Sonographic Assessment of Regional Adiposity

Abdominal subcutaneous fat thickness combined with a 50-g glucose challenge test at 24-28 weeks of pregnancy in predicting gestational diabetes mellitus

BACKGROUND

This investigation aimed to analyse the efficacy of abdominal subcutaneous fat thickness (ASFT) value >18.1 mm combined with a 50-g glucose challenge test (GCT) between 24-28 weeks of gestation in predicting gestational diabetes mellitus (GDM) cases.

METHODS

This cross-sectional study was carried out from February 2021 to December 2022. All pregnant women received a 50-g GCT at 24-28 weeks of pregnancy for the GDM screening. Pregnant women with a blood glucose value between 140-190 mg/dl experienced 100 g OGTT. Even if 50-g GCT was normal, 100-g OGTT was offered to patients with an ASFT value above 18.1 mm.

RESULTS

Among the 728 pregnant women we enrolled, 154 (21.2%) cases were screened as positive. The number of patients who first screened positive and determined to be GDM after the 100-g oral glucose tolerance test (OGTT) was 43 (5.9%). A total of 67 cases (9.2%) had an ASFT measurement above 18.1 mm. Two cases with a negative 50-g GCT and ASFT <18.1 mm were diagnosed as GDM in the later weeks of pregnancy. A 50-g GCT combined with ASFT measurement above 18.1 mm predicted GDM with a sensitivity of 87.9%, a specificity of 88.7%, a positive predictive value (PPV) of 36.0%, and a negative PV (NPV) of 99.7%.

CONCLUSIONS

A 50-g GCT combined with ASFT measurement that can be easily and accurately obtained during routine antenatal care in the second trimester might be a beneficial indicator for predicting GDM cases.

The predictive value of GLIM criteria on clinical outcomes and responses to nutritional support in patients with neurocritical illnesses

Neurocritically ill patients frequently exhibit coma, gastroparesis, and intense catabolism, leading to an increased risk of malnutrition. The Global Leadership Initiative on Malnutrition (GLIM) criteria for the diagnosis of malnutrition was created to achieve a consistent malnutrition diagnosis across diverse populations. This study aimed to validate the concurrent and predictive validity of GLIM criteria in patients with neurocritical illnesses. A total of 135 participants were followed from admission to the neurocritical unit (NCU) until discharge. Comparing GLIM criteria to the Subjective Global Assessment (SGA), sensitivity was 0.95 and specificity was 0.69. Predictive validity of GLIM criteria was assessed using a composite adverse clinical outcome, comprising mortality and various major complications. Adjusted hazard ratios for moderate and severe malnutrition were 2.86 (95% CI 1.45-5.67) and 3.88 (95% CI 1.51-9.94), respectively. Changes in indicators of nutritional status, including skeletal muscle mass and abdominal fat mass, within 7 days of admission were obtained for 61 participants to validate the predictive capability of the GLIM criteria for the patients' response of standardized nutritional support. The GLIM criteria have a statistically significant predictive validity on changes in rectus femoris muscle thickness and midarm muscle circumference. In conclusion, the GLIM criteria demonstrate high sensitivity for diagnosing malnutrition in neurocritically ill patients and exhibit good predictive validity.

Ultrasound-based measurement of central adiposity: Key considerations and guidelines

Central adiposity, which is visceral and subcutaneous adiposity in the abdominal region, is a known risk factor for developing chronic cardiometabolic diseases. Central adiposity can be measured relatively inexpensively using ultrasound. Ultrasound has been shown to be precise and reliable, with measurement accuracy comparable to computed tomography and magnetic resonance. Despite the advantages conferred by ultrasound, widespread adoption has been hindered by lack of reliable standard operating procedures. To consolidate the literature and bring clarity to the use of ultrasound-derived measures of central adiposity, this review outlines (i) the [patho]physiological importance of central adiposity to cardiometabolic disease risk; (ii) an overview of the history and main technical aspects of ultrasound methodology; (iii) key measurement considerations, including transducer selection, subject preparation, image acquisition, image analysis, and operator training; and (iv) guidelines for standardized ultrasound protocols for measuring central adiposity.

Laser Diode - GaAlAs Acupuncture in the Treatment of Central Obesity: a Randomized Clinical Trial

Background

: Obesity is a global health challenge. Traditional approaches, including increased physical activity, dietary interventions, and medical therapy, often yield limited success, propelling some patients toward costly and invasive procedures like bariatric surgery. Laser acupuncture has been suggested as a complementary therapeutic approach to overcome this challenge. The present study investigated the effectiveness of laser acupuncture treatment in weight loss and abdominal subcutaneous fat reduction.

Methods

: A randomized, blinded, sham-controlled clinical trial was conducted, with 30 subjects each in the intervention and control groups. Patients in the intervention group underwent 12 sessions of laser acupuncture treatment within a month (three sessions/week), whereas those in the control group received sham laser treatment on identical acupoints. The patients were instructed not to alter their physical activity levels or dietary regimens. All parameters were evaluated before and after the treatment.

Results

: Significant reductions in weight, body mass index, and waist circumference were noted in both intervention and control groups. Further analysis revealed a more significant decrease in the laser acupuncture group. Abdominal sonography revealed a marked decrease in periumbilical fat thickness in the intervention group. Conversely, laboratory evaluations showed no significant difference between the two groups.

Conclusion

: Laser acupuncture is an effective method for weight loss in patients with periumbilical abdominal fat. The observed impact on subcutaneous fat suggests its potential as a non-invasive intervention for individuals seeking weight management alternatives. Further research is warranted to validate these findings and explore the underlying mechanisms of laser acupuncture in adipose tissue modulation.

CT and MR imaging of the properitoneal fat pad: a pictorial essay

The properitoneal fat pad is a distinctive anatomical structure located in the midline of anterior abdominal wall between the transversalis fascia and parietal peritoneum. It has variable size and configuration depending on the gender and nutritional status of individuals, but CT and MR images of the upper abdomen can readily depict its shape and adipose composition. The purpose of this essay is to illustrate the CT and MRI features of normal properitoneal fat pad, and the spectrum of pathological processes that affect it among patients. This information can be relevant to the practicing radiologists and clinicians for the correct diagnosis and management of such conditions because most lesions of this fat pad produce nonspecific symptoms.

Unraveling the Connection: Visceral Adipose Tissue and Vitamin D Levels in Obesity

Vitamin D deficiency and insufficiency are widespread on a global scale, with multiple factors playing a role in their development, such as limited exposure to sunlight, inadequate dietary consumption, as well as obesity and abdominal fat accumulation. Abdominal obesity, assessed with waist circumference (WC), is associated with metabolic syndrome and has been linked to low vitamin D levels. This study aimed to investigate the relationship between visceral adipose tissue (VAT) and vitamin D levels, particularly examining the potential threshold for vitamin D storage and sequestration using adipose tissue. The study was conducted between 2020 and 2022 with 58 patients from an internal medicine outpatient department. Patients with certain medical conditions and those taking medications affecting bone metabolism were excluded. Blood samples were collected at baseline and after 6 months of monthly cholecalciferol supplementation. Ultrasonography was used to evaluate adipose tissue measurements, including subcutaneous adipose tissue thickness, VAT, preperitoneal adipose tissue (PPAT), and prerenal adipose tissue (PRAT). Anthropometric measures such as the waist-to-hip ratio and waist-to-height ratio were also assessed. The results showed that all subjects had significant hypovitaminosis D at baseline. After 6 months of supplementation, the mean increase in vitamin D levels was 9.6 ng/mL, with 55.2% of subjects becoming deficient. The study revealed a significant correlation between follow-up vitamin D levels and waist circumference, hip circumference, and VAT. VAT exhibited a strong correlation not only with vitamin D levels but also with waist circumference. When analyzing gender differences, males showed a higher weight and waist-to-hip ratio, while females had higher body adiposity indexes and subcutaneous adipose tissue measurements. In conclusion, this study highlights the relationship between VAT and vitamin D levels, emphasizing the potential role of adipose tissue in vitamin D availability. Waist circumference was identified as a surrogate measure for VAT evaluation. Furthermore, the study showed variations in vitamin D response to supplementation between genders, with a higher percentage of males reaching normal vitamin D levels. Predictive factors for vitamin D levels differed between genders, with waist circumference being a significant predictor in males and body adiposity index in females.

Predictive importance of the visceral adiposity index and atherogenic index of plasma of all-cause and cardiovascular disease mortality in middle-aged and elderly Lithuanian population

Background

Two indices: visceral adiposity index (VAI) and atherogenic index of plasma (AIP) during several recent years were implemented into epidemiological studies for predicting of cardiovascular diseases (CVD) and mortality risk. Our study aimed to evaluate the association of VAI and AIP with the risk of all-cause and CVD mortality among the Lithuanian urban population aged 45–72 years.

Methods

In the baseline survey (2006–2008), 7,115 men and women 45–72 years of age were examined within the framework of the international study Health, Alcohol and Psychosocial Factors in Eastern Europe (HAPIEE). Six thousand six hundred and seventy-one participants (3,663 women and 3,008 men) were available for statistical analysis (after excluding 429 respondents with the missed information on study variables) and for them, VAI and AIP were calculated. The questionnaire evaluated lifestyle behaviors, including smoking and physical activity. All participants in the baseline survey were followed up for all-cause and CVD mortality events until December 31st, 2020. Multivariable Cox regression models were applied for statistical data analysis.

Results

After accounting for several potential confounders, higher levels of VAI (compared 5th quintile to 1st quintile) were associated with significantly higher CVD mortality in men [Hazards ratio (HR) = 1.38] and all-cause mortality in women (HR = 1.54) after 10-year follow-up. CVD mortality significantly increased in men with 0 the highest AIP quintile compared with that for the lowest quintile (HR = 1.40). In women, all-cause mortality was significantly higher for the 4th quintile of AIP as compared with the 1st quintile (HR = 1.36).

Conclusions

High-risk VAI levels were statistically significantly associated with all-cause mortality risk in men and women groups. The higher AIP level (5th quintile vs. 1st quintile—in men and 4th quintile vs. 1st quintile—in women) was significantly associated with increased mortality from CVD in the men group and increased all-cause mortality in the women group.

Evaluation of anterolateral thigh flap dimensions with virtual flap models

Free flaps are commonly used for head and neck reconstruction. However, flap dimensions are still evaluated by visual and tactile assessment. The aim of this study was to enable preoperative planning of flap dimensions for soft tissue reconstruction based on clinical parameters. Computed tomography records from 230 patients dated from 2009 to 2019 were analysed retrospectively. A virtual, three-dimensional anterolateral thigh flap model was standardized, aligned to segmented leg models in two positions, and flap thicknesses and volumes were determined. Associations of flap thickness and volume with clinical parameters were evaluated, and an approximative calculation method was derived. The laterally positioned anterolateral thigh flap showed an average (interquartile range) thickness of 15.6 mm (8.7 mm) and volume of 1.5 cm³ (0.9 cm³) per cm². The medially positioned anterolateral thigh flap showed an average (interquartile range) thickness of 16.3 mm (8.7 mm) and volume of 1.6 cm³ (0.9 cm³) per cm². For both flap positions, leg circumference was the strongest predictor of flap thickness (β = 0.545, P < 0.001 and β = 0.529, P < 0.001) and flap volume (β = 0.523, P < 0.001 and β = 0.480, P < 0.001). Flap dimensions can be calculated based on leg circumference, and this preoperative planning of flap dimensions can help the surgeon to select the appropriate flap.

Impact of Dysfunctional Adipose Tissue Depots on the Cardiovascular System

Obesity with its associated complications represents a social, economic and health problem of utmost importance worldwide. Specifically, obese patients carry a significantly higher risk of developing cardiovascular disease compared to nonobese individuals. Multiple molecular mechanisms contribute to the impaired biological activity of the distinct adipose tissue depots in obesity, including secretion of proinflammatory mediators and reactive oxygen species, ultimately leading to an unfavorable impact on the cardiovascular system. This review summarizes data relating to the contribution of the main adipose tissue depots, including both remote (i.e., intra-abdominal, hepatic, skeletal, pancreatic, renal, and mesenteric adipose fat), and cardiac (i.e., the epicardial fat) adipose locations, on the cardiovascular system. Finally, we discuss both pharmacological and non-pharmacological strategies aimed at reducing cardiovascular risk through acting on adipose tissues, with particular attention to the epicardial fat.

Once-Weekly Subcutaneous Semaglutide Improves Fatty Liver Disease in Patients with Type 2 Diabetes: A 52-Week Prospective Real-Life Study

Background. Nonalcoholic fatty liver disease (NAFLD) is commonly observed in patients with type 2 diabetes (T2D). Semaglutide, a glucagon-like peptide 1 receptor agonist, may have a therapeutic role by targeting common mechanisms involved in the pathophysiology of T2D and NAFLD. The study aimed to assess the effectiveness of Semaglutide on NAFLD in patients with T2D. Methods. Forty-eight patients were treated with subcutaneous Semaglutide in add-on to metformin for 52 weeks. After the baseline visit (T0), follow-up was scheduled quarterly (T3, and T6) and then at 12 months of therapy (T12). During each visit, body composition was analyzed by phase-sensitive bio-impedance, and NAFLD was diagnosed and staged by Ultrasound (US) imaging. Surrogate biomarkers of NAFLD were also calculated and followed over time. Results. A significant decrease in anthropometric and glucometabolic parameters, insulin resistance, liver enzymes, and laboratory indices of hepatic steatosis was observed during treatment. Similarly, fat mass and visceral adipose tissue (VAT) decreased over time more than skeletal muscle and free-fat mass. US-assessed VAT thickness and the 12-point steatosis score also declined at T3 up to T12. Liver steatosis improved in most patients (70%), showing a reduction by at least one class in the semiquantitative US staging. Conclusion. Besides glucose control and body composition improvements, Semaglutide was effective in ameliorating the clinical appearance and severity of NAFLD in T2D patients.

Once-Weekly Semaglutide Induces an Early Improvement in Body Composition in Patients with Type 2 Diabetes: A 26-Week Prospective Real-Life Study

BACKGROUND

Body weight (BW) loss is an essential therapeutic goal in type 2 diabetes (T2D). Glucagon-like peptide-1 receptor agonists are effective in reducing BW, but their effect on body composition has not yet been fully explored. The study aim was to assess the impact of Semaglutide on body composition in patients with T2D.

METHODS

Forty patients with T2D were treated with subcutaneous Semaglutide and evaluated at the baseline (T0) and after three (T3) and six (T6) months. Body composition was assessed by a phase-sensitive bioimpedance analyzer. Visceral adipose tissue (VAT) thickness was also measured with an ultrasonographic method (US-VAT). Anthropometric variables, muscular strength, and laboratory tests were analyzed and compared.

RESULTS

A significant decrease in VAT, the fat mass index (FMI), and BW loss was observed at all observation times. US-VAT, the skeletal mass index (SMI), the fat-free mass index (FFMI), waist circumferences, and glycated hemoglobin had lessened after three months and remained stable at T6. No variations in muscle strength, the muscle quality index, and body water were found.

DISCUSSION

In a real-life setting, Semaglutide provided significant weight loss mainly due to a reduction in the FMI and VAT, with non-clinically relevant changes in the SMI, the FFMI, and muscle strength. Most importantly, the results were obtained after three months of treatment and persisted thereafter.

Ultrasonographic measurement of abdominal and gluteal-femoral fat thickness as a predictor for android/gynoid ratio

OBJECTIVE

To evaluate the use of ultrasonography (US) as an alternative to dual-energy x-ray absorptiometry (DXA) to predict the percentage ratio of android/gynoid (A/G) fat mass.

METHODS

This was a cross-sectional study. Twenty-eight participants included in the study underwent whole-body DXA examinations and the A/G ratio was calculated. Soft-tissue US was performed in several standardised anthropometric areas of the body. Correlation analysis between abdominal and gluteal-femoral fat thickness based on US and A/G ratio was conducted using the Pearson or Spearman test depending on the data normality. Multiple regression analysis using the backward stepwise method was performed to establish an equation for estimating the A/G ratio.

RESULTS

There was a strong and significant correlation between fat thickness in the six anthropometric areas and the A/G ratio in female participants. The analysis revealed three anthropometric areas: upper abdomen (S4), lower abdomen (S5), and mid-xiphoid-umbilical region (S7), that can accurately predict the A/G ratio by 82.3%. (P < 0.05). However, no such correlation was found in male participants.

CONCLUSIONS

US measurement of fat thickness can predict A/G ratio in the female population. However, this method is not recommended for men.

Visceral fat in different locations assessed by ultrasound: Correlation with computed tomography and cut-off values in patients with metabolic syndrome

The aim of this study was to evaluate the correlation between ultrasound measurements of visceral adipose tissue (VAT) in different locations and visceral fat area parameters estimated by computed tomography (CT), as well as to determine the cut-off values of ultrasound measurements in patients with metabolic syndrome and in normal controls. Altogether, 304 patients aged 18 to 65 years were enrolled in the study. Ultrasound measurements of visceral fat volume were performed using a number of already described techniques. The correlations of ultrasound indices of VAT and СТ (104 patients) ranged from 0.420 to 0.726. For the most effective diagnostic VAT ultrasound indices, the cut-off values in metabolic syndrome were (200 patients): 21.12 cm² for the inferior part of perirenal fat (AUC = 0.983); and 47.00, 61.3 and 72.7 mm for the distance between the internal surface of the rectus abdominis muscle and the anterior wall of the aorta, the posterior wall of the aorta and the lumbar vertebra (AUC = 0.960, 0.966, 0.968, respectively). Ultrasound VAT measurements highly correlated with CT results. Cut-off VAT values, determined by ultrasound for the patients with metabolic syndrome, yielded good diagnostic operational characteristics.

The relationship between abdominal fat and change in left ventricular ejection fraction in cancer patients

Objectives

Prior studies have identified a relationship between body mass index (BMI) and intraperitoneal (IP) fat with heart failure; however, in prior studies of cancer patients receiving potentially cardiotoxic chemotherapy, elevations in BMI have not necessarily been associated with decrements in heart function. This study tested the hypothesis that IP fat may be associated with left ventricular ejection fraction (LVEF) decline among cancer patients receiving potentially cardiotoxic chemotherapy.

Methods

In this prospective study of 61 cancer patients (23 breast cancer, 32 lymphoma, and 6 sarcoma), IP fat and other assessments of body composition, and changes in LVEF from pre- to postcancer treatment using noninvasive magnetic resonance imaging was ascertained.

Results

After accounting for age, baseline LVEF, and confounding variables, pre- to 24-month post-treatment LVEF changes were inversely correlated with IP fat (r = -0.33; p = 0.02) and positively correlated with measures of subcutaneous (SQ) fat (r = 0.33; p = 0.01). These LVEF changes were not correlated with BMI (r = 0.12; p = 0.37).

Conclusion

Among patients receiving potentially cardiotoxic chemotherapy, pretreatment IP fat was associated with subsequent declines in LVEF. There was no association between BMI and LVEF decline. These findings may be related to a potential protective effect of SQ fat.

Ultrasound imaging, a stethoscope for body composition assessment

Dysregulation of the human's energy balance, mediated by non-performing endocrine organs (liver, skeletal muscle and adipose tissue, above all), can be related to human metabolic disorders characterized by an impaired body composition (BC), such as obesity and sarcopenia. While it is possible to monitor the BC and its variations at different levels, the tissue-organ composition studies have been proven to provide the most clinically applicable information. Ultrasonography (US), a fast, non-invasive, low-cost and widely available technique, holds great potential in the study of BC, as it can directly measure muscles, organs, visceral and subcutaneous fat tissue in different sections of the abdomen and body, overcoming some limits of anthropometric evaluation and other imaging techniques. Purpose of this review article is to explore the technical aspects and the applied methods of US examination to assess the potential clinical role of this technique in the context of BC characterization, investigating four pivotal topics [abdominal fat compartments, subcutaneous adipose tissue (SAT), skeletal muscle, liver].

[Anthropometric measures in the German National Cohort-more than weight and height]

High levels of adiposity in the population have a major impact on various diseases, but previous epidemiologic studies have largely been restricted to simple anthropometric measures such as the body mass index (BMI), an imperfect predictor of disease risk. There is a critical need for the use of improved measures of relative weight and body composition in large-scale, population-based research.The current article presents initial descriptive results of body composition and fat distribution based on the midterm baseline dataset of the German National Cohort, which included 101,817 participants who were examined in 18 study centers in Germany between March 2014 and March 2017. The anthropometric measures encompassed body weight, height, waist and hip circumference, bioelectrical impedance analysis (BIA), sonography of abdominal adipose tissue, 3D-body scanning, and magnetic resonance imaging.BMI analyses showed that 46.2% of men and 29.7% of women were overweight and 23.5% of men and 21.2% of women were obese. On average, women in almost all age groups demonstrated more subcutaneous adipose tissue layer thickness than men. The mean values of visceral adipose tissue layer thickness, on the other hand, were higher among men than among women in all age groups and increased continuously across age groups in both sexes.The comprehensive assessment of body composition and fat distribution provides novel future opportunities for detailed epidemiologic analyses of overweight and adiposity in relation to the development of chronic diseases.

Ultrasound assessment of maternal adipose tissue during 1st trimester screening for aneuploidies and risk of developing gestational diabetes

INTRODUCTION

The objective of the present study is to compare the sonographic measurement of subcutaneous adipose thickness and visceral adipose thickness during 1st trimester screening for aneuploidies between non-diabetic pregnant women and patients who develop 1st trimester or 2nd trimester gestational diabetes mellitus (GDM).

MATERIAL AND METHODS

Adipose thickness was measured by transabdominal ultrasound imaging in pregnant women attending our clinic for screening for fetal aneuploidies between 11 and 13 weeks of gestation. During the 1st trimester all patients were evaluated for fasting glycemia in accordance with the International Association of Diabetes and Pregnancy Study Groups (IADPSG) recommendations. Patients with confirmed fasting glycemia (FPG) ≥92 mg/dL were diagnosed as 1st trimester GDM. Patients with FPG <92 mg/dL underwent a 75-g oral glucose tolerance test between 24 and 28 weeks.

RESULTS

The study population included 238 non-diabetic women, 29 women with 1st trimester GDM and 28 women with 2nd trimester GDM. Mean subcutaneous adipose thickness and visceral adipose thickness values in non-diabetic women were 9.8 mm (standard deviation [SD = 4.9) and 7.2 mm (SD = 3.5), respectively. Values in women with 1st trimester GDM were 12.8 mm (SD = 6.5) and 9.9 mm (SD = 4.4). In the 2nd trimester GDM group, the mean subcutaneous adipose thickness was 11.1 mm (SD = 4.6) and the mean visceral adipose thickness 10.5 mm (SD = 5.3). Multiple logistic regression analysis showed that visceral adipose thickness, but not subcutaneous adipose thickness, was significantly and independently associated with both 1st trimester GDM (OR 1.15, 95% CI 1.02-1.29) and 2nd trimester GDM (odds ratio [OR] 1.19, 95% confidence interval [CI] 1.05-1.34).

CONCLUSIONS

Sonographic thickness of maternal visceral adipose tissue was greater in women with GDM than in non-diabetic patients, independently of other known risk factors associated with GDM in the 1st and in the 2nd trimester of pregnancy. Thus, this measurement may be considered of clinical use in 1st trimester screening.

Inter and intra-reliability of ultrasonography for the measurement of abdominal subcutaneous & visceral adipose tissue thickness at 12 weeks gestation

BACKGROUND

Excess abdominal adiposity cause metabolic disturbances, particularly in pregnancy. Methods of accurate measurement are limited in pregnancy due to risks associated with these procedures. This study outlines a non-invasive methodology for the measurement of adipose tissue in pregnancy and determines the intra- and inter-observer reliability of ultrasound (US) measurements of the two components of adipose tissue (subcutaneous (SAT) and visceral adipose tissue (VAT)) within a pregnant population.

METHODS

Thirty pregnant women were recruited at the end of their first trimester, from routine antenatal clinic at the University Maternity Hospital Limerick, Ireland. Measurements of adipose tissue thickness were obtained using a GE Voluson E8 employing a 1-5 MHz curvilinear array transducer. Two observers, employing methodological rigour in US technique, measured thickness of adipose tissue three times, and segmented the US image systematically in order to define measurements of SAT and VAT using specifically pre-defined anatomical landmarks.

RESULTS

Intra-observer and inter-observer precision was assessed using Coefficient of Variation (CV). Measurements of SAT and total adipose for both observers were < 5% CV and < 10% CV for VAT in measures by both observers. Inter-observer reliability was assessed by Limits of Agreement (LoA). LoA were determined to be - 0.45 to 0.46 cm for SAT and - 0.34 to 0.53 cm for VAT values. Systematic bias of SAT measurement was 0.01 cm and 0.10 cm for VAT. Inter-observer precision was also assessed by coefficient of variation (CV: SAT, 3.1%; VAT, 7.2%; Total adipose, 3.0%).

CONCLUSION

Intra-observer precision was found to be acceptable for measures of SAT, VAT and total adipose according to anthropometric criterion, with higher precision reported in SAT values than in VAT. Inter-observer reliability assessed by Limits-Of-Agreement (LoA) confirm anthropometrically reliable to 0.5 cm. Systematic bias was minimal for both measures, falling within 95% confidence intervals. These results suggest that US can produce reliable, repeatable and accurate measures of SAT and VAT during pregnancy.

ADRB2 GLN27GLU POLYMORPHISM ASSOCIATED WITH ADIPOSITY INDICATORS AND IL-10 IN ADOLESCENTS

ABSTRACT Introduction: Studies of association between obesity and genetic factors have demonstrated a significant contribution of polymorphisms related to body fat distribution and subclinical inflammatory process. Objective: To investigate the association between genotypes of the Gln27Glu polymorphism of the ADRB2 gene and indicators of adiposity, inflammatory markers, metabolic parameters and parameters of physical fitness in overweight adolescents. Methods: A total of 44 male and female adolescents, aged between 13 and 17 years, with positive clinical diagnosis of overweight, were divided into two groups according to the Gln27Glu polymorphism genotypes of the ADRB2 gene: a) Group of carriers of the 27Glu allele (Gln27Glu/Glu27Glu) (n = 22); b) Group of non-carriers of the 27Glu allele (Gln27Gln) (n = 22). Both groups were evaluated for body composition, sexual maturation, cardiorespiratory fitness variables and indicators of muscle strength. Basal glycemia and insulin, lipid profile and inflammatory profile were measured. Abdominal subcutaneous and visceral adiposities were evaluated by ultrasonography. Genotyping of the Gln27Glu polymorphism of the ADRB2 gene was performed by the Taqman allelic discrimination assay. Results: The genotype frequency found was: Gln/Gln (n = 22) (50.0%), Gln/Glu (n = 18) (41.0%) and Glu/Glu (n = 4) %). The frequency of the 27Glu allele was 29.5%. The group of adolescent carriers of the 27Glu allele of the ADRB2 gene presented higher mean adiposity indicators (abdominal circumference, trunk fat mass and visceral fat), as well as lower IL-10 concentrations when compared to non-carriers. Conclusions: The 27Glu allele was associated with adiposity indicators in overweight adolescents, while subcutaneous abdominal fat exhibited an inverse relationship with inflammatory variables and maximum oxygen uptake, which may result in more damage to health. Level of evidence III; Case-control study.

Body fat index: A novel alternative to body mass index for prediction of gestational diabetes and hypertensive disorders in pregnancy

OBJECTIVES

To evaluate the association of ultrasound measurement of maternal abdominal subcutaneous and pre-peritoneal fat thickness in relation to the subsequent diagnosis of gestational diabetes (GDM), and to assess the association of body fat index (BFI), compared to conventional body mass index (BMI), with respect to the development of some obstetric related complications.

STUDY DESIGN

A prospective study included non-diabetic pregnant women who were scheduled for fetal anatomic survey. Women underwent fat measurements and BFI (pre-peritoneal fat x subcutaneous fat/height) was calculated. They underwent routine glucose screening and diagnostic tests for GDM. Obstetric complications, mode of delivery, and delivery related events were reported. Multivariable logistic regression was used to test potential predictors for development of obesity-related complications. Primary outcome was development of GDM. Secondary outcomes included development of hypertensive disorders during pregnancy and need for cesarean delivery due to labor dystocia. The optimal cut-off points for continuous variables were obtained using a receiver operating characteristic (ROC) curve analyses.

RESULTS

389 women met study criteria. Median gestational age at time of ultrasound evaluation was 19.1 weeks. Positive family history of diabetes (adjusted odds ratio "OR" 2.30, 95% CI 1.35-3.92), history of GDM (adjusted OR 6.87, 95% CI 3.03-15.61), subcutaneous fat≥13 mm (adjusted OR 4.63, 95% CI 1.60-13.38) and pre-peritoneal fat≥12 mm (adjusted OR 3.32, 95% CI 1.06-10.42) were significant predictors for development of GDM. ROC analysis demonstrated that a BFI > 0.5 was statistically superior to a BMI > 25 or 30 as a predictor of gestational diabetes (adjusted OR 6.24, 95% CI 1.86-20.96). A Similar ROC analysis demonstrated that a BFI > 0.8 was associated with a higher risk for the development of hypertensive disorders of pregnancy (adjusted OR 2.70 [95% CI 1.60-4.55]), and need for cesarean delivery (adjusted OR 2.01[95% CI 1.23-3.28]) than a BMI > 25 or 30.

CONCLUSION

Values obtained by ultrasound measurement of subcutaneous and pre-peritoneal fat are associated with development of GDM and hypertensive disorders in pregnancy. Our data suggest that BFI was a better predictor than BMI for development of GDM and hypertensive disorders in pregnancy and should be studied further.

Comparative Study of Ultrasonographic and Anthropometric Measurements of Regional Adiposity in Metabolic Syndrome

INTRODUCTION

Metabolic syndrome is complex disorder unifying dyslipidemia, insulin resistance and hyper insulinemia. Rising global epidemic of obesity has tremendous impact on metabolic syndrome. Ultrasound is becoming widely utilized modality for measuring the visceral adiposity.

AIM

To determine the usefulness of ultrasonographic measurements in the estimation of regional adiposity and to compare them with anthropometric measurements and to correlate ultrasonographic measurements of regional adiposity and metabolic syndrome.

MATERIALS AND METHODS

A cross-sectional study was conducted to compare anthropometry and ultrasonography in assessing the regional adiposity in metabolic syndrome. A total of 105 consecutive participants were included in the study after scrutinizing them for various definable factors of metabolic syndrome. Body Mass Index (BMI) of all participants was calculated and their available serological investigations were gathered. Primarily participants were subjected for anthropometric measurements like waist circumference and hip circumference, further waist/hip ratio was calculated. Following which all participants underwent sonological examination and sonographic indices like intraabdominal fat thickness, preperitoneal fat thickness, minimum and maximum subcutaneous fat thicknesses were measured. Abdominal wall fat index was calculated as ratio of maximum preperitoneal fat thickness to minimum subcutaneous fat thickness. Statistical analysis was performed using SPSS (Statistical Package Social Science, version-10.0.5) software. A p-value was calculated and values <0.05 were considered as statistically significant.

RESULTS

Significant correlation was established between the BMI and waist and hip circumferences. Mild positive correlation was obtained between BMI and sonographic indices like IAF, SCF and PPF with Pearson correlation (r) values of 0.324, 0.585 and 0.211 respectively. Anthropometric measurements showed higher r-values (WC- 0.624 and HC- 0.825) than sonographic indices; indicating anthropometry is better in assessing the regional adiposity than the sonography.

CONCLUSION

Sonography can be considered as one of the reliable imaging modality for assessing the regional adiposity but not as better as waist or hip circumferences.

Reproducibility of abdominal fat assessment by ultrasound and computed tomography

Objective:

To test the accuracy and reproducibility of ultrasound and computed tomography (CT) for the quantification of abdominal fat in correlation with the anthropometric, clinical, and biochemical assessments.

Materials and Methods:

Using ultrasound and CT, we determined the thickness of subcutaneous and intra-abdominal fat in 101 subjects-of whom 39 (38.6%) were men and 62 (61.4%) were women-with a mean age of 66.3 years (60-80 years). The ultrasound data were correlated with the anthropometric, clinical, and biochemical parameters, as well as with the areas measured by abdominal CT.

Results:

Intra-abdominal thickness was the variable for which the correlation with the areas of abdominal fat was strongest (i.e., the correlation coefficient was highest). We also tested the reproducibility of ultrasound and CT for the assessment of abdominal fat and found that CT measurements of abdominal fat showed greater reproducibility, having higher intraobserver and interobserver reliability than had the ultrasound measurements. There was a significant correlation between ultrasound and CT, with a correlation coefficient of 0.71.

Conclusion:

In the assessment of abdominal fat, the intraobserver and interobserver reliability were greater for CT than for ultrasound, although both methods showed high accuracy and good reproducibility.

Occurrence of Diabetes Mellitus in Obese Nondiabetic Patients, with Correlative Analysis of Visceral Fat, Fasting Insulin, and Insulin Resistance: A 3-year Follow-up Study (Mysore Visceral Adiposity in Diabetes Follow-up Study)

OBJECTIVE

To assess the occurrence of diabetes in obese nondiabetic patients over a 3-year follow-up period with a correlative analysis of visceral fat (VF), fasting insulin levels, (FILs) and insulin resistance (IR).

MATERIAL AND METHODS

Thirty-seven obese and nineteen nonobese nondiabetics of our previous study, Mysore Visceral Adiposity in Diabetes were followed for the next 3 years. Their blood pressure, body mass index, waist circumference (WC), fasting blood sugar (FBS), FIL, lipid profile and subcutaneous fat (SCF), and VF measurement by US method were repeated every 6 months for the next 3 years. The findings were analyzed with appropriate statistical methods.

RESULTS

Twenty-three obese and 18 nonobese nondiabetics completed the study. There were 17 dropouts. The changes in the physical and biochemical characteristics of the two groups before and after the study were not significant. SCF had no correlation with IR whereas VF correlated with FIL and IR. There were three diabetics in the obese group and two from the control group at the end of the study. There were 12 impaired glucose tolerance (IGT) in the test group and 2 in the control group. Those who developed diabetes had higher VF, WC, FBS, FIL, and IR. Those who showed IGT also had these at higher levels compared to others. There was no change in the VF at the end of the study.

CONCLUSIONS

This follow-up study on South Indians has shown that VF is a significant risk factor for the development of IR. IR can develop without any increase in the volume of the VF, is the essential finding of this study. SCF has not shown any significant relationship with IR. We recommend FBS and FIL in all the obese nondiabetics to calculate IR, which has given much insight in the development of IGT and diabetes. Large multicentric, longitudinal studies are required to establish the cause of IR.

Abdominal Adiposity Distribution Quantified by Ultrasound Imaging and Incident Hypertension in a General Population

Abdominal obesity is a major risk factor for hypertension. However, different distributions of abdominal adipose tissue may affect hypertension risk differently. The main purpose of this study was to explore the association of subcutaneous abdominal adipose tissue (SAT) and visceral adipose tissue (VAT) with incident hypertension in a population-based setting. We hypothesized that VAT, rather than SAT, would be associated with incident hypertension. VAT and SAT were determined by ultrasound imagining in 3363 randomly selected Danes (mean age 49 years, 56% women, mean body mass index 25.8 kg/m 2 ). We constructed multiple logistic regression models to compute standardized odds ratios with 95% confidence intervals per SD increase in SAT and VAT. Of the 2119 normotensive participants at baseline, 1432, with mean SAT of 2.8 cm and mean VAT of 5.7 cm, returned 5 years later for a follow-up examination and among them 203 had developed hypertension. In models including both VAT and SAT, the Framingham Hypertension Risk Score variables (age, sex, smoking status, family history of hypertension, and baseline blood pressure) and glycated hemoglobin, odds ratio (95% confidence interval) for incident hypertension for 1 SD increase in VAT and SAT was 1.27 (1.08–1.50, P =0.004) and 0.97 (0.81–1.15, P =0.70), respectively. Adjusting for body mass index instead of SAT attenuated the association between VAT and incident hypertension, but it was still significant (odds ratio, 1.22 [1.01–1.48, P =0.041] for each SD increase in VAT). In conclusion, ultrasound-determined VAT, but not SAT, was associated with incident hypertension in a random sample of Danish adults.

Relative abdominal adiposity is associated with chronic low back pain: a preliminary explorative study

Background

Although previous research suggests a relationship between chronic low back pain (cLBP) and adiposity, this relationship is poorly understood. No research has explored the relationship between abdominal-specific subcutaneous and visceral adiposity with pain and disability in cLBP individuals. The aim of this study therefore was to examine the relationship of regional and total body adiposity to pain and disability in cLBP individuals.

Methods

A preliminary explorative study design of seventy (n = 70) adult men and women with cLBP was employed. Anthropometric and adiposity measures were collected, including body mass index, waist-to-hip ratio, total body adiposity and specific ultrasound-based abdominal adiposity measurements. Self-reported pain and disability were measured using a Visual Analogue Scale (VAS) and the Oswestry Disability Index (ODI) questionnaires respectively. Relationships between anthropometric and adiposity measures with pain and disability were assessed using correlation and regression analyses.

Results

Significant correlations between abdominal to lumbar adiposity ratio (A-L) variables and the waist-to-hip ratio with self-reported pain were observed. A-L variables were found to predict pain, with 9.1–30.5 % of the variance in pain across the three analysis models explained by these variables. No relationships between anthropometric or adiposity variables to self-reported disability were identified.

Conclusions

The findings of this study indicated that regional distribution of adiposity via the A-L is associated with cLBP, providing a rationale for future research on adiposity and cLBP.

Body composition and functional assessment of nutritional status in adults: a narrative review of imaging, impedance, strength and functional techniques

The accurate and valid assessment of body composition is essential for the diagnostic evaluation of nutritional status, identifying relevant outcome measures, and determining the effectiveness of current and future nutritional interventions. Developments in technology and our understanding of the influences of body composition on risk and outcome will provide practitioners with new opportunities to enhance current practice and to lead future improvements in practice. This is the second of a two-part narrative review that aims to critically evaluate body composition methodology in diverse adult populations, with a primary focus on its use in the assessment and monitoring of under-nutrition. Part one focused on anthropometric variables [Madden and Smith (2016) J Hum Nutr Diet 29: 7-25] and part two focuses on the use of imaging techniques, bioelectrical impedance analysis, markers of muscle strength and functional status, with particular reference to developments relevant to practice.

Ultrasound: Which role in body composition?

Ultrasound is a non-invasive, fast, relatively inexpensive and available tool for estimating adiposity in clinical practice, and in several research settings. It does not expose patients to ionizing radiation risks, making the method ideal for the evaluation, and for follow-up studies. Several parameters and indexes based on adipose tissue thickness have been introduced and tested, and these have been correlated with clinical and laboratoristic parameters. Moreover, ultrasound can also be directed to the estimation of adipose tissue and intracellular fat indirectly, at cellular-molecular level: an opportunity for many radiologists who already and sometimes unconsciously perform "body composition" assessment when looking at the liver, at muscle as well as at other organs. However, standardized procedure and parameters are needing to improve accuracy and reproducibility. The purposes of this review are: 1) to provide a complete overview of the most used and shared measurements of adiposity; 2) to analyze technical conditions, accuracy, and clinical meaning of ultrasound in the study of body composition; 3) to provide some elements for the use of ultrasound in the evaluation of intra-cellular lipids accumulation, in two hot spots: liver and skeletal muscle.

Obesity, ultrasound indexes of fat depots and lipid goal attainment in patients with high and very high cardiovascular risk: A novel approach towards better risk reduction

AIM

Our aim was to assess the attainment of primary (low density lipoprotein cholesterol; LDL-C) and secondary (non-high density lipoprotein cholesterol; non-HDL-C) lipid therapeutic goals in relation to obesity, clinical measures of adiposity and ultrasound indexes of fat depots, including the novel index of periarterial adipose tissue (PAT): carotid artery extra media thickness (EMT).

METHODS AND RESULTS

High and very high cardiovascular (CV) risk patients (n = 420; F/M: 34/66%; age: 61.2 ± 7 years) with prior statin treatment (≥ 18 months) were enrolled into this cross-sectional study. All patients had a detailed assessment with several anthropometric measures and ultrasound indexes of fat depots indexed to BMI: abdominal (Intra-abdominal Fat Thickness; IAT and Pre-peritoneal Fat Thickness; PreFT), paracardial (Epicardial Fat Thickness; EFT and Pericardial Fat Thickness; PFT) and the new index corresponding to PAT (carotid EMT). Lipid goals attainment in the study group was as follows: 34% (LDL-C goal), 39% (non-HDL-C goal) and 35% (both LDL and non-HDL-C goals). Among ultrasound indexes, patients with both lipid goals attainment revealed significantly lower carotid EMT/BMI (LDL-C goal: 25.2 ± 4.2 vs 27.5 ± 4.1, p < 0.01 and non-HDL-C goal: 26.1 ± 4 vs 27.7 ± 4.2, p < 0.01) and IAT/BMI (LDL-C goal: 2.35 ± 0.66 vs 2.51 ± 0.71, p = 0.02 and non-HDL-C goal: p = ns) compared to individuals without goals achievement. Moreover, lipid goals attainment was associated with both measures: carotid EMT/BMI (LDL-C goal: r = -0.2, p < 0.05 and non-HDL-C goal: r = -0.2, p < 0.05) and IAT/BMI (LDL-C goal: r = -0.2, p < 0.05 and non-HDL-C goal: r = -0.2, p < 0.05). Multivariable regression analysis showed also independent association between carotid EMT/BMI and both goals achievement: LDL-C (p = 0.01) and non-HDL-C goal (p = 0.01). Other fat depots indexes (EFT, PFT and PreFT) failed to provide additional data.

CONCLUSION

Contrary to overall obesity and most clinical measures of adiposity, carotid EMT and abdominal IAT, but not other ultrasound indexes of fat depots revealed associations independent from BMI with lipid goal attainment and may help identify patients requiring more aggressive lipid management.

Association between high visceral fat area and postoperative complications in patients with Crohn's disease following primary surgery

AIM

The aim of this study was to determine the association between visceral fat area (VFA) on CT and postoperative complications after primary surgery in patients with Crohn's disease (CD).

METHOD

Inclusion criteria were patients with a confirmed diagnosis of CD who had preoperative abdominal CT scan. The areas of total fat, subcutaneous fat and visceral fat were measured using an established image-analysis method at the lumbar 3 (L3) level on CT cross-sectional images. Visceral obesity was defined as a visceral fat area (VFA) of ≥ 130 cm(2) . Clinical variables, intra-operative outcomes and postoperative courses within 30 days were analysed.

RESULTS

A total of 164 patients met the inclusion criteria. Sixty-three (38.4%) patients had postoperative complications. The mean age of the patients with complications (the study group) was 40.4 ± 15.4 years and of those without complications (the control group) was 35.8 ± 12.9 years (P = 0.049). There were no differences in disease location and behaviour between patients with or without complications (P > 0.05). In multivariable analysis, VFA [odds ratio (OR) = 2.69; 95% confidence interval (CI): 1.09-6.62; P = 0.032] and corticosteroid use (OR = 2.86; 95% CI: 1.32-6.21; P = 0.008) were found to be associated with postoperative complications. Patients with visceral obesity had a significantly longer operative time (P = 0.012), more blood loss (P = 0.019), longer bowel resection length (P = 0.003), postoperative ileus (P = 0.039) and a greater number of complications overall (P < 0.001).

CONCLUSION

High VFA was found to be associated with an increased risk for 30-day postoperative complications in patients with CD undergoing primary surgery.

Metabolic correlates of subcutaneous and visceral abdominal fat measured by ultrasonography: a comparison with waist circumference

BACKGROUND

The relative contribution of visceral (VAT) and subcutaneous (SAT) adipose tissue to cardiometabolic disease is controversial. The aim of this study was to evaluate whether dissecting abdominal fat in VAT and SAT using US may detect stronger and more specific association with MS, MS components, hyperuricemia and altered liver enzymes compared to waist circumference.

METHODS

We performed a cross-sectional study on 2414 subjects aged 18 to 66 years (71 % women) followed at the International Center for the Assessment of Nutritional Status (ICANS, Milan, Italy). VAT and SAT were measured using ultrasonography. Multivariable logistic regression controlling for age and gender was used to evaluate the association of the parameters of interest (waist circumference (WC), VAT, SAT and VAT + SAT) with the MS (international harmonized definition), its components (high triglycerides, low HDL, high blood pressure, high glucose), high uric acid (≥7 mg/dl), high alanine transaminase (ALT, ≥ 30 U/l) and high gamma-glutamyl-transferase (GGT, ≥ 30 U/l).

RESULTS

VAT was independently associated with all the outcomes of interest, while SAT was independently associated with MS and only with high blood pressure and high ALT when we considered the single parameters of MS and NAFLD. VAT had the strongest association with high triglycerides, high ALT and high GGT. The VAT + SAT association had the strongest association with MS. WC had the strongest association with low HDL and high blood pressure. VAT and WC were similarly associated to high glucose and high uric acid.

CONCLUSION

US-determined VAT and SAT are both independently associated with MS. Moreover, to our knowledge, we are the first to show that VAT, being associated to all of the MS components in addition to hyperuricemia and altered liver enzymes, performs equally or better than WC except for high blood pressure and low HDL.

Impact of epidermal fatty acid binding protein on 2D-NMR-assessed atherogenic dyslipidemia and related disorders

BACKGROUND

The role of circulating FABP5 on metabolic alterations is under active evaluation. On the other hand, FABP5 SNPs (rs454550 and rs79370435) seem to modulate its effect.

OBJECTIVES

Our aim was to examine the role of circulating FABP5 levels and its main SNPs in atherogenic dyslipidemia (AD) assessed by 2D-Nuclear Magnetic Resonance (NMR) and related metabolic and inflammation markers. We hypothesized that circulating FABP5 may be a biomarker for metabolic risk.

METHODS

We studied 459 subjects admitted to the metabolism unit because of lipid metabolism disturbances and/or associated disorders. After a 6-week lipid-lowering drug wash-out period, anamnesis and physical examination were performed. Carotid intime-media thickness (cIMT) was measured by ultrasound. FABP5, FABP4, lipids, metabolic proteins, and enzymes were determined by biochemical methods. The lipid profile was assessed by NMR. The rs454550 and rs79370435 FABP5 gene variants were also determined.

RESULTS

The FABP5 plasma levels were positively correlated with adiposity, glucose metabolism, and lipolysis parameters and were associated with AD, as assessed by NMR. There was a significant positive correlation between hsCRP and FABP5. The presence of type 2 diabetes, obesity, metabolic syndrome, or AD was associated with higher FABP5 plasma levels (P < .005). The FABP5 concentrations, but not those of FABP4, were higher in patients with carotid plaques. FABP5 was a main determinant of plaque presence according to logistic regression analysis. The rare rs454550 allele was hyper-represented in nonobese subjects (P = .011).

CONCLUSIONS

FABP5 is a biomarker of adiposity-associated metabolic derangements that include AD thus underscoring the concomitant presence of inflammation. FABP5 is associated with increased subclinical atherosclerosis.

The impact of abdominal adiposity measured by sonography on the pulmonary function of pre-menopausal females

Background

The Body Mass Index (BMI) is a widely used parameter to study obesity; however it does not assess the distribution of body adiposity. Ultrasonography is a reliable method of measuring subcutaneous (SAT), visceral (VAT) and Total adipose tissue of the abdomen (TAT) to determine the influence of abdominal fat on pulmonary function by directly measuring abdominal adipose tissue.

Methods

Eighty pre-menopausal, non-smoker, sedentary females with no history of pulmonary disease were subdivided into three groups: 25 normal-weight, 28 overweight, 27 obese. Absolute and predictive spirometric values were obtained: FVC, FEV₁, FEV₁/FVC, IC, ERV.

Results

A positive correlation between increased %IC and decreased %ERV was observed with increased BMI (p < 0.02; 0.001 respectively); %FVC, %FEV₁ and %ERV decreased significantly as SAT (p = 0.01, p = 0.02; p < 0.001) and TAT (p = 0.01, p = 0.03, p < 0.001) increased, whereas VAT was negatively correlated only with %ERV (p < 0.001). Increments of 5 mm in TAT, VAT and SAT were followed by a reduction of 0.83 %, 0.81 %, 1.90 % in %FVC, respectively, as well as a reduction of 4.25 %, 4.31 % and 9.44 % in %ERV, respectively.

Conclusions

Subcutaneous abdominal adipose tissue deposition in obese females has a greater negative influence on pulmonary function than visceral adipose tissue deposition.

Impact of body mass index, gender, and smoking on thickness of free soft tissue flaps used for orofacial reconstruction

Donor-site selection may play an important role in the reconstruction of large orofacial defects. The thickness and structure of transplanted tissue has to fit those of the recipient site to achieve a satisfactory outcome. To evaluate the thickness of free flaps that are frequently used for orofacial reconstruction and its association with body mass index (BMI), gender, and smoking, a prospective study was conducted. A total of 122 volunteers were included in the study, and their data regarding BMI, gender, and tobacco use were documented. Ultrasonography was used to evaluate the thickness of the radial and ulnar forearm flaps (RFFF and UFFF, respectively), the scapular and parascapular flaps (SF and PSF, respectively), the anterolateral thigh flap (ALT), and the free fibular flap (FF). Correlation and regression analysis were performed to assess any relationship among parameters and to investigate their effect on flap thickness. The UFFF showed the lowest thickness (0.65 ± 0.16 cm), followed by the RFFF (0.83 ± 0.20 cm). The FF showed a comparable thickness (0.82 ± 0.26 cm), followed by the SF (0.99 ± 0.13 cm) and the PSF (1 ± 0.14 cm). The ALT flap displayed the greatest thickness (1.42 ± 0.42 cm) and correlated especially with BMI and gender, whereas the UFFF was the thinnest with relatively constant values, regardless of potential influential factors.

Adiposity measures and vitamin D concentrations in Northeast Germany and Denmark

BACKGROUND

Body mass index (BMI) and serum 25-hydroxy vitamin D3 (25OHD) concentrations are inversely related. As BMI contains only limited information regarding body fat distribution, we aimed to analyze the cross-sectional associations of abdominal visceral or subcutaneous adipose tissue, next to common adiposity measures, with the 25OHD concentration.

METHODS

Data were obtained from three cohorts of two large epidemiological studies in the northeast of Germany (Study of Health in Pomerania, SHIP-1 and SHIP-Trend), and in Denmark (Health2006). The study populations included adult men and women from the general population (N = 3072 SHIP-1, N = 803 SHIP-Trend, N = 3195 Health2006). Visceral and subcutaneous adipose tissue were quantified by magnetic resonance imagining (SHIP-Trend) or ultrasound (Health2006). Common adiposity measures, including BMI, waist circumference, waist-to-hip ratio, waist-to-height ratio, body surface area, and body fat percentage were determined by standardized methods in SHIP-1 and Health2006.

RESULTS

The average study participant was overweight (median BMI 27.4, 26.6, and 25.2 kg/m(2) in SHIP-1, SHIP-Trend, and Health2006, respectively). Visceral and subcutaneous adipose tissue as well as the common adiposity measures were inversely associated with serum 25OHD concentrations in linear regression models adjusted for age, sex, alcohol consumption, physical activity, smoking status, and month of blood sampling.

CONCLUSIONS

Next to common adiposity measures, also abdominal visceral or subcutaneous adipose tissue are inversely associated with serum 25OHD concentrations in the general adult population.

Carotid extra-media thickness in obesity and metabolic syndrome: a novel index of perivascular adipose tissue: extra-media thickness in obesity and metabolic syndrome

OBJECTIVES

We aimed to evaluate the association between a novel ultrasound index extra-media thickness (EMT), obesity, and metabolic syndrome (MS) using several measures of adiposity.

METHODS

Four hundred patients were included in the study (age: 60.95 ± 7.3 years, F/M: 35/65%). Both common carotid arteries (CCA) indexes (EMT and intima-media thickness), anthropometric parameters, body fat percentage and ultrasound measures of different fat depots were obtained in all patients. MS was identified using three alternative definitions: International Diabetes Federation 2005 (IDF), National Cholesterol Education Program Adult Treatment Panel III 2001 (NCEP ATP III) and World Health Organization 1998 (WHO).

RESULTS

The study group included patients with very high (80.2%) or high (19.8%) CV risk (IDF MS: 59.5%). Carotid EMT measures averaged from both sides (±SD) were as follows: mean EMT: 791 ± 126 μm, mean minimum EMT: 731 ± 115 μm and mean maximum EMT: 885 ± 210 μm. Patients with MS, irrespective of its definition and measures of obesity, displayed significantly thicker mean EMT compared to non-MS individuals: 819 ± 129 μm vs 747 ± 113 μm (p < 0.001; IDF), 824 ± 131 μm vs 751 ± 112 μm (p < 0.001; NCEP ATP III) and 825 ± 137 μm vs 773 ± 120 μm (p < 0.001; WHO). Moreover, EMT was related to all major parameters of general obesity, abdominal fat distribution, regional neck subcutaneous fat with weaker association between EMT and epicardial fat thickness. Finally, EMT is associated with an increasing number of CV risk factors.

CONCLUSIONS

This is the first study providing novel findings on the relationship between EMT, MS, and adiposity indexes. Our results suggest that EMT may be a new non-invasive index of perivascular adipose tissue corresponding to cardiometabolic risk.

The Relation between Visceral and Subcutaneous Fat to Bone Mass among Egyptian Children and Adolescents

BACKGROUND: The relation between fat distribution and bone mass is still being debated in children and adolescents.AIM: To verify the influence of both visceral and subcutaneous fat on bone mass among Egyptian children and adolescents.SUBJECTS AND METHODS: The study involved 78 (38 boys and 40 girls) individuals from children (42) and adolescents (36), aged 8-17 years. They were divided into 2 age groups: children group (20 boys and 22 girls) aged 8-12 years and adolescent group (18 boys and 18 girls) aged 13-17 years. Anthropometric measurements, visceral and subcutaneous fat (measured by ultrasound), body composition, BMD and BMC (Measured by DXA), were attempted.RESULTS: Among children, significant positive correlations between visceral fat; in males; and subcutaneous fat; in females; with total BMC, BMD and its Z-score were revealed. After exclusion of age effect, the association between visceral fat in females with total BMD and its Z-score and lumbar BMD-Z-score became significant.  For adolescents, no correlation was observed between either visceral or subcutaneous fat with any parameter of bone mass.CONCLUSIONS: Visceral and subcutaneous fat had significant positive association with bone mass in children; males and females respectively. On the contrary such association disappeared during adolescence.

Abdominal adiposity by ultrasonography: a "pocket" database for reference standard in Italian people

AIMS

To provide a reference standard database of ultrasonographic parameters of abdominal adiposity in healthy people.

METHODS

Italian non-obese volunteers among blood donors were enrolled in 5 age bands (from 18 to 70 year-old) to reach the threshold of 25 males and 25 females per single band (total: 250). All subjects were measured for weight, height and waist circumference and underwent ultrasonography (US) by an expert radiologist for the assessment of several abdominal fat thicknesses (minimum and maximum subcutaneous fat thickness, maximum preperitoneal fat thickness, intrabdominal fat thickness, aorto-mesenteric thickness, and mesenteric fat thickness). In addition, US data were normalized per waist circumference.

RESULTS

From 30s to 50s no statistically significant differences were achieved between males and females for the adiposity markers of visceral fat, while a relevant divergence was proved from 60s to 70s. During ageing a marked increase of the visceral fat compartment was observed in males, while only the preperitoneal circumference was significantly modified in females.

CONCLUSIONS

This paper reports on US parameters of abdominal adiposity of healthy Italian adults, to be used as a reference for daily clinical practice. Data could be also considered as control group for future investigations on physiology, pathological conditions, and differences between countries.

Correlation of abdominal adiposity with components of metabolic syndrome, anthropometric parameters and Insulin resistance, in obese and non obese, diabetics and non diabetics: A cross sectional observational study. (Mysore Visceral Adiposity in Diabetes Study)

OBJECTIVES

To measure Visceral Fat (VF) and Subcutaneous Fat (SCF) by ultrasound, in obese and non-obese diabetics and obese and non-obese non diabetics, in a South Indian (Asian Indian) Population and correlate them with Body Mass Index (BMI), Waist Circumference (WC), components of metabolic syndrome and Insulin Resistance (IR).

RESEARCH DESIGN AND METHODS

This was a prospective observational study, 80 diabetics (40 obese and 40 non obese) and 80 non diabetics (40 obese and 40 non obese) a total of 160 subjects were enrolled, out of whom 153 completed the study. The subjects were evaluated with respect to BMI, WC, Blood Pressure (BP); Fasting Blood Sugar (FBS) Fasting Insulin levels (FIL), HbA1C and Lipid profile. The SCF and VF were measured by Ultrasonography.The results were statistically analyzed.

RESULTS

WC correlated significantly with VF in all the groups. Diabetics had more VF compared to non-diabetics. Insulin resistance was significant in all the groups; however diabetics had greater levels of IR, BMI, WC, VF and SCF had no correlation with IR and had no significant correlation with metabolic parameters.

CONCLUSIONS

In this study population, WC was found to be a useful surrogate measure of VF conforming to its well established applicability in other populations. Contrary to other studies elsewhere, SCF and VF were found to be poor indicators of Insulin Resistance. BMI, WC, VF and SCF were not useful in the prediction of metabolic syndrome. Ultrasound was found to be an easier and economic method of measuring abdominal adiposity and actual measurement of abdominal fat was more informative than anthropometric measurements.

Physical activity below the minimum international recommendations improves oxidative stress, ADMA levels, resting heart rate and small artery endothelial function

BACKGROUND

A moderate level of physical activity (PA), such as a daily 30-min walk, reduces cardiovascular risk. There is a lack of evidence about the cardiovascular benefits of PA below this recommendation of minimum PA level.

OBJECTIVE

We aimed to study the impact of a lower level of PA on cardiovascular health.

DESIGN

Sixty-four overweight/obese men and women were enrolled in a community programme consisting of 4 months of 1h, low-intensity PA two days per week. Before and after the intervention, PA level (METs/h/wk), endogenous antioxidant status (SOD and GPX concentration and activity and oxidised LDL), ADMA concentrations, endothelial function by small artery reactive hyperaemia index (saRHI), and resting heart rate (RHR) were assessed.

RESULTS

After the intervention, significant increases in saRHI (P=0.031), SOD and GPX activities, and a decrease in ADMA plasma concentrations, and RHR (P<0.001 for all) were observed. Increases in PA were positively associated with increases in saRHI (r=0.341, P=0.022), GPx (r=0.303, P=0.047) and decreases in RHR (r=-0.302, P=0.047). Multivariate analyses showed that independent predictors of saRHI improvement were an increase in PA (2.65, 95%CI: 1.21-4.01), decrease in RHR (1.91, 95%CI: 1.01-4.98), and an increase in GPx (2.61, 95%CI: 1.16-5.01).

CONCLUSION

In obese and overweight men and women, an increase in PA, even below the minimal international recommendations, improves antioxidant capacity, RHR and peripheral small artery reactivity.

Liver in the analysis of body composition by dual-energy X-ray absorptiometry

OBJECTIVE

To investigate the predictive value for hepatic steatosis of a new software for the quantification of visceral fat by dual-energy X-ray absorptiometry (DXA) and to design new regions of interest (ROIs).

METHODS

Adult volunteers were prospectively screened for hepatic steatosis by ultrasonography to obtain a well-balanced population according to the presence/absence of the disease. 90 adult patients without steatosis and 90 with steatosis (mild, 53.3%; moderate, 37.7%; and severe, 10.0%) were recruited. On the same day, all subjects were submitted to blood testing and to anthropometric and whole-body DXA for body composition evaluation. A new software for android visceral fat assessment was employed, and six new "liver-suited" ROIs as well as two modified android ROIs were designed. Their association with steatosis grade was tested by correlation analysis.

RESULTS

Fat mass (FM) of the new ROIs showed the highest correlation coefficients with steatosis grade (ρ = 0.610-0.619; p < 0.001), which was also confirmed by multivariate analysis. On the whole population, the new ROIs maintained the highest predictive role for liver steatosis, with areas under the receiver operating characteristic curve up to 0.820 ± 0.032. Inter- and intra-operator agreement for the new ROIs was excellent (k = 0.915-1.000 and k = 0.927-1.000).

CONCLUSION

New ROIs could be designed, standardized and implemented in DXA whole-body scan to provide more specific and predictive values of hepatic lipid content.

ADVANCES IN KNOWLEDGE

This is the first study to investigate the predictive value for hepatic steatosis of visceral and regional FM assessed on the hepatic site by DXA in comparison with ultrasonography, anthropometry and surrogate markers derived by previously validated algorithms (fatty liver index).

Preperitoneal fat tissue may be associated with arterial stiffness in obese adolescents

Vascular aging is a chronic process, and many negative effects of obesity in this process have been well defined. We assessed arterial stiffness in obese adolescents and evaluated the relationship between intra-abdominal fat distribution and arterial stiffness. Arterial stiffness parameters and pulse wave velocity (PWV) were evaluated in 61 obese adolescents and 58 healthy controls. Carotid-femoral PWV was calculated by arterial tonometry. Additionally, all obese children were evaluated for metabolic syndrome and insulin resistance. Intra-abdominal fat distribution, including subcutaneous, preperitoneal and visceral fat thicknesses, was assessed by ultrasonography. PWVs of obese children were significantly higher than those of healthy controls (5.0 ± 0.7 m/s vs. 4.7 ± 0.5 m/s). Parameters affecting PWV were evaluated by regression analysis. The independent variable in the regression analysis model was PWV, and the dependent variables were age, metabolic syndrome, body mass index and Homeostasis Model Assessment--Insulin Resistance, as well as subcutaneous, preperitoneal and visceral fat tissue thicknesses measured by ultrasonography. The only parameter associated with PWV was preperitoneal fat tissue thickness. Vascular changes related to obesity may begin in adolescence, as illustrated by the increased PWV. Preperitoneal fat tissue may be related to arterial stiffness. Intra-abdominal fat distributions obtained by ultrasonography may provide clinicians with valuable information needed to determine cardiovascular disease risk factors in obese adolescents.

A 360-degree overview of body composition in healthy people: relationships among anthropometry, ultrasonography, and dual-energy x-ray absorptiometry

OBJECTIVE

The aim of this study was to test the relationship between anthropometry, ultrasonography, and dual-energy x-ray absorptiometry (DXA) for the assessment of body composition in clinical practice.

METHODS

The study was carried out in Italian blood donor volunteers belonging to five different age groups (18-70 y old; 25 men and 25 women per group; N = 250 participants; n = 125 men, n = 125 women). A complete history was collected and routine blood analyses were performed to confirm healthy status. All participants were submitted to whole-body DXA (tricompartmental analysis, regional, and total body), ultrasonography (abdominal adiposity evaluation), and anthropometric measurements. DXA was used as gold standard and its biomarkers were taken as reference for fat-lean mass balance, central-peripheral fat distribution, central or visceral fat, and subcutaneous fat.

RESULTS

Anthropometric and ultrasound parameters were closely associated with most of DXA parameters. Composite markers representative of central and abdominal visceral fat compartments were significantly correlated with waist circumference, waist-to-hip ratio, and intra-abdominal fat thickness by ultrasound, in both men and women (P < 0.025). As expected, subcutaneous depots were significantly correlated with maximum subcutaneous fat thickness measured by ultrasonography (P < 0.025).

CONCLUSIONS

Both anthropometry and ultrasonography provide a reliable estimate of visceral adipose tissue in a non-obese population compared with DXA, whereas anthropometry prediction of subcutaneous adiposity is weak. Physicians should be aware of the limits of these techniques for the assessment of body composition.

Circulating FABP4 and FABP5 levels are differently linked to OSA severity and treatment

OBJECTIVE

To evaluate circulating adipocyte and epidermal fatty acid-binding protein (FABP4 and FABP5) concentrations in patients with obstructive sleep apnea (OSA), as well as the effects of continuous positive airway pressure (CPAP) treatment.

METHODS

Our cross-sectional study included 125 patients. After polysomnography, 58 participants met the criteria for CPAP treatment and were included in a closed cohort study of 8 weeks of CPAP treatment. General anthropometric and biochemical data and circulating FABP4 and FABP5 levels were determined in all patients at baseline and after CPAP treatment in those receiving this therapy.

RESULTS

Circulating FABP4 but not FABP5 levels were higher in patients with OSA (P = 0.003). FABP4 but not FABP5 values were associated with parameters of OSA severity independently of age, gender, adiposity and insulin resistance (P < 0.05). FABP4 but not FABP5 concentrations were determinants of OSA presence (OR: 1.11, P = 0.010) and severity (OR: 1.06, P = 0.020). After CPAP treatment, FABP4 levels decreased in the more severe patients (P = 0.019), while FABP5 levels increased in all patients (P < 0.001).

CONCLUSIONS

FABP4 is directly associated with obstructive sleep apnea severity and did not change with continuous positive airway pressure treatment, while FABP5 was not associated with obstructive sleep apnea severity and increased with continuous positive airway pressure treatment. FABP4 and FABP5 have different associations with obstructive sleep apnea. FABP4 but not FABP5 could be considered a marker of metabolic alterations in obstructive sleep apnea patients.

Abdominal fat sonographic measurement compared to anthropometric indices for predicting the presence of coronary artery disease

OBJECTIVES

Sonography for measuring intra-abdominal fat is more accurate than anthropometric measurements. Computed tomographic (CT) angiography has become an accurate noninvasive method for detection of coronary artery disease (CAD). We examined the associations between both sonographic and anthropometric measurements of abdominal adiposity and the presence of CAD on CT angiography.

METHODS

We evaluated 83 consecutive patients (70% men; mean age ± SD, 56 ± 10.8 years) who were referred for CT angiography. Clinical and laboratory variables were determined, and CT angiography was performed using a 64-slice scanner. The severity of CAD was defined by visual assessment of any plaque, either calcified or noncalcified. Preperitoneal fat, subcutaneous fat, and visceral fat thicknesses were determined on sonography, and the abdominal fat index was calculated as the preperitoneal fat thickness-to-subcutaneous fat thickness ratio.

RESULTS

Coronary artery disease was detected in 56 patients (67%). Patients with CAD had higher visceral fat thickness (9.3 ± 2.0 versus 8.2 ± 2.2 cm; P = .035) and a higher waist-to-hip ratio (0.97 ± 0.07 versus 0.92 ± 0.07; P = .018) than those without CAD. The preperitoneal fat thickness, subcutaneous fat thickness, and abdominal fat index were not correlated with the CAD status. After adjusting for traditional cardiovascular risk factors, however, only a waist-to-hip ratio higher than 0.95 remained significantly associated with the presence of CAD (odds ratio, 4.03; 95% confidence interval, 1.2-13.4).

CONCLUSIONS

This study shows that sonographically based obesity measurements are not superior to anthropometric indices in predicting the presence of CAD.

The role of ultrasonography in the evaluation of abdominal fat: analysis of technical and methodological issues

RATIONALE AND OBJECTIVES

Ultrasonography (US) is becoming popular for the assessment of adiposity, but no one has studied this tool in the light of its potential limitations. Our purpose was to investigate the impact of technical conditions on the evaluation of abdominal fat by US.

MATERIALS AND METHODS

Forty-five healthy males and 45 healthy females were consecutively enrolled in the study, randomly assigned to three groups equally distributed by sex, and examined accordingly to three technical points: fasting state (before and after meal [A]), breathing (expiration and inspiration [B]), and US equipment from different generations: 2003 and 1998 (C). Two blinded radiologists performed US in the these opposite conditions, acquiring five parameters representative of subcutaneous and visceral adiposity in two times. Student's t-test and Lin's correlation coefficient were used for statistical analysis to assess differences in the measures as well as in inter- and intra-observer agreements.

RESULTS

The maximum and the only statistically significant changes were observed for intra-abdominal fat thickness regarding fasting state and breathing (Δ% = 24.1 ± 21.3 and Δ% = 9.2 ± 20.4, respectively; P < .0001). Reproducibility and repeatability, especially for visceral fat, were proved more stable in the following conditions: fasting state, expiration, and newer machine (2003).

CONCLUSION

This article provides essential information and "range of confidence" for variations that can be expected from using different conditions in the measurement of abdominal adiposity by US to be carefully addressed as well as considered by US users and by researchers involving this technique in the field of body composition.

Reproducibility of ultrasonography for assessing abdominal fat distribution in a population at high risk of diabetes

Background:

Visceral fat plays an important role in the development of metabolic disease independently of the effect of overall abdominal fat. Ultrasonography is an accessible method of accurately assessing abdominal fat distribution in epidemiological studies, but few details about the reproducibility of this method have been published.

Objective:

The aim of this study was to investigate the reproducibility of ultrasonography in the assessment of abdominal fat distribution in a population at high risk of type 2 diabetes.

Design and Methods:

Ultrasonography was used to estimate visceral and subcutaneous abdominal fat. Intra- and interobserver variation, short-term variation and variation between estimates in the fasting and non-fasting state were examined in three samples of 30, 33 and 23 participants from the ADDITION-PRO study. A variance components model was used to calculate intra- and interobserver variation, and Bland–Altman plots were drawn for all three substudies.

Results:

Coefficients of variation for intra- and interobserver variation were in the range 3.4–6.1%, except for interobserver variation for subcutaneous fat (9.5%). Short-term variation over a median of 35 days had a coefficient of variation of 15%. The effect of a meal was primarily on the visceral estimates and did not extend beyond the first postprandial hour. Non-fasting visceral estimates were larger than fasting estimates.

Conclusion:

Both visceral and subcutaneous fat can be estimated with ultrasonography with adequate intra- and interobserver reproducibility by clinical researchers with limited training, making it a feasible method of assessing abdominal fat distribution in epidemiological studies.

Global adiposity and thickness of intraperitoneal and mesenteric adipose tissue depots are increased in women with polycystic ovary syndrome (PCOS)

CONTEXT

Sexual dimorphism suggests a role for androgens in body fat distribution. Women with polycystic ovary syndrome (PCOS), a mainly androgen excess disorder, often present with abdominal obesity and visceral adiposity.

OBJECTIVE

We hypothesized that women with PCOS have a masculinized body fat distribution favoring the deposition of fat in visceral and organ-specific adipose tissue depots.

DESIGN

This was a case-control study.

SETTING

The study was conducted at an academic hospital.

PARTICIPANTS

Women with PCOS (n = 55), women without androgen excess (n = 25), and men (n = 26) presenting with similar body mass index participated in the study.

INTERVENTIONS

There were no interventions.

MAIN OUTCOME MEASURES

Ultrasound measurements of adipose tissue depots including sc (minimum and maximum), preperitoneal, ip, mesenteric, epicardial, and perirenal fat thickness were obtained and total body fat mass was estimated using a body fat monitor.

RESULTS

Men and patients with PCOS had increased amounts of total body fat compared with control women. Men had increased thickness of intraabdominal adipose tissue depots compared with the control women, with the women with PCOS showing intermediate values that were also higher than those of control women in the case of ip and mesenteric fat thickness and was close to reaching statistical significance in the case of epicardial fat thickness. Women with PCOS also showed increased minimum sc fat thickness compared with the control women. Obesity increased the thickness of all of the adipose tissue depots in the 3 groups of subjects.

CONCLUSIONS

Women with PCOS have higher global adiposity and increased amounts of visceral adipose tissue compared with control women, especially in the ip and mesenteric depots.