Efficacy of visceral fat estimation by dual bioelectrical impedance analysis in detecting cardiovascular risk factors in patients with type 2 diabetes

Association between abdominal obesity indices and falls among older community-dwellers in Guangzhou, China: a prospective cohort study

BACKGROUND

Central obesity was considered as a risk factor for falls among the older population. Waist circumference (WC), lipid accumulation product (LAP), visceral adiposity index (VAI), and the Chinese visceral adiposity index (CVAI) are considered as surrogate markers for abdominal fat deposition in increasing studies. Nevertheless, the longitudinal relationship between these indices and falls among the older population remains indistinct. This study aimed to explore the association between abdominal obesity indices and falls among older community-dwellers.

METHODS

Our study included 3501 individuals aged ≥ 65 years from the Guangzhou Falls and Health Status Tracking Cohort at baseline in 2021 and then prospectively followed up in 2022. The outcome of interest was the occurrence of falls. The Kaplan-Meier curves and multivariable Cox regression analysis were used to explore the associations between abdominal obesity indices and falls. Moreover, the restricted cubic spline analysis (RCS) was conducted to test the non-linear relationships between abdominal obesity indices and hazards of falls incident.

RESULTS

After a median follow-up period of 551 days, a total of 1022 participants experienced falls. The cumulative incidence rate of falls was observed to be higher among individuals with central obesity and those falling within the fourth quartile (Q4) of LAP, VAI, and CVAI. Participants with central obesity and those in Q4 of LAP, VAI, and CVAI were associated with higher risk of falls, with hazard ratios (HRs) of 1.422 (HR 95%CI: 1.255-1.611), 1.346 (1.176-1.541), 1.270 (1.108-1.457), 1.322 (1.154-1.514), respectively. Each 1-SD increment in WC, LAP, VAI, and CVAI was a significant increased risk of falls among participants. Subgroup analysis further revealed these results were basically stable and appeared to be significantly stronger among those females, aged 65-69 years, and with body mass index (BMI) ≥ 28 kg/m2. Additionally, RCS curves showed an overall upward trend in the risk of falls as the abdominal indices increased.

CONCLUSIONS

Abdominal obesity indices, as WC, LAP, VAI, and CVAI were significantly associated with falls among older community-dwellers. Reduction of abdominal obesity indices might be suggested as the strategy of falls prevention.

Adiposity modifies the association between heart failure risk and glucose metabolic disorder in older individuals: a community-based prospective cohort study

BACKGROUND

Glucose metabolic disorder is associated with the risk of heart failure (HF). Adiposity is a comorbidity that is inextricably linked with abnormal glucose metabolism in older individuals. However, the effect of adiposity on the association between glucose metabolic disorder and HF risk, and the underlying mechanism remain unclear.

METHODS

A total of 13,251 participants aged ≥ 60 years from a cohort study were categorized into euglycemia, prediabetes, uncontrolled diabetes, and well-controlled diabetes. Adiposity was assessed using body mass index (BMI), waist-to-hip ratio (WHR), and visceral fat area (VFA). Adiposity-associated metabolic activities were evaluated using adiponectin-to-leptin ratio (ALR), homeostatic model assessment of insulin resistance (HOMA-IR), and triglyceride-glucose index (TyG). The first occurrence of HF served as the outcome during the follow-up period.

RESULTS

A total of 1,138 participants developed HF over the course of an average follow-up period of 10.9 years. The rate of incident HF occurrence was higher in prediabetes, uncontrolled diabetes, and well-controlled diabetes participants compared to that in euglycemia participants. However, the high rates were significantly attenuated by BMI, VFA, and WHR. For WHR in particular, the hazard ratio for incident HF was 1.18 (95% confidence interval (CI): 1.03, 1.35, Padj.=0.017) in prediabetes, 1.59 (95% CI: 1.34, 1.90, Padj.<0.001) in uncontrolled diabetes, and 1.10 (95% CI: 0.85, 1.43, Padj.=0.466) in well-controlled diabetes. The population attributable risk percentage for central obesity classified by WHR for incident HF was 30.3% in euglycemia, 50.0% in prediabetes, 48.5% in uncontrolled diabetes, and 54.4% in well-controlled diabetes. Adiposity measures, especially WHR, showed a significant interaction with glucose metabolic disorder in incident HF (all Padj.<0.001). ALR was negatively associated and HOMA-IR and TyG were positively associated with BMI, WHR, VFA, and incident HF (all Padj.<0.05). ALR, HOMA-IR, and TyG mediated the associations for BMI, WHR and VFA with incident HF (all Padj.<0.05).

CONCLUSIONS

Adiposity attenuated the association of glucose metabolic disorder with incident HF. The results also showed that WHR may be an appropriate indicator for evaluating adiposity in older individuals. Adiposity-associated metabolic activities may have a bridging role in the process of adiposity attenuating the association between glucose metabolic disorder and incident HF.

TRIAL REGISTRATION

retrospectively registered number: ChiCTR-EOC-17,013,598.

Visceral fat area is more strongly associated with arterial stiffness than abdominal subcutaneous fat area in Chinese patients with type 2 diabetes

BACKGROUND

Few studies have compared the correlation between visceral fat area (VFA) and abdominal subcutaneous fat area (SFA) with arterial stiffness (AS) in patients with type 2 diabetes (T2D). In addition, there is currently controversy regarding the correlation between VFA and SFA with AS. We aimed to investigate the relationship between VFA and SFA with AS in patients with T2D.

METHODS

In this cross-sectional study, 1475 Chinese T2D patients with an average age of 52.32 ± 10.96 years were included. VFA and SFA were determined by a dual bioelectrical impedance analyzer, and AS was determined by measurement of brachial-ankle pulse wave conduction velocity (baPWV). Atherosclerosis was deemed present in study participants with baPWV values higher than 75th percentile (1781 cm/s). Independent correlations of logVFA and logSFA with AS were assessed using multiple linear regression and multivariate logistic regression.

RESULTS

The baPWV was linked with VFA, waist circumference, and women's SFA in a general linear correlation study (P < 0.05), but not with body mass index (P = 0.3783) or men's SFA (P = 0.1899). In both men and women, VFA and SFA were positively correlated with AS, according to the generalized additive model (GAM). After fully adjusting for confounders, multiple linear regression analyses showed that for every 1-unit increase in logVFA, the beta coefficient of baPWV increased by 63.1 cm/s (95% CI: 18.4, 107.8) (P < 0.05). logSFA did not correlate significantly with baPWV (P = 0.125). In the multiple logistic regression analysis, the odds ratio (OR) of elevated baPWV was 1.8 (95% CI: 1.1, 3.1) (P = 0.019) per 1-unit increase in logVFA. logSFA did not correlate significantly with AS (P = 0.091). In the subgroup analysis, the correlation between logVFA and baPWV did not interact across subgroups (P-interaction > 0.05).

CONCLUSIONS

Compared with SFA, VFA had a stronger independent positive correlation with AS in Chinese T2D patients. Patients with T2D should pay more attention to monitoring VFA and lowering it to minimize cardiovascular events.

Excessive generalized and visceral adiposity is associated with a higher prevalence of diabetic retinopathy in Caucasian patients with type 2 diabetes

BACKGROUND AND AIMS

Type 2 Diabetes Mellitus (T2D) has heterogeneous clinical phenotypes related to different risk of developing diabetes complications. We investigated the correlation between generalized and abdominal adiposity and the prevalence of both micro- and macrovascular complications in Caucasian patients with T2D.

METHODS AND RESULTS

We evaluated 769 individuals with T2D consecutively referred to our diabetes center. Body mass index (BMI), waist circumference (WC), waist to hip (W/H) ratio, glycated hemoglobin (HbA1c), systolic and diastolic blood pressure, lipid profile, smoking habit, diabetes therapy, and micro- and macrovascular complications were recorded. Patients were divided into three groups based on BMI and WC: non-obese with normal WC (nWC, n = 220), non-obese with excess of abdominal fat (AF, n = 260) and obese (Ob, n = 289). We found that nWC, compared with AF and Ob individuals, were predominantly males (p<0.01), had lower HbA1c (p<0.01), diastolic blood pressure (p<0.01), triglycerides (p<0.01), and showed a significantly lower prevalence of diabetic retinopathy (DR) (p = 0.01). The rate of proliferative DR was significantly higher in Ob (13.2 %) compared to the other groups (p = 0.03). Multivariate analyses showed a significantly decreased prevalence of DR in nWC compared to both AF (OR 0.58, 95 CI 0.34-0.96; p = 0.03) and Ob (OR 0.57, 95 CI 0.33-0.98; p = 0.04) individuals. Conversely, DR was associated, mainly in women, to higher WC and W/H ratio. The prevalence of the other diabetes-related complications was similar among the studied groups.

CONCLUSIONS

In our population, nWC subjects showed a lower prevalence of DR. An increased generalized and abdominal adiposity was associated to a higher prevalence of DR, especially among females.

Association between visceral fat area and diabetic retinopathy among people with type 2 diabetes mellitus: a cross-sectional study in Ningbo, Zhejiang Province, China

Aim

The objective of this study is to investigate the relationship between visceral fat area (VFA) and diabetic retinopathy (DR) in the context of type 2 diabetes mellitus (T2DM) within Ningbo, China.

Methods

The data of a total of 3,707 subjects with T2DM treated at The First Affiliated Hospital of Ningbo University were enrolled. The existence and severity of diabetic retinopathy were assessed by employing the 45° two-field stereoscopic digital photography. Subjects were categorized into four distinct groups: those without DR (NDR), individuals with mild non-proliferative DR (mild NPDR), people with moderate non-proliferative DR (moderate NPDR), and those suffering from vision-threatening DR (VTDR). Bio-electrical impedance was employed to estimate the Visceral fat area (VFA). Multinomial logistic regression models were utilized to evaluate the association between VFA and DR.

Results

The mean VFA in patients without diabetic retinopathy (NDR) was notably lower compared to that of patients with diabetic retinopathy (DR) (85.21 ± 37.78 vs. 97.37 ± 44.58 cm2, p < 0.001). As the severity of DR increased, VFA increased gradually but insignificantly (94.41 ± 43.13 cm2, 96.75 ± 40.82 cm2, 100.84 ± 49.34 cm2, p = 0.294). After adjusting the confounding factors, there was an association identified between VFA and the occurrence of DR (OR = 1.020, 95% CI = 1.016-1.024). It showed that regardless of BMI, whether it's less than 25 kg/m2 or greater than or equal to 25 kg/m2, a higher VFA (≥100 cm2) level came with a higher prevalence of DR (p < 0.001).

Conclusion

The outcomes of this research indicate a modest association between VFA and the incidence of DR among Chinese patients who have been diagnosed with T2DM in Ningbo.

Clusters of Body Fat and Nutritional Parameters are Strongly Associated with Diabetic Kidney Disease in Adults with Type 2 Diabetes

INTRODUCTION

Diabetic kidney disease (DKD) has become the leading cause of chronic kidney disease and end-stage renal failure in most developed and many developing countries. Strategies aimed at identifying potential modifiable risk factors for DKD are urgently needed. Here, we investigated the association between clusters of body fat and nutritional parameters with DKD in adults with type 2 diabetes mellitus (T2DM).

METHODS

This was a cross-sectional study of 184 participants with T2DM. Biochemical parameters including fasting blood glucose, hemoglobin A1c, hemoglobin, albumin, creatinine, and urinary albumin-to-creatinine ratio (UACR) were measured. The data for percentage of body fat mass (PBF), visceral fat area (VFA), phase angle at 50 kHz (PA50), and body cell mass (BCM) were obtained by bioelectrical impedance analysis (BIA). DKD was diagnosed by UACR and estimated glomerular filtration rate. Factor analysis was used for dimensionality reduction clustering among variables. The association of clusters with the presence of DKD was assessed using binary logistic regression analysis.

RESULTS

Factor analysis identified two clusters which were interpreted as a body fat cluster with positive loadings of VFA, body mass index, waist circumstance, and PBF and a nutritional parameters cluster with positive loadings of PA50, hemoglobin, BCM, and albumin. Participants were divided into the four groups based on the sex-specific cutoff value (median) of each cluster score calculated using the cluster weights and the original variable values. Only participants with high body fat and poor nutritional parameters (OR 3.43, 95% CI 1.25-9.42) were associated with increased odds of having DKD.

CONCLUSION

Body fat and nutritional parameters were strongly associated with and considerably contributed to the presence of DKD, suggesting that body fat and nutrition might be promising markers representing metabolic state in pathogenesis of DKD and clinical utility of BIA might provide valuable recommendations to patients with T2DM.

Bioelectrical Impedance Analysis and Body Composition in Cardiovascular Diseases

Nutritional status and body composition in cardiovascular (CV) patients are important aspects of their performance. Bioelectrical impedance analysis (BIA) is a noninvasive method that provides reliable information about bioelectrical parameters which reflect nutritional status and body composition data. The aim of this paper was to describe BIA, its advantages, limitations, and clinical applications in CV patients. The PubMed database was searched for all papers showing the use of BIA in CV conditions until January 1, 2023. A total of 42 papers regarding BIA application in CV patients were identified. Phase angle, Z200/5 parameter, and membrane capacitance are the BIA parameters that can be used for nutritional status assessment in CV patients, mainly in heart failure and after myocardial infarction. Among secondary body composition parameters, fat mass can be used for obesity assessment which is a CV risk factor. Body cell mass can be used together which the direct BIA parameters for nutritional status assessment which is an important factor in treatment outcome, quality of life, and disease prognosis. Total body water can be used for hydration assessment in heart failure and during invasive procedures. To conclude, BIA is a noninvasive method that provides essential information about the general condition of the body which is the result of nutritional and hydration status in CV patients.

Correlation Between the Variability of Different Obesity Indices and Diabetic Kidney Disease: A Retrospective Cohort Study Based on Populations in Taiwan

Purpose

To investigate the association of five obesity indices and the variability of these indices with diabetic kidney disease (DKD) in patients with type 2 diabetes and compare the predictive validity of these markers for the risk of DKD in this large longitudinal cohort study.

Patients and Methods

A total of 2659 patients with type 2 diabetes who did not have DKD were enrolled between 2006 and 2019 at Lee's United Clinic in Taiwan. Data were collected for each subject, including demographic data, personal medical history, clinical parameters and calculated Body mass index (BMI), visceral adiposity index (VAI), lipid accumulation product (LAP), body roundness index (BRI) and variability of five obesity indices. Cox regression analysis was performed to determine the relationship between different obesity indicators and DKD risk. Cox's proportional hazards model was evaluated the predictive effect of obesity indices on DKD.

Results

The risk of developing DKD increased with an increase in the BRI, LAP, VAI, WC and BMI (all P trend<0.05), and the variability of VAI was significantly associated with DKD [HR=1.132, 95% CI (1.001, 1.281)] after adjusting for corresponding variables. BRI had the strongest predictive effect on DKD. BRI had the best predictive performance, with AUC of 0.807, 0.663 and 0.673 at 1, 3 and 5 years, respectively. Cox regression analysis of risk factors for DKD in patients stratified by BRI quartiles showed that patients in the Q4 group had the highest risk of developing DKD [HR=1.356, 95% CI (1.131, 1.626)].

Conclusion

BMI, WC, VAI, LAP, BRI and VAI variability were associated with a significant increase in the risk of DKD events, and BRI was superior and alternative obesity index for predicting DKD.

Association Between Visceral Fat Area and Cancer Prognosis: A Population-Based Multicenter Prospective Study

BACKGROUND

Diverse indicators have been used to represent adipose tissue, while the relationship between body adipose mass and the prognosis of patients with cancer remains controversial.

OBJECTIVE

This study aimed to explore the indicators of optimal body composition that represent body fat mass to predict risk of cancer-related mortality.

METHODS

We conducted a population-based multicenter prospective cohort study of patients with initial cancer between February 2012 and September 2020. Clinical information, body composition indicators, hematologic test results, and follow-up data were collected. Body composition indicators were analyzed using principal component analysis to select the most representative indicators, and the cutoff value was set according to the optimal stratification method. The hazard ratio (HR) for mortality was calculated using Cox proportional hazards regression models.

RESULTS

Among 14,018 patients with complete body composition data, visceral fat area (VFA) is a more optimal indicator for body fat content (principal component index: 0.961) than body mass index (principal component index: 0.850). The cutoff points for VFA in terms of time to mortality were 66 cm2 and 102 cm2 for gastric/esophageal cancer and other cancers, respectively. Among the 2788 patients treated systemically, multivariate analyses demonstrated that a lower VFA was associated with a higher risk of death in patients with cancer of diverse types (HR: 1.33; 95% CI: 1.08, 1.64; P = 0.007), especially gastric cancer (HR: 2.13; 95% CI: 1.3, 3.49; P = 0.003), colorectal cancer HR: 1.81; 95% CI: 1.06, 3.08; P = 0.030) and nonsmall-cell lung cancer (HR: 1.27; 95% CI: 1.01, 1.59; P = 0.040).

CONCLUSION

VFA is an independent prognostic indicator of muscle mass in patients with diverse types of cancer, particularly gastric, colorectal, and nonsmall-cell lung cancers.

TRIAL REGISTRATION NUMBER

ChiCTR1800020329.

Can Cardiometabolic Risk Be Reduced in the Elderly? Comprehensive Epidemiological Study

Through these epidemiological studies, which are based on statistical and observational calculations, without visual appeal, we tracked the incidence of public health problems. In this study, our research objective was to determine and evaluate the health patterns present in a population, along with identifying the factors that contribute to the risks or provide protection against specific diseases or conditions. The progression of cardiometabolic diseases is closely linked to various chronic conditions, such as diabetes, hypertension, dyslipidemia, and chronic kidney disease. This research study involved 578 patients, who were divided into six-year cohorts ranging from 2017 to 2022. The study examined parameters related to cardiometabolic diseases, including alcoholic hepatopathies, non-alcoholic hepatopathy, chronic kidney disease, hypertension, myocardial infarction, other forms of chronic coronary syndrome, peripheral vascular disease, microvascular diseases, macrovascular diseases, and hypercholesterolemia, while considering age and physical activity levels. The study concluded that individuals in the age group of 41-50 years exhibited the highest propensity for cardiometabolic damage. Additionally, the promotion of a healthy and active lifestyle is increasingly gaining traction among elderly patients.

Normal-weight visceral obesity promotes a higher 10-year atherosclerotic cardiovascular disease risk in patients with type 2 diabetes mellitus-a multicenter study in China

BACKGROUND

Visceral obesity is associated with high cardiovascular events risk in type 2 diabetes mellitus (T2DM). Whether normal-weight visceral obesity will pose a higher atherosclerotic cardiovascular disease (ASCVD) risk than body mass index (BMI)-defined overweight or obese counterparts with or without visceral obesity remains unclear. We aimed to explore the relationship between general obesity and visceral obesity and 10-year ASCVD risk in patients with T2DM.

METHODS

Patients with T2DM (6997) who satisfied the requirements for inclusion were enrolled. Patients were considered to have normal weight when 18.5 kg/m² ≤ BMI < 24 kg/m²; overweight when 24 kg/m² ≤ BMI < 28 kg/m²; and obesity when BMI ≥ 28 kg/m². Visceral obesity was defined as a visceral fat area (VFA) ≥ 100 cm². Patients were separated into six groups based on BMI and VFA. The odd ratios (OR) for a high 10-year ASCVD risk for different combinations of BMI and VFA were analysed using stepwise logistic regression. Receiver operating characteristic (ROC) curves for diagnosing the high 10-year ASCVD risk were constructed, and areas under the ROC curves were estimated. Potential non-linear relationships between VFA levels and high 10-year ASCVD risk were examined using restricted cubic splines (knot = 4). Multilinear regression was used to identify factors affecting VFA in patients with T2DM.

RESULTS

In patients with T2DM, subjects with normal-weight visceral obesity had the highest 10-year ASCVD risk among the six groups, which had more than a 2-fold or 3-fold higher OR than those who were overweight or obese according to BMI but did not have visceral obesity (all P < 0.05). The VFA threshold for high 10-year ASCVD risk was 90 cm². Multilinear regression showed significant differences in the effect of age, hypertension, drinking, fasting serum insulin, fasting plasma glucose, 2 h postprandial C-peptide, triglyceride, total cholesterol, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol on VFA in patients with T2DM (all P < 0.05).

CONCLUSIONS

T2DM patients with normal-weight visceral obesity had a higher 10-year ASCVD risk than BMI-defined overweight or obese counterparts with or without visceral obesity, which should initiate standardised management for ASCVD primary prevention.

Serum triglyceride glucose index is a valuable predictor for visceral obesity in patients with type 2 diabetes: a cross-sectional study

BACKGROUND

Since the triglyceride glucose (TyG) index can reflect insulin resistance, it has been proven to be an efficient predictor of glycolipid-metabolism-related diseases. Therefore, this study aimed to investigate the predictive value of the TyG index for visceral obesity (VO) and body fat distribution in patients with type 2 diabetes mellitus (T2DM).

METHODS

Abdominal adipose tissue characteristics in patients with T2DM, including visceral adipose area (VAA), subcutaneous adipose area (SAA), VAA-to-SAA ratio (VSR), visceral adipose density (VAD), and subcutaneous adipose density (SAD), were obtained through analyses of computed tomography images at the lumbar 2/3 level. VO was diagnosed according to the VAA (> 142 cm² for males and > 115 cm² for females). Logistic regression was performed to identify independent factors of VO, and receiver operating characteristic (ROC) curves were used to compare the diagnostic performance according to the area under the ROC curve (AUC).

RESULTS

A total of 976 patients were included in this study. VO patients showed significantly higher TyG values than non-VO patients in males (9.74 vs. 8.88) and females (9.59 vs. 9.01). The TyG index showed significant positive correlations with VAA, SAA, and VSR and negative correlations with VAD and SAD. The TyG index was an independent factor for VO in both males (odds ratio [OR] = 2.997) and females (OR = 2.233). The TyG index ranked second to body mass index (BMI) for predicting VO in male (AUC = 0.770) and female patients (AUC = 0.720). Patients with higher BMI and TyG index values showed a significantly higher risk of VO than the other patients. TyG-BMI, the combination index of TyG and BMI, showed significantly higher predictive power than BMI for VO in male patients (AUC = 0.879 and 0.835, respectively) but showed no significance when compared with BMI in female patients (AUC = 0.865 and 0.835, respectively).

CONCLUSIONS

. TyG is a comprehensive indicator of adipose volume, density, and distribution in patients with T2DM and is a valuable predictor for VO in combination with anthropometric indices, such as BMI.

Body fat patterning in lean Asian Indians with diabetes: Case-control study

AIM

To perform body fat patterning in Asian-Indian individuals with T2D.

METHODS

A total of 53 patients with recent-onset diabetes and 106 non-diabetic controls were included from screened 261 individuals. Data was divided into 2 groups; overweight/obese [(BMI ≥23 kg/m²); 45 diabetic, 84 non-diabetic] and lean [(BMI <23 kg/m²); 8 diabetic, 22 non-diabetic]. Anthropometry (weight, height, BMI, waist, hip circumference, waist-hip ratio) and lipids, adiponectin and hsCRP were measured. Body composition (BC) was assessed by bioimpedance analysis (BIA) and Dual Energy X-ray absorptiometry (DEXA). We analyzed the association of visceral adipose tissue (VAT) with anthropometric measures to identify predictors of diabetes.

RESULTS

Total body fat percentage was comparable between patients with T2D and non-diabetic controls in both, obese [35.0 ± 9.1% vs 36.8 ± 8.4%, p = 0.29 (BIA), 40.1 ± 6.7 vs 46.6 ± 4.1%, p = 0.052 (DEXA) and lean [25.1 ± 5.6% vs 26.0 ± 6.7%, p = 0.74 (BIA), 35.3 ± 4.8% vs 34.1 ± 6.3%, p = 0.72 (DEXA) study group. Individuals of T2D (obese or lean) had significantly higher visceral fat rating (BIA), VAT area, volume, mass and VAT corrected for total body fat percentage (DEXA). Obese T2D had lower muscle mass (57.0 ± 6.4% vs 60.0 ± 5.5%, p = 0.03) than obese controls. Intra-abdominal visceral fat (IAVF) [(VFR, VAT (mass/area/volume) and VAT mass corrected for body fat)] had the best sensitivity (71%) for incident diabetes.

CONCLUSION

Higher Intra-abdominal visceral fat and not total body fat is associated with incident diabetes independent of BMI. IAVF estimation by either BIA or DEXA should be performed to predict diabetes especially in lean individuals.

Habitual night sleep duration is associated with general obesity and visceral obesity among Chinese women, independent of sleep quality

Purpose

Research on the relationship between sleep duration and obesity defined using multiple anthropometric and bioelectrical indices in women remains scarce. We aimed to explore the association between sleep duration and body mass index (BMI), waist-hip ratio (WHR), body fat percentage (PBF) and visceral fat area (VFA) among females.

Methods

We recruited women for medical examination using multistage cluster sampling. Sleep was assessed using Pittsburgh Sleep Quality Index (PSQI) and sleep duration was categorized into short (<7 h), optimal (7 <9 h) and long sleep (≥ 9 h). Weight and height were measured using a calibrated stadiometer. Waist circumference was manually measured. PBF, and VFA were estimated by bioelectrical impedance analysis. Data on sociodemographic characteristics and lifestyle factors were also collected and included in the logistic regression models to explore the independent association between sleep duration and obesity defined by different indices.

Results

A total of 7,763 women with a mean age of 42.6 ± 13.5 years were included. The percentage of women reporting short and long sleep was 10.3 and 13.4% respectively. The mean BMI, WHR, PBF and VFA were 23.07 ± 3.30 kg/m², 0.78 ± 0.06, 32.23 ± 6.08% and 91.64 ± 35.97cm², respectively. Short sleep was independently associated with 35% (95% CI: 1.05-1.75) increased odds of general obesity (BMI ≥ 28 kg/cm²), and long sleep was associated with 18% (95% CI: 1.01-1.37) increased odds of visceral obesity (VFA > 100 cm²). No association was observed between sleep deprivation or excessive sleep and high WHR or high PBF.

Conclusion

In women, short sleep was associated with an increased odds of general obesity, whereas long sleep was associated with an increased odds of visceral obesity. Longitudinal observations are needed to confirm this cross-sectional relationship.

The Use of Information and Communication Technology-Based Self-management System DialBeticsLite in Treating Abdominal Obesity in Japanese Office Workers: Prospective Single-Arm Pilot Intervention Study

BACKGROUND

Making lifestyle changes is an essential element of abdominal obesity (AO) reduction. To support lifestyle modification and self-management, we developed an information and communication technology-based self-management system-DialBeticsLite-with a fully automated dietary evaluation function for the treatment of AO.

OBJECTIVE

The objective of this study was to evaluate the preliminary efficacy and feasibility of DialBeticsLite among Japanese office workers with AO.

METHODS

A 2- to 3-month prospective single-arm pilot intervention study was designed to assess the effects of the intervention using DialBeticsLite. The information and communication technology system was composed of 4 modules: data transmission (body weight, blood pressure, blood glucose, and pedometer count); data evaluation; exercise input; and food recording and dietary evaluation. Eligible participants were workers who were aged ≥20 years and with AO (waist circumference ≥85 cm for men and ≥90 cm for women). Physical parameters, blood tests, nutritional intake, and self-care behavior were compared at baseline and after the intervention.

RESULTS

A total of 48 participants provided completed data for analysis, which yielded a study retention rate of 100%. The average age was 46.8 (SD 6.8) years, and 92% (44/48) of participants were male. The overall average measurement rate of DialBeticsLite, calculated by dividing the number of days with at least one measurement by the number of days of the intervention, was 98.6% (SD 3.4%). In total, 85% (41/48) of the participants reported that their participation in the study helped them to improve their lifestyle. BMI, waist circumference, and visceral fat area decreased significantly after the intervention (P<.001). In addition, the daily calorie intake reduced significantly (P=.02). There was a significant improvement in self-care behavior in terms of exercise and diet (P=.001).

CONCLUSIONS

Using DialBeticsLite was shown to be a feasible and potentially effective method for reducing AO by providing users with a motivational framework to evaluate their lifestyle behaviors.

Comparison of adiposity anthropometric indices and their associations with visceral fat levels determined by bioelectrical impedance analysis among diabetic patients

Visceral fat (VF) and its effect on metabolic disorders have been extensively studied; nevertheless, there is a need for a simple and reliable index to equally assess VF in low-resource settings. This multihospital-based study was designed to compare the five adiposity anthropometric indices and their associations with VF levels determined by bioelectrical impedance analysis as the reference standard among diabetic patients. A pretested questionnaire was used to collect anthropometric, biochemical and hemodynamic data from 473 diabetic patients. Regression analysis was performed to determine the associations between the five adiposity anthropometric indices and VF levels. Receiver operating characteristic (ROC) curves were used to confirm the predictive capacities of the five adiposity anthropometric indices with VF levels. The waist-to-height ratio WHtR showed the greatest ROC value [area under the curve (AUC) = 0.745, p ˂0.001] in identifying diabetic patients with high VF levels compared to body mass index BMI [AUC = 0.584, p = 0.047], waist circumference WC [AUC = 0.723, p ˂0.001], hip circumference HC [AUC = 0.647, p ˂0.001] and waist-to-hip ratio WHR [AUC = 0.711, p ˂0.001]. Likewise, the regression analysis of WHtR and VF levels revealed the strongest association [unadjusted odds ratio (UOR) = 21.49, p < 0.001] compared to BMI [UOR = 6.77, p = 0.008], WC [UOR = 6.37, p < 0.001], HC [UOR = 5.93, p = 0.002] and WHR [UOR = 13.17, p < 0.001]. The optimal cut-off values to identify diabetic patients with high VF levels were > 0.5 for WHtR, > 25.7 kg/m2 for BMI, > 80.5 cm for WC, > 95.5 cm for HC and > 0.82 for WHR. WHtR was shown to have overpowered BMI, HC, WC and WHR in identifying diabetic patients with high VF levels. Therefore, the Ghana Health Service could recommend WHtR as a better diagnostic index for assessing VF levels due to its high predictive capacity.

Associations between visceral adipose tissue estimates produced by near-infrared spectroscopy, mobile anthropometrics, and traditional body composition assessments and estimates derived from dual-energy X-ray absorptiometry

Assessments of visceral adipose tissue (VAT) are critical in preventing metabolic disorders; however, there are limited measurement methods that are accurate and accessible for VAT. The purpose of this cross-sectional study was to evaluate the association between VAT estimates from consumer-grade devices and traditional anthropometrics and VAT and subcutaneous adipose tissue (SAT) from dual-energy X-ray absorptiometry (DXA). Data were collected from 182 participants (female = 114; White = 127; Black/African-American (BAA) = 48) which included anthropometrics and indices of VAT produced by near-infrared reactance spectroscopy (NIRS), visual body composition (VBC) and multifrequency BIA (MFBIA). VAT and SAT were collected using DXA. Bivariate and partial correlations were calculated between DXAVAT and DXASAT and other VAT estimates. All VAT indices had positive moderate–strong correlations with VAT (all P < 0·001) and SAT (all P < 0·001). Only waist:hip (r = 0·69), VATVBC (r = 0·84), and VATMFBIA (r = 0·86) had stronger associations with VAT than SAT (P < 0·001). Partial associations between VATVBC and VATMFBIA were only stronger for VAT than SAT in White participants (r = 0·67, P < 0·001) but not female, male, or BAA participants individually. Partial correlations for waist:hip were stronger for VAT than SAT, but only for male (r = 0·40, P < 0·010) or White participants (r = 0·48, P < 0·001). NIRS was amongst the weakest predictors of VAT which was highest in male participants (r = 0·39, P < 0·010) but non-existent in BAA participants (r = –0·02, P > 0·050) after adjusting for SAT. Both anthropometric and consumer-grade VAT indices are consistently better predictors of SAT than VAT. These data highlight the need for a standardised, but convenient, VAT estimation protocol that can account for the relationship between SAT and VAT that differs by sex/race.

Metabolic Score for Visceral Fat: a novel predictor for the risk of type 2 diabetes mellitus

To investigate the association between the Metabolic Score for Visceral Fat (METS-VF) and risk of type 2 diabetes mellitus (T2DM) and compare the predictive value of the METS-VF for T2DM incidence with other obesity indices in Chinese people. A total of 12 237 non-T2DM participants aged over 18 years from the Rural Chinese Cohort Study of 2007-2008 were included at baseline and followed up during 2013-2014. The cox proportional hazards regression was used to calculate hazard ratios (HR) and 95 % CI for the association between baseline METS-VF and T2DM risk. Restricted cubic splines were used to model the association between METS-VF and T2DM risk. Area under the receiver operating characteristic curve (AUC) analysis was used to evaluate the ability of METS-VF to predict T2DM incidence. During a median follow-up of 6·01 (95 % CI 5·09, 6·06) years, 837 cases developed T2DM. After adjusting for potential confounding factors, the adjusted HR for the highest v. lowest METS-VF quartile was 5·97 (95 % CI 4·28, 8·32), with a per 1-sd increase in METS-VF positively associated with T2DM risk. Positive associations were also found in the sensitivity and subgroup analyses, respectively. A significant nonlinear dose-response association was observed between METS-VF and T2DM risk for all participants (P_nonlinearity = 0·0347). Finally, the AUC value of METS-VF for predicting T2DM was largest among six indices. The METS-VF may be a reliable and applicable predictor of T2DM incidence in Chinese people regardless of sex, age or BMI.

Sex differences in the association between visceral adipose tissue and atherosclerosis in type 2 diabetes patients with normal bodyweight: A study in a Chinese population

AIMS/INTRODUCTION

To investigate the impact of visceral adipose tissue (VAT) on atherosclerosis in type 2 diabetes patients with normal bodyweight (OB[-]) in the Chinese population, and to further assess the sex-age differences between them.

MATERIALS AND METHODS

A total of 8,839 type 2 diabetes patients from two of the National Metabolic Management Centers in China were included in this study. Participants were classified into four groups by visceral fat area (VFA; cm² ) and body mass index (BMI; kg/m² ): VFA < 100 and BMI < 23.9 (VA[-]OB[-]), VFA < 100 and BMI ≥ 23.9 (VA[-]OB[+]), VFA ≥ 100 and BMI < 23.9 (VA[+]OB[-]), VFA ≥ 100 and BMI ≥ 23.9 (VA[+]OB[+]). Atherosclerosis was defined by brachial-ankle pulse wave velocity (baPWV; cm/s), and we analyzed the association between VFA, BMI and the tertiles of baPWV values.

RESULTS

The VA(+)OB(-) prevalence was 3.7% among these participants. Patients with VA(+)OB(-) had the highest baPWV value (P < 0.001) and the highest proportion of the tertile 3 of baPWV (P < 0.001) among four groups, and were significantly associated with baPWV (standardized β = 0.026, P = 0.008). VFA was significantly related to tertile 2 to tertile 3 of baPWV in (OB[-]) type 2 diabetes patients, when compared with tertile 1 of baPWV, respectively. In sex-age stratified analysis, the association of VFA and the tertiles of baPWV showed sex differences. For the 55 years age stratification analysis, there was no age difference in the relationship between VFA and baPWV in (OB[-]) patients.

CONCLUSION

Increased VAT was an independent risk factor for atherosclerosis in female type 2 diabetes patients with normal weight.

Change of neck circumference in relation to visceral fat area: a Chinese community-based longitudinal cohort study

Background/Objectives

Neck circumference (NC) has been positively associated with visceral fat area (VFA) in cross-sectional studies. This study aimed to evaluate the effects of NC changes on VFA in a Chinese community-based longitudinal cohort.

Subjects/Methods

Subjects recruited from Shanghai communities were followed up for 1.1–2.9 years. A total of 1421 subjects (men 578, women 843) were included, aged 24–80 years, with an average age of 57.8 ± 7.1 years.

Interventions/Methods

Biochemical and anthropometric measurements, including NC, were obtained from all subjects. VFA was assessed by magnetic resonance imaging. Abdominal obesity was defined as a VFA ≥ 80 cm².

Results

After a mean follow-up of 2.1 years, the NCs for men and women were 38.1 ± 2.3 cm and 33.8 ± 2.0 cm, respectively, and the average value of VFA was 84.55 (59.83–113.50) cm². After adjusting for age, sex, body mass index, smoking, history of drinking, glycated hemoglobin, blood pressure and blood lipids, individuals who had gained a NC of more than 5% had 1.26 (95% CI: 1.05–1.49) times more visceral adipose tissue at follow-up than NC maintainers (NC change between –2.5% and 2.5%). In the non-abdominal obesity group at baseline (n = 683), after adjusting for confounding factors, changes in NC were associated with abdominal obesity (odd ratio 1.23, 95% CI: 1.09–1.39).

Conclusions

Changes in NC were positively associated with VFA in a Chinese community-based cohort, suggesting that NC measurement is practical for assessing abdominal obesity.

Impact of a Mediterranean diet on hepatic and metabolic outcomes in non-alcoholic fatty liver disease: The MEDINA randomised controlled trial

BACKGROUND

Non-alcoholic fatty liver disease (NAFLD) is predominantly managed by lifestyle intervention, in the absence of effective pharmacotherapies. Mediterranean diet (MedDiet) is the recommended diet, albeit with limited evidence.

AIMS

To compare an ad libitum MedDiet to low-fat diet (LFD) in patients with NAFLD for reducing intrahepatic lipids (IHL) by proton magnetic resonance spectroscopy (1 H-MRS). Secondary outcomes include insulin resistance by homeostatic model of assessment (HOMA-IR), visceral fat by bioelectrical impedance analysis (BIA), liver stiffness measurement (LSM) and other metabolic outcomes.

METHODS

In this parallel multicentre RCT, subjects were randomised (1:1) to MedDiet or LFD for 12 weeks.

RESULTS

Forty-two participants (25 females [60%], mean age 52.3 ± 12.6 years) were included, 23 randomised to LFD and 19 to MedDiet.; 39 completed the study. Following 12 weeks, there were no between-group differences. IHL improved significantly within the LFD group (-17% [log scale]; p = .02) but not within the MedDiet group (-8%, p = .069). HOMA-IR reduced in the LFD group (6.5 ± 5.6 to 5.5 ± 5.5, p < .01) but not in the MedDiet group (4.4 ± 3.2 to 3.9 ± 2.3, p = .07). No differences were found for LSM (MedDiet 7.8 ± 4.0 to 7.6 ± 5.2, p = .429; LFD 11.8 ± 14.3 to 10.8 ± 10.2 p = .99). Visceral fat reduced significantly in both groups; LFD (-76% [log scale], p = <.0005), MedDiet (-61%, p = <.0005).

CONCLUSIONS

There were no between-group differences for hepatic and metabolic outcomes when comparing MedDiet to LFD. LFD improved IHL and insulin resistance. Significant improvements in visceral fat were seen within both groups. This study highlights provision of dietary interventions in free-living adults with NAFLD is challenging.

Association of visceral adiposity index with incident nephropathy and retinopathy: a cohort study in the diabetic population

Background

The association between visceral adiposity index (VAI) and diabetic complications has been reported in cross-sectional studies, while the effect of VAI on complication development remains unclear. This study aims to evaluate the longitudinal association of VAI and Chinese VAI (CVAI) with the incidence of diabetic nephropathy and retinopathy using a Chinese cohort.

Methods

A total of 8 948 participants with type 2 diabetes from Beijing Health Management Cohort were enrolled during 2013–2014, and followed until December 31, 2019. Nephropathy was confirmed by urine albumin/creatinine ratio and estimated glomerular filtration rate; retinopathy was diagnosed using fundus photograph.

Results

The mean (SD) age was 53.35 (14.66) years, and 6 154 (68.8%) were men. During a median follow-up of 4.82 years, 467 participants developed nephropathy and 90 participants developed retinopathy. One-SD increase in VAI and CVAI levels were significantly associated with an increased risk of nephropathy, and the adjusted hazard ratios (HR) were 1.127 (95% CI 1.050–1.210) and 1.165 (95% CI 1.003–1.353), respectively. On contrary, VAI and CVAI level were not associated with retinopathy after adjusting confounding factors.

Conclusion

VAI and CVAI are independently associated with the development of nephropathy, but not retinopathy in Chinese adults with diabetes.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12933-022-01464-1.

Morphofunctional and Molecular Assessment of Nutritional Status in Head and Neck Cancer Patients Undergoing Systemic Treatment: Role of Inflammasome in Clinical Nutrition

Simple Summary

Malnutrition in patients with head and neck cancer is associated with worse clinical evolution and prognosis. Accurate nutritional assessments allow for early-identification of patients at risk of malnutrition. We aimed to perform a novel morphofunctional nutritional evaluation, including molecular analysis in patients with head and neck cancer who are undergoing systemic treatment. A morphofunctional nutritional assessment includes bioimpedance, anthropometric, ultrasound and biochemical measurements. We observed that malnutrition induces a profound alteration in the gene-expression pattern of inflammasome-machinery components, which are related with clinical nutritional parameters. This molecular analysis should be further studied as potential targets for nutrition-focused treatment strategies in cancer patients.

Abstract

Malnutrition in patients with head and neck cancer is frequent, multifactorial and widely associated with clinical evolution and prognosis. Accurate nutritional assessments allow for early identification of patients at risk of malnutrition in order to start nutritional support and prevent sarcopenia. We aimed to perform a novel morphofunctional nutritional evaluation and explore changes in inflammasome-machinery components in 45 patients with head and neck cancer who are undergoing systemic treatment. To this aim, an epidemiological/clinical/anthropometric/biochemical evaluation was performed. Serum RCP, IL6 and molecular expression of inflammasome-components and inflammatory-associated factors (NOD-like-receptors, inflammasome-activation-components, cytokines and inflammation/apoptosis-related components, cell-cycle and DNA-damage regulators) were evaluated in peripheral-blood mononuclear-cells (PBMCs). Clinical-molecular correlations/associations were analyzed. Coherent and complementary information was obtained in the morphofunctional nutritional assessment of the patients when bioimpedance, anthropometric and ultrasound data were analyzed. These factors were also correlated with different biochemical and molecular parameters, revealing the complementary aspect of the whole evaluation. Serum reactive C protein (RCP) and IL6 were the most reliable parameters for determining patients with decreased standardized phase angle, which is associated with increased mortality in patients with solid malignancies. Several inflammasome-components were dysregulated in patients with malnutrition, decreased phase angle and dependency grade or increased circulating inflammation markers. A molecular fingerprint based on gene-expression of certain inflammasome factors (p27/CCL2/ASC) in PBMCs accurately differentiated patients with and without malnutrition. In conclusion, malnutrition induces a profound alteration in the gene-expression pattern of inflammasome-machinery components in PBMCs. A comprehensive nutritional assessment including novel morphofunctional techniques and molecular markers allows a broad characterization of the nutritional status in cancer patients. Profile of certain inflammasome-components should be further studied as potential targets for nutrition-focused treatment strategies in cancer patients.

Heterogeneity of abdominal obesity in patients with cardiovascular diseases

Aim: To assess the content of visceral adipose tissue (VAT) in patients with abdominal obesity and its relationship with metabolic disorders.

Material and methods. Patients with abdominal obesity (n=107) were included in the study. All participants had an assessment of anthropometric parameters (height, weight), calculation of body mass index (BMI), proportion of total adipose tissue and VAT (bioimpedance analyzer), high-density lipoprotein cholesterol (HDL-c) levels, triglycerides, fasting blood glucose, epicardial thickness adipose tissue (two-dimensional echocardiography).

Results. The median share of VAT (bioimpedance method) was 13%. Patients with abdominal obesity are divided by VAT into 2 groups: ≥14% or ≤13%. Patients with VAT≥14% had significantly higher levels of triglycerides (1.76 [1.27; 2.38] mmol / L) and glucose (6.33 [5.78; 7.87] mmol / L), and below HDL-c levels (0.95 [0.85; 1.21] mmol / L) compared with patients with VAT≤13% (1.32 [1.02; 1.50], 5.59 [5, 11; 6.16] and 1.31 [1.07; 1.58] mmol / L, respectively; p<0.001 for all three comparisons). A significant correlation was found between VAT and triglyceride, glucose and HDL-c levels (r=0.40; r=0.40; r=-0.31, respectively; p<0.001).

Conclusion. Persons with abdominal obesity are heterogeneous in the proportion of VAT. The proportion of VAT above the median is associated with metabolic disorders that are significant for the development and progression of atherosclerosis. An increase in BMI in obese individuals is not associated with an increase in VAT and an increase in the severity of metabolic disorders.

Lower Visceral Fat Area in Patients with Type 2 Diabetic Peripheral Neuropathy

OBJECTIVE

There is preliminary evidence that visceral fat area (VFA) was associated with the presence of type 2 diabetic peripheral neuropathy (DPN) in the Korean population; however, no studies have reported the association in Chinese population. The purpose of this study was to explore the possible correlation of VFA with DPN in such a population.

METHODS

A total of 2498 hospitalized patients with type 2 diabetes mellitus (T2DM) undergone VFA measurement, and were divided into DPN group (n=900) and non-DPN group (n=1594). The association of VFA with the presence of DPN was evaluated by correlation and multiple logistic regression analyses, generalized additive model with a smooth curve fitting, and receiver operating characteristic (ROC) curve analysis.

RESULTS

The VFA was significantly lower in the DPN group than in the non-DPN group (P < 0.001). VFA was significantly and positively associated with sural nerve conduction velocity (SNCV) and amplitude potential (SNAP) and negatively associated with the presence of DPN (all P< 0.001); there was no significant difference in the curve fitting (P = 0.344). Multivariate logistic regression analysis showed that the risk of presence of DPN decreased progressively across the VFA quartiles (P for trend < 0.001) and was significantly lower in patients in the highest VFA quartile than in those in the lowest quartile (OR: 0.382, 95% CI 0.151-0.968, P< 0.001) after multivariate adjustment. The ROC analysis revealed that the best cut-off value of VFA for predicting the presence of DPN was 50.5cm² (sensitivity 84.40%; specificity 34.00%).

CONCLUSION

These results suggest that lower VFA level may be associated with increased risk of the presence of DPN in T2DM patients.

Magnetic Resonance Imaging Assessment of Abdominal Ectopic Fat Deposition in Correlation With Cardiometabolic Risk Factors

PURPOSE

Ectopic fat accumulation and abdominal fat distribution may have different cardiometabolic risk profiles. This study aimed to assess the associations between various magnetic resonance imaging (MRI)-acquired fat depots and cardiometabolic risk factors.

METHODS

A total of 320 subjects with median age of 59 years, 148 men and 172 women, were enrolled in the study. Visceral adipose tissue (VAT) area and fat fraction (FF), subcutaneous adipose tissue (SAT) area and FF at the L1-L2 levels, preperitoneal adipose tissue (pPAT) area and FF, hepatic FF, pancreatic FF, and intramuscular FF were assessed by MRI FF maps. The associations of various MRI-acquired fat depots with blood pressure, glucose, and lipid were examined using sex-stratified linear regression. Logistic regression stratified by sex was used to analyze the association of various MRI-acquired fat depots with the risk of hypertension, T2DM, and dyslipidemia.

RESULTS

The intraclass correlation coefficient (ICC) values were >0.9, which suggested good interobserver and intraobserver agreement. VAT area, V/S, hepatic fat, pancreatic fat, and pPAT rather than SAT area were significantly associated with multiple cardiometabolic risk factors (all p < 0.05). However, the patterns of these correlations varied by sex and specific risk factors. Also, VAT and SAT FF were only significantly associated with multiple cardiometabolic risk factors in women (all p < 0.05).

CONCLUSIONS

VAT, hepatic fat, pancreatic fat, and pPAT were associated with cardiovascular metabolic risk factors independent of BMI. The patterns of these correlations were related to gender. These findings further the understanding of the association between ectopic fat deposition and cardiometabolic risk factors and help to better understand the obesity heterogeneity.

Novel Adiposity and Biochemical-Anthropometric Indices to Identify Cardiometabolic Risk and Metabolic Syndrome in Mexican Adults

Although several indices used in clinical practice identify cardiometabolic risk (CR) and metabolic syndrome (MetS), it is imperative to develop indices for specific populations. Therefore, we proposed and validated sex-specific indices to identify CR associated with visceral adipose tissue (VAT) accumulation or MetS in Mexican adults. Additionally, a cut-off value for the visceral fat area (VFA) to identify CR was proposed. Clinical, anthropometric, biochemical, and body composition variables were evaluated in 904 subjects (25-45 years old) (84.4% men). Multiple and logistic regressions were used to model the indices and ROC curve analysis to determine predictive performance. An additional cohort (n = 186) was used for indices validation, and Cohen's kappa coefficient was employed for agreement analysis. The proposed sex-specific indices, called Mexican adiposity indices (MAIs) and biochemical-anthropometric indices (BAIs), were good predictors for CR and MetS. The kappa coefficients showed a moderate agreement level. The VFA cut-off value chosen to identify CR was 100.3 cm2 because it had the best combination of sensitivity (66.8%) and specificity (64.4%). MAIs and BAIs could be clinical tools to identify either CR associated to VAT accumulation or MetS, respectively. A VFA cut-off value of 100.3 cm2 could identify CR in Mexican men.

The Possibility of Using Bioelectrical Impedance Analysis in Pregnant and Postpartum Women

Pregnancy is a time of significant changes occurring in the composition of a woman’s body in order to provide support for the growth and development of the foetus. Bioelectrical impedance analysis (BIA) is used to assess the body composition and hydration status. This technique represents a non-invasive, reliable, and fast clinical approach, which is well tolerated by patients. A segmental impedance measurement might be advantageous in pregnant women, particularly in late pregnancy. The purpose of this paper is to provide a review of different applications of BIA in pregnant and postpartum women. It seems that BIA has a better prognostic potential for gestational and post-partum outcomes than body mass index. The BIA method can be successfully used to study the effect of excessive gestational weight gain in pregnancy on the development of obstetric complications. Studying the mother’s body composition and correlating it with her energy balance could facilitate the development of dietary recommendations for women. Evaluation of the body composition can provide important clues for diagnosis of gestational diabetes mellitus in pregnant women with a low risk of this disease. BIA is also used as one of the additional tests in assessing the risk of developing gestational hypertension and preeclampsia.

The Association of Body Composition Parameters and Simultaneously Measured Inter-Arm Systolic Blood Pressure Differences

Background and Objectives: An inter-arm systolic blood pressure difference (IASBPD) is defined as a blood pressure (BP) disparity of ≥10 mmHg between arms. IASBPDs are associated with an increased risk of cardiovascular disease (CVD). Similarly, visceral fat accumulation (VFA) is clinically important because it is associated with higher cardiovascular disease risk. Accordingly, this study compared the body composition parameters of IASBPD individuals with individuals who did not express an IASBPD. Materials and Methods: The analysis included 104 patients. The blood pressures of all participants were measured simultaneously in both arms using automated oscillometric devices. Then patients were divided into two groups according to their IASBPD status: Group 1 (IASBPD- (<10 mmHg)); Group 2 (IASPPD+ (≥10 mmHg)). Body composition parameters were measured using bioelectrical impedance analysis. Results: In 42 (40%) patients, the simultaneously measured IASBPD was equal to or higher than 10 mmHg. The right brachial SBP was higher in 63% of patients. There were no differences between the groups in terms of demographic and clinical characteristics. Regarding the two groups' body composition parameter differences, VFA was significantly higher in group 2 (p = 0.014). Conclusions: The IASBPD is known to be associated with an increased risk of cardiovascular events. Although the body mass indexes (BMIs) of the two groups were similar, VFA levels in those with a greater than 10 mmHg IASBPD were found to be significantly higher. This finding may explain the increased cardiovascular risk in this group.

Visceral fat area and cardiometabolic risk: The Kardiovize study

BACKGROUND

Visceral fat is associated with adiposity-based complications. Bioimpedance measurement allows estimation of visceral fat area (VFA) in an easy manner. However, a validated cut-off value for VFA by bioimpedance associated with cardiometabolic risk is lacking in European population.

AIM

To determine cut-off values of VFA measured via bioimpedance associated with cardiometabolic risk.

METHODS

Random cross-sectional Czech population-based sample of 25-64 years old subjects. Receiver Operating Characteristic (ROC) curves were used and the area under the curve (AUC), sensitivity, and specificity were calculated. The Cardiometabolic Disease Staging System (CMDS) was used to classify cardiometabolic risk: Stage 1 - 1 or 2 metabolic syndrome (MetS) components, without impaired fasting glucose (IFG); Stage 2 - MetS or IFG; Stage 3 - MetS with IFG; Stage 4 - type 2 diabetes and/or cardiovascular disease.

RESULTS

2052 participants (54.5% females, median age 49 years) were included. Median VFA (inter-quartile range) were 82.2 cm² (54.8) in men and 89.8 cm² (55.6) in women. The best VFA cut-offs associated with Stage 1 in men and women were 71 cm² (sensitivity = 0.654; specificity = 0.427) and 83 cm² (sensitivity = 0.705; specificity = 0.556) ; Stage 2: 84 cm² (sensitivity = 0.673; specificity = 0.551) and 98 cm² (sensitivity = 0.702; specificity = 0.628) ; Stage 3: 90 cm² (sensitivity = 0.886; specificity = 0.605) and 109 cm² (sensitivity = 0.755; specificity = 0.704); Stage 4: 91 cm² (sensitivity = 0.625; specificity = 0.611) and 81 cm² (sensitivity = 0.695; specificity = 0.448), respectively.

CONCLUSION

A cut-off value of VFA of 71 cm² in men and 83 cm² in women exhibited the earliest stage of cardiometabolic risk, and 90 cm² in men and 109 cm² in women showed the best performance to detect risk.

Relationship Between Skeletal Muscle Mass to Visceral Fat Area Ratio and Cardiovascular Risk in Type 2 Diabetes

PURPOSE

Either visceral fat or muscle mass is identified to be correlated with cardiometabolic diseases, especially in type 2 diabetes (T2DM). But, the synergistical effect of visceral fat along with skeletal muscle on the risk of cardiovascular diseases (CVD) in T2DM still remains controversial. Thus, we investigated the relationship between skeletal muscle mass to visceral fat area ratio (SVR) and 10-yr CVD risk scores.

PATIENTS AND METHODS

A total of 291 T2DM patients aged 40-80 years were enrolled in the current study. SVR was evaluated based on bioelectrical impedance measurements. Both Framingham risk score system and China-PAR risk model were applied to estimate future 10-yr CVD risk in T2DM population.

RESULTS

The 10-yr CVD risk scores increased with the decreased SVR tertiles in T2DM (All P<0.001). SVR value was obviously lower in the high-risk group than that of low- or moderate-risk group (All P<0.05). However, no significant differences were observed in BMI among different CVD risk groups. Besides, SVR was correlated with Framingham risk score (r=-0.408; P<0.001) and China-PAR risk score (r=-0.336; P<0.001). HOMA-IR, triglycerides and blood pressure were also inversely related to SVR (All P<0.05). Furthermore, SVR value was independently correlated with both Framingham 10-yr CVD risk score (β=-0.074, P=0.047) and China-PAR risk score (β=-0.100, P=0.004) after adjustment for confounding factors, including age, gender, BMI, FPG, HbA1c, diabetes duration, albumin, creatinine, uric acid, smoking, blood pressure and blood lipid. The linear regression analysis was also conducted for men and women, respectively, indicating that the negative relationship between SVR and 10-yr CVD risk was observed in men but not in women.

CONCLUSION

T2DM populations who have lower SVR value are more likely to increase CVD risk. SVR levels show marked and inverse correlation with estimated 10-yr CVD risk in T2DM, indicating that SVR could be a valuable parameter to assess the risk of CVD events in clinical practice, especially in men.

Intra-abdominal fat estimation by bio-electrical impedance analysis in patients with fibrocalculous pancreatic diabetes compared with BMI matched type 2 diabetic subjects and healthy controls

BACKGROUND AND AIMS

Intra-abdominal adipose tissue (IAAT) is a major contributor to insulin resistance (IR) in type 2 diabetes mellitus (T2D). Prior studies have demonstrated evidence of IR in fibrocalculous pancreatic diabetes (FCPD). However, no data exists on IAAT estimation in FCPD. Hence, we compared IAAT area among FCPD patients and an equal number of body mass index (BMI) matched T2D patients and healthy controls.

METHODS

We recruited 60 patients with FCPD between January 2019 and February 2020. Body composition analysis was performed via bio-electrical impedance analysis.

RESULTS

The mean ages were 37.82 ± 10.07, 51.02 ± 9.9, and 30.7 ± 11.51 years for patients in the FCPD, T2D, and control groups, respectively. The mean BMI of patients in the three groups was 20.65 ± 2.01, 20.83 ± 1.49, and 20.91 ± 1.59 kg/m², respectively (P = 0.684). The mean IAAT area of patients in the FCPD, T2D, and control groups was 67.93 ± 43.38, 117.78 ± 48.03, and 100.52 ± 42.31 cm², respectively. IAAT was significantly lower in patients with FCPD compared with those in the other two groups (P < 0.0001). In the entire cohort, IAAT showed significant positive correlation with age (r = 0.20), abdominal circumference (r = 0.80), waist hip ratio (r = 0.75), and LDL level (r = 0.25) (P < 0.05).

CONCLUSIONS

Patients with FCPD have significantly lower IAAT compared to BMI matched T2D subjects and healthy controls. IAAT does not appear to be a major contributor to insulin resistance observed in patients with FCPD.

Associations between abdominal obesity indices and diabetic complications: Chinese visceral adiposity index and neck circumference

Background and aims

Obesity, especially abdominal obesity, has been considered a risk factor for diabetic complications. Many abdominal obesity indices have been established, including neck circumference (NC), waist-to-hip ratio (WHR), lipid accumulation product (LAP), visceral adiposity index (VAI) and the Chinese visceral adiposity index (CVAI). However, studies investigating the associations between these indices and diabetic complications are limited. The objective of this study was to investigate the associations of the abdominal obesity indices with cardiovascular and cerebrovascular disease (CVD), diabetic kidney disease (DKD) and diabetic retinopathy (DR).

Methods

A total of 4658 diabetic participants were enrolled from seven communities in Shanghai, China, in 2018. Participants completed questionnaires and underwent blood pressure, glucose, lipid profile, and urine albumin/creatinine ratio measurements; fundus photographs; and anthropometric parameters, including height, weight, waist circumference (WC), NC and hip circumference (HC).

Results

In men, a one standard deviation (SD) increase in CVAI level was significantly associated with a greater prevalence of CVD (OR 1.35; 95% CI 1.13, 1.62) and DKD (OR 1.38; 95% CI 1.12, 1.70) (both P < 0.05). In women, a one SD increase in CVAI level was significantly associated with a greater prevalence of CVD (OR 1.32; 95% CI 1.04, 1.69) and DKD (OR 2.50; 95% CI 1.81, 3.47) (both P < 0.05). A one SD increase in NC was significantly associated with a greater prevalence of CCA plaque in both men (OR 1.26; 95% CI 1.10, 1.44) and women (OR 1.20; 95% CI 1.07, 1.35). These associations were all adjusted for potential confounding factors.

Conclusions

CVAI was most strongly associated with the prevalence of CVD and DKD among the abdominal obesity indices, and NC was unique associated with the prevalence of CCA plaque in Chinese adults with diabetes.

Trial registration ChiCTR1800017573, www.chictr.org.cn. Registered 04 August 2018.

Analysis of risk factors for carotid intima-media thickness in patients with type 2 diabetes mellitus in Western China assessed by logistic regression combined with a decision tree model

BACKGROUND

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in patients with type 2 diabetes (T2DM). Carotid intima-media thickness (CIMT) is considered a preclinical stage of atherosclerosis. Therefore, it is necessary to identify the related risk factors for CIMT to facilitate the early prevention of CVD. Previous studies have shown that visceral fat area (VFA) is a risk factor for T2DM and CVD. However, few studies have focused on the effects of VFA on CIMT associated with T2DM. Moreover, considering that the body fat distribution shows regional and racial heterogeneity, the purpose of this study was to investigate the predictive value of VFA and other risk factors for CIMT associated with T2DM in Western China.

METHODS

In a cross-sectional study, a total of 1372 patients with T2DM were divided into the CIMT (-) group (n = 965) and the CIMT (+) group (n = 407) based on CIMT values. In addition to the univariate analyses, logistic regression analysis and a decision tree model were simultaneously performed to establish a correlation factor model for CIMT.

RESULTS

Univariate analyses showed that sex, smoking status, age, heart rate, systolic blood pressure (SBP), diastolic blood pressure (DBP), height, weight, body mass index (BMI), waist circumference, hip circumference, waist-hip ratio, VFA, subcutaneous fat area, and the levels of 2-h C-peptide, serum creatinine, urea nitrogen and uric acid were significantly different between the two groups (all p < 0.05). Smoking, increased VFA, female sex and increased BMI were risk factors in the logistic regression analyses (OR = 5.759, OR = 1.364, OR = 2.239, OR = 1.186, respectively). In the decision tree model, smoking was the root node, followed by sex, waist circumference, VFA and chronic kidney disease (CKD) in order of importance.

CONCLUSIONS

In addition to smoking, sex and BMI, VFA has a significant effect on CIMT associated with T2DM in the Chinese Han population in Western China. In addition, the decision tree model could help clinicians make more effective decisions, with its simplicity and intuitiveness, making it worth promoting in future medical research.Trial registration ChiCTR, ChiCTR1900027739. Registered 24 November 2019-Retrospectively registered, http://www.chictr.org.cn/index.aspx.

Visceral Fat Area, Not Subcutaneous Fat Area, is Associated with Cardiac Hemodynamics in Type 2 Diabetes

BACKGROUND

This study was conducted in patients with type 2 diabetes mellitus (T2DM) to assess the association between visceral fat area (VFA) and cardiac hemodynamics.

METHODS

A total of 568 patients with type 2 diabetes (mean age 54±12 years; 40.8% of women) were enrolled. Visceral fat area (VFA, m²) and subcutaneous fat area (SFA, m²) were evaluated by a bioelectrical impedance analyzer. Cardiac hemodynamics were measured by echocardiography, and other clinical and laboratory variables were also assessed and recorded. Patients were divided into those with VFA ≤ 100 (n=369) and those with VFA > 100 (n=199).

RESULTS

VFA, SFA, LVMI (left ventricular mass index), left atrial diameter, left ventricular diastolic diameter (LvDd), interventricular septal thickness (IVST), left ventricular systolic diameter (LvSd), and posterior wall thickness (PWT) levels in high-V groups were significantly higher than those in low-V groups. Correlation analysis showed that VFA was positively correlated with LVMI (r=0.120, p=0.004), LVM (r=0.249, p<0.0001), left atrial diameter (r=0.375, p<0.0001), aortic root diameter (r=0.243, p<0.0001), left ventricular systolic diameter (LvSd) (r=0.211, p<0.0001) and negatively correlated with LVEF (r=-0.107, p=0.011). In multivariate linear regression analysis, VFA was the strongest independent determinant of LVMI (β=0.04, p=0.016), LVEF (β=-0.01, p=0.023), and left atrial diameter (β=0.035, p<0.0001), Internal diameter of the aortic root (β=0.014, p<0.0001) and LvSd (β=0.017, p<0.0001). In addition, the VFA also better predicted cardiovascular disease risk with AUC of 0.609 (95% CI:0.563-0.656), compared with SFA, waist-hip ratio (WHR), in a statistically significant manner.

CONCLUSION

We found a significant correlation between VFA (but not SFA) and cardiac hemodynamic parameters. The VFA has advantages as a predictor of visceral obesity and is significantly associated with the development of cardiovascular risk factors (CVD) in T2DM patients.