Body fat distribution, in particular visceral fat, is associated with cardiometabolic risk factors in obese women

Association of a composite trait for anthropometrics, adiposity and energy expenditure with cardiometabolic diseases: An age-stratified cohort and genetic risk score analysis

AIM

Various anthropometric measures capture distinct as well as overlapping characteristics of an individual's body composition. To characterize independent body composition measures, we aimed to reduce easily-obtainable individual measures reflecting adiposity, anthropometrics and energy expenditure into fewer independent constructs, and to assess their potential sex- and age-specific relation with cardiometabolic diseases.

METHODS

Analyses were performed within European ancestry participants from UK Biobank (N = 418,963, mean age 58.0 years, 56% women). Principal components (PC) analyses were used for the dimension reduction of 11 measures of adiposity, anthropometrics and energy expenditure. PCs were studied in relation to incident type 2 diabetes mellitus (T2D) and coronary artery disease (CAD). Multivariable-adjusted Cox regression analyses, adjusted for confounding factors, were performed in all and stratified by age. Genome-wide association studies were performed in half of the cohort (N = 156,295) to identify genetic variants as instrumental variables. Genetic risk score analyses were performed in the other half of the cohort stratified by age of disease onset (N = 156,295).

RESULTS

We identified two PCs, of which PC1 reflected lower overall adiposity (negatively correlated with all adiposity aspects) and PC2 reflected more central adiposity (mainly correlated with higher waist-hip ratio, but with lower total body fat) and increased height, collectively capturing 87.8% of the total variance. Similar to that observed in the multivariable-adjusted regression analyses, we found associations between the PC1 genetic risk score and lower risks of CAD and T2D [CAD cases <50 years, odds ratio: 0.91 (95% confidence interval 0.87, 0.94) per SD; T2D cases <50 years, odds ratio: 0.76 (0.72, 0.81)], which attenuated with higher age (p-values 8.13E-4 and 2.41E-6, respectively). No associations were found for PC2.

CONCLUSIONS

The consistently observed weaker associations of the composite traits with cardiometabolic disease suggests the need for age-specific cardiometabolic disease prevention strategies.

Fat Distribution and its Correlation with Insulin Resistance, Androgen Markers, and Proinflammatory Cytokines in Polycystic Ovary Syndrome

The high cardiometabolic risk associated with polycystic ovary syndrome (PCOS) may be linked to central fat accumulation. This study compared fat distribution between women with PCOS and controls matched by body mass index. It also sought to determine if insulin resistance (IR), androgens, or inflammatory markers correlate with body composition parameters in PCOS patients. In total, thirty-five women with PCOS and 37 controls, aged 18-40 years, were included. Hormonal/metabolic profiles, inflammatory biomarkers [tumor necrosis factor-alpha (TNF-α and interleukin-6 (IL-6)], anthropometry (waist circumference, waist-to-hip ratio, lipid accumulation product [LAP], visceral adiposity index [VAI]), and body composition assessed through dual-energy X-ray absorptiometry were assessed. The PCOS group exhibited significantly higher androgen levels and markers of IR. However, levels of TNF-α and IL-6 were comparable between the groups. Despite having similar total body fat mass (FM), the PCOS group had excessive central fat, including increased truncal FM and visceral adipose tissue (VAT). In PCOS, androgens were not associated with body fat or its distribution. IL-6 was positively correlated with total and truncal FM, while insulinemia and the homeostatic model assessment for IR were positively associated with VAT, as well as with total and truncal FM. Although anthropometric measurements and indices were positively associated with DXA-derived central FM parameters, our data suggest that LAP is the most effective tool for assessing central fat deposition and metabolic dysfunction in the PCOS patients studied herein. Furthermore, in this population, IR, rather than androgens or proinflammatory cytokines, is more closely associated with abdominal obesity.

Visceral Adiposity and Progression of ADPKD: A Cohort Study of Patients From the TEMPO 3:4 Trial

RATIONALE & OBJECTIVE

Body mass index (BMI) is an independent predictor of kidney disease progression in individuals with autosomal dominant polycystic kidney disease (ADPKD). Adipocytes do not simply act as a fat reservoir but are active endocrine organs. We hypothesized that greater visceral abdominal adiposity would associate with more rapid kidney growth in ADPKD and influence the efficacy of tolvaptan.

STUDY DESIGN

A retrospective cohort study.

SETTING & PARTICIPANTS

1,053 patients enrolled in the TEMPO 3:4 tolvaptan trial with ADPKD and at high risk of rapid disease progression.

PREDICTOR

Estimates of visceral adiposity extracted from coronal plane magnetic resonance imaging (MRI) scans using deep learning.

OUTCOME

Annual change in total kidney volume (TKV) and effect of tolvaptan on kidney growth.

ANALYTICAL APPROACH

Multinomial logistic regression and linear mixed models.

RESULTS

In fully adjusted models, the highest tertile of visceral adiposity was associated with greater odds of annual change in TKV of≥7% versus<5% (odds ratio [OR], 4.78 [95% CI, 3.03-7.47]). The association was stronger in women than men (interaction P<0.01). In linear mixed models with an outcome of percent change in TKV per year, tolvaptan efficacy (% change in TKV) was reduced with higher visceral adiposity (3-way interaction of treatment ∗ time ∗ visceral adiposity, P=0.002). Visceral adiposity significantly improved classification performance of predicting rapid annual percent change in TKV for individuals with a normal BMI (DeLong's test z score: -2.03; P=0.04). Greater visceral adiposity was not associated with estimated glomerular filtration rate (eGFR) slope in the overall cohort; however, visceral adiposity was associated with more rapid decline in eGFR slope (below the median) in women (fully adjusted OR, 1.06 [95% CI, 1.01-1.11] per 10 unit increase in visceral adiposity) but not men (OR, 0.98 [95% CI, 0.95-1.02]).

LIMITATIONS

Retrospective; rapid progressors; computational demand of deep learning.

CONCLUSIONS

Visceral adiposity that can be quantified by MRI in the coronal plane using a deep learning segmentation model independently associates with more rapid kidney growth and improves classification of rapid progression in individuals with a normal BMI. Tolvaptan efficacy decreases with increasing visceral adiposity.

PLAIN-LANGUAGE SUMMARY

We analyzed images from a previous study with the drug tolvaptan conducted in patients with autosomal dominant polycystic kidney disease (ADPKD) to measure the amount of fat tissue surrounding the kidneys (visceral fat). We had previously shown body mass index can predict kidney growth in this population; now we determined whether visceral fat was an important factor associated with kidney growth. Using a machine learning tool to automate measurement of fat in images, we observed that visceral fat was independently associated with kidney growth, that it was a better predictor of faster kidney growth in lean patients than body mass index, and that having more visceral fat made treatment of ADPKD with tolvaptan less effective.

Hypertension and diabetes, but not leptin and adiponectin, mediate the relationship between body fat and chronic kidney disease

PURPOSE

Obesity may promote kidney damage through hemodynamic and hormonal effects. We investigated the association between body mass index (BMI), total body fat (TBF) and chronic kidney disease (CKD) and whether hypertension, diabetes, leptin and adiponectin mediated these associations.

METHODS

In this cross-sectional analysis of the Netherlands Epidemiology of Obesity study, 6671 participants (45-65 y) were included. We defined CKD as eGFR <60 ml/min/1.73 m2 and/or moderately increased albuminuria. The percentage of mediation was calculated using general structural equation modeling, adjusted for potential confounding factors age, sex, smoking, ethnicity, physical activity and Dutch healthy diet index.

RESULTS

At baseline mean (SD) age was 56 (6), BMI 26.3 (4.4), 44% men, and 4% had CKD. Higher BMI and TBF were associated with 1.08 (95%CI 1.05; 1.11) and 1.05-fold (95%CI 1.02; 1.08) increased odds of CKD, respectively. As adiponectin was not associated with any of the outcomes, it was not studied further as a mediating factor. The association between BMI and CKD was 8.5% (95%CI 0.5; 16.5) mediated by diabetes and 22.3% (95%CI 7.5; 37.2) by hypertension. In addition, the association between TBF and CKD was 9.6% (95%CI -0.4; 19.6) mediated by diabetes and 22.4% (95%CI 4.2; 40.6) by hypertension. We could not confirm mediation by leptin in the association between BMI and CKD (35.6% [95%CI -18.8; 90.3]), nor between TBF and CKD (59.7% [95%CI -7.1; 126.6]).

CONCLUSION

Our results suggest that the relations between BMI, TBF and CKD are in part mediated by diabetes and hypertension.

Sexual Dimorphism's impact on adipogenesis: A three-dimensional in vitro model treated with 17β-estradiol and testosterone

Using a three-dimensional (3-D) in vitro culture model, we report the dose dependent effect of 17β-estradiol and testosterone on the adipogenic differentiation and maturation of human adipose derived stem cells (hASCs) obtained from female and male patients. Considering sexual dimorphism, we expected male and female adipocytes to respond differently to the sex steroids. Both male and female hASC spheroids were exposed to 100 nM and 500 nM of 17β-estradiol and testosterone either at the beginning of the adipogenic maturation (Phase I) to discourage intracellular triglyceride accumulation or exposed after adipogenic maturation (Phase II) to reduce the intracellular triglyceride accumulation. The results show that 17β-estradiol leads to a dose dependent reduction in intracellular triglyceride accumulation in female hASC spheroids compared to the both untreated and testosterone-treated cells. Affirming our hypothesis, 17β-estradiol prevented intracellular triglyceride accumulation during Phase I, while it stimulated lipolysis during Phase II. PPAR-γ and adiponectin gene expression also reduced upon 17β-estradiol treatment in female cells. Interestingly, 17β-estradiol and testosterone had only a modest effect on the male hASC spheroids. Collectively, our findings suggest that 17β-estradiol can prevent fat accumulation in adipocytes during early and late stages of maturation in females.

Artificial intelligence-enhanced electrocardiography derived body mass index as a predictor of future cardiometabolic disease

The electrocardiogram (ECG) can capture obesity-related cardiac changes. Artificial intelligence-enhanced ECG (AI-ECG) can identify subclinical disease. We trained an AI-ECG model to predict body mass index (BMI) from the ECG alone. Developed from 512,950 12-lead ECGs from the Beth Israel Deaconess Medical Center (BIDMC), a secondary care cohort, and validated on UK Biobank (UKB) (n = 42,386), the model achieved a Pearson correlation coefficient (r) of 0.65 and 0.62, and an R2 of 0.43 and 0.39 in the BIDMC cohort and UK Biobank, respectively for AI-ECG BMI vs. measured BMI. We found delta-BMI, the difference between measured BMI and AI-ECG-predicted BMI (AI-ECG-BMI), to be a biomarker of cardiometabolic health. The top tertile of delta-BMI showed increased risk of future cardiometabolic disease (BIDMC: HR 1.15, p < 0.001; UKB: HR 1.58, p < 0.001) and diabetes mellitus (BIDMC: HR 1.25, p < 0.001; UKB: HR 2.28, p < 0.001) after adjusting for covariates including measured BMI. Significant enhancements in model fit, reclassification and improvements in discriminatory power were observed with the inclusion of delta-BMI in both cohorts. Phenotypic profiling highlighted associations between delta-BMI and cardiometabolic diseases, anthropometric measures of truncal obesity, and pericardial fat mass. Metabolic and proteomic profiling associates delta-BMI positively with valine, lipids in small HDL, syntaxin-3, and carnosine dipeptidase 1, and inversely with glutamine, glycine, colipase, and adiponectin. A genome-wide association study revealed associations with regulators of cardiovascular/metabolic traits, including SCN10A, SCN5A, EXOG and RXRG. In summary, our AI-ECG-BMI model accurately predicts BMI and introduces delta-BMI as a non-invasive biomarker for cardiometabolic risk stratification.

A review of dolutegravir-associated weight gain and secondary metabolic comorbidities

Dolutegravir is an integrase inhibitor and is recommended by the World Health Organization as the preferred first-line and second-line human immunodeficiency virus treatment in all populations. Excessive weight gain associated with dolutegravir-based regimens is an emerging issue; however, the long-term metabolic consequences of this effect have not been fully understood. Growing evidence shows that this leads to a higher incidence of hyperglycemia, hypertension, and metabolic syndrome, along with elevated cardiovascular risk. Dolutegravir-based regimens, also associated with greater adipocyte differentiation and greater expression of markers associated with lipid storage, continue to be a problem among patients living with human immunodeficiency virus. The mechanisms by which certain antiretroviral therapy agents differentially contribute to weight gain remain unknown. Some clinical investigators speculate that dolutegravir could interfere with central nervous system appetite regulation (melanocortin-4 receptor) and insulin signaling, or may have better penetration of adipose tissue where they could exert a direct impact on adipose tissue adipogenesis, fibrosis, and insulin resistance. This review summarizes our current understanding of weight gain and fat changes associated with dolutegravir and its possible secondary metabolic comorbidities.

Obesity, body fat distribution and eye diseases

BACKGROUND

The prevalence of obesity, a chronic disease, is increasing, and obesity is now considered a global epidemic. Eye diseases are also increasing worldwide and have serious repercussions on quality of life as well as increasingly high costs for the community. The relationships between obesity and ocular pathologies are not yet well clarified and are not pathologically homogeneous: they seem to be somehow linked to excess body fat, especially to the distribution of adipose tissue and its ectopic deposits.

PURPOSE

Our objective was to examine the associations between obesity and anthropometric indices, including body mass index (BMI), waist circumference (WC), and the waist/hip ratio (WHR), and the risk of most widespread eye diseases, with particular attention given to the most significant metabolic mechanisms.

METHODS

This article provides a narrative overview of the effect of obesity and anthropometric measurements of body fat on prevalent eye diseases. We used the MEDLINE/PubMed, CINAHL, EMBASE, and Cochrane Library databases from 1984 to 2024. In addition, we hand-searched references from the retrieved articles and explored a number of related websites. A total of 153 publications were considered.

RESULTS

There is significant evidence that obesity is associated with several eye diseases. Waist circumference (WC) and the waist/hip ratio (WHR) have been observed to have stronger positive associations with eye diseases than BMI.

CONCLUSIONS

Obesity must be considered a significant risk factor for eye diseases; hence, a multidisciplinary and multidimensional approach to treating obesity, which also affects ocular health, is important. In the prevention and treatment of eye diseases related to obesity, lifestyle factors, especially diet and physical activity, as well as weight changes, both weight loss and weight gain, should not be overlooked.

LEVEL OF EVIDENCE

Level V narrative review.

Fasting plasma lactate as a possible early clinical marker for metabolic disease risk

BACKGROUND AND AIM

Elevated fasting plasma lactate concentrations are evident in individuals with metabolic diseases. However, it has yet to be determined if these associations exist in a young, healthy population as a possible early marker for metabolic disease risk. The purpose of this study was to determine if indices of the metabolic syndrome are related to plasma lactate concentrations in this population.

METHODS

Fifty (29 ± 7 yr) men (n = 19) and women (n = 31) classified as overweight (26.4 ± 1.8 kg/m2) participated in this observational study. Blood pressure and blood metabolites were measured after an overnight fast. Lactate was also measured before and after a three-day eucaloric high-fat (70 %) diet. The homeostatic model assessment for insulin resistance (HOMA-IR) was calculated as a measure of insulin resistance. Visceral adipose tissue mass was determined via dual X-ray absorptiometry.

RESULTS

Triglycerides (r = 0.55, p=<0.0001), HOMA-IR (r = 0.53, p=<0.0001), and systolic and diastolic (both, r = 0.36, p = 0.01) blood pressures associated with fasting plasma lactate. No differences in visceral adipose tissue existed between the sexes (p = 0.41); however, the relationship between visceral adipose tissue and lactate existed only in females (r = 0.59, p = 0.02) but not in males (p = 0.53). Fasting lactate and HOMA-IR increased in males (p = 0.01 and p = 0.02, respectively), but not females, following a three-day high-fat diet.

CONCLUSION

Indices of the metabolic syndrome associated with fasting plasma lactates in young relatively healthy individuals. Fasting lactate also increased in a sex-specific manner after a three-day high fat diet. Thus, lactate could become a clinical marker for metabolic disease risk.

Effectiveness of breath acetone monitoring in reducing body fat and improving body composition: a randomized controlled study

When attempts to lose body fat mass frequently fail, breath acetone (BA) monitoring may assist fat mass loss during a low-carbohydrate diet as it can provide real-time body fat oxidation levels. This randomized controlled study aimed to evaluate the effectiveness of monitoring BA levels and providing feedback on fat oxidation during a three-week low-carbohydrate diet intervention. Forty-seven participants (mean age = 27.8 ± 4.4 years, 53.3% females, body mass index = 24.1 ± 3.4 kg m-2) were randomly assigned to three groups (1:1:1 ratio): daily BA assessment with a low-carbohydrate diet, body weight assessment (body scale (BS)) with a low-carbohydrate diet, and low-carbohydrate diet only. Primary outcome was the change in fat mass and secondary outcomes were the changes in body weight and body composition. Forty-five participants completed the study (compliance rate: 95.7%). Fat mass was significantly reduced in all three groups (allP< 0.05); however, the greatest reduction in fat mass was observed in the BA group compared to the BS (differences in changes in fat mass, -1.1 kg; 95% confidence interval: -2.3, -0.2;P= 0.040) and control (differences in changes in fat mass, -1.3 kg; 95% confidence interval: -2.1, -0.4;P= 0.013) groups. The BA group showed significantly greater reductions in body weight and visceral fat mass than the BS and control groups (allP< 0.05). In addition, the percent body fat and skeletal muscle mass were significantly reduced in both BA and BS groups (allP< 0.05). However, no significant differences were found in changes in body fat percentage and skeletal muscle mass between the study groups. Monitoring BA levels, which could have motivated participants to adhere more closely to the low-carbohydrate diet, to assess body fat oxidation rates may be an effective intervention for reducing body fat mass (compared to body weight assessment or control conditions). This approach could be beneficial for individuals seeking to manage body fat and prevent obesity.

Automated Deep Learning-Based Segmentation of Abdominal Adipose Tissue on Dixon MRI in Adolescents: A Prospective Population-Based Study

BACKGROUND. The prevalence of childhood obesity has increased significantly worldwide, highlighting a need for accurate noninvasive quantification of body fat distribution in children. OBJECTIVE. The purpose of this study was to develop and test an automated deep learning method for subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT) segmentation using Dixon MRI acquisitions in adolescents. METHODS. This study was embedded within the Generation R Study, a prospective population-based cohort study in Rotterdam, The Netherlands. The current study included 2989 children (1432 boys, 1557 girls; mean age, 13.5 years) who underwent investigational whole-body Dixon MRI after reaching the age of 13 years during the follow-up phase of the Generation R Study. A 2D competitive dense fully convolutional neural network model (2D-CDFNet) was trained from scratch to segment abdominal SAT and VAT using Dixon MRI-based images. The model underwent training, validation, and testing in 62, eight, and 15 children, respectively, who were selected by stratified random sampling, with manual segmentations used as reference. Segmentation performance was assessed using the Dice similarity coefficient and volumetric similarity. Two observers independently performed subjective visual assessments of automated segmentations in 504 children, selected by stratified random sampling, with undersegmentation and oversegmentation scored on a scale of 0-3 (with a score of 3 denoting nearly perfect segmentation). For 2820 children for whom complete data were available, Spearman correlation coefficients were computed among MRI measurements and BMI and dual-energy x-ray absorptiometry (DEXA)-based measurements. The model used (gitlab.com/radiology/msk/genr/abdomen/cdfnet) is publicly available. RESULTS. In the test dataset, the mean Dice similarity coefficient and mean volu-metric similarity, respectively, were 0.94 ± 0.03 [SD] and 0.98 ± 0.01 [SD] for SAT and 0.85 ± 0.05 and 0.92 ± 0.04 for VAT. The two observers assigned a score of 3 for SAT in 94% and 93% for the undersegmentation proportion and in 99% and 99% for the oversegmentation proportion, and they assigned a score of 3 for VAT in 99% and 99% for the undersegmentation proportion and in 95% and 97% for the oversegmentation proportion. Correlations with SAT and VAT were 0.808 and 0.698 for BMI and 0.941 and 0.801 for DEXA-derived fat mass. CONCLUSION. We trained and evaluated the 2D-CDFNet model on Dixon MRI in adolescents. Quantitative and qualitative measures of automated SAT and VAT segmentations indicated strong model performance. CLINICAL IMPACT. The automated model may facilitate large-scale studies investigating abdominal fat distribution on MRI among adolescents as well as associations of fat distribution with clinical outcomes.

TMT-Based Proteomics Analysis Revealed the Protein Changes in Perirenal Fat from Obese Rabbits

Obesity has become increasingly prevalent in recent years, and there is a need for a deeper understanding of the complex pathogenesis underlying the obesity condition. Therefore, the objective of this study was to investigate how a high-fat diet (HFD) affects protein expression in a female-rabbit model compared to a standard normal-diet group (SND), to gain comprehensive insights into the molecular mechanisms involved in obesity. To achieve this objective, a tandem mass tag (TMT)-based quantitative proteomics analysis was conducted to examine the molecular changes occurring in the white adipose tissue (WAT) from the HFD and SND groups. The sequencing results identified a total of 4215 proteins, among which 151 proteins exhibited significant differential expression. Specifically, there were 85 upregulated proteins and 66 downregulated proteins in the HFD group compared to the SND group. Further analysis of these differentially expressed proteins (DEPs) revealed their involvement in crucial biological processes, including energy metabolism, hormonal regulation, and inflammatory response. In conclusion, this study sheds light on the impact of HFD on protein expression in a female-rabbit model, providing new insights into the molecular mechanisms underlying obesity and the associated metabolic disorders.

New Therapeutic Strategies for Obesity and Its Metabolic Sequelae: Brazilian Cerrado as a Unique Biome

Brazil has several important biomes holding impressive fauna and flora biodiversity. Cerrado being one of the richest ones and a significant area in the search for new plant-based products, such as foods, cosmetics, and medicines. The therapeutic potential of Cerrado plants has been described by several studies associating ethnopharmacological knowledge with phytochemical compounds and therapeutic effects. Based on this wide range of options, the Brazilian population has been using these medicinal plants (MP) for centuries for the treatment of various health conditions. Among these, we highlight metabolic diseases, namely obesity and its metabolic alterations from metabolic syndrome to later stages such as type 2 diabetes (T2D). Several studies have shown that adipose tissue (AT) dysfunction leads to proinflammatory cytokine secretion and impaired free fatty acid (FFA) oxidation and oxidative status, creating the basis for insulin resistance and glucose dysmetabolism. In this scenario, the great Brazilian biodiversity and a wide variety of phytochemical compounds make it an important candidate for the identification of pharmacological strategies for the treatment of these conditions. This review aimed to analyze and summarize the current literature on plants from the Brazilian Cerrado that have therapeutic activity against obesity and its metabolic conditions, reducing inflammation and oxidative stress.

A pilot study of the effects of supervised exercise training on body composition, cardiometabolic risk factors, muscle strength and functional capacity in individuals with bariatric surgery

The main objective of this pilot study was to evaluate the effects of functional exercise training (FET) and home exercise training (HET) on body composition, cardiometabolic risk factors, muscle strength, and functional capacity in individuals with bariatric surgery. The sample of the study included 30 individuals who underwent bariatric surgery. The FET group had functional exercise training consisting of stretching, aerobic, strengthening, and balance exercises assigned by a physiotherapist (n = 15), and the HET group had the same exercises under supervision (n = 15). The training sessions were planned as × 3 per week for a period of 8 weeks. Body composition, cardiometabolic risk factors, cardiometabolic risk status, muscle strength, and functional capacity of all individuals were evaluated before and after training. According to the measurements, body weight (BW), body mass index (BMI), body fat mass (BFM), C-reactive protein, glycated hemoglobin, insulin resistance, cardiovascular risk total score, and ten-year cardiovascular percentage risk decreased significantly (p < 0.05), while HDL-C, leg, back, and hand grip strength (right-left), and walking distance increased significantly (p < 0.05) in the FET group. In the HET group, there were significant increases in body fat percentage (BFM %), BFM, and body muscle mass percentage (BMM %) (p < 0.05), while body muscle mass (BMM), right hand grip strength, leg and back muscle strength, and walking distance scores significantly decreased (p < 0.05). It was concluded that personalized and supervised FET has a positive effect on body composition, cardiometabolic risk factors, muscle strength, and functional capacity, and it can be recommended as a safe exercise model for bariatric surgery patients.

Effect of lipid accumulation product on the development of hypertension among nondiabetic individuals in eastern China: A cross-sectional study

This study was aimed at assessing the risk factors for hypertension (HTN) and prehypertension (PHT) in order to clarify the role of lipid accumulation product (LAP) in the development of HTN among nondiabetic individuals. A large cross-sectional study was conducted in community health service centers in urban Bengbu, Anhui Province, China. All participants completed an interview questionnaire and procedures to obtain physical measurements and biochemical indicators. Multivariate logistic regression was used to test for the prevalence of HTN and PHT in relation to each quartile increase in LAP level and family history of HTN. The resulting interaction effects were evaluated by relative excess risk of interaction (RERI), attributable proportion due to interaction (AP), and synergy index (SI). A total of 7733 subjects were enrolled in the study. The overall prevalence rates of PHT and HTN were 37.1% and 24.8%, respectively. After adjusting for confounding factors, multinomial logistic regression analysis showed that compared with subjects in LAP quartile 1, those in quartile 3 (OR, 1.257; 95% CI, 1.062-1.494) and quartile 4 (OR, 1.323; 95% CI, 1.101-1.592) had a significantly higher risk for HTN (p for trend < .001). A significant interaction was observed between LAP and family history of HTN in men (AP, 0.1661; 95% CI, 0.0024-0.3296; SI, 1.4037; 95% CI, 1.0599-1.8593) and in women (RERI, 1.4111; 95% CI, 0.1458-2.9678; AP, 0.1662; 95% CI, 0.0085-0.3237; SI, 1.3886; 95% CI, 1.0568-1.8247). The results demonstrated that the interactive effects of LAP with family history of HTN may influence the development of HTN synergistically.

The importance of exercise for glycemic control in type 2 diabetes

Exercise is a first-line therapy recommended for patients with type 2 diabetes (T2D). Although moderate to vigorous exercise (e.g. 150 min/wk) is often advised alongside diet and/or behavior modification, exercise is an independent treatment that can prevent, delay or reverse T2D. Habitual exercise, consisting of aerobic, resistance or their combination, fosters improved short- and long-term glycemic control. Recent work also shows high-intensity interval training is successful at lowering blood glucose, as is breaking up sedentary behavior with short-bouts of light to vigorous movement (e.g. up to 3min). Interestingly, performing afternoon compared with morning as well as post-meal versus pre-meal exercise may yield slightly better glycemic benefit. Despite these efficacious benefits of exercise for T2D care, optimal exercise recommendations remain unclear when considering, dietary, medication, and/or other behaviors.

Percent body fat, but not body mass index, is associated with cardiometabolic risk factors in children and adolescents

Background

The epidemic of overweight and obesity has become a worldwide public health problem. Cardiometabolic diseases may originate in childhood. We investigated the association between percent body fat (PBF) measured by the bioelectrical impedance assay and cardiometabolic risk (CMR) in pediatrics.

Methods

This cross-sectional study involved 3819 subjects (6-17 years old) in Shanghai. We assessed the association between PBF and body mass index (BMI) with multiple CMR factors. We examined the risk for cardiometabolic abnormalities attributable to overweight and obesity based on age- and sex-specific PBF Z-scores and BMI Z-scores, respectively.

Results

PBF, but not BMI, was positively associated with multiple CMR factors in males and females except for total cholesterol in females (all p < 0.05). Compared with the non-overweight group based on PBF, overweight and obese subjects had increasingly higher odds ratio of dyslipidemia (2.90 (1.99-4.23), 4.59 (2.88-7.32) for males and 1.82 (1.20-2.75), 2.46 (1.47-4.11) for females) and elevated blood pressure (BP) (3.26 (2.35-4.51), 4.55 (2.92-7.09) for males and 1.59 (1.07-2.34), 3.98 (2.27-6.17) for females). Obesity females showed a higher likelihood for hyperglycemia (2.19 (1.24-3.84)) than non-overweight females. In both sexes, the predictive effect of PBF on dyslipidemia and elevated BP in adolescents was better than that in children. For hyperglycemia, the predictive effect of PBF was better in male adolescents and female children. There was no risk difference for cardiometabolic abnormalities attributable to BMI-based obesity categories.

Conclusions

PBF but not BMI was associated with CMR. Overweight and obesity categories based on PBF had an increased risk for cardiometabolic abnormalities in children and adolescents.

Comparison of CT and Dixon MR Abdominal Adipose Tissue Quantification Using a Unified Computer-Assisted Software Framework

PURPOSE

Reliable and objective measures of abdominal fat distribution across imaging modalities are essential for various clinical and research scenarios, such as assessing cardiometabolic disease risk due to obesity. We aimed to compare quantitative measures of subcutaneous (SAT) and visceral (VAT) adipose tissues in the abdomen between computed tomography (CT) and Dixon-based magnetic resonance (MR) images using a unified computer-assisted software framework.

MATERIALS AND METHODS

This study included 21 subjects who underwent abdominal CT and Dixon MR imaging on the same day. For each subject, two matched axial CT and fat-only MR images at the L2-L3 and the L4-L5 intervertebral levels were selected for fat quantification. For each image, an outer and an inner abdominal wall regions as well as SAT and VAT pixel masks were automatically generated by our software. The computer-generated results were then inspected and corrected by an expert reader.

RESULTS

There were excellent agreements for both abdominal wall segmentation and adipose tissue quantification between matched CT and MR images. Pearson coefficients were 0.97 for both outer and inner region segmentation, 0.99 for SAT, and 0.97 for VAT quantification. Bland-Altman analyses indicated minimum biases in all comparisons.

CONCLUSION

We showed that abdominal adipose tissue can be reliably quantified from both CT and Dixon MR images using a unified computer-assisted software framework. This flexible framework has a simple-to-use workflow to measure SAT and VAT from both modalities to support various clinical research applications.

Body mass index combined with (waist + hip)/height accurately screened for normal-weight obesity in Chinese young adults

OBJECTIVES

Only a few studies have explored the prevalence of normal-weight obesity in young adults or the development of a simple evaluation index for body fat percentage. Therefore, this study aimed to examine the prevalence of normal-weight obesity in young Chinese adults and use anthropometric measurements to develop an evaluation index.

METHODS

In total, 1322 college students participated in the study and were divided into the normal-weight lean, normal-weight obese, and overweight and obese groups based on their body mass index and body fat percentage. The differences in body composition, circumference, and circumference ratio among these three groups were examined.

RESULTS

When exploring the correlation between the circumference ratio and body fat percentage, the circumference ratio was suitable for early screening of abnormal body fat percentage, and the cutoff value was calculated. Body composition and circumference were significantly different among the three groups: (waist + hip)-to-height, hip-to-height, and waist-to-height ratios were strongly correlated with body fat percentage.

CONCLUSIONS

(Waist + hip)-to-height ratio can be used as a simple evaluation index for indicating abnormal body fat percentage when higher than 1.032 in male and 1.047 in female individuals. Downregulating the normal upper limit for body mass index to 24.4 and 23.8 kg/m² in male and female individuals, respectively, is recommended. Body mass index combined with (waist + hip)-to-height ratio allowed for more accurate screening of normal-weight obesity as an easy and cost-free evaluation measure for abnormal body fat percentage.

Association between Skeletal Muscle Mass-to-Visceral Fat Ratio and Dietary and Cardiometabolic Health Risk Factors among Korean Women with Obesity

Sarcopenic obesity (SO) is more associated with cardiovascular diseases than sarcopenia or obesity alone. This study aimed to assess the association between the skeletal muscle mass-to-visceral fat area ratio (SVR) and dietary and cardiometabolic health risk factors in obese women. Fifty-nine women aged 19-65 years with BMI values of ≥25 kg/m² and <32 kg/m² were included. The SVR was inversely correlated with blood lipids (total cholesterol, β = -0.369, p = 0.022; low-density lipoprotein cholesterol, β = -0.326, p = 0.049) and hs-CRP (β = -0.305, p = 0.043). Among the dietary factors, fatty acid intake (saturated fatty acids (SFA), β = -0.287, p = 0.044; monounsaturated fatty acids (MUFA), β = -0.282, p = 0.048; polyunsaturated fatty acids (PUFA), β = -0.301, p = 0.035) was inversely correlated with the SVR. Conversely, vitamin B₆ and B₁₂ intake (vitamin B₆, β = 0.338, p = 0.012; vitamin B₁₂, β = 0.281, p = 0.024) showed positive associations with the SVR. Individuals with a lower SVR were more likely to have SO and higher blood lipids and inflammatory marker levels. Regarding dietary factors, the SVR increased with vitamin B₆ and B₁₂ intake, which was less likely to occur in individuals with SO.

Vitamin A Deficiency and Its Association with Visceral Adiposity in Women

Body adiposity is associated with increased metabolic risk, and evidence indicates that vitamin A is important in regulating body fat. The aim of this study was to evaluate serum concentrations of vitamin A and its association with body adiposity in women with the recommended intake of vitamin A. A cross-sectional study was designed with 200 women divided into four groups according to Body Mass Index (BMI): normal weight (NW), overweight (OW), class I obesity (OI), and class 2 obesity (OII). The cut-off points to assess inadequate participants were retinol < 1.05 µmol/L and β-carotene < 40 µg/dL. Body adiposity was assessed through different parameters and indexes, including waist circumference (WC), waist-to-height ratio (WHtR), hypertriglyceridemic waist (HW), lipid accumulation product (LAP), Visceral Adiposity Index (VAI), and Body Adiposity Index (BAI). It was observed that 55.5% of women had low serum concentrations of β-carotene (34.9 ± 13.8 µmol/L, p < 0.001) and 43.5% had low concentrations of retinol (0.71 ± 0.3 µmol/L, p < 0.001). Women classified as OI and OII had lower mean values of β-carotene (OI—35.9 ± 4.3 µg/dL: OII—32.0 ± 0.9 µg/dL [p < 0.001]). IAV showed significant negative correlation with retinol (r = −0.73, p < 0.001). Vitamin A deficiency is associated with excess body adiposity in women with the recommended intake of vitamin. Greater body adiposity, especially visceral, was correlated with reduced serum concentrations of vitamin A.

Fully automated CT-based adiposity assessment: comparison of the L1 and L3 vertebral levels for opportunistic prediction

PURPOSE

The purpose of this study is to compare fully automated CT-based measures of adipose tissue at the L1 level versus the standard L3 level for predicting mortality, which would allow for use at both chest (L1) and abdominal (L3) CT.

METHODS

This retrospective study of 9066 asymptomatic adults (mean age, 57.1 ± 7.8 [SD] years; 4020 men, 5046 women) undergoing unenhanced low-dose abdominal CT for colorectal cancer screening. A previously validated artificial intelligence (AI) tool was used to assess cross-sectional visceral and subcutaneous adipose tissue areas (SAT and VAT), as well as their ratio (VSR) at the L1 and L3 levels. Post-CT survival prediction was compared using area under the ROC curve (ROC AUC) and hazard ratios (HRs).

RESULTS

Median clinical follow-up interval after CT was 8.8 years (interquartile range, 5.2-11.6 years), during which 5.9% died (532/9066). No significant difference (p > 0.05) for mortality was observed between L1 and L3 VAT and SAT at 10-year ROC AUC. However, L3 measures were significantly better for VSR at 10-year AUC (p < 0.001). HRs comparing worst-to-best quartiles for mortality at L1 vs. L3 were 2.12 (95% CI, 1.65-2.72) and 2.22 (1.74-2.83) for VAT; 1.20 (0.95-1.52) and 1.16 (0.92-1.46) for SAT; and 2.26 (1.7-2.93) and 3.05 (2.32-4.01) for VSR. In women, the corresponding HRs for VSR were 2.58 (1.80-3.69) (L1) and 4.49 (2.98-6.78) (L3).

CONCLUSION

Automated CT-based measures of visceral fat (VAT and VSR) at L1 are predictive of survival, although overall measures of adiposity at L1 level are somewhat inferior to the standard L3-level measures. Utilizing predictive L1-level fat measures could expand opportunistic screening to chest CT imaging.

Association between Vitamin B and Obesity in Middle-Aged and Older Chinese Adults

OBJECTIVE

Previous studies have found that obese people have lower levels of vitamin B, but most have focused on obesity as defined by body mass index (BMI), and its relationship with other types of obesity is unclear. The aim of this study was to explore the relationship between vitamin B levels and obesity assessed by different definitions among Chinese middle-aged and older community-dwelling adults.

METHODS

This cross-sectional study included 887 participants aged 45 years and older (45-82 years). The concentrations of vitamin B (B₁, B₂, B₆, and B₉) were measured by robotic dry blood spot extraction systems in combination with liquid chromatography-tandem mass spectrometry. BMI, body fat percentage (BF%), visceral fat area (VFA), and waist circumference (WC) were used to diagnose obesity. VFA and BF% were assessed by bioelectrical impedance analysis. The logistic regression model was used to assess the associations between vitamin B levels and the odds of obesity.

RESULTS

The average age of all participants was 60.77 (SD 6.33) years. The prevalence of obesity varied from 8.6% to 52.4% depending on different diagnostic criteria. After adjusting for covariates, a negative correlation was observed between vitamin B₁ level and obesity according to the criteria of WC, VFA, and BF%, and the adjusted odds ratio (OR) was 0.47, 0.52, and 0.46, respectively. When using WC and BF% to define obesity, higher quartiles of vitamin B₂ were negatively associated with the odds of obesity (OR: 0.62 and 0.62, respectively). Vitamin B₆ was inversely associated with VFA-defined and BF%-defined obesity (OR: 0.64 and 0.64, respectively). When using VFA and BF% to define obesity, a negative correlation was observed in vitamin B₉ (OR: 0.61 and 0.67, respectively).

CONCLUSIONS

Vitamin B (B₁, B₂, B₆, and B₉) level was negatively related to obesity (defined by WC, VFA, or BF%) in Chinese middle-aged and older adults.

Metabolic effects of lipectomy and of adipose tissue transplantation

OBJECTIVE

The goal of this study was to review the metabolic effects of fat transplantation.

METHODS

Fat (adipose tissue [AT]) transplantation has been performed extensively for many years in the cosmetic reconstruction industry. However, not all fats are equal. White, brown, and beige AT differ in energy storage and use. Brown and beige AT consume glucose and lipids for thermogenesis and, theoretically, may provide greater metabolic benefit in transplantation. Here, the authors review the metabolic effects of AT transplantation.

RESULTS

Removal of subcutaneous human AT does not have beneficial metabolic effects. Most studies find no benefit from visceral AT transplantation and some studies report harmful effects. In contrast, transplantation of inguinal or subcutaneous AT in mice has positive effects. Brown AT transplant studies have variable results depending on the model but most show benefit.

CONCLUSIONS

Many technical improvements have optimized fat grafting and transplantation in cosmetic surgery. Transplantation of subcutaneous AT has the potential for significant metabolic benefits, although there are few studies in humans or using human AT. Brown AT transplantation is beneficial but not readily feasible in humans thus ex vivo "beiging" may be a useful strategy. AT transplantation may provide clinical benefits in metabolic disorders, especially in the setting of lipodystrophy.

Postprandial Responses to a Standardised Meal in Hypertension: The Mediatory Role of Visceral Fat Mass

Postprandial insulinaemia, triglyceridaemia and measures of inflammation are thought to be more closely associated with cardiovascular risk than fasting measures. Although hypertension is associated with altered fasting metabolism, it is unknown as to what extent postprandial lipaemic and inflammatory metabolic responses differ between hypertensive and normotensive individuals. Linear models adjusting for age, sex, body mass index (BMI), visceral fat mass (VFM) and multiple testing (false discovery rate), were used to investigate whether hypertensive cases and normotensive controls had different fasting and postprandial (in response to two standardised test meal challenges) lipaemic, glycaemic, insulinaemic, and inflammatory (glycoprotein acetylation (GlycA)) responses in 989 participants from the ZOE PREDICT-1 nutritional intervention study. Compared to normotensive controls, hypertensive individuals had significantly higher fasting and postprandial insulin, triglycerides, and markers of inflammation after adjusting for age, sex, and BMI (effect size: Beta (Standard Error) ranging from 0.17 (0.08), p = 0.04 for peak insulin to 0.29 (0.08), p = 4.4 × 10-4 for peak GlycA). No difference was seen for postprandial glucose. When further adjusting for VFM effects were attenuated. Causal mediation analysis suggests that 36% of the variance in postprandial insulin response and 33.8% of variance in postprandial triglyceride response were mediated by VFM. Hypertensive individuals have different postprandial insulinaemic and lipaemic responses compared to normotensive controls and this is partially mediated by visceral fat mass. Consequently, reducing VFM should be a key focus of health interventions in hypertension. Trial registration: The ClinicalTrials.gov registration identifier is NCT03479866.

Is Neck Circumference Related to Other Anthropometric Measurements and Biochemical Parameters in Type 2 Diabetes?

Background

Obesity is one of the leading risk factors for developing type 2 diabetes mellitus (T2DM). Body mass index (BMI), waist circumference, and waist/hip ratio are anthropometric measurements used to diagnose obesity. In recent years, neck circumference, one of the anthropometric indicators used in assessing obesity, has come to the fore. This study investigates the relationship between neck circumference and other anthropometric measurements and specific biochemical parameters in T2DM.

Methods

Four hundred sixty-four individuals with type 2 diabetes were included in the study. Subjects’ body weight, height, and other anthropometric measurements like circumferences of the waist, hip, and neck were measured. BMI, waist/hip, and waist/height ratio were calculated. The biochemical tests of the subjects in the previous month from the study were accessed from the hospital information system. The relationship between anthropometric measurements and biochemical parameters with neck circumference was evaluated.

Results

The mean age of the subjects was 54.6±8.51 years. 56.2% were female and 43.8% were male, and the time from T2DM diagnosis was 9.9±7.49 years. Most male subjects were overweight (49.8%), and approximately one-third of the women were first-degree obese (33.0%). Body weight, BMI, waist, hip, and neck circumferences, and waist/hip and waist/height ratios were significantly higher in both male and female subjects in the neck circumference high-risk group than those in the low-risk group (p<0.05). In terms of biochemical parameters, fasting blood glucose and HbA1c values of men with neck circumference at risk were significantly higher than those in the low-risk group. Neck circumference measurements of the participants were positively correlated with body weight (r=0.543; p<0.001), height (r=0.260; p<0.001), waist circumference (r=0.562; p<0.001), hip circumference (r=0.293; p<0.001), BMI (r=0.366; p<0.001), waist/hip ratio (r=0.428, p<0.001), and waist/height ratio (r=0.393, p<0.001). Neck circumference had a low positive correlation with fasting blood glucose (r=0.165; p<0.001), HbA1c (r=0.281; p<0.001), and triglyceride (r=0.231; p<0.001) and a negative relationship with low-density lipoprotein cholesterol (r=-0.118; p=0.001). When the relationship between neck circumference and biochemical parameters was examined, it was seen that this correlation was only in men.

Conclusion

Neck circumference measurement is a simple and reliable method and is not affected by external factors. It correlates with other anthropometric measurements and can be used as a good indicator of the distribution of upper subcutaneous adipose tissue in T2DM. However, more studies with larger samples are needed on this subject.

Sex hormones, intestinal inflammation, and the gut microbiome: Major influencers of the sexual dimorphisms in obesity

Obesity is defined as the excessive accumulation of body fat and is associated with an increased risk of developing major health problems such as cardiovascular disease, diabetes and stroke. There are clear sexual dimorphisms in the epidemiology, pathophysiology and sequelae of obesity and its accompanying metabolic disorders, with females often better protected compared to males. This protection has predominantly been attributed to the female sex hormone estrogen and differences in fat distribution. More recently, the sexual dimorphisms of obesity have also been attributed to the differences in the composition and function of the gut microbiota, and the intestinal immune system. This review will comprehensively summarize the pre-clinical and clinical evidence for these sexual dimorphisms and discuss the interplay between sex hormones, intestinal inflammation and the gut microbiome in obesity. Major gaps and limitations of this rapidly growing area of research will also be highlighted in this review.

The Demographic Specific Abdominal Fat Composition and Distribution Trends in US Adults from 2011 to 2018

Despite the rising awareness of abdominal adiposity associated health problems and demographic health disparities, research is lacking about abdominal fat trends using a national representative sample of US adults. Our purpose was to examine national demographic specific abdominal fat composition and distribution trends from 2011 to 2018. This trend analysis was using National Health and Nutrition Examination Survey data (n = 13,163). Visceral adipose percent (VAT%), visceral adipose tissue area (VAA) and visceral to subcutaneous adipose area ratio (VSR) were utilized in data analyses. Multiple polynomial linear regression was utilized with adjustment for confounding variables. Our findings revealed that VAT%, VAA and VSR trends were concave among all demographic groups. The VAT%, VAA and/or VSR changes were observed in most demographic groups (p < 0.05) except younger, White and Black respondents. The pattern was consistent with biennial increases up to 2014 or 2016 followed by decreases in 2017-2018. There were demographic disparities, with middle-aged respondents and Hispanics having the most evident VAT%, VSR and/or VAA changes biennially when compared to their counterparts (p < 0.05). In conclusion, abdominal fat composition and distribution increased before 2014 or 2016 but decreased afterwards with variations by age and/or race/ethnicity. Further research is needed to explore the possible causes of abdominal fat changes overtime.

Dissecting the relationship between plasma and tissue metabolome in a cohort of women with obesity: Analysis of subcutaneous and visceral adipose, muscle, and liver

Untargeted metabolomics of blood samples has become widely applied to study metabolic alterations underpinning disease and to identify biomarkers. However, understanding the relevance of a blood metabolite marker can be challenging if it is unknown whether it reflects the concentration in relevant tissues. To explore this field, metabolomic and lipidomic profiles of plasma, four sites of adipose tissues (ATs) from peripheral or central depot, two sites of muscle tissue, and liver tissue from a group of nondiabetic women with obesity who were scheduled to undergo bariatric surgery (n = 21) or other upper GI surgery (n = 5), were measured by liquid chromatography coupled with mass spectrometry. Relationships between plasma and tissue profiles were examined using Pearson correlation analysis subject to Benjamini-Hochberg correction. Plasma metabolites and lipids showed the highest number of significantly positive correlations with their corresponding concentrations in liver tissue, including lipid species of ceramide, mono- and di-hexosylceramide, sphingomyelin, phosphatidylcholine (PC), phosphatidylethanolamine (PE), lysophosphatidylethanolamine, dimethyl phosphatidylethanolamine, ether-linked PC, ether-linked PE, free fatty acid, cholesteryl ester, diacylglycerol and triacylglycerol, and polar metabolites linked to several metabolic functions and gut microbial metabolism. Plasma also showed significantly positive correlations with muscle for several phospholipid species and polar metabolites linked to metabolic functions and gut microbial metabolism, and with AT for several triacylglycerol species. In conclusion, plasma metabolomic and lipidomic profiles were reflective more of the liver profile than any of the muscle or AT sites examined in the present study. Our findings highlighted the importance of taking into consideration the metabolomic relationship of various tissues with plasma when postulating plasma metabolites marker to underlying mechanisms occurring in a specific tissue.

Improvement of Pancreatic Steatosis and Indices of Insulin Resistance After Metabolic Surgery

Purpose

Obesity is associated with fat accumulation in ectopic sites such as the pancreas, the so-called pancreatic steatosis (PS). Bariatric surgery has been shown to be associated with reducing pancreatic fat. This study investigated the effect of laparoscopic sleeve gastrectomy (LSG) on pancreatic volume and its fat content and glucose homeostasis.

Methods

The study enrolled 54 patients subjected to LSG. Metabolic variables and pancreatic exocrine function were assessed immediately before surgery and 12 months after. MRI of the abdomen was performed to measure pancreatic fat content and its total volume and visceral adipose tissue (VAT).

Results

Surgery resulted in a significant reduction in body weight and BMI. HbA1c, fasting insulin, C-peptide levels, HOMA-IR, and Hs-CRP levels decreased significantly. Surgery resulted in significant improvement in lipid profile except for HDL-cholesterol and liver function tests. Total VAT volume decreased significantly. Total pancreas volume decreased by a mean of 9.0 cm³ (95% CI: 6.6–11.3). The median change of pancreatic fat was −26.1% (range: −55.6 to 58.3%). Pancreatic lipase decreased significantly (P < 0.001). There was a positive correlation between the percentage of total weight loss and decrease in pancreatic fat volume (r = 0.295, P = 0.030).

Conclusion

Weight loss after LSG is associated with a reduction of total VAT volume, total pancreatic volume, and pancreatic fat content. These changes are associated with improved glucose homeostasis, reduced systemic inflammation, and decreased pancreatic lipase secretion.

Mindfulness-based program to support lifestyle modification and weight loss in infertile women: randomized controlled trial

OBJECTIVE

We evaluated the short-term effects of a mindfulness-based program (MBP) on weight loss through lifestyle modification in infertile women who were overweight or obese.

METHODS

The participants were randomly assigned to 8 consecutive weekly sessions of MBP plus diet or diet alone. Both groups received a customized dietary plan. Body measures were taken and a questionnaire was applied to evaluate dietary habits at baseline and three months later.

RESULTS

The study was completed by 28 women in the MBP group and 24 in the control group. Body weight decreased 1.8 kg (2.1%) in the MBP group (p = 0.001, follow-up vs. baseline) and 1.7 kg (1.9%) in the control group (p = 0.035). There was an average reduction of 2.9 cm of waist circumference in the MBP group (p = 0.008) and 0.3 cm in the control group (p = 0.633). There was a significant reduction in the daily energy intake of the women attending the MBP (mean difference -430 Kcal/day, p=0.010) whereas no significant change was observed in the control group.

CONCLUSION

In the short term, this MBP did not affect weight loss in infertile women, but the MBP intervention contributed to reduce waist circumference, possibly due to a significant decrease in food energy intake.

TRIAL REGISTRATION NUMBER

RBR-7by76r.

Influence of Nutritional Status and Physical Exercise on Immune Response in Metabolic Syndrome

Metabolic Syndrome (MetS) is a cluster of metabolic alterations mostly related to visceral adiposity, which in turn promotes glucose intolerance and a chronic systemic inflammatory state, characterized by immune cell infiltration. Such immune system activation increases the risk of severe disease subsequent to viral infections. Strong correlations between elevated body mass index (BMI), type-2-diabetes and increased risk of hospitalization after pandemic influenza H1N1 infection have been described. Similarly, a correlation between elevated blood glucose level and SARS-CoV-2 infection severity and mortality has been described, indicating MetS as an important predictor of clinical outcomes in patients with COVID-19. Adipose secretome, including two of the most abundant and well-studied adipokines, leptin and interleukin-6, is involved in the regulation of energy metabolism and obesity-related low-grade inflammation. Similarly, skeletal muscle hormones—called myokines—released in response to physical exercise affect both metabolic homeostasis and immune system function. Of note, several circulating hormones originate from both adipose tissue and skeletal muscle and display different functions, depending on the metabolic context. This review aims to summarize recent data in the field of exercise immunology, investigating the acute and chronic effects of exercise on myokines release and immune system function.

Body Fat Percentage and Normal-Weight Obesity in the Chinese Population: Development of a Simple Evaluation Indicator Using Anthropometric Measurements

Few studies explore the associations between body fat percentage (BFP) prediction and evaluation indicators for Chinese with normal-weight obesity. We aimed to explore convenient and cost-free BFP evaluation indicators to routinely monitor BFP status in Chinese patients with normal-weight obesity. Participants (N = 164) were divided into three groups according to body mass index (BMI) and BFP: normal-weight lean, normal-weight obese, and overweight and obese. Differences in body composition and circumference were compared to examine the relationship between BFP and circumference, determine a simple evaluation indicator reflecting BFP, and identify cutoff values for normal-weight obesity circumference. Significant differences in body composition and circumference were observed among the three groups. The correlation between thigh/height, hip/height, (hip + waist)/height, and BFP was stronger than that with BMI. The (hip + waist)/height ratio was the indicator most reflective of BFP (95% confidence interval: 3.004−9.018, p = 0.013), and a ratio above 1.115 (95% confidence interval: 0.936−0.992, p < 0.001) was predictive of normal-weight obesity. Furthermore, we suggest that the upper value for a normal BMI in Chinese individuals be lowered to 23.4 kg/m2 (95% confidence interval: 0.984−0.999, p < 0.001). The (hip + waist)/height ratio can be used with body mass index for a more accurate evaluations of BFP abnormalities and health risks.

Body Fat Composition Related to Fatty Snack Habit Consumption of Office Workers in Urban Area

BACKGROUND:The fatty snack cooked with a deep-fried process is a snack that is often consumed by Indonesian people. The high oil content in fatty snacks results in the risk of obesity. AIM: The purpose of this study was to analyze the consumption habits of fatty snacks with body fat composition of office workers in urban area. METHOD: This research design uses a cross-sectional study with a purposive sampling method consisting of men and women with a total of 112 respondents. Food consumption data were obtained using semi-quantitative FFQ, while body fat composition used Bio Electrical Impedance Analysis. The relationship between fatty snacks consumption and body fat was analyzed using the chi-square test, while the differences between the two groups based on gender were analyzed using the independent sample t-test. RESULT:  There was a significant relationship between age and body fat (P=0.005) and visceral fat (P=0.004). Nutritional status had a significant relationship with body fat (P=0.003) and visceral fat (P=0.000). Fatty snacks consumption habits were associated with body fat (P=0.008), while not visceral fat (P>0.05). There was no significant difference (p>0.05) between men and women based on body and visceral fat composition, nutritional status, and frequency of consumption of fatty snacks. CONCLUSION: Consumption of Fatty snacks more than once per day is closely related to body fat.

Renin-angiotensin system modulation through enalapril and/or exercise training improves visceral adiposity in obese mice

INTRODUCTION

Obesity-related metabolic diseases occur as a result of disruptions in white adipose tissue (WAT) plasticity, especially through visceral fat accumulation and adipocyte hypertrophy. This study aimed to evaluate the impact of renin-angiotensin system (RAS) and bradykinin receptors modulation by enalapril treatment and/or exercise training on WAT morphology and related deleterious outcomes.

METHODS

Male C57BL/6 mice were fed either a standard chow or a high-fat (HF) diet for 16 weeks. At the 8th week, HF-fed animals were divided into sedentary (HF), enalapril treatment (HF-E), exercise training (HF-T), and enalapril treatment plus exercise training (HF-ET) groups. Following the experimental protocol, body mass gain, adiposity index, insulin resistance, visceral WAT morphometry, renin-angiotensin system, and bradykinin receptors were evaluated.

RESULTS

The HF group displayed increased adiposity, larger visceral fat mass, and adipocyte hypertrophy, which was accompanied by insulin resistance, overactivation of Ang II/AT1R arm, and favoring of B1R in bradykinin receptors profile. All interventions ameliorated visceral adiposity and related outcomes by favoring the Ang 1-7/MasR arm and the B2R expression in B1R/B2R ratio. However, combined therapy additively reduced Ang II/Ang 1-7 ratio.

CONCLUSION

Our results suggest that Ang 1-7/MasR arm and B2R activation might be relevant targets in the treatment of visceral obesity.

The role of metabolic syndrome in sudden cardiac death risk: Recent evidence and future directions

Metabolic syndrome (MetS) is a frequent condition whose deleterious effects on the cardiovascular system are often underestimated. MetS is nowadays considered a real pandemic with an estimated prevalence of 25% in general population. Individuals with MetS are at high risk of sudden cardiac death (SCD) as this condition accounts for 50% of all cardiac deaths in such a population. Of interest, recent studies demonstrated that individuals with MetS show 70% increased risk of SCD even without previous history of coronary heart disease (CHD). However, little is known about the interplay between the two conditions. MetS is a complex disease determined by genetic predisposition, unhealthy lifestyle and ageing with deleterious effects on different organs. MetS components trigger a systemic chronic low-grade pro-inflammatory state, associated with excess of sympathetic activity, cardiac hypertrophy, arrhythmias and atherosclerosis. Thus, MetS has an important burden on the cardiovascular system as demonstrated by both preclinical and clinical evidence. The aim of this review is to summarize recent evidence concerning the association between MetS and SCD, showing possible common aetiological processes, and to indicate prospective for future studies and therapeutic targets.

Multimodal analysis suggests differential immuno-metabolic crosstalk in lung squamous cell carcinoma and adenocarcinoma

Immunometabolism within the tumor microenvironment is an appealing target for precision therapy approaches in lung cancer. Interestingly, obesity confers an improved response to immune checkpoint inhibition in non-small cell lung cancer (NSCLC), suggesting intriguing relationships between systemic metabolism and the immunometabolic environment in lung tumors. We hypothesized that visceral fat and ¹⁸F-Fluorodeoxyglucose uptake influenced the tumor immunometabolic environment and that these bidirectional relationships differ in NSCLC subtypes, lung adenocarcinoma (LUAD) and lung squamous cell carcinoma (LUSC). By integrating ¹⁸F-FDG PET/CT imaging, bulk and single-cell RNA-sequencing, and histology, we observed that LUSC had a greater dependence on glucose than LUAD. In LUAD tumors with high glucose uptake, glutaminase was downregulated, suggesting a tradeoff between glucose and glutamine metabolism, while in LUSC tumors with high glucose uptake, genes related to fatty acid and amino acid metabolism were also increased. We found that tumor-infiltrating T cells had the highest expression of glutaminase, ribosomal protein 37, and cystathionine gamma-lyase in NSCLC, highlighting the metabolic flexibility of this cell type. Further, we demonstrate that visceral adiposity, but not body mass index (BMI), was positively associated with tumor glucose uptake in LUAD and that patients with high BMI had favorable prognostic transcriptional profiles, while tumors of patients with high visceral fat had poor prognostic gene expression. We posit that metabolic adjunct therapy may be more successful in LUSC rather than LUAD due to LUAD's metabolic flexibility and that visceral adiposity, not BMI alone, should be considered when developing precision medicine approaches for the treatment of NSCLC.

Association of adiposity evaluated by anthropometric, BIA, and DXA measures with cardiometabolic risk factors in nonobese postmenopausal women: the CoLaus/OsteoLaus cohort

OBJECTIVE

After menopause, body composition changes with body fat accumulation, and an increase in cardiometabolic risk factors. Total fat mass, regional fat mass, and visceral adipose tissue (VAT) may be estimated with anthropometric measures, bioelectrical impedance analysis (BIA), and dual-energy X-ray absorptiometry (DXA). The aim of our study was to assess which measurement correlated best with cardiometabolic risk factors in healthy nonobese postmenopausal women.

METHODS

The CoLaus/OsteoLaus cohort included 1,500 postmenopausal women (age range 50-80). We analyzed correlations between: 1) measurements of body composition assessed by anthropometric measures, BIA, and DXA and 2) these measurements and different selected cardiometabolic risk factors, such as blood pressure, lipid markers (cholesterol subtypes and triglycerides), and metabolic markers (glucose, insulin, adiponectin, and leptin). Spearman correlation coefficient, stepwise forward regression, and linear regression analyses were used to determine association between anthropometric measurements and cardiometabolic risk factors.

RESULTS

In the 803 included participants (mean age 62.0 ± 7.1 y, mean body mass index 25.6 kg/m2 ± 4.4), correlations between total fat mass measured by BIA and total fat mass, android fat, gynoid fat, or VAT measured by DXA are very strong (from r = 0.531, [99% confidence interval (CI), 0.443-0.610] to r = 0.704, [99% CI, 0.640-0.758]). Body mass index and waist circumference have a higher correlation with VAT (r = 0.815, [99% CI, 0.772-0.851] and r = 0.823 [99% CI, 0.782-0.858], respectively) than BIA (r = 0.672 [99% CI, 0.603-0.731]). Among the anthropometric measurement and the measurements derived from DXA and BIA, VAT is the parameter most strongly associated with cardiometabolic risk factors. VAT better explains the variation of most of the cardiometabolic risk factors than age and treatment. For example, nearly 5% of the variability of the diastolic blood pressure (9.9 vs 4.9), nearly 15% of the variability of high-density lipoprotein cholesterol (20.3 vs 3.8) and triglyceride (21.1 vs 6.5), 25.3% of the variability of insulin (33.3 vs 8.1), and 37.5% of the variability of leptin (37.7 vs 1.1) were explained by VAT.

CONCLUSIONS

BIA seems not to be a good tool to assess VAT. At the population level, waist circumference and body mass index seem to be good tools to estimate VAT. VAT measured by DXA is the parameter most correlated with cardiometabolic risk factors and could become a component of the cardiometabolic marker on its own.

Adverse Changes in Body Composition During the Menopausal Transition and Relation to Cardiovascular Risk: A Contemporary Review

The menopausal transition period in aging women is strongly associated with weight gain. Evidence shows that weight changes during menopause increases the risk of developing cardiovascular disease (CVD) in postmenopausal women. However, the potential mechanisms that cause weight gain and adverse changes to body composition specifically during the menopausal transition period remain to be elucidated. In this contemporary review, we examined recent evidence for adverse changes in body composition at midlife during the menopausal transition and the link to increased CVD risk and described factors that may contribute to these changes, including normal chronological aging, hormonal factors (decreased estrogen, etc.), behavioral factors (changes in diet, physical activity), or other emerging factors (e.g., sleep). This review focused on identifying factors that make the menopausal transition period a critical window for prevention of CVD. Future study is needed to decipher the extent to which hormonal changes, age-related factors, and behavioral factors interact with and contribute to increased CVD risk in women undergoing menopause. Understanding the causes of weight gain during the menopausal transition may help to inform strategies to mitigate adverse CVD outcomes for women transitioning through menopause.

Accuracy of obesity indices alone or in combination for prediction of diabetes: A novel risk score by linear combination of general and abdominal measures of obesity

Background

The predictive power of obesity measures varies according to the presence of coexistent measures. The present study aimed to determine the predictive power of combinations of obesity measures for diabetes by calculation of a linear risk score.

Methods

Data from a population-based cross-sectional study of 994 representative samples of Iranian adults in Babol, Iran were analyzed. Measures of obesity including waist circumference (WC), body mass index (BMI), waist-to-height ratio (WHtR), and waist to hip ratio (WHR) were calculated, and diabetes was diagnosed by fasting blood sugar >126 mg/dl or taking antidiabetic medication. Multiple logistic regression model was used to develop a logit risk score based on BMI, WC, WHtR, and WHR. The ROC analysis was applied to determine the priority of every single index and combined logit score for the prediction of diabetes.

Results

All four measures of general and abdominal obesity were predictors of diabetes individually in both sexes (P=0.0001). Calculation of risk score for a combination of all measures use full model improved predictive power. Adjustment for age resulted in further improvement in diagnostic power and combined novel risk score differentiated individuals with and without diabetes with an accuracy of 0.747 (95%CI: 0.690-0.808) in men and 0.789 (95%CI: 0.740, 0.837) in women.

Conclusion

These findings indicate that the simultaneous calculation of age-adjusted risk score for all measures provides stronger diagnostic accuracy in both sexes. This issue suggests the calculation of combined risk scores for all obesity indices especially in a population at borderline risk.

Multiprofessional intervention and telenursing in the treatment of obese people in the COVID-19 pandemic: a pragmatic clinical trial

ABSTRACT Objectives: to analyze the effects of a multiprofessional remote intervention and telenursing in the treatment of obesity. Methods: pragmatic clinical trial of intervention, conducted with obese adults. The multiprofessional remote intervention with a nurse occurred for 16 weeks through a messaging application. The application analyzed body composition, hemodynamic and laboratory variables, comparing the results obtained with the group that participated in face-to-face multiprofessional intervention without a nurse. The study investigated the effects of the intervention comparing the intervention groups and the moments through the ANOVA test for repeated measures. Results: Group 1 obtained significance in the variables: percentage of body fat (p = 0.008); blood glucose (p = 0.014); insulin (p = 0.001); abdominal and waist circumference; and HDL cholesterol (p = 0.000). Conclusions: the effects of multiprofessional remote intervention and telenursing significantly decreased the risk variables for metabolic syndrome in the treatment of obesity.

Identifying dietary pattern associated with adiposity among Malaysian young adults

BACKGROUND: Recognizing food groups consumption in young adults offers an opportunity to improve dietary pattern in early adulthood. OBJECTIVE: Hence, this cross-sectional study aimed to determine food groups’ intake of young adults and to identify food groups associated with adiposity. METHODS: Youths aged 18–25 years old from private universities in Klang Valley, Malaysia, participated in the study (n = 294). Three days 24-hour dietary recall assessed youths’ food groups intake. Adiposity (BMI, body fat percentage, visceral fat level, waist circumference) was determined based on standard protocol. Height was measured using SECA 206 body meter, while weight, body fat percentage, and visceral fat level were measured using the Omron HBF-356 Body Fat Analyzer. Waist circumference was determined using a measuring tape. RESULTS: In total, 49.3% and 34.7% of youths were overweight/obese and abdominally obese, respectively. The median visceral fat level was 4 (6). Youths consumed 214 (247) kcal of ultra-processed foods daily and exceeded the sugar [32.43 (41.20) g] and sodium recommendation [2425.26 (1455.18) mg]. Fruits [0.29±0.72 servings/day], vegetables [0.95±0.77 servings/day] and milk [0.24±0.38 servings/day] were below recommendations. Increased intake of meat and sodium were associated with higher BMI, waist circumference, body fat percentage, and visceral fat (p <  0.001). Greater intake of ultra-processed food was associated with high BMI (p = 0.009), waist circumference (p = 0.046), and visceral fat (p = 0.014). Besides, high sugar intake was associated with greater BMI (p = 0.003), body fat percentage (p = 0.020), and visceral fat (p = 0.027). CONCLUSIONS: Meat, sugar, sodium, and ultra-processed foods were high-risk foods associated with adiposity among young adults. There is a need to improve education and support to promote healthy eating for chronic disease prevention related to metabolic abnormalities.

Self-Care by Muslim Women during Ramadan Fasting to Protect Nutritional and Cardiovascular Health

The practice of Ramadan involves a series of changes in lifestyle, mainly in eating habits. The research aim of this study is to determine the prevalence of overweight-obesity, the degree of compliance with dietary recommendations and the effects of religious fasting on cardiovascular health among a population of Muslim women living in Melilla, a Spanish city in North Africa. A follow-up cohort study was conducted on 62 healthy adult women (33.6 ± 12.7 years). Anthropometric and body composition parameters were obtained using bioimpedance and dietary records. All of the participants were overweight or obese, especially due to the non-compliance with dietary recommendations; however, more than 60% considered their weight was appropriate or even low. By the end of Ramadan, the women's body mass index and fat component values had fallen significantly (p < 0.001), but this loss was later recovered. Dietary records revealed an excessive consumption of lipids and sodium, and the presence of a high waist-to-hip ratio. All of these factors are related to cardiovascular risk. In conclusion, promoting nutritional health and encouraging year-round self-care among adult Muslim women is necessary in order to ensure healthy fasting during Ramadan.

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.

Effect of very large body mass loss on energetics, mechanics and efficiency of walking in adults with obesity: mass-driven versus behavioural adaptations

Abstract

Understanding the mechanisms involved in the higher energy cost of walking (NC_w: the energy expenditure above resting per unit distance) in adults with obesity is pivotal to optimizing the use of walking in weight management programmes. Therefore, this study aimed to investigate the mechanics, energetics and mechanical efficiency of walking after a large body mass loss induced by bariatric surgery in individuals with obesity. Nine adults (39.5 ± 8.6 year; BMI: 42.7 ± 4.6 kg m^–2) walked at five fixed speeds before (baseline) and after the bariatric surgery (post 1 and post 2). Gas exchanges were measured to obtain NC_w. A motion analysis system and instrumented treadmill were combined to assess total mechanical work (W_tot). Mechanical efficiency (W_tot NC_w^–1) was also calculated. Participants lost 25.7 ± 3.4% of their body mass at post 1 (6.6 months; P < 0.001) and 6.1 ± 4.9% more at post 2 (12 months; P = 0.014). Mass‐normalized NC_w was similar between baseline and post 1 and decreased at post 2 compared to that at baseline (−6.2 ± 2.7%) and post 1 (−8.1 ± 1.9%; P ≤ 0.007). No difference was found in mass‐normalized W_tot during follow‐up (P = 0.36). Mechanical efficiency was similar at post 1 and post 2 when compared to that at baseline (P ≥ 0.19), but it was higher (+14.1 ± 4.6%) at post 2 than at post 1 (P = 0.013). These findings showed that after a very large body mass loss, individuals with obesity may reorganize their walking pattern into a gait more similar to that of lean adults, thus decreasing their NC_w by making their muscles work more efficiently.

Key points

A higher net (above resting) energy cost of walking (lower gait economy) is observed in adults with obesity compared to lean individuals.

Understanding the mechanisms (i.e. mass driven, gait pattern and behavioural changes) involved in this extra cost of walking in adults with obesity is pivotal to optimizing the use of walking to promote daily physical activity and improve health in these individuals.

We found that very large weight loss induced by bariatric surgery significantly decreased the energy cost of walking per kg of body mass after 1 year with similar total mechanical work per kg of body mass, resulting in an increased mechanical efficiency of walking.

Individuals with obesity may reorganize their walking pattern into a gait more similar to that of adults of normal body mass, thus decreasing their energy cost of walking by making their muscles work more efficiently.

Obesity and risk of age-related eye diseases: a systematic review of prospective population-based studies

BACKGROUND

Obesity is a public health challenge worldwide. The relationship between obesity and age-related eye diseases including cataract, glaucoma, age-related macular degeneration (AMD) and diabetic retinopathy (DR) have remained elusive.

DESIGN AND METHODS

We conducted a systematic review of three electronic databases for longitudinal population-based studies that described associations between measures of obesity including body mass index (BMI), waist-circumference (WC), and waist-to-hip ratio (WHR), and age-related eye diseases.

RESULTS

Our search yielded 1731 articles, of which 14, 10, 16 and 8 articles met our eligibility criteria for cataract, glaucoma, AMD and DR, respectively. BMI-defined obesity was positively associated with incident cataract, incident AMD and incident DR in Western populations, but in Asian populations associations for incident AMD were not significant and associations for incident DR were inverse. WC-defined obesity was associated with incident glaucoma in non-Western populations. WHR-defined obesity but not BMI-defined obesity was associated with the incidence or progression of AMD in two Western studies.

CONCLUSIONS

Overall, we found strong evidence supporting associations between obesity and age-related eye diseases. Further research on the association of abdominal obesity and effect of weight loss and physical activity on age-related eye diseases is warranted to support clinical and public health recommendations.

Lower High-Density Lipoprotein Cholesterol Concentration Is Independently Associated with Greater Future Accumulation of Intra-Abdominal Fat

BACKGROUND

Both intra-abdominal fat (IAF) and high-density lipoprotein cholesterol (HDL-C) are known to be associated with cardiometabolic health. We evaluated whether the accumulation of computed tomography (CT)-measured IAF over 5 years was related to baseline HDL-C concentration in a prospective cohort study.

METHODS

All participants were Japanese-Americans between the ages of 34 and 74 years. Plasma HDL-C concentration and CT measurements of IAF, abdominal subcutaneous fat (SCF), and thigh SCF cross-sectional areas were assessed at baseline and at 5-year follow-up visits.

RESULTS

A total of 397 subjects without diabetes were included. The mean±standard deviation HDL-C concentration was 51.6±13.0 mg/dL in men and 66.0±17.0 mg/dL in women, and the IAF was 91.9±48.4 cm2 in men and 63.1±39.5 cm2 in women. The baseline plasma concentration of HDL-C was inversely associated with the change in IAF over 5 years using multivariable regression analysis with adjustment for age, sex, family history of diabetes, weight change over 5 years, and baseline measurements of body mass index, IAF, abdominal SCF, abdominal circumference, thigh SCF, and homeostatic model assessment for insulin resistance.

CONCLUSION

These results demonstrate that HDL-C concentration significantly predicts future accumulation of IAF over 5 years independent of age, sex, insulin sensitivity, and body composition in Japanese-American men and women without diabetes.