Visceral obesity determined by CT as a predictor of short-term postoperative complications in patients with ovarian cancer

OBJECTIVE

To explore the association between visceral obesity and short-term postoperative complications in patients with advanced ovarian cancer undergoing cytoreductive surgery.

METHODS

The medical records of patients with advanced epithelial ovarian cancer were reviewed. The visceral fat area, subcutaneous fat area and total fat area at the L3/4 level were measured on a preoperative single-slice CT scan. The receiver operating characteristic (ROC) curve was used to calculate the optimal cutoff value for the visceral fat area. The relationship between the visceral fat area and the characteristics of ovarian cancer patients were analyzed. Univariable and multivariable logistic regression analyses were performed to investigate relationship between perioperative characteristics and short-term complications.

RESULTS

According to the ROC curve, the best cutoff value of the VFA was 93 cm2. Of the 130 patients, 53.8% (70/130) had visceral obesity. Patients with visceral obesity were older than those with nonvisceral obesity (58.4 years old vs. 52.1 years old, p < 0.001). The proportion of patients with hypertension was higher (35.7 vs. 13.3%, p = 0.003). The total fat area and subcutaneous fat area were larger in patients with visceral obesity (294.3 ± 75.5 vs. 176.2 ± 68.7, p < 0.001; 158.9 ± 54.7 vs. 121.7 ± 52.6, p < 0.001). Compared with patients in the nonvisceral obese group, patients in the visceral obese group were more likely to have postoperative fever (21/70 30.0% vs. 8/60 1.25%, p = 0.023), leading to a longer length of hospital stay (21 days vs. 17 days, p = 0.009). The time from surgery to adjuvant chemotherapy for patients with visceral obesity was shorter (24 days vs. 19 days, p = 0.037). Multivariate analysis showed that visceral obesity (OR = 6.451, p < 0.001) and operation time (OR = 1.006, p < 0.001) were independent predictors of postoperative complications.

CONCLUSION

Visceral obesity is an important risk factor for short-term postoperative complications in patients with advanced ovarian cancer undergoing cytoreductive surgery.

Impact of sarcopenia on recurrent biliary obstruction after EUS-guided biliary drainage in patients with malignant biliary obstruction

BACKGROUND AND AIMS

Sarcopenia is an important prognostic factor for cancer patients. The aim of this study was to assess the ability of sarcopenia to predict recurrent biliary obstruction (RBO) in patients with unresectable cancer after EUS-guided biliary drainage (EUS-BD).

METHODS

The study enrolled 113 patients who underwent EUS-BD using the self-expandable metal stent (SEMS) for unresectable malignant biliary obstruction (MBO) between April 2016 and December 2021 at Wakayama Medical University Hospital. The skeletal muscle index at the third lumbar spine level (L3) was calculated from computed tomography images. We analyzed the cumulative incidence of RBO at 180 days after stent insertion. Univariate and multivariate analyses were performed to identify variables significantly associated with RBO.

RESULTS

Seventy-six patients were assigned to the sarcopenia group, and 37 were assigned to the non-sarcopenia group. The 180-day cumulative incidence of RBO was 11% in the non-sarcopenia group and 29% in the sarcopenia group (p = 0.034). The time to RBO was significantly shorter for the sarcopenia group (p = 0.028; Gray's test). Multivariate analyses identified sarcopenia as an independent prognostic factor for RBO (present vs absent; HR 4.61; 95% CI 1.76-12.10, p = 0.001). The rates of biliary sludge/food impaction were significantly higher in the sarcopenia group for the causes of RBO (p = 0.048). There were no significant differences between the sarcopenia and the non-sarcopenia groups with respect to related EUS-BD adverse events.

CONCLUSION

Sarcopenia is an independent indicator of RBO in patients with MBO who receive EUS-BD with SEMS.

Estimation of visceral fat area using criteria for metabolic syndrome: A cross-sectional study

BACKGROUND AND AIMS

The aim of this study was to calculate the visceral fat area (VFA) based on the criteria for metabolic syndrome (MetS).

METHODS

A multiple regression analysis was performed to determine the estimated VFA using data from Japanese participants (2315 men and 1684 women). Receiver operating characteristic curve (ROC) analyses were performed to determine the optimal estimated VFA cutoff for the diagnosis of central obesity. The cutoff was also applied to a second cohort to validate the model.

RESULTS

The estimated VFA was calculated using the MetS criteria, age, and body mass index (adjusted coefficient of determination = 0.682 for men and 0.726 for women). The area under the ROC curve for waist circumference, VFA, and estimated VFA were 0.669, 0.741, and 0.749, respectively, for men and 0.711, 0.787, and 0.803, respectively, for women. The optimal cutoffs for estimated VFA were 128.1 cm² for men and 82.2 cm² for women. Multivariate logistic regression for heart disease revealed that estimated VFA, rather than waist circumference, was associated with a high risk of heart disease.

CONCLUSION

The estimated VFA is a better index of central obesity than waist circumference and VFA for the diagnosis of MetS.

Impact of sarcopenia on prediction of progression-free survival and overall survival of patients with pancreatic ductal adenocarcinoma receiving first-line gemcitabine and nab-paclitaxel chemotherapy

BACKGROUND AND AIMS

Sarcopenia is an important prognostic factor for cancer patients. Here, we assessed the effects of sarcopenia on progression-free survival (PFS) and overall survival (OS) of patients with pancreatic ductal adenocarcinoma (PDAC) who underwent treatment with first-line gemcitabine and nab-paclitaxel (GEM and nab-PTX).

METHODS

The study enrolled patients with unresectable PDAC who underwent chemotherapy between April 2016 and May 2020. The skeletal muscle index (SMI) at the third lumbar spine level (L3) was calculated from computed tomography (CT) images. Propensity score analysis was used to compare PFS and OS in the sarcopenia and non-sarcopenia groups. Univariate and multivariate analyses were performed to determine variables significantly associated with prognosis.

RESULTS

Of the 176 patients who received first-line GEM and nab-PTX, 84 were selected and divided into two groups of 42 (the sarcopenia and the non-sarcopenia groups) by propensity score matching. The median PFS of the sarcopenia and the non-sarcopenia groups was 5.0 and 8.0 months, respectively (p = 0.004). The median OS was 10.3 and 18.1 months, respectively (p = 0.001). Multivariate analyses revealed that sarcopenia was an independent prognostic factor for PFS and OS (p = 0.004, p = 0.001, respectively). The rates of major grade 3 or 4 AEs were significantly higher in the sarcopenia group (p = 0.008).

CONCLUSIONS

Sarcopenia is an independent indicator of a poor prognosis in patients with PDAC treated with first-line GEM and nab-PTX.

Clinical Outcomes of Subcutaneous and Visceral Adipose Tissue Characteristics Assessed in Patients Underwent Transcatheter Aortic Valve Replacement

BACKGROUND

Adipose tissue (AT) characteristics are considered to be a marker for predicting clinical outcomes. This study aimed to investigate the prognostic value of subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT) computed tomography (CT) assessment in patients who underwent transcatheter aortic valve replacement (TAVR).

METHODS

We used the Japanese multicentre registry data of 1372 patients (age: 84.5 ± 5.0 years, women: 70.6%) who underwent TAVR. The SAT and VAT were assessed according to the preprocedural CT area and density. Baseline characteristics and clinical outcomes were compared based on the differences in AT characteristics. The independent associations with all-cause mortality after TAVR were evaluated according to the CT area and density of AT.

RESULTS

Low-volume area of SAT and VAT was associated with worse clinical outcomes compared with high-volume area of SAT and VAT in patients who underwent TAVR (log-rank test P = 0.016 and P = 0.014). High CT density of SAT and VAT was associated with increasing mortality in comparison with low CT density of SAT and VAT (log-rank test P < 0.001 and P = 0.007). The Cox regression multivariate analysis demonstrated the independent association of increased all-cause mortality in the high SAT and VAT density (hazard ratio [HR]: 1.41, 95% confidence interval [CI]: 1.06-1.88, P = 0.019, and HR: 1.34, 95% CI: 1.03-1.76, P = 0.031, respectively), but not in the low SAT and VAT area (HR: 0.85, 95% CI: 0.74-1.29, P = 0.85, and HR: 0.78, 95% CI: 0.60-1.03, P = 0.085, respectively).

CONCLUSIONS

CT-derived AT characteristics, particularly the qualitative assessments, were useful for predicting the prognosis in patients after TAVR.

Associations between visceral obesity and renal impairment in health checkup participants: a retrospective cohort study

BACKGROUND

Obesity is a risk factor for chronic kidney disease. Although body mass index (BMI) or waist circumference is indicators of obesity, actual measurements of visceral fat area (VFA) more accurately reflect the amount of visceral fat. We aimed to determine the most sensitive obesity indicator for predicting renal impairment among VFA, BMI, waist circumference, waist-to-height ratio, and visceral-to-subcutaneous fat ratio (VSR).

METHODS

Subjects who underwent VFA measurements during health checkups in 2012 were included. Obesity was defined using a separate baseline value for each indicator [VFA (100 cm²), BMI (25 kg/m²), waist circumference (85 cm for men and 90 cm for women), waist-to-height ratio (0.5), VSR (0.4)]. Changes in estimated glomerular filtration rate (eGFR_cr) and time to new-onset proteinuria were measured. The relationships between obesity indicators and eGFR_cr were evaluated using a linear mixed-effects model. The relationships between obesity indicators and new-onset proteinuria were evaluated using Poisson regression analysis.

RESULTS

Analysis was performed on 2753 subjects (mean age 50.3 years). The VFA ≥ 100 cm² group exhibited a larger annual difference in eGFR_cr compared to the < 100 cm² group (- 0.24 mL/min/1.73 m², P = 0.03). There was a statistically significant difference in the proteinuria incidence rate ratio, which was 1.54 times (95% confidence interval 1.01-2.35) in the VFA ≥ 100 cm² group. Statistically significant correlations were not observed with any of the other obesity indicators.

CONCLUSION

VFA is suggested to be the most sensitive obesity indicator for decline in kidney function and new-onset proteinuria.

Prognostic value of sarcopenic obesity estimated by computed tomography in patients with cardiovascular disease and undergoing surgery

BACKGROUND

Sarcopenic obesity is a health condition involving a combination of excess adipose tissue and loss of muscle mass. Although sarcopenic obesity is known to contribute to the morbidity and mortality of chronic diseases, limited data are available in patients with cardiovascular disease. The present study was performed to examine whether sarcopenic obesity determined by preoperative computed tomography (CT) is a useful predictor of postoperative mortality in patients undergoing cardiovascular surgery.

METHODS

We reviewed the findings in 664 consecutive cardiovascular surgery patients (mean age, 65.8±12.7 years; male, 66.6%) who underwent preoperative CT including the level of the third lumbar vertebra for clinical purposes. Psoas muscle attenuation (MA) and visceral adipose tissue (VAT) were measured as metrics of sarcopenia and obesity, respectively. Sarcopenia was defined as low MA (below median), while obesity was defined as high VAT (≥103cm² for males and ≥69cm² for females). The endpoint was all-cause mortality and secondary outcomes were muscle function.

RESULTS

After adjusting for age and sex, sarcopenic obesity showed significant associations with lower grip strength and quadriceps strength, slower gait speed, and shorter 6-min walking distance compared to the normal group (p<0.05). On multivariate Cox regression analysis, sarcopenic obesity was associated with increased risk of mortality after adjusting for EuroSCORE (hazard ratio, 3.04; 95% confidence interval, 1.25-7.40).

CONCLUSIONS

Sarcopenic obesity is associated with poor muscle function and all-cause mortality in patients undergoing cardiovascular surgery.

Perspective on Diagnostic Criteria for Obesity and Abdominal Obesity in Korean Adults

Excessive body weight is associated with increased health risks in humans. In general, the risk of mortality increases with greater obesity. The 2018 guideline for the management of obesity by the Korean Society for the Study of Obesity proposed the body mass index (BMI) cut-off levels of 25 kg/m2 and 23 kg/m2 as diagnostic criteria for obesity and overweight (pre-obese) in Korean adults, respectively. Abdominal obesity has been defined as waist circumference (WC) ≥90 cm in men and WC ≥85 cm in women. In this review, the validity of these criteria for Korean adults was examined based on the evidence regarding the associations of obesity index with mortality and morbidity. The American Association of Clinical Endocrinologists/American College of Endocrinology algorithm and American Diabetes Association guideline for the medical care of obese and overweight patients support a BMI of 25 kg/m2 and 23 kg/m2, respectively, as the cut-off levels for Asians (and some ethnicities) corresponding to the BMI values of 30 kg/m2 and 25 kg/m2, respectively, for Caucasians. In the future, the optimal cut-off levels for obesity and abdominal obesity may require adjustment as the demographic characteristics of the Korean population change. In addition, development of more valid indicators that better reflect health risks of obesity is needed.

Clinical impact of sarcopenia on prognosis in pancreatic ductal adenocarcinoma: A retrospective cohort study

OBJECTIVES

To investigate the impact of the body composition such as skeletal muscle, visceral fat and body mass index (BMI) on patients with resected pancreatic ductal adenocarcinoma (PDAC).

METHODS

A total of 265 patients who underwent curative surgery for PDAC were examined in this study. The total skeletal muscle and fat tissue areas were evaluated in a single image obtained at the third lumber vertebra during a preoperative computed tomography (CT) scan. The patients were assigned to either the sarcopenia or non-sarcopenia group based on their skeletal muscle index (SMI) and classified into high visceral fat area (H-VFA) or low VFA (L-VFA) groups. The association of clinicopathological features and prognosis with the body composition were statistically analyzed.

RESULTS

There were 170 patients (64.2%) with sarcopenia. The median survival time (MST) was 23.7 months for sarcopenia patients and 25.8 months for patients without sarcopenia. The MST was 24.4 months for H-VFA patients and 25.8 months for L-VFA patients. However, sarcopenia patients with BMI ≥22 exhibited significantly poorer survival than patients without sarcopenia (MST: 19.2 vs. 35.4 months, P = 0.025). There was a significant difference between patients with and without sarcopenia who did not receive chemotherapy (5-year survival rate: 0% vs. 68.3%, P = 0.003). The multivariate analysis revealed that tumor size, positive dissected peripancreatic tissue margin, and sarcopenia were independent prognostic factors.

CONCLUSIONS

Sarcopenia is an independent prognostic factor in PDAC patients with a BMI ≥22. Therefore, evaluating skeletal muscle mass may be a simple and useful approach for predicting patient prognosis.

Association of Waist Circumference and Body Fat Weight with Insulin Resistance in Male Subjects with Normal Body Mass Index and Normal Glucose Tolerance

Objective We investigated the relationship of the waist circumference (WC) and body fat weight (BF) with insulin resistance in subjects with normal body mass index (BMI) and normal glucose tolerance (NGT) during a routine medical check-up. Methods We categorized 167 male subjects in three groups as follows: a group with normal BMI but high WC (normal-BMI/high-WC group; 22≤BMI<25 kg/m(2), waist ≥85 cm; n=31), a group with normal BMI and normal WC (normal-BMI/normal-WC group, waist <85 cm; n=68), and a group with low normal BMI and normal WC (low normal-BMI/normal-WC group; 18.5≤BMI<22 kg/m(2) and waist<85 cm; n=68). We measured the plasma glucose and serum insulin levels before glucose loading and after 30 and 120 minutes and calculated several indexes of insulin secretion and sensitivity. Results Subjects from the normal-BMI/high-WC group showed significantly decreased Matsuda index and increased homeostasis model assessment for insulin resistance (HOMA-IR) compared with normal-BMI/normal-WC group. Univariate regression analyses showed significant correlation of HOMA-IR with WC (r=0.39) and BF (r=0.37). Matsuda index was significantly correlated with WC (r=-0.39) and BF (r=-0.47). The multiple regression analysis showed that the BF is significantly correlated with HOMA-IR (p<0.05) and Masuda index (p<0.005) among the clinical variables and with HOMA-IR (p<0.05) and Masuda index (p<0.0001) among the anthropometric variables but not with WC in either analysis. Conclusion Decreased Matsuda index and increased HOMA-IR were observed in subjects from the normal-BMI/high-WC group. Multivariate analysis showed that BF is associated with decreased Matsuda index and increased HOMA-IR and that WC is not associated with either factors.

Baseline estradiol concentration in community-dwelling Japanese American men is not associated with intra-abdominal fat accumulation over 10 years

PROBLEM

The role of plasma estradiol in the accumulation of intra-abdominal fat (IAF) in men is uncertain. Cross-sectional studies using imaging of IAF have shown either a positive or no association. In contrast, a randomised controlled trial using an aromatase inhibitor to suppress estradiol production found an association between oestrogen deficiency and short-term IAF accumulation. No longitudinal study has been conducted to examine the relationship between plasma estradiol concentration and the change in IAF area measured using direct imaging.

METHODS

This is a longitudinal observational study in community-dwelling Japanese-American men (n=215, mean age 52 years, BMI 25.4kg/m²). IAF and subcutaneous fat areas were assessed using computerized tomography (CT) at baseline, 5 and 10 years. Baseline plasma estradiol concentrations were measured using liquid chromatography-tandem mass spectrometry.

RESULTS

Univariate analysis found no association between baseline estradiol concentration and baseline IAF, or 5- or 10-year changes in IAF area (r=-0.05 for both time points, p=0.45 and p=0.43, respectively). Multivariate linear regression analysis of the change in IAF area by baseline estradiol concentration adjusted for age, baseline IAF area, and weight change found no association with either the 5- or 10-year IAF area change (p=0.52 and p=0.55, respectively).

CONCLUSIONS

Plasma estradiol concentration was not associated with baseline IAF nor with change in IAF area over 5 or 10 years based on serial CT scans in community-dwelling Japanese-American men. These results do not support a role for oestrogen deficiency in IAF accumulation in men.

Cardiovascular disease incidence, mortality and case fatality related to diabetes and metabolic syndrome: A community-based prospective study (Ansung-Ansan cohort 2001-12)

BACKGROUND

We evaluated the separate and combined effect of metabolic syndrome (MS) and diabetes on incident cardiovascular disease (CVD), CVD mortality and case fatality risk (CFR).

METHODS

8898 subjects were categorized into four groups on the basis of the presence of MS and diabetes (with MS, with diabetes, with both or without either). We compared the development of CVD events, mortality and CFR.

RESULTS

Over a mean follow-up of 8.0 years, 690 subjects developed CVD. There were 434 deaths, of which 101 were from CVD. The presence of diabetes alone, MS alone, or both was associated with an increased risk for incident CVD and CVD mortality. Compared with the MS only group, the adjusted hazard ratio (HR) for CVD events and CVD mortality in the diabetes only group was 1.07 (95% confidence interval [CI] 0.77-1.48) and 2.02 (95% CI 0.99-1.72), respectively. Among individuals with diabetes, the presence of MS did not significantly increase CVD risk and CVD mortality. The adjusted odds ratio for CVD CFR, including adjustment for the presence of MS, in subjects with diabetes versus without diabetes was 2.11 (95% CI 1.34-3.31).

CONCLUSIONS

There was no difference in the risk of incident CVD between individuals with diabetes alone and MS alone, whereas CVD mortality was much higher in individuals with diabetes only. The presence of MS did not exhibit an additive effect on CVD risk and mortality in individuals with diabetes. Individuals with diabetes had a higher CVD case fatality regardless of the presence of MS.

Prognostic Impact of Visceral Fat Amount and Branched-Chain Amino Acids (BCAA) in Hepatocellular Carcinoma

BACKGROUND

Dysregulation of lipid and amino acid metabolism in patients with liver diseases results in obesity-related carcinogenesis and decreased levels of branched-chain amino acids (BCAA), respectively. This study assessed the clinical and prognostic impact of visceral fat amount (VFA) and its association with amino acid metabolism in patients with hepatocellular carcinoma (HCC).

METHODS

In this study, 215 patients who underwent hepatic resection for HCC were divided into two groups based on VFA criteria for metabolic abnormalities in Japan. Computed tomography was used to measure VFA at the third lumbar vertebra in the inferior direction.

RESULTS

Of the 215 patients, 132 had high and 83 had low VFA. High VFA was significantly associated with older age and higher body mass index (BMI), subcutaneous fat amount, and BCAA, but not with liver function, nutrient status, or tumoral factors. VFA was positively correlated with BMI (P < 0.0001; r = 0.63) and BCAA levels (P < 0.0001; r = 0.29). Overall survival was significantly greater in the high than in the low VFA group (P = 0.002). Multivariate analyses showed that high VFA [hazard ratio (HR) 7.06; P = 0.024] and neutrophil/lymphocyte ratio (HR 3.47; P = 0.049) were significantly prognostic of overall survival, whereas subcutaneous fat amount, BMI, BCAA, serum albumin, and prognostic nutritional index were not.

CONCLUSIONS

High VFA was associated with a high BCAA level, with high VFA prognostic of improved overall survival in Japanese patients with HCC.

Increased abdominal fat levels measured by bioelectrical impedance are associated with histological lesions of nonalcoholic steatohepatitis

BACKGROUND/AIM

Abdominal fat is considered to play an important role in nonalcoholic fatty liver disease (NAFLD), although it is not adequately studied because abdominal fat levels cannot be estimated easily. In this study, associations between abdominal obesity, as assessed by abdominal bioelectrical impedance analysis (BIA), and the characteristics of patients with NAFLD were explored.

PATIENTS AND METHODS

Seventy-four consecutive NAFLD patients who underwent measurement of abdominal fat levels by BIA were included. Levels of abdominal fat 12.5 or less and more than 12.5 were considered to be average and increased, respectively.

RESULTS

The mean±SD BMI was 30±4 kg/m and the mean abdominal fat levels were 16±5, whereas 26% of patients had average abdominal fat levels. Patients with average compared with those with increased abdominal fat levels were more frequently women (50 vs. 12%, P=0.001), had lower BMI (27±3 vs. 31±4 kg/m, P<0.001), lower Homeostasis Model Assessment index (2.6±1.4 vs. 3.9±2.7, P=0.045), and lower median liver stiffness on transient elastography (5.3 vs. 6.8 kPa, P=0.025). In patients with available liver biopsy, steatohepatitis was present more frequently in patients with increased compared with average abdominal fat levels (78 vs. 38%, P=0.030) and in patients with BMI 30 or more compared with less than 30 kg/m (87 vs. 48%, P=0.033), but similar in patients with increased or normal waist circumference (67 vs. 56%, P=0.693).

CONCLUSION

Average levels of abdominal fat, as assessed by abdominal BIA, are mainly present in female patients with NAFLD and are associated with a lower degree of insulin resistance. Increased abdominal fat as assessed by BIA and obesity seem to represent strong risk factors for histological steatohepatitis.

Impact of Obstructive Sleep Apnea on Liver Fat Accumulation According to Sex and Visceral Obesity

Rationale

Associations between obstructive sleep apnea (OSA) and liver fat accumulation have been frequently investigated because both morbidities are common. Visceral fat was reported to be closely related to OSA and liver fat accumulation. Recently, sex differences in the association between OSA and mortality have gained much attention.

Objectives

To investigate the associations among OSA, liver fat accumulation as determined by computed tomography, and visceral fat area and their sex differences.

Methods

Studied were 188 males and 62 females who consecutively underwent polysomnography and computed tomography.

Results

Although the apnea-hypopnea index was positively correlated with liver fat accumulation in the total males, none of the OSA-related factors was independently associated with liver fat accumulation in either the total male or female participants in the multivariate analyses. When performing subanalyses using a specific definition for Japanese of obesity or visceral obesity (body mass index (BMI) ≥25 kg/m² or visceral fat area ≥100 cm²), in only males without visceral obesity, percent sleep time with oxygen saturation <90%, in addition to BMI, insulin resistance, and serum triglyceride values, was independently correlated with liver fat accumulation (R² = 15.1%, P<0.001). In males, percent sleep time of oxygen saturation <90% was also a determining factor for alanine aminotransferase values regardless of visceral fat area. In contrast, OSA was not associated with liver fat accumulation or alanine aminotransferase values in females whether or not visceral obesity was absent.

Conclusions

Sex differences in the visceral fat-dependent impact of OSA on liver fat accumulation existed. Although the mechanisms are not known and ethnic differences may exist in addition to the specific criteria of visceral obesity in Japan, the treatment of male patients with OSA might be favorable from the viewpoint of preventing liver fat accumulation and liver dysfunction even in patients without obvious visceral fat accumulation.

Association between the Postprandial Glucose Levels and Arterial Stiffness Measured According to the Cardio-ankle Vascular Index in Non-diabetic Subjects

OBJECTIVE

Although a relationship between post-challenge hyperglycemia and arterial stiffness has been reported, the relationship between the postprandial glucose levels and cardio-ankle vascular index (CAVI) in non-diabetic subjects is not clear. This study thus evaluated the association between the postprandial glucose levels after a composite meal and the degree of arterial stiffness measured according to CAVI in non-diabetic subjects.

METHODS

The subjects included 1,291 individuals (655 men and 636 women; mean age, 48.6 years; range, 23-85 years) who underwent medical examinations, including blood tests and CAVI assessments, between October 2005 and April 2012. The 1-hour postprandial glucose levels were determined after a 600-kcal traditional Japanese meal.

RESULTS

The CAVI values were significantly higher in the subjects with higher 1-hour postprandial glucose levels (≥140 mg/dL in men; ≥158 mg/dL in women). A simple regression analysis indicated that the CAVI values were significantly correlated with the 1-hour postprandial glucose levels in men (r=0.286, p<0.0001) and women (r=0.228, p<0.0001). After adjusting for age, BMI, systolic blood pressure, triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, 1-hour postprandial glucose, homeostatis model assessment of insulin resistance, estimated glemerular filtration rate, and high sensitive C-reactive protein, stepwise multiple regression analysis demonstrated that the 1-hour postprandial glucose level was an independent predictor associated with the CAVI in men (p=0.003) and older women 50 years of age or older (p=0.003).

CONCLUSION

This study demonstrated that the 1-hour postprandial glucose levels are associated with increased CAVI values in non-diabetic men and older women 50 years of age or older.

Association between lifestyle-related disorders and visceral fat mass in Japanese males: a hospital based cross-sectional study

OBJECTIVE

This study aimed to examine the association between lifestyle-related disorders and visceral fat mass, and to estimate an appropriate cutoff value for visceral fat mass that correlated with body mass index (BMI) and waist circumference (WC).

METHODS

This cross-sectional study was conducted between July 2012 and August 2013 at Bange Kosei General Hospital, in Fukushima, Japan. All study participants were adult males who had completed voluntary medical check-ups that included estimation of visceral fat mass by bioelectrical impedance analysis (BIA). Participants were without past histories of atherosclerotic complications or were not currently taking medications for lifestyle-related disorders. Multivariate analysis was performed to estimate the association between lifestyle-related disorders and quartiles of visceral fat mass.

RESULTS

Of 536 total respondents, 442 were included in the analysis. Mean participant age was 56 years, and mean values of BMI, WC, and visceral fat mass were 24.1 kg/m(2), 85.9 cm, and 2.1 kg, respectively. Visceral fat mass ≥1.8 kg was positively associated with an increased prevalence of dyslipidemia, elevated blood pressure, and impaired glucose tolerance. Cutoff values that correlated with visceral fat mass (≥1.8 kg) were 85.3 cm for WC and 23.25 kg/m(2) for BMI.

CONCLUSION

Visceral fat mass ≥1.8 kg was positively associated with lifestyle-related disorders and closely related to WC and BMI cutoff values used to diagnose obesity. BIA may be a useful method for assessing visceral fat mass, and these findings provide important evidence for the use of BIA in the early detection of central obesity for preventing lifestyle-related disorders.

Aging attenuates the association of central obesity with the accumulation of metabolic risk factors when assessed using the waist circumference measured at the umbilical level (the Japanese standard method)

Objective:

The objective of this study was to clarify the generation and gender differences in the association between central obesity and the accumulation of metabolic risk factors (RFs) in the Japanese population.

Material and methods:

A total of 12 389 subjects (age: 18–80 years) without receiving medication for diabetes, dyslipidemia or hypertension were enrolled in this study and divided according to age and gender. In each group, we performed analyses as follows: (1) a receiver operating characteristic (ROC) analysis to evaluate the utility of the waist circumference (WC) for detecting subjects with multiple RFs of metabolic syndrome (MS); (2) a cross-sectional study to examine the relationship between the WC and the odds ratio (OR) for detecting those subjects and (3) a longitudinal study to examine how longitudinal changes (Δ) in WC over a 1-year period affected the values of each metabolic RF.

Results:

With age, the WC cutoff values yielding the maximum Youden index for detecting subjects with multiple RFs increased only in women, and the areas under the curves of the ROC analysis of WC for detecting those subjects decreased in both genders. The positive correlation between the WC and the OR for detecting subjects with multiple RFs became weaker with age, especially in women. In the longitudinal study, the significant correlation between ΔWC and Δ each metabolic RF, except for hypertension, and between ΔWC and Δ the number of RFs became weaker with age in women, whereas the significant correlation between ΔWC and Δ the number of RFs was not affected with age in men. In women aged ⩾60 years, none of the changes in each metabolic RF were significantly associated with ΔWC.

Conclusions:

Aging attenuates the association of central obesity with the accumulation of metabolic RFs, especially in women.

Effect of age on the association between waist-to-height ratio and incidence of cardiovascular disease: the Suita study

Background

Waist-to-height ratio (WHtR) has been shown to be a useful screening tool for metabolic syndrome and cardiovascular disease (CVD). We investigated the association of WHtR with CVD incidence by age group.

Methods

We conducted a 13.0-year cohort study of Japanese adults (2600 men and 2888 women) with no history of CVD. WHtR was calculated as waist circumference (cm) (WC) divided by height (cm). We stratified participants by sex and age group (30–49, 50–69, ≥70 years). Using the Cox proportional hazards model, we calculated hazard ratios (HRs) and 95% CIs for CVD in relation to WHtR quartile for participants aged 50 to 69 years and 70 years or older.

Results

Men aged 50 to 69 years in the highest quartile had significantly increased risks of CVD and coronary heart disease as compared with the lowest quartile; the HRs (95% CI) were 1.82 (1.13–2.92) and 2.42 (1.15–5.12), respectively. Women aged 50 to 69 years in the highest quartile had a significantly increased risk of stroke (HR, 2.43; 95% CI, 1.01–5.85). No significant results were observed in men or women aged 70 years or older. The likelihood ratio test showed that the predictive value of WHtR was greater than that of WC among men aged 50 to 69 years.

Conclusions

The association between WHtR and CVD risk differed among age groups. WHtR was useful in identifying middle-aged Japanese at higher risk of CVD and was a better predictor than WC of CVD, especially in men.

Visceral adiposity index is highly associated with adiponectin values and glycaemic disturbances

BACKGROUND

Visceral Adiposity Index (VAI) is a gender-specific mathematical index estimated with the use of simple anthropometric (body mass index and waist circumference) and biochemical (triglycerides and high density lipoprotein cholesterol) parameters. Recent studies have shown that VAI reflects accurately the degree of visceral adiposity and insulin resistance. However, up to now, VAI has not been evaluated if it correlates with carbohydrate metabolism disorders, as well as with adipokine secretion from the fat mass.

METHODS

In a cohort of 308 out of 414 adult Saudi subjects screened for the study, detailed personal medical history, anthropometrics and metabolic/hormonal profiles were obtained. Additionally, the circulating concentrations of several circulating adipokines, namely adiponectin, leptin, tumour necrosis factor-α (TNF-α) and resistin, were measured.

RESULTS

Stepwise multivariate analysis showed that VAI was the sole determinant of adiponectin levels (R(2)  = 0·07, beta ± SE: -0·25 ± 0·05), while BMI and female gender predicted leptin levels (R(2)  = 0·26, 0·10 ± 0·01 and 0·61 ± 0·15, respectively). Furthermore, the presence of impaired fasting glucose (IFG)/diabetes was predicted only by age and VAI.

CONCLUSIONS

We report for the first time the direct relations of VAI with adipose tissue secretion, as well as with functional glycaemic disorders. Because VAI is estimated easily with data obtained in everyday practice, it could be used as an indirect index of adiponectin levels and the risk of impaired glucose metabolism.

Visceral adipose tissue, but not waist circumference is a better measure of metabolic risk in Singaporean Chinese and Indian men

OBJECTIVES

Visceral adipose tissue (VAT) is an independent risk factor in cardiometabolic diseases and is commonly measured by computed tomography (CT). It is measured clinically by waist circumference (WC). The L4/5 intervertebral space VAT (L4/5 VAT) is traditionally used to represent total VAT volume. We set out to determine (1) the level of intervertebral space on CT that best approximates the total VAT volume; (2) compare the association between WC and VAT in Singaporean Chinese and Indian; and (3) examine the correlation between VAT and cardiometabolic risk factors.

SUBJECTS

A total of 60 Chinese and 60 Asian Indian men older than 60 years were recruited. Their medical history was taken and anthropometry was measured. Fasting glucose, insulin, lipids, adipokines and inflammatory markers were measured. Insulin resistance was evaluated by homeostasis model assessment-insulin resistance. VAT was determined by CT. Total VAT volume was calculated in 22 patients from VAT areas at seven intervertebral levels. The optimal VAT area most representative of total VAT volume was determined and used for all patients to approximate total VAT volume.

RESULTS

The VAT area at L2/3 intervertebral space (L2/3 VAT) correlated almost perfectly with VAT volume (R(2)=0.974 and 0.946 for Chinese and Indians, respectively). SUBJECTS from the two races had similar height, weight, body mass index (BMI), WC and L2/3 VAT but more Indian men had hypertension, hyperlipidemia and type 2 diabetes mellitus. WC was correlated with the L2/3 VAT area in both Chinese (r=0.484, P<0.001) and Indian subjects (r=0.366, P=0.004) without racial difference (P=0.2 for interaction term). L2/3 VAT also correlated better with cardiometabolic risk factors, adipokines and C-reactive protein than WC, BMI or L4/5 VAT.

CONCLUSION

The L2-L3 intervertebral space was the best anatomic level for a single-slice CT cross-sectional area measurement of VAT to approximate total body visceral adipose volume in this population of Chinese and Asian Indian men older than 60 years. L2/3 VAT was better correlated with multiple cardiovascular risk factors, adipokines and inflammatory marker than either L4/5 VAT, WC or BMI.

Visceral fat area cutoff for the detection of multiple risk factors of metabolic syndrome in Japanese: the Hitachi Health Study

The relationships between metabolic risk factors and abdominal fat distribution determined using computed tomography (CT) are poorly defined in large populations. We investigated the cutoff values of the visceral fat area (VFA) to detect subjects with multiple risk factors of metabolic syndrome (MS) by sex and age groups, and attempted to examine whether sex- and age-specific cutoff values are needed. The subjects of this study were 11,561 Japanese men and women who participated in the Hitachi Health Study, received CT examination, and answered questionnaires on lifestyles between 2004 and 2009. VFA and waist circumference were measured using CT. The VFA cutoff values yielding an 80% sensitivity for the detection of multiple risk factors of MS were typically smaller among men under the age of 40 years (<40 years vs. ≥40 years; 86.4 cm(2) vs. 103.9 cm(2)). The area under the receiver operator characteristic curve of VFA for the detection tended to decrease according to age (P = 0.056 and P = 0.020 for trends in men and women). Age- and sex-specific cutoff values are needed. The sensitivity of the subjects under the age of 40 years is relatively smaller (70.0% for men and 60.0% for women) compare to other age groups when the same cutoff value is used regardless of age (e.g., cutoff value calculated to correspond to 80% sensitivity for subjects of all ages). Therefore, a smaller VFA cutoff point should be used among men under the age of 40 years.

The utility of visceral fat level by bioelectrical impedance analysis in the screening of metabolic syndrome - the results of the Kyushu and Okinawa Population Study (KOPS)

AIM

A simple, non-invasive medical device, using bioelectrical impedance analysis (BIA) for the evaluation of visceral fat level (VFL) was developed recently. The aim of this study was to investigate the utility of VFL by BIA in the screening of metabolic syndrome (MetS).

METHODS

VFL was measured by the BIA device in 1,451 Japanese residents (546 men and 905 women, age range 30-69 years).

RESULTS

VFL had significant positive correlations with waist circumference (WC) and body mass index (r=0.772 and 0.849, all P < 0.0001). The overall MetS prevalence using Japanese Diagnosis Criteria was 19.8%: men 36.3% and women 9.8%. The mean VFL of the participants with MetS was significantly higher than those without MetS (men; 12.1 and 9.4, women; 13.3 and 8.7) (both P < 0.001). VFL significantly correlated with blood pressure, lipid profiles, fasting plasma glucose, and hemoglobin A1c (all P < 0.001). Receiver operating characteristic curve analysis for a diagnosis of two or more MetS risk factors excluding WC resulted in the same cutoff values for the VFL (10.0) of men and women.

CONCLUSIONS

The VFL by BIA is useful for the detection of MetS because it is correlated with all metabolic parameters and shows the same normal limit in both sexes.

Obesity and metabolic syndrome in Korea

In Korea, a person with a body mass index (BMI) ≥25 kg/m(2) is considered obese, and a person with a BMI ≥30 kg/m(2) is classified as severely obese. Central obesity is defined as a waist circumference ≥90 cm for Korean men and ≥85 cm for Korean women. Recent epidemiologic data show that the prevalence of severe obesity and metabolic syndrome is steadily increasing. These epidemics increased morbidity and mortality of type 2 diabetes, cardiovascular diseases, and obesity-related cancers such as breast, colorectal, and other cancers in Korea. Decreased physical activity, increased fat and alcohol consumption, heavy smoking, and stress/depressed mood are the primary modifiable life-style risk factors for Koreans. Recently, public health interventions to encourage life-style changes have shown promising results in reducing the prevalence of severe obesity and metabolic syndrome.

Serum insulin is significantly related to components of the metabolic syndrome in Japanese working women

BACKGROUND

The aim of this study was to examine the association between serum insulin levels and components of the metabolic syndrome (MetS) in working women.

METHODS

The target subjects were 141 working women. Serum triglyceride, HDL cholesterol, uric acid, plasma insulin and plasma glucose were measured in addition to waist circumference and blood pressure.

RESULTS

MetS was diagnosed based on the modified criteria of the International Diabetes Federation, and was present in 7.1% (10/141) of the study subjects. Stepwise multiple regression analysis showed that some components of MetS were significantly associated with log-transformed values of the serum insulin. The standardized regression coefficient for the waist circumference, high density lipoprotein cholesterol, systolic blood pressure and age were 0.238, -0.333, 0.309 and -0.156, respectively.

CONCLUSIONS

A statistically significant relationship existed between the components of MetS and the serum insulin levels in working women.

Determination of the cutoff point for waist circumference that establishes the presence of abdominal obesity in Latin American men and women

AIMS

The recent definitions of the metabolic syndrome (MS) recognize the need for ethnic and region-specific waist circumference (WC) cut-offs that identify people with abdominal obesity. We tested WC as a diagnostic tool to identify people with visceral adiposity in Hispanics from the Latin America region.

METHODS

We used the area of visceral adipose tissue (VAT) ≥ 100 cm² at the level between the 4th and 5th lumbar vertebrae in abdominal CT scans as a marker of visceral adiposity and established the optimal WC threshold for men and women by means of receiver operating characteristic (ROC) curves.

RESULTS

179 men and 278 women from Mexico, El Salvador, Venezuela, Colombia and Paraguay were included. The ROC curves were highly discriminative of excess VAT for men and women (area under the curve 0.9 and 0.8 respectively) and the WC threshold was identified at 94 cm for men and between 90 and 92 cm for women.

CONCLUSION

In men the WC cutoff was equal to that proposed for europids and suggested for US adults who may have strong genetic contribution to insulin resistance such as Hispanics. In women the threshold was significantly higher than previously proposed for South and Central Americans.

Visceral adiposity, insulin resistance and cancer risk

BACKGROUND

There is a well established link between obesity and cancer. Emerging research is characterising this relationship further and delineating the specific role of excess visceral adiposity, as opposed to simple obesity, in promoting tumorigenesis. This review summarises the evidence from an epidemiological and pathophysiological perspective.

METHODS

Relevant medical literature was identified from searches of PubMed and references cited in appropriate articles identified. Selection of articles was based on peer review, journal and relevance.

RESULTS

Numerous epidemiological studies consistently identify increased risk of developing carcinoma in the obese. Adipose tissue, particularly viscerally located fat, is metabolically active and exerts systemic endocrine effects. Putative pathophysiological mechanisms linking obesity and carcinogenesis include the paracrine effects of adipose tissue and systemic alterations associated with obesity. Systemic changes in the obese state include chronic inflammation and alterations in adipokines and sex steroids. Insulin and the insulin-like growth factor axis influence tumorigenesis and also have a complex relationship with adiposity. There is evidence to suggest that insulin and the IGF axis play an important role in mediating obesity associated malignancy.

CONCLUSIONS

There is much evidence to support a role for obesity in cancer progression, however further research is warranted to determine the specific effect of excess visceral adipose tissue on tumorigenesis. Investigation of the potential mechanisms underpinning the association, including the role of insulin and the IGF axis, will improve understanding of the obesity and cancer link and may uncover targets for intervention.

Impact of obesity on plasma B-type natriuretic peptide levels in Japanese community-based subjects

The plasma B-type natriuretic peptide (BNP) concentration was recently shown to be inversely correlated with body mass index (BMI). However, very few attempts have been made to associate abdominal obesity and BNP in the Japanese general population. Here, we conducted a cross-sectional study, and examined 339 male and 429 female residents without heart disease in a rural Japanese community who received an annual health checkup in 2006. BNP was inversely associated with both BMI and abdominal circumference (AC) in the age-adjusted regression analysis (p < 0.05). Following adjustment for traditional risk factors, multiple regression analysis revealed that BNP was negatively correlated with AC (p < 0.05), but not BMI. Although metabolic syndrome was not associated with BNP levels, AC had an influence on low BNP levels in the multiple regression analysis using both AC and BMI concurrently (p < 0.05 for AC and p > 0.60 for BMI). These effects were more prominent in men than in women. Collectively, plasma BNP levels are inversely related with obesity, as measured by AC, in Japanese community-based subjects.

Body mass index is more strongly associated with hypertension than waist circumference in apparently healthy Japanese men and women

Obesity is associated with hypertension. However, it is controversial which obesity index, body mass index (BMI) or waist circumference (WC), is more strongly associated with hypertension. We compared the cross-sectional associations of BMI and WC with hypertension. Logistic regressions using hypertension as a dependent variable and age, BMI, WC, fasting plasma glucose, triglycerides, high-density lipoprotein cholesterol, smoking status, drinking status, and physical activity as independent variables were performed using data from apparently healthy 1,803 Japanese men aged 49.9 ± 9.0 and 1,150 women aged 49.5 ± 9.0 excluding subjects with a history of cardiovascular disease, or with antidiabetic, antihypertensive and/or antihyperlipidemic medications. The odds ratio [95% confidence interval] of 1 kg/m² increase in BMI and that of 1 cm increase in WC for diagnosing hypertension were 1.23 [1.11-1.36] (p < 0.0001) and 0.99 [0.95-1.02] (p = 0.4) in men and 1.35 [1.16-1.58] (p < 0.0001) and 0.97 [0.91-1.03] (p = 0.4) in women, respectively. Thus, BMI, but not WC, was independently associated with hypertension in apparently healthy Japanese men and women.

Absolute value of bioelectrical impedance analysis-measured visceral fat area with obesity-related cardiovascular risk factors in Japanese workers

AIM

The accumulation of Visceral fat is known to precede metabolic disorders and atherosclerosis. This study aimed to determine the relationships between body mass index (BMI), waist circumference (WC), estimated visceral fat area (eVFA) measured by bioelectrical impedance analysis (BIA), and obesity-related cardiovascular risk factors.

METHODS

The study population was 2,870 middle-aged Japanese employees (males/females=2,322/ 548), who had undergone a health check-up.

RESULTS

In the receiver operating characteristic (ROC) curve, the cutoff levels yielding maximal sensitivity plus specificity for predicting the prevalence of ≥ 2 risks were, 24.5 kg/m(2) for BMI, 84.6 cm for WC, and 111 cm(2) for eVFA in males, and 23.6 kg/m(2), 81.5 cm, and 67 cm(2) in females. The average number of risk factors was over 1.0 in those with a BMI ≥ 25 kg/m(2) and with a WC ≥ 85 cm for males, ≥ 28 kg/m(2) and ≥ 95 cm respectively for females, and those with an eVFA ≥ 100 cm(2) for both males and females. In males, it was around 1.0 with cutoff levels of BMI, WC, and eVFA from the ROC curve. However, in females, it was around 0.6, because the prevalence of subjects with obesity and multiple risks was very low.

CONCLUSIONS

These results suggested that the cutoff level for visceral fat reduction should be set based on an absolute value of risk factors, rather than a calculated value. In regular health check-up, it may be useful to set an absolute cutoff value for eVFA at 100 cm(2) as criteria to screen for multiple obesity-related cardiovascular risk factors.

Follow-up whole-body assessment of adipose tissue compartments during a lifestyle intervention in a large cohort at increased risk for type 2 diabetes

PURPOSE

To assess adipose body compartments with magnetic resonance (MR) imaging and MR spectroscopy during a lifestyle intervention program that included optimized nutrition and controlled physical activity in subjects at increased risk for type 2 diabetes to determine factors that may help predict an increase in insulin sensitivity following the intervention.

MATERIALS AND METHODS

This prospective study was approved by the local review board. All participants gave written informed consent. MR imaging and MR spectroscopy were performed in 243 subjects (99 men and 144 women) before and 9 months after enrollment in a lifestyle intervention program. The results of whole-body MR imaging were used to calculate tissue profiles, differentiating between adipose tissue--especially visceral adipose tissue--and lean tissue. The concentration of hepatic lipids and intramyocellular lipids in the anterior tibial and soleus muscles was determined with MR spectroscopy, and insulin sensitivity was estimated by using an oral glucose tolerance test. The Student t test was used to assess differences between groups, and multivariate regression models were used to assess the value of adipose tissue compartments in the prediction of insulin sensitivity.

RESULTS

Compared with women, men had almost twice the amount of visceral adipose tissue and a smaller amount of total adipose tissue (25.9% for men and 36.9% for women) at baseline. In addition, their insulin sensitivity was significantly lower than that of women. The most pronounced changes in adipose tissue were detected for visceral adipose tissue (from 4.9 L to 4.1 L [ie, -15.1%] in men and from 2.3 L to 1.9 L [ie, -15.8%] in women) and hepatic lipids (from 8.6% to 5.4% [ie, -36.8%] in men and from 5.1% to 4.3% [ie, -16.5%] in women). The mean insulin sensitivity improved significantly (from 11.3 arbitrary units [au] to 14.6 au [ie, +29.9%] in men and from 13.6 au to 14.6 au [ie, +7.5%] in women), with 70 of the 99 men (71%) and 84 of 144 women (58%) showing an increase in insulin sensitivity. In men, low concentrations of visceral adipose tissue, hepatic lipids, and abdominal subcutaneous fat at baseline were predictive of successful intervention in terms of changes in insulin sensitivity; in women, only low hepatic lipid levels were significantly predictive of successful intervention.

CONCLUSION

Visceral adipose tissue and hepatic lipids, as assessed with MR imaging and MR spectroscopy, can be significantly reduced during lifestyle intervention. Their baseline values emerged as predictive factors for an improvement of insulin sensitivity.

Optimal cut-off values and population means of waist circumference in different populations

Abdominal obesity is a risk factor for cardiometabolic disease, and has become a major public health problem in the world. Waist circumference is generally used as a simple surrogate marker to define abdominal obesity for population screening. An increasing number of publications solely rely on the method that maximises sensitivity and specificity to define ‘optimal’ cut-off values. It is well documented that the optimal cut-off values of waist circumference vary across different ethnicities. However, it is not clear if the variation in cut-off values is a true biological phenomenon or an artifact of the method for identifying optimal cut-off points. The objective of the present review was to assess the relationship between optimal cut-offs and population waist circumference levels. Among sixty-one research papers, optimal cut-off values ranged from 65·5 to 101·2 cm for women and 72·5 to 103·0 cm for men. Reported optimal cut-off values were highly correlated with population means (correlation coefficient: 0·91 for men and 0·93 for women). Such a strong association was independent of waist circumference measurement techniques or the health outcomes (dyslipidaemia, hypertension or hyperglycaemia), and existed in some homogeneous populations such as the Chinese and Japanese. Our findings raised some concerns about applying the sensitivity and specificity approach to determine cut-off values. Further research is needed to understand whether the differences among populations in waist circumference were genetically or environmentally determined, and to understand whether using region-specific cut-off points can identify individuals with the same absolute risk levels of metabolic and cardiovascular outcomes among different populations.

A computed tomography scan application to evaluate adiposity in a minipig model of human obesity

The aim of the present study was to describe and validate a computed tomography (CT) method to analyse adiposity distribution in Göttingen minipigs. Adiposity was evaluated in two groups of minipigs. In group 1 (n 8), measurements were performed before and after the induction of obesity. In group 2 (n 7), animals were fed rations designed to obtain heterogeneous adiposity before analyses. CT acquisitions were associated with anatomical, ultrasonography and body chemical measurements. Our CT method was based on acquisition of a single slice at a fixed anatomical landmark, calculation of individual X-ray density ranges for CT values and delineation of the three main adipose compartments (subcutaneous adipose tissue, SAT; retroperitoneal adipose tissue, RAT; and visceral adipose tissue, VAT). Our validation measures showed that the CT-scan method was accurate, sensitive and reliable. The CT data were found to be correlated with body weight, abdominal perimeter, ultrasonography, anatomical measurements and body chemical composition (from r 0·84 to 0·93, P < 0·001 for all), with a pitfall concerning the precise estimation of VAT. With increased body weight, the amount of adipose tissue increased and the relative proportion of SAT increased, whereas the relative proportion of RAT and VAT decreased (P < 0·001 for all). Adiposity measured by CT, and especially SAT, was found to be negatively correlated with insulin sensitivity (r 0·54, P < 0·05). In conclusion, a precise evaluation of the adipose compartments in minipigs was done by CT. Therefore, the use of Göttingen minipigs is relevant to further investigate the relationship between the different adipose tissues and obesity.

Relationship between number of metabolic syndrome components and dietary factors in middle-aged and elderly Japanese subjects

Metabolic syndrome (MetS) represents a cluster of risk factors for atherosclerosis and is considered a risk factor for cardiovascular disease. The role of diet in the etiology of MetS is poorly understood, especially among Asian subjects. This cross-sectional study assessed the relationship between diet and the number of MetS components among Japanese men (n=609) and women (n=631). Mean (s.d.) age and body mass index were 57.1 (12.1) years and 22.8 (2.8) kg m(-2) for men and 55.5 (12.0) years and 22.0 (3.0) kg m(-2) for women, respectively. Diet was assessed by a 3-day dietary record that included photographs: 16 nutrients, 11 food groups, and energy % of protein and dietary fat were selected as a dietary index. The definition of MetS was based on modified National Cholesterol Education Program, Adult Treatment Panel III criteria, and the number of clustering MetS components was calculated by adding the presence of each five MetS components. A total of 61 men (10.0%) and 46 women (7.3%) were determined to have MetS. After adjusting for age, energy intake, alcohol intake, smoking status and physical activity, a lower intake of vitamin B6 and dietary fiber in men, and lower intake of calcium, milk and dairy products and higher intake of cereal in women were related to the number of MetS components. These results suggest that some dietary factors were related to the number of MetS components among community-dwelling Japanese men and women.

Comparison among body mass index (BMI), waist circumference (WC), and percent body fat (%BF) as anthropometric markers for the clustering of metabolic risk factors in Japanese

OBJECTIVE

To compare body mass index (BMI), waist circumference (WC), and percent body fat (%BF) as markers for the clustering of metabolic risk factors in Japanese.

METHODS

Age-adjusted correlation coefficients (Rs) were calculated between the three anthropometric markers of obesity and metabolic risk factors in 2,444 men and 1,442 women among Japanese. Areas under receiver operating characteristic curves (AUCs) of BMI, WC, and %BF were calculated for diagnosing the clustering of 1 or more, 2 or more, 3 or more, and 4 risk factors among increased blood pressure, impaired fasting glucose, increased triglycerides, and decreased HDL cholesterol and for the clustering of 1 or more, 2 or more, 3 or more, 4 or more, 5 or more, and 6 risk factors among the upper four risk factors as well as increased high-sensitivity C-reactive protein and increased LDL cholesterol.

RESULTS

The Rs were not significantly different among BMI, WC, and %BF except for the difference between the R of BMI (0.217) and that of %BF (0.283) with LDL cholesterol in men (p=0.014). The AUCs of BMI, WC, and %BF for diagnosing any of the risk factor clustering patterns defined above were not significantly different in both men and women.

CONCLUSION

The AUCs for diagnosing the clustering of metabolic risk factors were not significantly different among BMI, WC, and %BF.