anti-CCP, and markers of inflammation (ESR, hs-CRP) were also associated with increased EFT.

Abdominal Visceral Adipose Tissue and All-Cause Mortality: A Systematic Review

INTRODUCTION

Increased abdominal visceral adipose tissue (VAT) implies an adverse cardio-metabolic profile. We examined the association of abdominal VAT parameters and all-cause mortality risk.

METHODS

We systematically searched four databases. We performed citations/articles screening, data abstraction, and quality assessment in duplicate and independently (CRD42020205021).

RESULTS

We included 12 cohorts, the majority used computed tomography to assess abdominal VAT area. Six cohorts with a mean age ≤ 65 years, examining all-cause mortality risk per increment in VAT area (cm²) or volume (cm³), showed a 11-98% relative risk increase with higher VAT parameters. However, the association lost significance after adjusting for glycemic indices, body mass index, or other fat parameters. In 4 cohorts with a mean age >65 years, the findings on mortality were inconsistent. Conversely, in two cohorts (mean age 73-77 years), a higher VAT density, was inversely proportional to VAT area, and implied a higher mortality risk.

CONCLUSION

A high abdominal VAT area seems to be associated with increased all-cause mortality in individuals ≤ 65 years, possibly mediated by metabolic complications, and not through an independent effect. This relationship is weaker and may reverse in older individuals, most likely secondary to confounding bias and reverse causality. An individual participant data meta-analysis is needed to confirm our findings, and to define an abdominal VAT area cutoff implying increased mortality risk.

SYSTEMATIC REVIEW REGISTRATION

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=205021, identifier CRD42020205021.

Triglyceride: A mediator of the association between waist-to-height ratio and non-alcoholic fatty liver disease: A second analysis of a population-based study

OBJECTIVE

Increasing evidence suggests that an increased waist-to-height ratio (WHtR) may increase the risk of non-alcoholic fatty liver disease (NAFLD). Whether this association is due to WHtR itself or mediated by WHtR-associated increases in triglyceride (TG) is uncertain. On that account, our research aims to disentangle these relationships.

METHODS

In this cross-sectional study, 14251 participants who participated in the medical examination program were consecutively and non-selectively collected in Murakami Memorial Hospital in Japan from 2004 to 2015. The independent and dependent variables were WHtR and NAFLD, respectively. Triglyceride was the mediating factor. The correlation between WHtR, TG, and NAFLD risk factors was examined using spearman correlation analysis. The association between WHtR or TG and NAFLD was examined using multiple logistic regression. In order to determine whether TG mediated the association between WHtR and NAFLD, a mediation analysis was performed.

RESULTS

The mean age of the included individuals was 43.53 ± 8.89 years old, and 7411 (52.00%) were male. The mean WHtR and TG were 0.46 ± 0.05, 0.89 ± 0.63, respectively. The prevalence rate of NAFLD was 2507 (17.59%). Individuals with NAFLD had significantly higher levels of WHtR and TG than those without NAFLD (P&lt;0.05). After adjusting covariates, the multivariate linear regression analysis showed that WHtR was positively associated with TG. That was, for every 0.1 increase in WHtR, TG increased by 0.226mmol/L (β=0.226, 95%CI: 0.206, 0.247). Multiple logistic regression analysis indicated that WHtR (OR=8.743, 95%CI: 7.528, 10.153) and TG (OR=1.897, 95%CI: 1.732, 2.078) were positively associated with NAFLD. The mediation analysis showed that WHtR had a direct, significant effect on NAFLD (β=0.139, 95%CI: 0.126, 0.148), and TG partially mediated the indirect effect of WHtR on NAFLD (β=0.016, 95% CI: 0.013-0.019). TG contributed to 10.41% of WHtR-related NAFLD development.

CONCLUSION

Findings suggest a mediation link between WHtR and TG and the risk of NAFLD. The significance of TG as a mediator deserves recognition and consideration.

Integrated omics analysis reveals sirtuin signaling is central to hepatic response to a high fructose diet

BACKGROUND

Dietary high fructose (HFr) is a known metabolic disruptor contributing to development of obesity and diabetes in Western societies. Initial molecular changes from exposure to HFr on liver metabolism may be essential to understand the perturbations leading to insulin resistance and abnormalities in lipid and carbohydrate metabolism. We studied vervet monkeys (Clorocebus aethiops sabaeus) fed a HFr (n=5) or chow diet (n=5) for 6 weeks, and obtained clinical measures of liver function, blood insulin, cholesterol and triglycerides. In addition, we performed untargeted global transcriptomics, proteomics, and metabolomics analyses on liver biopsies to determine the molecular impact of a HFr diet on coordinated pathways and networks that differed by diet.

RESULTS

We show that integration of omics data sets improved statistical significance for some pathways and networks, and decreased significance for others, suggesting that multiple omics datasets enhance confidence in relevant pathway and network identification. Specifically, we found that sirtuin signaling and a peroxisome proliferator activated receptor alpha (PPARA) regulatory network were significantly altered in hepatic response to HFr. Integration of metabolomics and miRNAs data further strengthened our findings.

CONCLUSIONS

Our integrated analysis of three types of omics data with pathway and regulatory network analysis demonstrates the usefulness of this approach for discovery of molecular networks central to a biological response. In addition, metabolites aspartic acid and docosahexaenoic acid (DHA), protein ATG3, and genes ATG7, and HMGCS2 link sirtuin signaling and the PPARA network suggesting molecular mechanisms for altered hepatic gluconeogenesis from consumption of a HFr diet.

Effect of resistance training with and without caloric restriction on visceral fat: A systemic review and meta-analysis

We performed a systematic review and meta-analysis to investigate the effect of resistance training (RT) with and without caloric restriction (CR) on visceral fat (VF). PubMed and Scopus were searched to identify original articles published through December 2020. Standardized mean differences and 95% confidence intervals (95% CIs) were determined, and separate analyses were conducted for RT versus control, and RT plus CR versus CR only. Thirty-four studies including 38 intervention arms and involving 2285 were included in the meta-analysis. RT effectively reduced VF [-24 (95% CI -0.34 to -0.13), p < 0.001; I²  = 4.17%, p = 0.40; 24 intervention arms] when compared with control. Based on subgroup analyses, reduction in VF was significant for individual with (p = 0.04) and without (p < 0.001) obesity as well as across medium-term (p = 0.001) and long-term (p = 0.002) interventions. Reduction in VF was significant for both middle-age (p = 0.03) and elderly (p = 0.001) adults but was not significant for pediatric (p = 0.08) participants. However, RT plus CR did not indicate superiority effect on VF [0.23 95% CI -0.04 to 0.51, p = 0.09; I²  = 58.76%, p = 0.003; 14 intervention arms] when compared with CR only. Our results confirm that RT may be effective for reducing VF, but adding RT with CR was not associated with a greater effect for reducing VF.

Protective effects of p-coumaric acid against high-fat diet-induced metabolic dysregulation in mice

p-Coumaric acid (PC), a naturally occurring phytochemical, possesses antioxidant and anti-inflammatory properties; however, the mechanisms underlying its protective effects against obesity-related metabolic dysfunction are largely unknown. Here, we treated C57BL/6J mice to a high-fat diet (HFD) with or without PC (10 mg/kg body weight/day) for 16 weeks to determine whether PC ameliorates HFD-induced obesity, insulin resistance, inflammation, and non-alcoholic fatty liver disease (NAFLD). We found no significant differences in food intake and body weight between the groups. However, PC-treated mice showed significantly lower white adipose tissue (WAT) weight, adipocyte size, and plasma leptin level, which were associated with decreased lipogenic enzyme activity and mRNA expression of their genes in the epididymal WAT. Moreover, hepatic lipogenic enzymes activities and expression of their genes and proteins were decreased with concomitant increases in hepatic fatty acid oxidation and mRNA expression of its gene; fecal lipid excretion was significantly increased, resulting in decreased liver weight, hepatic lipid levels, lipid droplet accumulation, and plasma aspartate aminotransferase and lipid levels. Additionally, PC-treated mice showed lower fasting blood glucose, plasma resistin, and MCP-1 levels, HOMA-IR, and mRNA expression of inflammatory genes in the epididymal WAT and liver. Our findings reveal potential mechanisms underlying the action of PC against HFD-induced adiposity, NAFLD, and other metabolic disturbances.

Investigation of the Association between Smoking Behavior and Metabolic Syndrome Using Lipid Accumulation Product Index among South Korean Adults

Electronic cigarette vaping has recently been chosen as a smoking alternative for those who want to quit smoking, but some of the electronic cigarette users use both traditional and electronic cigarettes (dual smoking) without stopping smoking. This study investigated the association between smoking behavior and metabolic syndrome among Korean adults. Data from 14,607 participants (6142 males and 8465 females) were examined. They were divided into four categories: dual smoking (both conventional and e-cigarettes), single smoking (only conventional cigarettes), previously smoking, and non-smoking. Metabolic syndrome risk was calculated as a continuous variable using the lipid accumulation product (LAP) index. Multiple linear regression analyses were performed to examine the association of log-transformed LAP with smoking behavior. Among the total participants, 187 males and 35 females were dual smokers and 1850 males and 372 females were single smokers. LAP was significantly higher in male who practiced dual and single smoking than LAP of non-smokers-dual: β = 0.27, standard error (SE) = 0.06, p < 0.0001; single: β = 0.18, SE = 0.03, p < 0.0001. In female, LAP was significantly higher among those who practiced only single smoking than LAP of non-smokers (β = 0.21, SE = 0.04, p < 0.0001). Dual and single smoking were significantly associated with higher LAP, a strong predictor of metabolic syndrome. Further studies and awareness regarding the adverse effects of dual smoking are required.

Effect of genetic liability to visceral adiposity on stroke and its subtypes: A Mendelian randomization study

BACKGROUND

Observational studies have found an association between visceral adiposity and stroke.

AIMS

The purpose of this study was to investigate the role and genetic effect of visceral adipose tissue accumulation on stroke and its subtypes.

METHODS

In this two-sample Mendelian randomization study, genetic variants (221 single nucleotide polymorphisms; P < 5 × 10^-8) using as instrumental variables for Mendelian randomization analysis was obtained from a genome-wide association study of visceral adipose tissue. The outcome datasets for stroke and its subtypes were obtained from the MEGASTROKE consortium (up to 67,162 cases and 453,702 controls). Mendelian randomization standard analysis (inverse variance weighted method) was conducted to investigate the effect of genetic liability to visceral adiposity on stroke and its subtypes. Sensitivity analyses (Mendelian randomization-Egger, weighted median, Mendelian randomization-pleiotropy residual sum and outlier) were also utilized to assess horizontal pleiotropy and remove outliers. Multi-variable Mendelian randomization analysis was employed to adjust potential confounders.

RESULTS

In the standard Mendelian randomization analysis, genetically determined visceral adiposity (per 1 SD) was significantly associated with a higher risk of stroke (odds ratio (OR) 1.30; 95% confidence interval (CI) 1.21-1.41, P = 1.48× 10^-11), ischemic stroke (OR 1.30; 95% CI 1.20-1.41, P = 4.01 × 10^-10) and large artery stroke (OR 1.49; 95% CI 1.22-1.83, P = 1.16 × 10^-4). The significant association was also found in sensitivity analysis and multi-variable Mendelian randomization analysis.

CONCLUSIONS

Genetic liability to visceral adiposity was significantly associated with an increased risk of stroke, ischemic stroke, and large artery stroke. The effect of genetic susceptibility to visceral adiposity on the stroke warrants further investigation.

Validity of Wrist-Wearable Activity Devices for Estimating Physical Activity in Adolescents: Comparative Study

BACKGROUND

The rapid advancements in science and technology of wrist-wearable activity devices offer considerable potential for clinical applications. Self-monitoring of physical activity (PA) with activity devices is helpful to improve the PA levels of adolescents. However, knowing the accuracy of activity devices in adolescents is necessary to identify current levels of PA and assess the effectiveness of intervention programs designed to increase PA.

OBJECTIVE

The study aimed to determine the validity of the 11 commercially available wrist-wearable activity devices for monitoring total steps and total 24-hour total energy expenditure (TEE) in healthy adolescents under simulated free-living conditions.

METHODS

Nineteen (10 male and 9 female) participants aged 14 to 18 years performed a 24-hour activity cycle in a metabolic chamber. Each participant simultaneously wore 11 commercial wrist-wearable activity devices (Mi Band 2 [XiaoMi], B2 [Huawei], Bong 2s [Meizu], Amazfit [Huamei], Flex [Fitbit], UP3 [Jawbone], Shine 2 [Misfit], GOLiFE Care-X [GoYourLife], Pulse O2 [Withings], Vivofit [Garmin], and Loop [Polar Electro]) and one research-based triaxial accelerometer (GT3X+ [ActiGraph]). Criterion measures were total EE from the metabolic chamber (mcTEE) and total steps from the GT3X+ (AGsteps).

RESULTS

Pearson correlation coefficients r for 24-hour TEE ranged from .78 (Shine 2, Amazfit) to .96 (Loop) and for steps ranged from 0.20 (GOLiFE) to 0.57 (Vivofit). Mean absolute percent error (MAPE) for TEE ranged from 5.7% (Mi Band 2) to 26.4% (Amazfit) and for steps ranged from 14.2% (Bong 2s) to 27.6% (Loop). TEE estimates from the Mi Band 2, UP3, Vivofit, and Bong 2s were equivalent to mcTEE. Total steps from the Bong 2s were equivalent to AGsteps.

CONCLUSIONS

Overall, the Bong 2s had the best accuracy for estimating TEE and total steps under simulated free-living conditions. Further research is needed to examine the validity of these devices in different types of physical activities under real-world conditions.

Assessing the utility of cardiorespiratory fitness, visceral fat, and liver fat in predicting changes in insulin sensitivity beyond simple changes in body weight after exercise training in adolescents

To examine the utility of changes in cardiorespiratory fitness (CRF) and body composition in response to exercise training in adolescents with obesity beyond simple measures of body weight change. This is a secondary analysis of our previously published randomized trials of aerobic, resistance, and combined training. We included 104 adolescents (body mass index (BMI) ≥85th percentile) who had complete baseline and post-intervention data for CRF, regional body fat, insulin sensitivity, and oral glucose tolerance. Associations between changes in body composition and CRF with cardiometabolic variables were examined adjusted for age, sex, Tanner stage, race, exercise group, and weight loss. At baseline, CRF, visceral fat and liver fat were correlated with insulin sensitivity with and without adjustment for BMI percentile. Training-associated changes in CRF, visceral fat, and liver fat were also correlated with insulin sensitivity changes, but not independent of body weight change. After accounting for body weight change, none of the body composition or CRF were associated with changes in insulin sensitivity, glucose tolerance, systolic blood pressure, or high-density lipoprotein cholesterol. Although CRF and body composition were strong independent correlates of insulin sensitivity at baseline, changes in CRF and visceral fat were not associated with changes in insulin sensitivity after accounting for body weight change. Clinicaltrials.gov registration nos.: NCT00739180, NCT01323088, NCT01938950. Novelty With exercise training, changes in body weight, CRF, visceral fat, and liver fat were correlated with changes in insulin sensitivity. Changes in body composition or CRF generally did not remain significant correlates of changes in insulin sensitivity after adjusting for body weight changes.

Body composition, phenotype and central obesity indices in Egyptian women with non-alcoholic fatty liver disease

OBJECTIVES

Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease worldwide. The aim of this study is to investigate body composition and phenotype of Egyptian women with non-alcoholic fatty liver disease (NAFLD) and compare with those without and determine the optimal cut-off values of central obesity indices for predicting NAFLD.

METHODS

The study included 100 women with NAFLD and 100 age and sex matched healthy controls without NAFLD. All women were subjected to ultrasonography examination. Anthropometric measurements included weight, height, waist circumference (WC), hip circumference (HC) and skinfolds thickness were assessed for all participants. Body fat % was evaluated by Tanita body composition analyzer. Body mass index (BMI), WC / height ratio (WHtR), WC / HC ratio (WHR) and visceral adiposity index (VAI) were calculated. Receiver-operating characteristic (ROC) curve was used to determine the optimal cut-off values.

RESULTS

Data showed significant higher levels of WHtR, WHR, BMI, sum of skinfolds, body fat %, serum fasting blood lipids and glucose in NAFLD women compared to group of patients without NAFLD. The area under curve (AUC) was 0.920 for VIA, 0.883 for WHtR and 0.647 for WHR. The optimal cutoff value of VAI was 3.66, of WHtR was 0.66 and WHR was 0.84. All values showed high sensitivity and specificity values.

CONCLUSION

NAFLD women were obese, had excess subcutaneous fat and body fat ratio. Central obesity indices are closely associated with the presence of NAFLD in Egyptian women and might be responsible for its development. Visceral adiposity index had superior diagnostic performance.

The relationship between metabolic syndrome and increased risk of Barrett's esophagus: an updated systematic review and meta-analysis

BACKGROUND

The relationship between metabolic syndrome (MetS) and Barrett's esophagus (BE) is still a challenging issue, and inconsistent results have been reported in different studies. Therefore, this study was conducted to determine the relationship between MetS and BE.

METHODS

In this study, we followed the MOOSE protocol and results were reported according to the PRISMA guidelines. All study steps were performed independently by two authors. If necessary, the dispute was resolved by consultation with a third author. The search strategy is designed to find published studies. Comprehensive search was done in the following databases until July 2019: Cochrane Library, PubMed/Medline, Web of Science, Science Direct, EMBASE, Scopus, CINAHL, EBSCO, and Google Scholar search engine. All analyses were performed using Comprehensive Meta-Analysis Software Ver.2, while p-value lower than 0.05 was considered significant.

RESULTS

In 14 studies with a sample size of 108,416, MetS significantly increased the risk of BE (OR = 1.354; 95% CI: 1.145-1.600; P < 0.001; Heterogeneity: I2 = 81.95%; P < 0.001). Sensitivity analysis by omitting one study showed that overall estimates are still robust. Subgroup analysis was significant for continent (P < 0.001) and MetS diagnostic criteria (P = 0.043), but was not significant for variables of study type (P = 0.899), study setting (P = 0.115), control groups (P = 0.671) and quality of studies (P = 0.603). The Begg (P = 0.912) and Egger's (P = 0.094) tests were not significant; therefore, the publication bias did not play a role in the results.

CONCLUSION

MetS increases the risk of BE compared to control groups. The results of this study can help health practitioners by identifying a treatable risk factor for the most important risk factor for esophageal carcinoma (ie, BE). Future studies should examine whether treatment for MetS reduces the risk of BE.

Exercise Combats Hepatic Steatosis: Potential Mechanisms and Clinical Implications

Hepatic steatosis, the excess storage of intrahepatic lipids, is a rampant clinical problem associated with the obesity epidemic. Hepatic steatosis is linked to increased risk for insulin resistance, type 2 diabetes, and cardiovascular and advanced liver disease. Accumulating evidence shows that physical activity, exercise, and aerobic capacity have profound effects on regulating intrahepatic lipids and mediating susceptibility for hepatic steatosis. Moreover, exercise can effectively reduce hepatic steatosis independent of changes in body mass. In this perspective, we highlight 1) the relationship between obesity and metabolic pathways putatively driving hepatic steatosis compared with changes induced by exercise; 2) the impact of physical activity, exercise, and aerobic capacity compared with caloric restriction on regulating intrahepatic lipids and steatosis risk; 3) the effects of exercise training (modalities, volume, intensity) for treatment of hepatic steatosis, and 4) evidence for a sustained protection against steatosis induced by exercise. Overall, evidence clearly indicates that exercise powerfully regulates intrahepatic storage of fat and risk for steatosis.

Waist circumference as a vital sign in clinical practice: a Consensus Statement from the IAS and ICCR Working Group on Visceral Obesity

Despite decades of unequivocal evidence that waist circumference provides both independent and additive information to BMI for predicting morbidity and risk of death, this measurement is not routinely obtained in clinical practice. This Consensus Statement proposes that measurements of waist circumference afford practitioners with an important opportunity to improve the management and health of patients. We argue that BMI alone is not sufficient to properly assess or manage the cardiometabolic risk associated with increased adiposity in adults and provide a thorough review of the evidence that will empower health practitioners and professional societies to routinely include waist circumference in the evaluation and management of patients with overweight or obesity. We recommend that decreases in waist circumference are a critically important treatment target for reducing adverse health risks for both men and women. Moreover, we describe evidence that clinically relevant reductions in waist circumference can be achieved by routine, moderate-intensity exercise and/or dietary interventions. We identify gaps in the knowledge, including the refinement of waist circumference threshold values for a given BMI category, to optimize obesity risk stratification across age, sex and ethnicity. We recommend that health professionals are trained to properly perform this simple measurement and consider it as an important 'vital sign' in clinical practice.

Evaluation of Several Anthropometric and Metabolic Indices as Correlates of Hyperglycemia in Overweight/Obese Adults

AIM

Rapid and growing rise in obesity and diabetes mellitus, as serious human health-threatening issues, is alarming. The aim of the present study was assessing the accuracy of several obesity indices to predict hyperglycemia in overweight and obese Iranian populations and determining the value of such indices in comparison to the conventional parameters. We also evaluated new latent combined scores in this matter.

PATIENTS AND METHODS

Overall, there were 2088 patients recruited from the weight loss clinic of Sina Hospital, an educational hospital of Tehran University of Medical Sciences for this cross-sectional study. Demographic information, anthropometric indices and biochemical measurements were collected and calculated. The multivariable regression modeling as well as area under the receiver-operating characteristic (ROC) analysis was used. To detect the existence of new combined scores, we used SEM (structural equation modeling) analysis through SmartPLS.

RESULTS

Combined latent scores and WHtR (waist-to-height ratio) gave us a higher area under the curve in predicting hyperglycemia associated with WC (waist circumference) in women, whereas FFMI (fat-free mass index) gave low values. Additionally, BRI (body roundness index) and latent scores had slightly higher AUC values in predicting hyperglycemia in men. According to the age-adjusted odds ratio (OR) in the presence of hyperglycemia, OR was the highest for WHR (waist to hip ratio) in women (OR, 7.74; 95% confidence interval [CI], 1.71-15.13). The association of WHR and hyperglycemia remained significant by adjusting for BMI (body mass index), WC and menopausal status.

CONCLUSION

WHR had the strongest association with hyperglycemia in women with only sufficient discrimination ability. However, neither BSI (body shape index) and BAI (body adiposity index) nor FMI (fat mass index) and FFMI were superior to BMI (body mass index), WC or WHtR in predicting hyperglycemia. It was revealed that BRI and combined scores had a more predictive power compared to the BSI, BAI, FMI and FFMI, simplifying hyperglycemia evaluation.

High Protein Diet and Metabolic Plasticity in Non-Alcoholic Fatty Liver Disease: Myths and Truths

Non-alcoholic fatty liver disease (NAFLD) is characterized by lipid accumulation within the liver affecting 1 in 4 people worldwide. As the new silent killer of the twenty-first century, NAFLD impacts on both the request and the availability of new liver donors. The liver is the first line of defense against endogenous and exogenous metabolites and toxins. It also retains the ability to switch between different metabolic pathways according to food type and availability. This ability becomes a disadvantage in obesogenic societies where most people choose a diet based on fats and carbohydrates while ignoring vitamins and fiber. The chronic exposure to fats and carbohydrates induces dramatic changes in the liver zonation and triggers the development of insulin resistance. Common believes on NAFLD and different diets are based either on epidemiological studies, or meta-analysis, which are not controlled evidences; in most of the cases, they are biased on test-subject type and their lifestyles. The highest success in reverting NAFLD can be attributed to diets based on high protein instead of carbohydrates. In this review, we discuss the impact of NAFLD on body metabolic plasticity. We also present a detailed analysis of the most recent studies that evaluate high-protein diets in NAFLD with a special focus on the liver and the skeletal muscle protein metabolisms.

Associations Between Body Fat, Muscle Mass, and Nonalcoholic Fatty Liver Disease: A Population-Based Study

Nonalcoholic fatty liver disease (NAFLD) is one of the most common forms of liver disease worldwide and has emerged as a significant public health concern in China. A better understanding of the etiology of NAFLD can inform effective management strategies for this disease. We examined factors associated with NAFLD in two districts of Hangzhou, China, focusing on the relationship of regional body fat distribution, muscle mass, and NAFLD. We used baseline data to carry out a cross‐sectional analysis among 3,589 participants from the Wellness Living Laboratory (WELL) China study, a longitudinal population‐based study that aims to investigate and promote well‐being among the Chinese population. NAFLD was defined using the widely validated fatty liver index (FLI). Multivariate logistic regressions were performed to assess independent associations between NAFLD and metabolic risk factors (e.g., insulin resistance) and dual x‐ray absorptiometry (DXA)‐derived measures (e.g., android fat ratio [AFR] and skeletal muscle index [SMI]). Of the 3,589 participants, 476 (13.3%) were classified as having FLI‐defined NAFLD (FLI ≥60). Among those, 58.0% were men. According to our analysis, AFR (odds ratio [OR], 10.0; 95% confidence interval [CI], 5.8‐18.5), insulin resistance (OR, 4.0; 95% CI, 3.0‐5.3), high alanine aminotransferase levels (OR, 7.6; 95% CI, 5.8‐10.0), smoking (OR, 2.0; 95% CI, 1.4‐3.0), and male sex (OR, 2.9; 95% CI, 2.0‐4.2) were positively associated with NAFLD risk, while SMI (OR, 0.1; 95% CI, 0.07‐0.13) was inversely associated with NAFLD risk. Conclusion: In addition to known metabolic risk factors, DXA‐derived AFR and SMI may provide additional insights to the understanding of NAFLD. Interventions that aim to decrease AFR and increase SMI may be important to reduce the burden of NAFLD in this population.

Comprehensive lifestyle intervention vs soy protein-based meal regimen in non-alcoholic steatohepatitis

BACKGROUND

Non-alcoholic steatohepatitis (NASH) has become one of the leading causes of liver disease in the western world. In obese patients weight reduction is recommended. Up to now there are no specific guidelines for weight loss in order to reduce hepatic fat content.

AIM

To investigate the effects of a 24-wk guided lifestyle intervention program compared to a meal replacement regimen based on soy protein.

METHODS

Twenty-six subjects with NASH participated in a randomized single-center study. They were randomly assigned to either meal replacement group (MR-G) with soy-yogurt-honey preparation or to guided lifestyle change group (LC-G) with endurance activity and nutrition counselling. Serum alanine transaminase (ALT), aspartate transaminase (AST), lipid parameters, and adipokines were measured. Liver fat content and lipid composition were determined by magnetic resonance imaging and magnetic resonance spectroscopy. Body fat mass and lean body mass were assessed using Bod Pod^® device. Pre- and post-intervention monitoring of parameters was performed. Statistical analyses were conducted with SPSS software, results were expressed as median (interquartile range).

RESULTS

Twenty-two subjects (MR-G, n = 11 and LC-G, n = 11) completed the study (9 women, 13 men; age 52.1 (15.0) years, body mass index (BMI) 32.3 (3.3) kg/m²). In both groups a significant weight loss was achieved (MR-G: -6.4 (3.6) kg, P < 0.01; LC-G: -9.1 (10.4) kg, P < 0.01). BMI dropped in both groups (MR-G: -2.3 (1.5) kg/m², P = 0.003; LC-G: -3.0 (3.4) kg/m², P = 0.006). Internal fat and hepatic lipid content were markedly reduced in both groups in comparable amount. There was a strong correlation between reduction in liver fat and decrease in ALT. Likewise, both groups showed an improvement in glycemic control and lipid profile. Changes in adipokines, particularly in adiponectin and leptin were closely related to intrahepatic lipid changes.

CONCLUSION

Comprehensive lifestyle intervention and meal replacement regimen have comparable effects on body and liver fat, as well as decrease in markers of hepatic inflammation among NASH patients.

Association and Interaction Analysis of Lipid Accumulation Product with Impaired Fasting Glucose Risk: A Cross-Sectional Survey

AIMS

Lipid accumulation product (LAP) is put forward as a powerful marker showing the accumulation of visceral fat. The present study is aimed at (i) analyzing the predictive performances of LAP in the identification of impaired fasting glucose (IFG) in Chinese population and (ii) exploring the potentially interactive effect between LAP and other factors on IFG risk.

METHODS

Analysis was conducted on the data obtained from a community-based cross-sectional survey in Chinese population, and all the participants enrolled were required to complete a face-to-face questionnaire survey and related health checks. Then, for the purpose of comparing predictive values between LAP and conventional obesity indices for IFG, relevant analysis was carried out on the receiver operating characteristic (ROC) curve. The assessment of interactive effects was conducted by employing the three indicators as follows: (1) RERI (the relative excess risk due to interaction), (2) AP (attributable proportion due to interaction), and (3) SI (synergy index).

RESULTS

A total of 1777 participants (748 males and 1029 females) were involved in the final analysis. It was finally obtained that the prevalence rate of IFG was 14.1% in total, 15.5% for males and 13.1% for females, respectively. In logistic regression analysis, individuals with LAP levels in the fourth quartile had a significant higher risk of getting IFG in comparison with that of the lowest quartile (crude OR: 4.58, 95% CI: 3.01-6.98; adjusted OR: 3.81, 95% CI: 2.33-6.23). In addition, it was indicated by the ROC curve analysis that LAP showed a better performance in discriminating IFG risk than BMI in both males (Z = 2.20, P = 0.028) and females (Z = 2.13, P = 0.033). However, LAP displayed a higher predictability in comparison with WC only in females (Z = 2.07, P = 0.038), but not in males (Z = 0.18, P = 0.860). Furthermore, LAP and family history of diabetes were able to impose significant synergistic interaction on the risk of IFG, which was indicated by all the parameters in females (RERI: 2.52, 95% CI: 0.19-4.84; AP: 0.47, 95% CI: 0.20-0.74; SI: 2.39, 95% CI: 1.17-4.87) and males (RERI: 2.18, 95% CI: 0.08-4.73; AP: 0.43, 95% CI: 0.07-0.79; SI: 2.15, 95% CI: 1.03-5.45). However, none of the indicators showed significant interaction between LAP and smoking on the risk of IFG in females (RERI: 0.92, 95% CI: -2.79-4.63; AP: 0.20, 95% CI: -0.50-0.92; SI: 1.37, 95% CI: 0.42-4.52). Meanwhile, there was also no significant interaction between LAP and smoking on the risk of IFG in males as indicated by the value of SI (2.22, 95% CI: 0.80-6.21).

CONCLUSION

It was concluded that LAP was significantly related to a higher risk of IFG in Chinese population, and its performance was superior to that of conventional obesity indices, especially in females. Apart from that, LAP with family history of diabetes may have an interactive effect that can impose a great influence on the development of IFG.

Prediction of Blood Lipid Phenotypes Using Obesity-Related Genetic Polymorphisms and Lifestyle Data in Subjects with Excessive Body Weight

Background and Aim

Individual lipid phenotypes including circulating total cholesterol (TC), low-density lipoprotein cholesterol (LDL-c), high-density lipoprotein cholesterol (HDL-c), and triglycerides (TG) determinations are influenced by gene-environment interactions. The aim of this study was to predict blood lipid level (TC, LDL-c, HDL-c, and TG) variability using genetic and lifestyle data in subjects with excessive body weight-for-height.

Methods

This cross-sectional study enrolled 304 unrelated overweight/obese adults of self-reported European ancestry. A total of 95 single nucleotide polymorphisms (SNPs) related to obesity and weight loss were analyzed by a targeted next-generation sequencing system. Relevant genotypes of each SNP were coded as 0 (nonrisk) and 1 (risk). Four genetic risk scores (GRS) for each lipid phenotype were calculated by adding the risk genotypes. Information concerning lifestyle (diet, physical activity, alcohol drinking, and smoking) was obtained using validated questionnaires. Total body fat (TFAT) and visceral fat (VFAT) were determined by dual-energy X-ray absorptiometry.

Results

Overall, 45 obesity-related genetic variants were associated with some of the studied blood lipids. In addition to conventional factors (age, sex, dietary intakes, and alcohol consumption), the calculated GRS significantly contributed to explain their corresponding plasma lipid trait. Thus, HDL-c, TG, TC, and LDL-c serum concentrations were predicted by approximately 28% (optimism-corrected adj. R² = 0.28), 25% (optimism-corrected adj. R² = 0.25), 24% (optimism-corrected adj. R² = 0.24), and 21% (optimism-corrected adj. R²=0.21), respectively. Interestingly, GRS were the greatest contributors to TC (squared partial correlation (PC²) = 0.18) and LDL-c (PC² = 0.18) features. Likewise, VFAT and GRS had a higher impact on HDL-c (PC² = 0.09 and PC² = 0.06, respectively) and TG levels (PC² = 0.20 and PC² = 0.07, respectively) than the rest of variables.

Conclusions

Besides known lifestyle influences, some obesity-related genetic variants could help to predict blood lipid phenotypes.

The Effects of Physical Exercise on Fatty Liver Disease

The increasing prevalence of obesity has made nonalcoholic fatty liver disease (NAFLD) the most common chronic liver disease. As a consequence, NAFLD and especially its inflammatory form nonalcoholic steatohepatitis (NASH) are the fastest increasing etiology of end-stage liver disease and hepatocellular carcinoma. Physical inactivity is related to the severity of fatty liver disease irrespective of body weight, supporting the hypothesis that increasing physical activity through exercise can improve fatty liver disease. This review summarizes the evidence for the effects of physical exercise on NAFLD and NASH. Several clinical trials have shown that both aerobic and resistance exercise reduce the hepatic fat content. From clinical and basic scientific studies, it is evident that exercise affects fatty liver disease through various pathways. Improved peripheral insulin resistance reduces the excess delivery of free fatty acids and glucose for free fatty acid synthesis to the liver. In the liver, exercise increases fatty acid oxidation, decreases fatty acid synthesis, and prevents mitochondrial and hepatocellular damage through a reduction of the release of damage-associated molecular patterns. In conclusion, physical exercise is a proven therapeutic strategy to improve fatty liver disease.

Effects of Exercise Training Alone on Depot-Specific Body Fat Stores in Youth: Review of Recent Literature

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.

Physical activity and central adiposity in a cohort of African-American adults

Background

Visceral adipose tissue (VAT) is known as an independent predictor of cardiometabolic risk and all-cause mortality, while increased physical activity has been shown to improve cardiometabolic risk. The purpose of the present study was to determine whether or not there is an association between objectively-measured physical activity and VAT in a community-based cohort of African-American adults, a population at higher-than-average risk for cardiometabolic diseases.

Methods

Free-living physical activity was quantified using accelerometry while VAT and abdominal subcutaneous fat were estimated using dual x-ray absorptiometry in a cohort of African Americans, ages 30–50 years, enrolled in the Modeling the Epidemiologic Transition Study. Univariate and multivariate analyses were used to determine the degree of association comparing moderate-to-vigorous physical activity (MVPA), vigorous activity, and sedentary behavior with measures of central adiposity including VAT, subcutaneous fat, and waist circumference.

Results

A total of 271 individuals with complete data were included in the analyses. Women, on average, had significantly more VAT and abdominal subcutaneous fat than men. There were statistically significant inverse univariate correlations between MVPA and measures of abdominal adiposity (−0.30, p < 0.001) and activity counts and adiposity (−0.31, p < 0.001) among both sexes. These significant associations remained after controlling for age, sex, and smoking status; neither alcohol consumption nor employment status were associated with abdominal adiposity. Time in sedentary behavior was not meaningfully associated with central adiposity in either sex (women: −0.02, p = 0.79; men: −0.21, p = 0.04).

Conclusions

To our knowledge, this study is the first to identify significant inverse associations between MVPA and measures of central adiposity among African American adults from a community-based cohort using an objective measure of physical activity and a validated quantitative imaging technique.

Serum levels of omentin-1 are increased after weight loss and are particularly associated with increases in obese children with metabolic syndrome

AIM

There have been very few paediatric studies on omentin-1, an anti-inflammatory adipokine that provides a link between adiposity, insulin resistance and metabolic syndrome. This Chinese study evaluated the association between omentin-1 and metabolic syndrome and analysed the effect of a six-month lifestyle intervention on the levels in obese children.

METHODS

We recruited 119 obese outpatients (75% boys) aged 7-18 years from the Second Affiliated Hospital of Xi'an Jiaotong University, who underwent a six- month lifestyle intervention. Our controls were 55 matched children with normal weight. Anthropometric parameters, biochemical data and circulating omentin-1 levels were measured at baseline and after six months.

RESULTS

Of the 119 obese children, 32 (27%) had metabolic syndrome. The obese children, particularly those with metabolic syndrome, had significantly lower serum omentin-1 levels at baseline than the controls. We also found that the omentin-1 levels were negatively associated with their body mass index, waist circumference and homoeostasis model assessment of insulin resistance. After the six-month lifestyle intervention, the obese children showed significant weight loss and their omentin-1 levels increased.

CONCLUSION

Serum omentin-1 was regulated by weight and seemed to be associated with children's metabolic disorders. A six-month lifestyle intervention significantly increased serum omentin-1 levels.

Nation-wide trends in non-alcoholic steatohepatitis (NASH) in patients with and without diabetes between 2004-05 and 2014-15 in England

AIMS

There are no national studies evaluating the epidemiology of non-alcoholic steatohepatitis (NASH) in England. NASH is becoming an increasingly important health issue given the inexorable rise in obesity and diabetes. We evaluated the rates of NASH in people with and without diabetes from 2004-2005 to 2014-2015.

METHODS

We identified cases of biopsy-proven NASH in people with and without diabetes in England over an eleven-year period using Hospital Episode Statistics. We estimated incidence rates for each year. Negative binomial regression models were fitted to test trends.

RESULTS

Over the study period, people without diabetes recorded a 3% reduction in admission rates per year (incidence rate ratio (IRR) (95% CI) 0.97 (0.96-0.98), p<0.001), whilst there was an increase in admission rates in people with diabetes (IRR (95% CI) 1.01 (1.00-1.02), p=0.04). In people with diabetes, this upward trend was driven by people over 65years (IRR (95% CI) 1.03 (1.02-1.04), p<0.001) and men (IRR (95% CI) 1.01 (1.0-1.02), p=0.03). Inpatient mortality declined for people with diabetes by 2% per year after adjusting for age, sex and year (IRR (95% CI) 0.98 (0.95-0.99), p=0.03). The 2% decline per year in inpatient mortality for people without diabetes did not achieve statistical significance after adjustment (IRR (95% CI) 0.98 (0.95-1.01), p=0.175).

CONCLUSIONS

There was a decline in NASH-related hospital admissions amongst people without diabetes over eleven years, whilst rates increased in people with diabetes. These observations highlight the increasing burden of NASH.

Liver Adiposity and Metabolic Profile in Individuals with Chronic Spinal Cord Injury

PURPOSE

To quantify liver adiposity using magnetic resonance imaging (MRI) and to determine its association with metabolic profile in men with spinal cord injury (SCI).

MATERIALS AND METHODS

MRI analysis of liver adiposity by fat signal fraction (FSF) and visceral adipose tissue (VAT) was completed on twenty participants. Intravenous glucose tolerance test was conducted to measure glucose effectiveness (S_g) and insulin sensitivity (S_i). Lipid panel, fasting glucose, glycated hemoglobin (HbA1c), and inflammatory cytokines were also analyzed.

RESULTS

Average hepatic FSF was 3.7% ± 2.1. FSF was positively related to TG, non-HDL-C, fasting glucose, HbA1c, VAT, and tumor necrosis factor alpha (TNF-α). FSF was negatively related to S_i and testosterone. FSF was positively related to VAT (r = 0.48, p = 0.032) and TNF-α (r = 0.51, p = 0.016) independent of age, level of injury (LOI), and time since injury (TSI). The associations between FSF and metabolic profile were independent of VAT.

CONCLUSIONS

MRI noninvasively estimated hepatic adiposity in men with chronic SCI. FSF was associated with dysfunction in metabolic profile, central adiposity, and inflammation. Importantly, liver adiposity influenced metabolic profile independently of VAT. These findings highlight the significance of quantifying liver adiposity after SCI to attenuate the development of metabolic disorders.

Serum Vaspin Concentration in Elderly Type 2 Diabetes Mellitus Patients with Differing Body Mass Index: A Cross-Sectional Study

Aims. This study was to evaluate the association of serum vaspin concentrations with body mass index (BMI) among elderly patients (>60 years old). Methods. A total of 227 elderly individuals included 76 healthy with normal glucose tolerance, which divided into normal weight control (BMI < 25, n = 38) and overweight or obese control (BMI ≥ 25, n = 38) subgroups, and 150 T2DM patients, which divided into normal weight diabetes (BMI < 25, n = 55), overweight diabetes (30 > BMI ≥ 25, n = 52), and obese diabetes (BMI ≥ 30, n = 43) subgroups. Relevant parameters were matched for age and gender ratio. Serum vaspin concentrations were measured by enzyme-linked immunosorbent assay. Results. Serum vaspin concentration was significantly higher in the T2DM than the healthy (451.9 ± 32.6 versus 284.2 ± 21.7, P < 0.01). In the diabetic patients, the vaspin concentration was significantly higher in the obese group than the normal weight group (498.2 ± 17.1 versus 382.1 ± 21.3, P < 0.05). In addition, the concentration of vaspin in normal weight T2DM was higher than in healthy control group with normal weight (382.1 ± 21.3 versus 192.5 ± 45.2, P < 0.05). Multiple regression analysis revealed that BMI was independent factors influencing the serum vaspin concentration in all participants. Conclusion. Vaspin may play an important compensatory role in obesity and insulin resistance in elderly people. The clinical trial registration number is ChiCTR-OPC-14005698.

Sedentary Behavior, Physical Activity, and Abdominal Adipose Tissue Deposition

PURPOSE

We examined whether sedentary lifestyle habits and physical activity level are associated with abdominal visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), intermuscular adipose tissue (IMAT), and liver attenuation, independently of one another and potential confounders.

METHODS

This study analyzed 3010 African American and Caucasian men and women, 42-59 yr old, from the Coronary Artery Risk Development in Young Adults (CARDIA) study, who completed multiple-slice abdominal computed tomography in 2010-2011. Participants reported average hours per day sitting (television, computing, paperwork, music, telephone, and car). Physical activity was assessed with the CARDIA physical activity history. VAT, SAT, IMAT, and liver attenuation were estimated from computed tomography. Multivariable general linear regression models regressed means of fat depots on total sedentary time, task-specific sedentary time, and total physical activity.

RESULTS

Television viewing was positively, and physical activity inversely, associated with fat depots. For each 1 SD increment in television viewing (1.5 h·d), VAT, SAT, and IMAT were greater by 3.5, 3.4, and 3.9 cm, respectively (P < 0.03 for all). For each 1 SD increment in physical activity (275 exercise units), VAT, SAT, and IMAT were lower by 7.6, 6.7, and 8.1 cm, respectively, and liver attenuation was greater (indicating more liver fat) by 0.5 Hounsfield units (P < 0.01 for all). Total sedentary time was associated with VAT, IMAT, and liver attenuation in White men only after controlling for physical activity, SAT, and other potential confounders (P ≤ 0.01 for all). No other task-specific sedentary behaviors were associated with fat depots.

CONCLUSIONS

Sedentary behaviors, particularly television viewing, and physical activity levels have distinct, independent associations with fat deposition.

High-Intensity Aerobic Exercise Improves Both Hepatic Fat Content and Stiffness in Sedentary Obese Men with Nonalcoholic Fatty Liver Disease

We compared the effects of 12-week programs of resistance training (RT), high-intensity interval aerobic training (HIAT), and moderate-intensity continuous aerobic training (MICT). The primary goal was to evaluate the therapeutic effects of the exercise modalities for the management of nonalcoholic fatty liver disease (NAFLD). A total of 61 sedentary obese men with NAFLD were randomized into one of the following exercise regimens (RT, HIAT, or MICT). Hepatic fat content was decreased to a similar extent in the RT, HIAT, and MICT groups (−14.3% vs. −13.7% vs. −14.3%) without significant changes in weight and visceral fat. The gene expression levels of fatty acid synthesis were significantly decreased in the subjects’ monocytes. Hepatic stiffness was decreased only in the HIAT group (−16.8%). The stiffness change was associated with restored Kupffer cell phagocytic function (+17.8%) and decreased levels of inflammation such as leptin (−13.2%) and ferritin (−14.1%). RT, HIAT, and MICT were equally effective in reducing hepatic fat content, but only HIAT was effective in improving hepatic stiffness and restoring Kupffer cell function. These benefits appeared to be independent of detectable weight and visceral fat reductions; the benefits were acquired through the modulation of in vivo fatty acid metabolism and obesity-related inflammatory conditions.

Subcutaneous Fat Accumulation Shows a Beneficial Correlation with Serum Cholesterol in Postmenopausal Japanese Women

This study aimed to investigate whether accumulation of subcutaneous abdominal fat has a beneficial correlation with lipid metabolism in premenopausal and/or postmenopausal Japanese women. The study enrolled 146 premenopausal women, ranging in age from 19 to 54 years, and 82 postmeno-pausal women, ranging in age from 47 to 66 years. Fat distribution, including abdominal visceral fat area (VFA) and abdominal subcutaneous fat area (SFA), were measured in an outpatient clinic by magnetic resonance imaging. Homogeneity of the regression slopes for SFA to total cholesterol ( P = 0.030), low-density lipoprotein cholesterol ( P = 0.020), apolipoprotein B (apoB) ( P = 0.001), and the ratio of apoB to apolipoprotein A-I (apoA-I) ( P = 0.003) were not found between premenopausal and postmenopausal women, even after adjustment for both VFA and age. However, the regression slopes for VFA to all measured lipid parameters, as well as apolipoproteins, were homogeneous between the premenopausal and postmeno-pausal groups. Abdominal SFA in postmenopausal women correlated negatively with total cholesterol ( P = 0.007), low-density lipoprotein cholesterol ( P = 0.002), apoB ( P < 0.001), and the ratio of apoB to apoA-I ( P = 0.001), after adjustment for age and VFA, but this was not the case in premenopausal women. The mechanisms involved in the beneficial effects of subcutaneous fat accumulation in postmenopausal women remain obscure, but upregulated aromatase expression, derived from adipose tissue, may possibly improve lipid and apolipoprotein metabolism.