Influence of Sugar-Sweetened Beverages Intake on Sarcopenic Obesity, Visceral Obesity, and Sarcopenia in Lebanese Patients with MASLD: A Case-Control Study

Chronic liver diseases are a major global health concern.

AIMS

this study investigated the links between medical, clinical, anthropometric, and dietary factors with dysfunction-associated steatotic liver disease (MASLD) in the Lebanese population using a case-control approach to uncover factors influencing visceral obesity, sarcopenia, and sarcopenic obesity.

METHODS AND MATERIALS

a total of 120 participants (20-70 years old) were divided into case and control groups based on liver disease diagnosis. Patient information was gathered through a questionnaire encompassing demographics, medical history, and beverage consumption. Anthropometric and body composition data were collected in a clinical setting.

RESULTS

our findings indicated a clear association between the presence of MASLD and obesity, hypertension, and diabetes. The positive association with higher body mass index and all three conditions remained consistent even when data was stratified by case and control groups. A greater proportion of MASLD patients exhibited sarcopenic obesity. Furthermore, MASLD cases showed higher consumption of sugary beverages and a reduced intake of milk and water in their diets.

CONCLUSIONS

this study shed light on the health attributes and diets of the Lebanese population with liver diseases and suggested more research in this area and in a more ethnically diverse population.

Impact of a robotic system on intra-abdominal infectious complications after minimally invasive gastrectomy in patients with gastric cancer: A propensity score matching analysis regarding visceral obesity

Background

The efficacy of robotic gastrectomy (RG) on postoperative complications in patients with gastric cancer (GC) is unclear in terms of the volume of intra-abdominal fat tissue.

Patients and Methods

We enrolled 403 patients with GC who had minimally invasive surgery between January 2015 and July 2022. During this time, 197 RG and 206 laparoscopic gastrectomies (LG) were performed on the study participants. According to the computed tomography scan, patients were defined as having or not having visceral obesity based on the visceral fatty area (VFA). In each high and low VFA group, we compared short-term outcomes between the RG group and LG group.

Results

After PS matching for patients with high VFA, the two groups were well matched, with 71 cases in both the RG and LG groups. The median surgical time in the RG group was significantly longer (420 vs. 365 min, p < 0.001). However, the RG group had a significantly lower rate of severe intra-abdominal infectious complications (IAIC), such as anastomotic leakage, pancreatic fistula, and intra-abdominal abscess (1.4% vs. 15.4%, p = 0.004). However, among the 77 patients with low VFA values, we found no significant difference in the rate of severe IAIC between the two groups (1.1% in the RG group vs. 2.6% in the LG group, p = 1.00).

Conclusion

RG may be a viable alternative to LG because of the lower postoperative IAIC for patients with visceral obesity and GC. However, RG may not benefit non-obese patients.

The Level of Sex Hormones and Corticosterone in Female Rats during Modeling of Visceral Obesity, Subsequent Physical Activity, and Normalization of the Diet

The effects of diet-induced visceral obesity and non-drug options of its correction on the level of sex hormones and corticosterone were evaluated in 84 female Wistar rats. During stage I, the rats received either a standard diet (STD) or a high-calorie diet (HCD) for 8 weeks. During stage II, the animals were divided into subgroups depending on obesity correction: without correction (STD control and HCD), transition from HCD to STD (HCD/STD) and/or physical activity (treadmill exercise) for the next 8 weeks (HCD/STD+exercise, STD+exercise, and HCD+exercise). Diet-induced visceral obesity resulted in hyperandrogenization and increased blood corticosterone levels in females. Transition from HCD to STD regardless of physical activity led to normalization of testosterone level and, accordingly, to return to the functional norm of estrogen-androgen balance. The positive effect of moderate physical activity on hormonal status is realized only against the background of a balanced diet or during the transition from HCD to STD.

Study from the United States: increased prevalence of kidney stones in patients with high weight-adjusted waist index

Objective

Using data from NHANES 2007-2018, to examine the association between WWI (weight-adjusted waist index) index and prevalence of kidney stones.

Methods

Using multiple logistic regression analysis of the National Health and Nutrition Examination Survey (NHANES) 2007-2018, we evaluated the association between WWI index and the prevalence of kidney stones, followed by subgroup analysis of sensitive populations. Smooth curve fitting was used to determine whether there was a non-linear relationship between the WWI index and kidney stone prevalence, and threshold effect analysis was used to test this relationship.

Results

Among 29,280 participants, 2,760 self-reported renal calculi. After adjustment for all confounders, there was a positive association between WWI and kidney stone prevalence (OR = 1.20, 95% CI: 1.12, 1.28), and this positive association was stronger with increasing WWI (and P = 0.01 for trend). Our results indicate a non-linear positive correlation between WWI index and kidney stones, with the saturation threshold effect analysis and the most important threshold value at 11.02. According to subgroup analysis, WWI showed the strongest association with kidney stone prevalence in participants aged 20-39 years, males, other US ethnic groups, and participants without hypertension and diabetes.

Conclusion

Increased WWI is positively associated with increased incidence of kidney stones, and increased WWI is a high risk for kidney stones that should be treated with caution. This association should be more pronounced in people between the ages of 20 and 39 years, in men, in other US ethnic populations, and in participants who do not have hypertension or diabetes.

Fat Matters: Exploring Cancer Risk through the Lens of Computed Tomography and Visceral Adiposity

Obesity is an established risk factor for cancer. However, conventional measures like body mass index lack precision in assessing specific tissue quantities, particularly of the two primary abdominal fat compartments, visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT). Computed tomography (CT) stands as the gold standard for precisely quantifying diverse tissue types. VAT, distinguished by heightened hormonal and metabolic activity, plays a pivotal role in obesity-related tumor development. Excessive VAT is linked to aberrant secretion of adipokines, proinflammatory cytokines, and growth factors, fostering the carcinogenesis of obesity-related tumors. Accurate quantification of abdominal fat compartments is crucial for understanding VAT as an oncological risk factor. The purpose of the present research is to elucidate the role of CT, performed for staging purposes, in assessing VAT (quantity and distribution) as a critical factor in the oncogenesis of obesity-related tumors. In the field of precision medicine, this work takes on considerable importance, as quantifying VAT in oncological patients becomes fundamental in understanding the influence of VAT on cancer development-the potential "phenotypic expression" of excessive VAT accumulation. Previous studies analyzed in this research showed that VAT is a risk factor for clear cell renal cell carcinoma, non-clear cell renal cell carcinoma, prostate cancer, and hepatocarcinoma recurrence. Further studies will need to quantify VAT in other oncological diseases with specific mutations or gene expressions, in order to investigate the relationship of VAT with tumor genomics.

The Metabolically Obese, Normal-Weight Phenotype in Young Rats Is Associated with Cognitive Impairment and Partially Preventable with Leptin Intake during Lactation

The intake of high-fat diets (HFDs) and obesity are linked to cognitive impairment. Here, we aimed to investigate whether an early metabolically obese, normal-weight (MONW) phenotype, induced with an HFD in young rats, also leads to cognitive dysfunction and to evaluate the potential cognitive benefits of neonatal intake of leptin. To achieve this, Wistar rats orally received physiological doses of leptin or its vehicle during lactation, followed by 11 weeks of pair-feeding with an HFD or control diet post-weaning. Working memory was assessed using a T-maze, and gene expression in the hippocampus and peripheral blood mononuclear cells (PBMCs) was assessed with real-time RT-qPCR to identify cognition biomarkers. Young MONW-like rats showed hippocampal gene expression changes and decreased working memory. Animals receiving leptin during lactation presented similar gene expression changes but preserved working memory despite HFD intake, partly due to improved insulin sensitivity. Notably, PBMC Syn1 expression appears as an accessible biomarker of cognitive health, reflecting both the detrimental effect of HFD intake at early ages despite the absence of obesity and the positive effects of neonatal leptin treatment on cognition. Thus, the MONW phenotype developed at a young age is linked to cognitive dysfunction, which is reflected at the transcriptomic level in PBMCs. Neonatal leptin intake can partly counteract this impaired cognition resulting from early HFD consumption.

Reduced Lipopolysaccharide-Binding Protein (LBP) Levels Are Associated with Non-Alcoholic Fatty Liver Disease (NAFLD) and Adipose Inflammation in Human Obesity

Lipopolysaccharide (LPS) and its binding protein LBP have emerged as potential contributors to the progression from overweight/obesity to overt metabolic diseases and NAFLD. While LPS is known to activate hepatocyte inflammation, thus contributing toward NAFLD development, the role of LBP is more intricate, and recent data have shown that experimental reduction in hepatic LBP promotes NAFLD progression. In this cross-sectional investigation, we evaluated circulating LBP in relation to obesity, NAFLD, visceral adipose tissue (VAT) inflammation, and type 2 diabetes (T2D). We recruited 186 individuals (M/F: 81/105; age: 47 ± 10.4 years; BMI: 35.5 ± 8.6 kg/m2); a subgroup (n = 81) underwent bariatric surgery with intra-operative VAT and liver biopsies. LBP levels were higher in obese individuals than non-obese individuals but were inversely correlated with the parameters of glucose metabolism. Reduced LBP predicted T2D independent of age, sex, and BMI (p < 0.001). LBP levels decreased across more severe stages of hepatosteatosis and lobular inflammation, and were inversely associated with VAT inflammation signatures. In conclusion, LBP levels are increased in obese individuals and are associated with a more favorable metabolic profile and lower NAFLD/NASH prevalence. A possible explanation for these findings is that hepatic LBP production may be triggered by chronic caloric excess and facilitate LPS degradation in the liver, thus protecting these individuals from the metabolic consequences of obesity.

Correlation between visceral fat metabolism score and erectile dysfunction: a cross-sectional study from NHANES 2001-2004

Backgrounds

The factors associated with erectile dysfunction (ED) are diverse, and obesity is a significant component. Metabolic Score for Visceral Fat (METS-VF) can assess obesity more accurately than body mass index (BMI). However, the association between METS-VF and ED remains unclear.

Objective

This study aimed to investigate the association between the METS-VF and ED using National Health and Nutrition Examination Survey (NHANES) 2001-2004 data.

Methods

Data were sourced from NHANES 2001-2004. The relationship between METS-VF and ED was analyzed using multivariate logistic regression, followed by subgroup analyses to identify sensitive populations. Nonlinear correlation was evaluated through smoothed curve fitting, and a threshold effect analysis validated the findings. Comparative logistic regression of the Receiver Operating Characteristic (ROC) curve assessed the diagnostic capability of METS-VF against the classical obesity index for ED.

Results

The study enrolled 3625 participants, of whom 961 self-reported ED history and 360 reported severe ED. After adjusting for confounders, METS-VF exhibited a positive association with asthma prevalence (OR= 3.47, 95% CI: 2.83, 14.24). Stratification based on median METS-VF revealed higher ED prevalence in participants with elevated METS-VF (OR= 2.81,95% CI:2.32, 3.41). Nonlinear correlation was observed, with a significant association between METS-VF and ED when METS-VF exceeded 6.63. Subgroup analysis highlighted a stronger correlation in participants aged 50-85 years, Caucasians, hypertensive individuals, diabetics, and those with coronary heart disease. Sensitivity analysis using severe ED as the outcome reaffirmed the nonlinear positive association with METS-VF (OR=3.86, 95% CI:2.80,5.33), particularly when METS-VF surpassed 6.68.

Conclusion

Elevated METS-VF was nonlinearly correlated with increased ED incidence. Individuals with METS-VF above 6.63 should be vigilant about heightened ED risk. Special attention should be given to participants aged 50-85 years, Caucasians, hypertensive individuals, diabetics, and those with coronary heart disease.

Iron Levels and Markers of Inflammation in a Population of Adults with Severe Obesity, a Cross-Sectional Study

Low-grade chronic inflammation linked to obesity can lead to alterations in biomarkers of iron status. The aim of this study was to investigate the primary determinant of serum iron levels among anthropometric measurements, body fat, and serum biomarkers of low-grade chronic inflammation in a group of adult individuals with severe obesity. We enrolled 114 individuals (84 females; 30 males) aged 40.96 ± 12.54 years. Weight and body mass index (BMI) were 121.20 ± 22.33 kg and 44.94 ± 7.29 kg/m2, respectively. Some 30% of individuals had class-II obesity (BMI ≥ 35 ≤ 39.9 kg/m2) and 70% had class-III obesity (BMI ≥ 40 kg/m2). A weak, albeit significant, inverse correlation was found between serum iron levels and c-reactive protein (CRP) (r = -0.259, p = 0.008), fibrinogen (r = -0.261, p = 0.006), BMI (r = -0.186, p = 0.04), waist circumference (WC) (r = -0.265, p = 0.004), and fat mass % (r = -0.285, p = 0.003). With multiple linear regression analysis including CRP, fibrinogen, BMI, WC, and fat mass % as independent variables and serum iron levels as dependent variable, WC was entered in the first step (p = 0.001), which was followed by fat mass % (p = 0.047) and CRP (p = 0.047). Grouping the individuals according to the interquartile range of BMI, WC, and fat mass % (Q1-Q4), the lowest serum iron levels were found in Q4 groups of WC and fat mass % (p = 0.02), while no significant differences were found between groups in BMI quartiles. In conclusion, in our study, population serum iron levels were inversely associated with BMI, visceral obesity, fat mass %, CRP, and fibrinogen, but WC was the major negative predictor of serum iron level. These results supported the fact that visceral distribution of body fat, more than obesity per se, was associated with low serum iron levels in adult individuals with severe obesity.

Elevated visceral adiposity index linked to improved cognitive function in middle-aged and elderly Chinese: evidence from the China health and retirement longitudinal study

Object

Cognitive decline and obesity are major global public health issues, and their association has been widely acknowledged. The link between the visceral adiposity index (VAI) and cognitive function in the Chinese population remains uncertain. This study aims to investigate the effects of VAI levels on cognitive function in the Chinese middle-aged and elderly population.

Methods

We analyzed longitudinal data from the China Health and Retirement Longitudinal Study (CHARLS) collected in 2011, 2013, 2015, and 2018. VAI levels were divided into three tertiles. Generalized estimating equation (GEE) models were used to explore the relationships between VAI levels and cognitive function, including overall cognitive scores, episodic memory, and mental status. Adjustments were made for potential confounders.

Results

The study consisted of 2,677 participants. Contrary to expectations, higher VAI levels were associated with higher overall cognitive scores and improved episodic memory scores, while no significant effect was observed on mental status. The GEE models consistently indicated that higher VAI levels were associated with higher overall cognitive scores, primarily due to their association with episodic memory. Stratified analyses revealed that the VAI was associated with better cognitive function primarily in males, individuals under 60 years old, those with lower education levels, rural residents, and married individuals, mainly in relation to episodic memory. No significant interactions were observed between VAI and demographic factors.

Conclusion

Our findings suggest that higher visceral adiposity is associated with slower cognitive decline in the Chinese middle-aged and elderly population, especially in its association with episodic memory. These results underline the need to further investigate the potential protective role of visceral fat in cognitive function, potentially offering new insights for interventions to enhance cognitive function and prevent dementia in this population.

Body composition is associated with disease aetiology and prognosis in patients undergoing resection of intrahepatic cholangiocarcinoma

BACKGROUND

Body composition alterations are frequent in patients with cancer or chronic liver disease, but their prognostic value remains unclear in many cancer entities.

OBJECTIVE

We investigated the impact of disease aetiology and body composition after surgery for intrahepatic cholangiocarcinoma (iCCA), a rare and understudied cancer entity in European and North American cohorts.

METHODS

Computer tomography-based assessment of body composition at the level of the third lumbar vertebra was performed in 173 patients undergoing curative-intent liver resection for iCCA at the Department of Surgery, Charité - Universitätsmedizin Berlin. Muscle mass and -composition as well as subcutaneous and visceral adipose tissue quantity were determined semi-automatically. (Secondary) sarcopenia, sarcopenic obesity, myosteatosis, visceral and subcutaneous obesity were correlated to clinicopathological data.

RESULTS

Sarcopenia was associated with post-operative morbidity (intraoperative transfusions [p = 0.027], Clavien-Dindo ≥ IIIb complications [p = 0.030], post-operative comprehensive complication index, CCI [p < 0.001]). Inferior overall survival was noted in patients with myosteatosis (33 vs. 23 months, p = 0.020). Fifty-eight patients (34%) had metabolic (dysfunction)-associated fatty liver disease (MAFLD) and had a significantly higher incidence of sarcopenic (p = 0.006), visceral (p < 0.001) and subcutaneous obesity (p < 0.001). Patients with MAFLD had longer time-to-recurrence (median: 38 vs. 12 months, p = 0.025, log-rank test). Multivariable cox regression analysis confirmed only clinical, and not body, composition parameters (age > 65, fresh frozen plasma transfusions) as independently prognostic for overall survival.

CONCLUSION

This study evidenced a high prevalence of MAFLD in iCCA, suggesting its potential contribution to disease aetiology. Alterations of muscle mass and adipose tissue were more frequent in patients with MAFLD.

Visceral obesity and anastomotic leakage rates in colorectal cancer: a systematic review and meta-analysis

Background

Numberous studies have heatedly discussed whether obesity is a risk factor for anastomotic leakage (AL) because of the increasing number of colorectal cancer (CRC) cases and high incidence of CRC in patients with obesity.

Objective

We aimed to explore the relationship between visceral obesity(VO) and AL after CRC surgery. The databases of Pubmed, Embase, and the Cochrane Library were searched for relevant data and articles published until November 1, 2022. We identified the difference in the incidence of AL after CRC surgery between patients with and without VO. The quality of included studies was evaluated using the Newcastle- Ottawa Scale, and odds ratio (OR) and 95% CI were used to assess the association between VO and AL.

Results

This meta-analysis included 7 studies with 2,136 patients. The OR of patients with VO versus those without VO was 2.15 (95%CIs = 1.46-3.15, test for heterogeneity: P = 0.29, I2 = 18%) based on the fixed-effect model in seven studies. Notably, the difference between the two groups was statistically significant (Z = 3.91 P < 0.0001). Patients with VO in the colon cancer group exhibited a higher incidence of AL (OR = 2.88, 95% CIs = 1.38-5.99, test for heterogeneity: P = 0.27, I2 = 20%) than those in the rectal cancer group (OR = 2.74, 95% CIs = 1.13-6.65, test for heterogeneity: P = 0.20, I2 = 38%). In the studies in the relevant literature, heterogeneity was low. Regarding patients with VO, four Asian studies reported increased morbidity due to AL (OR = 2.79, 95% CIs = 1.35-5.78, test for heterogeneity: P = 0.35, I2 = 9%) compared with three non-Asian studies.

Conclusions

Our findings confirmed the significant relationship between VO and AL. Thus, VO could be considered a reliable risk factor of surgery for colon cancer.

Association between visceral obesity and 10-year risk of first atherosclerotic cardiovascular diseases events among American adults: National Health and Nutrition Examination Survey

Background

In the United States, the relationship between visceral obesity and the risk of developing atherosclerosis cardiovascular disease (ASCVD) for the first time in 10 years is unclear.

Methods

Data for this cross-sectional study came from the National Health and Nutrition Examination Survey (NHANES) from 2011 to 2020. We collected variable information related to 10-year ASCVD risk and visceral obesity reliable indicators [Visceral obesity index (VAI) and Lipid accumulation product (LAP)]. And we used multiple logistic regression to analyze the correlation of visceral obesity indicators (VAI and LAP) with 10-year ASCVD risk. In addition, we assessed the linear relationship between VAI or LAP and 10-year ASCVD risk by smoothing curve fitting. Finally, we conducted subgroup analysis and sensitivity analysis after excluding participants with extreme VAI and LAP values to ensure that we obtained accurate and reliable results.

Results

Our study included a total of 1,547 participants (mean age: 56.5 ± 10.1, 60% of males). The results of the multiple logistic regression showed that compared with participants with the lowest VAI in the 1st Quartile (≤0.79), the adjusted OR values for VAI and elevated 10-year ASCVD risk in Q3 (1.30-2.14), and Q4 (≥2.15) were 2.58 (95% CI: 1.24-5.36, P = 0.011), 15.14 (95% CI: 6.93-33.05, P < 0.001), respectively. Compared with participants with the lowest LAP in the 1st Quartile (≤28.29), the adjusted OR values for VAI and elevated 10-year ASCVD risk in Q3 (46.52-77.00), and Q4 (≥77.01) were 4.63 (95% CI: 2.18-9.82, P < 0.001), 16.94 (95% CI: 6.74-42.57, P < 0.001), respectively. Stratified analysis showed that the association between VAI or LAP and the first ASCVD event was more pronounced in males.

Conclusion

Higher VAI or LAP scores are significantly associated with elevated 10-year ASCVD risk in adults aged 40 to 79 in the USA, which suggested that monitoring visceral obesity is crucial to reduce the risk of a first ASCVD event.

Whole-Body Cryotherapy Alters Circulating MicroRNA Profile in Postmenopausal Women

The incidence of metabolic syndrome (MetS) increases with age, especially in women. The role of microRNAs (miRs) in the regulation of metabolism is postulated. The aim of the study is to identify miRs that may be markers of MetS and to assess changes in miRs expression as a result of 10 and 20 whole-body cryotherapy treatments (WBC; 3 min, -120 °C) in postmenopausal women with MetS (M-60, BMI 30.56 ± 5.38 kg/m2), compared to healthy postmenopausal (H-60, BMI 25.57 ± 2.46 kg/m2) and healthy young women (H-20, BMI 22.90 ± 3.19 kg/m2). In a fasting state, before 1 WBC and after 10 WBCs, as well as 20 WBCs, the expression of miR-15a-5p, miR-21-5p, miR-23a-3p, miR-146a-5p, miR-197-3p, miR-223-3p, fasting blood glucose (FBG) and blood lipid profile were determined. miR-15a-5p and miR-21-5p were down-regulated in M-60, while miR-23a-3p and miR-197-3p were up-regulated, and miR-223-3p down-regulated in M-60 and H-60, compared to H-20. Significant positive correlations between up-regulated (mostly for miR-23-3p and miR-197-3p) and significant negative correlations between down-regulated (mostly for miR-15a-5p) miRs and markers of body composition as well as metabolic disorders were observed. After 20 WBCs, miR-15a-5p expression was up-regulated in all groups. In H-60, down-regulation of miR-197-3p expression occurred after 10 WBCs and 20 WBCs. Following 10 WBCs, FBG decreased in all groups, which intensified in M-60 post-20 WBCs. In our research, it has been shown that miR-23a-3p and miR-197-3p are accurate markers of MetS and MetS risk factors, while miR-15a-5p and miR-23a-3p are precise markers of body composition disorders. WBC is an effective treatment for up-regulating miR-15a-5p and lowering glucose levels in young and postmenopausal women and down-regulating miR-197-3p expression in postmenopausal women. It may be an adjunctive effective treatment method in MetS and hyperglycemia.

Impact of Quantitative Computed Tomography-Based Analysis of Abdominal Adipose Tissue in Patients with Lymphoma

Quantitative abdominal adipose tissue analysis is important for obtaining information about prognosis and clinical outcomes on a wide array of diseases. In recent years, the effects of abdominal adipose tissue compartments in patients with lymphoma and the changes in their distribution after therapies have been studied. This information could facilitate the improvement of therapies in patients with lymphoma, to prevent or treat both visceral obesity and sarcopenia. Opportunistic analysis of body composition on computed tomography (CT) images might contribute to the improvement of patient management and clinical outcomes together with implementation of targeted patient-tailored therapies. The purpose of this literature review is to describe the role of CT to evaluate abdominal adipose tissue quantity and distribution in patients with lymphoma.

Exploring the Influence of Age, Gender and Body Mass Index on Colorectal Cancer Location

Background and objectives: The global burden of non-communicable diseases like obesity and cancer, particularly colorectal cancer (CRC), is increasing. The present study aimed to investigate the association between CRC location (proximal vs. distal) and patient demographic factors including age, sex, and BMI, as well as cancer stage at diagnosis. Materials and Methods: In this cross-sectional study, data from 830 patients diagnosed with CRC were analyzed. The variables included age, sex, weight, height, BMI, cancer location, and cancer stage at diagnosis. Patients were stratified into three age groups and three BMI categories, and we analyzed the association between cancer location and these variables using Chi-squared tests and multivariate logistic regression. Results: The rectum and ascending colon were the most common locations of malignant neoplasms. No statistically significant differences in cancer location across age groups were observed. Significant differences were found in the BMI across age groups, particularly in the normal weight and overweight categories. Normal weight and obese patients had a higher proportion of Stage 3 and Stage 4 cancers. Obesity emerged as a significant predictor for rectal cancer in a multivariate logistic regression analysis, with an odds ratio of 1.56. However, no significant associations were found between cancer location and other factors like age, gender, or cancer stage. Conclusions: Our study revealed that normal weight and obese patients had a higher proportion of Stage 3 and Stage 4 cancers, with obesity emerging as a significant predictor for rectal cancer. It is important to note that while obesity was found to be a significant predictor for rectal cancer, the development and location of colorectal cancer is likely influenced by various factors beyond those studied here. Therefore, further research is needed to investigate the roles of other potential risk factors, like loss of SIRT6 and adipose tissue homeostasis. Additionally, inflammation associated with microbiota in the colorectal mucosa, systemic gene expression, and visceral obesity may also play important roles in the development and progression of colorectal cancer. Understanding these intricate relationships is crucial for better screening, disease prognosis, and management strategies.

Visceral Obesity and Cytokeratin-18 Antigens as Early Biomarkers of Liver Damage

Visceral obesity is linked to the progression of fatty liver to nonalcoholic steatohepatitis (NASH). Cytokeratin-18 (CK18) epitopes M30 (CK18M30) and M65 (CK18M65) represent accurate markers for detecting NASH. The aim of this study was to evaluate the association of CK18M30 and CK18M65 levels with anthropometric and metabolic characteristics, liver stiffness, and liver indices of steatosis and fibrosis in a cohort of subjects with visceral obesity; in this cross-sectional study, transient elastography (TE-Fibroscan^®), anthropometric measurements, metabolic parameters, High Sensitivity C-Reactive Protein (hsCRP), and CK18M30 and CK18M65 levels (Apoptosense ELISA, PEVIVA, Germany) were evaluated. Fatty Liver Index (FLI), Fibrosis 4 (FIB-4), and Aspartate transaminase (AST)-platelet ratio index (APRI) were calculated; among 48 subjects, 47.2% presented metabolic syndrome, 93.8% hepatic steatosis, 60.4% high liver stiffness, and 14.6% hypertransminasemia, while FIB-4 and APRI were normal. CK18M30 and CK18M65 levels were significantly correlated with waist circumference, AST, ALT, HoMA-IR, liver stiffness, and APRI (p < 0.001). Subjects with CK18 fragments above the median values showed significantly higher waist circumference, HbA1c, AST, ALT, HoMA-IR, FLI, and APRI compared to those with values below the median; CK18M30 and CK18M65 levels correlated well with anthropometric and metabolic characteristics, representing good biomarkers for early identification of NASH in subjects with visceral obesity.

Lean nonalcoholic fatty liver disease and sarcopenia

Nonalcoholic fatty liver disease (NAFLD) has become one of the most common chronic liver diseases in the world. The risk factor for NAFLD is often considered to be obesity, but it can also occur in people with lean type, which is defined as lean NAFLD. Lean NAFLD is commonly associated with sarcopenia, a progressive loss of muscle quantity and quality. The pathological features of lean NAFLD such as visceral obesity, insulin resistance, and metabolic inflammation are inducers of sarcopenia, whereas loss of muscle mass and function further exacerbates ectopic fat accumulation and lean NAFLD. Therefore, we discussed the association of sarcopenia and lean NAFLD, summarized the underlying pathological mechanisms, and proposed potential strategies to reduce the risks of lean NAFLD and sarcopenia in this review.

Perirenal fat thickness as a risk factor for postoperative complications in elective colorectal cancer surgery

Visceral obesity is an important factor that increases the risk of complications after colorectal cancer surgery. As calculating visceral fat is difficult and time-consuming, more practical fat measurements that are not time-consuming have been introduced. This study aimed to investigate the effects of perirenal fat thickness on postoperative complications and prognosis in patients undergoing surgery for colorectal cancer. Perirenal fat thickness was measured from the dorsal aspect of the left kidney on preoperative computerized tomography of patients who underwent surgery for colorectal cancer. The effects of perirenal fat thickness on postoperative complications were investigated. Diagnostic test performance was examined using the Roc Curve test to determine the cutoff value for the perirenal fat thickness values according to the complication findings of the patients. The cutoff value of perirenal fat thickness was found to be above 25.1, according to the presence of complications in the patients. Those with a perirenal fat thickness greater than 25.1 mm were considered to have high perirenal fat thickness values, and those with a low perirenal fat thickness value were considered low. Multivariate analysis revealed that increased perirenal fat thickness is an independent risk factor for postoperative complications. We believe that perirenal fat thickness measurement, as an indicator of visceral fat volume, can be used to identify patients at high risk of developing complications after colorectal cancer surgery. This may change the disease management and affect the patient information process.

Total serum FGF-21 levels positively relate to visceral adiposity differently from its functional intact form

Objective

Increased Fibroblast Growth Factor-21 (FGF-21) circulating levels have been described in obesity. In this observational study, we analysed a group of subjects with metabolic disorders to unravel the putative link between visceral adiposity and FGF-21 serum levels.

Methods

Total and intact serum FGF-21 concentration was measured with an ELISA assay respectively in 51 and 46 subjects, comparing FGF-21 levels in dysmetabolic conditions. We also tested Spearman's correlations between FGF-21 serum levels and biochemical and clinical metabolic parameters.

Results

FGF-21 was not significantly increased in high-risk conditions such as visceral obesity, Metabolic Syndrome, diabetes, smoking, and atherosclerosis. Waist Circumference (WC), but not BMI, positively correlated with total FGF-21 levels (r=0.31, p <0.05), while HDL-cholesterol (r=-0.29, p <0.05) and 25-OH Vitamin D (r=-0.32, p <0.05) showed a significant negative correlation with total FGF-21. ROC analysis of FGF-21 in prediction of increased WC, showed that patients with total FGF-21 level over cut-off value of 161.47 pg/mL presented with impaired FPG. Conversely, serum levels of the intact form of FGF-21 did not correlate with WC and other metabolic biomarkers.

Conclusion

Our newly calculated cut-off for total FGF-21 according to visceral adiposity identified subjects with fasting hyperglycemia. However, waist circumference correlates with total FGF-21 serum levels but does not correlate with intact FGF-21, suggesting that functional FGF-21 does not necessarily relate with obesity and metabolic features.

Asthma prevalence is increased in patients with high metabolism scores for visceral fat: study reports from the US

Objective

Data from NHANES 2001-2018 were used to examine the relationship between metabolism score for visceral fat (METS-VF) and asthma prevalence.

Methods

We assessed the association between METS-VF and asthma disease using multiple logistic regression analysis from the National Health and Nutrition Examination Survey (NHANES), 2001-2018, followed by subgroup analysis for sensitive populations. To determine whether METS-VF and asthma disease had a non-linear relationship, smooth curve fitting was used, and threshold effect analysis was used to verify the relationship.

Results

Among the 36,876 participants, 4,919 self-reported having asthma. When all confounders were controlled for, a positive association was found between METS-VF and asthma prevalence (OR = 1.27, 95% CI: 1.22,1.32), and this positive association was stronger with elevated METS-VF (P for trend = 0.01). According to the smooth curve fitting analysis, METS-VF and asthma prevalence do not have a linear relationship. The double-segmented threshold effect analysis suggested a negative correlation but no statistically significant difference between METS-VF less than 5.24 and asthma prevalence (OR = 0.60, 95% CI: 0.33, 0.91). Besides, other METS-VF showed positive associations with asthma prevalence before and after the effective inflection point. According to subgroup analysis, METS-VF is associated with asthma prevalence among participants aged 40 - 59, male, Mexican American, with hypertension and diabetes, and without asthma history.

Conclusion

A positive correlation between METS-VF and asthma was observed and this positive correlation was non-linear, and participants with METS-VF above 5.24 should be cautious about the high risk of asthma. The relationship should be given more attention to participants who are aged 40-59 years old, male, Mexican American, have hypertension, diabetes, and who do not have a family history of asthma.

Heterogeneous Comorbidity in Individuals With Different Phenotypes of Obesity

Introduction The prevalence of obesity is steadily increasing worldwide. Obesity is one of the most potent risk factors for various diseases and is simultaneously a heterogeneous condition. Different types of obesity could be identified according to body mass index (BMI), waist circumference, and visceral fat level; these conditions may present individually or in combination and pose a risk of developing certain comorbidities. However, the current obesity classification systems do not allow for accurate diagnosis and prediction of the comorbidity risk of patients, which is crucial for their clinical management. This points to the importance of studying obesity phenotyping in the context of body composition. Our study aimed to determine the contribution of obesity phenotypes in forming various comorbidities. Materials and methods This case-control study was conducted at the Clinical and Diagnostic Center of the Aviastroitelny District, Kazan. Patients were selected based on BMI per inclusion and exclusion criteria. A total of 151 patients with a median age of 43 [34.5-50] years were included in the study. The participants were distributed into six groups according to BMI and a combination of abdominal obesity (AO) and excess visceral fat. Results The participants were distributed in the following phenogroups: The first group - normal BMI without AO and excess visceral fat (n=47; 31.1%); the second group - overweight without AO and excess visceral fat (n=26; 17.2%); the third group - normal BMI with AO and without excess visceral fat (n=11; 7.3%); fourth group - overweight with AO and without excess visceral fat (n=34; 22.5%); fifth group - general obesity with AO and without excess visceral fat (n=20; 13.2%); sixth group - general obesity with AO and excess visceral fat (n=13; 8.6%). The five most frequently observed conditions in the general cohort were dyslipidemia (71.5%; n=108), disorders of the gastrointestinal tract (53.0%; n=80), cardiovascular disease (46.4%; n=70), musculoskeletal diseases (40.4%; n=61) and impaired carbohydrate metabolism (25.2%; n=38). The median number of pathological combinations in the general cohort was 5 [IQR: 3-7]. As the group number increased, the median number of comorbidities also increased. While BMI was significantly associated only with arterial hypertension, the level of visceral fat was associated with most comorbidities (obstructive sleep apnea syndrome, non-alcoholic fatty liver disease, chronic pancreatitis, hypertriglyceridemia, and prediabetes), followed by abdominal obesity (gastroesophageal reflux disease, hypertriglyceridemia, arterial hypertension, hypercholesterolemia). Conclusions In working-age people, group 1 and 4 phenotypes were more frequent than others. Abdominal obesity and visceral fat were associated with the most comorbid conditions. However, the individual types of these comorbidities were not the same.

Circadian Misalignment Impacts the Association of Visceral Adiposity With Elevated Blood Pressure in Adolescents

BACKGROUND

Although insufficient sleep has been shown to contribute to obesity-related elevated blood pressure, the circadian timing of sleep has emerged as a novel risk factor. We hypothesized that deviations in sleep midpoint, a measure of circadian timing of sleep, modify the association between visceral adiposity and elevated blood pressure in adolescents.

METHODS

We studied 303 subjects from the Penn State Child Cohort (16.2±2.2 years; 47.5% female; 21.5% racial/ethnic minority). Actigraphy-measured sleep duration, midpoint, variability, and regularity were calculated across a 7-night period. Visceral adipose tissue (VAT) was measured with dual-energy X-ray absorptiometry. Systolic blood pressure (SBP) and diastolic blood pressure levels were measured in the seated position. Multivariable linear regression models tested sleep midpoint and its regularity as effect modifiers of VAT on SBP/diastolic blood pressure levels, while adjusting for demographic and sleep covariables. These associations were also examined as a function of being in-school or on-break.

RESULTS

Significant interactions were found between VAT and sleep irregularity, but not sleep midpoint, on SBP (P interaction=0.007) and diastolic blood pressure (P interaction=0.022). Additionally, significant interactions were found between VAT and schooldays sleep midpoint on SBP (P interaction=0.026) and diastolic blood pressure (P interaction=0.043), whereas significant interactions were found between VAT and on-break weekdays sleep irregularity on SBP (P interaction=0.034).

CONCLUSIONS

A delayed and an irregular sleep midpoint during school and during free-days, respectively, increase the impact of VAT on elevated blood pressure in adolescents. These data suggest that deviations in the circadian timing of sleep contribute to the increased cardiovascular sequelae associated with obesity and that its distinct metrics require measurement under different entrainment conditions in adolescents.

Impact of visceral obesity on the short-term outcomes after laparoscopic appendectomy

OBJECTIVE

To investigate the effect of visceral obesity on short-term outcomes after laparoscopic appendectomy (LA).

METHODS

a retrospective study on 441 patients who underwent a LA between July 2019 and July 2020. According to the cutoff visceral fat area (VFA) for visceral obesity, the patients were divided into two groups: visceral obesity group (n = 123) and non-visceral obesity group (n = 318). The general information, comorbidities, perioperative monitoring indicators, and postoperative complications of the patients were collected.

RESULTS

Compared with the non-visceral obesity group, the proportion of overweight patients (56.10%), preoperative white blood cell count (12.92 (9.99, 15.58)*10⁹mg/dl), postoperative white blood cell count (9.71 ± 3.91*10⁹mg/dl), and hospitalization costs (16,220.93 ± 7038.76¥) in the visceral obesity group were significantly different (all p < 0.05). Additionally, multivariate logistic regression analysis revealed that visceral obesity (2.679, 95%CI: 1.155-5.849, p = 0.027), indwelling drainage tube (7.832, 95%CI: 2.151-27.428, p < 0.001), and perforated appendicitis (3.181, 95%CI: 1.195-7.136, p = 0.025) were identified to be independent risk factors for incision infection after LA. The area under receiver operating characteristic (ROC) curve value for VFA predicting incisional infection after LA was 0.770.

CONCLUSIONS

Visceral obesity is one of the independent risk factors for incisional infection after LA, and can be used as one of the reference indicators for prognostic assessment of short-term outcomes after LA.

A High-Quality Diet, as Measured by the DASH Score, Is Associated with a Lower Risk of Metabolic Syndrome and Visceral Obesity

The current study was designed to examine the relationship between diet quality, as measured by the Dietary Approaches to Stop Hypertension (DASH) score, and the prevalence of metabolic syndrome (MetS) and its components. The study was cross-sectional in design and enrolled 535 people, including 215 with MetS and 320 without MetS. Using a validated food frequency questionnaire, the DASH diet quality score was counted. The mean age of the MetS group and control subjects was 58.48 ± 14.65 and 58.33 ± 9.26 years, respectively. The study showed that the MetS group had a significantly lower mean total DASH score than the control group (23.13 ± 5.44 vs. 24.62 ± 5.07, p = 0.0023). In addition, it was found that an increase in the total DASH score was associated with a lower risk of MetS (odds ratio [OR] = 0.95, 95% confidence interval [CI] = 0.91-0.99, p = 0.009). In the correlation analysis of the total population, a better-quality diet (higher DASH score) was positively correlated with high-density lipoprotein cholesterol (HDL-c), and negatively correlated with triglyceride (TG) concentration and waist circumference. It was also found that an increase in the total DASH score was associated with a lower risk of abdominal obesity (OR = 0.93, 95% CI = 0.88-0.99, p = 0.017). The results from the analyzed data highlight the potential benefits of following a healthy diet such as DASH.

Gender difference in association between low muscle mass and risk of non-alcoholic fatty liver disease among Chinese adults with visceral obesity

Background and aims

Although the association between low muscle mass and the risk of non-alcoholic fatty liver disease is well-known, it has not been explored in viscerally obese populations by gender. Besides, whether low muscle mass still increases the NAFLD risk in subjects with visceral obesity, independent of obesity, is still unknown. The aim of this study was to explore the gender-specific association between low muscle mass and the risk of non-alcoholic fatty liver disease (NAFLD) in subjects with visceral obesity.

Methods

Overall, 1,114 participants aged 19-89 years were recruited in this retrospective study. Liver disease was diagnosed by hepatic ultrasound. Skeletal muscle mass was estimated by bioimpedance analysis and defined by the appendicular skeletal muscle index (ASMI). Gender-specific differences in the ASMI value were compared between NAFLD and control groups. Restricted cubic spline and multivariate logistic regression were performed to analyze the association (stratified by gender and age) between the ASMI and the risk of NAFLD, respectively.

Results

Middle-aged females (40-60 years) and males (of any age) with NAFLD had a significantly lower ASMI compared with controls (P-value < 0.05). An inverse linear association was found between the ASMI and risk of NAFLD (all P _{fornon-linearity} > 0.05). Lower quartiles of the ASMI conferred independent risk of NAFLD compared to higher quartiles (all P for trend < 0.001). Low muscle mass conferred a higher risk of NAFLD in middle-aged females (adjusted odds ratio = 2.43, 95% confidence interval: 1.19-4.95) and males [18-39 years: 3.76 (1.79-7.91); 40-60 years: 4.50 (2.16-9.39); and >60 years: 4.10 (1.13-14.84)]. Besides, Low muscle mass and low muscle mass with obesity increase the risk of developing NAFLD, independent of obesity.

Conclusion

Among those with visceral obesity, low muscle mass increased the risk of NAFLD in males of any age, and middle-aged females, this may be explained by the postmenopausal decline in estrogen.

Body roundness index is related to the low estimated glomerular filtration rate in Chinese population: A cross-sectional study

BACKGROUND

Kidney disease is related to visceral obesity. As a new indicator of obesity, body roundness index (BRI) has not been fully revealed with kidney disease. This study's objective is to assess the relationship between estimated glomerular filtration rate (eGFR) and BRI among the Chinese population.

METHODS

This study enrolled 36,784 members over the age of 40, they were from 7 centers in China by using a random sampling method. BRI was computed using height and waist circumference, eGFR ≤ 90 mL/min/1.73 m² was considered to indicate low eGFR. To lessen bias, propensity score matching was employed, multiple logistic regression models were utilized to examine the connection between low eGFR and BRI.

RESULTS

The age, diabetes and coronary heart disease rates, fasting blood glucose, and triglycerides were all greater in participants with low eGFR. The BRI quartile was still positively connected with low eGFR after controlling for confounding variables, according to multivariate logistic regression analysis. (OR [95%CI] Q2:1.052 [1.021-1.091], OR [95%CI] Q3:1.189 [1.062-1.284], OR [95%CI] Q4:1.283 [1.181-1.394], P trend < 0.001). Stratified research revealed that the elders, women, habitual smokers, and those with a history of diabetes or hypertension experienced the connection between BRI level and low eGFR. According to ROC, BRI was able to detect low eGFR more accurately.

CONCLUSION

Low eGFR in the Chinese community is positively connected with BRI, which has the potential to be used as an effective indicator for screening kidney disease to identify high-risk groups and take appropriate measures to prevent subsequent complications.

Impact of Visceral Obesity on Structural and Functional Alterations of Gut Microbiota in Polycystic Ovary Syndrome (PCOS): A Pilot Study Using Metagenomic Analysis

OBJECTIVE

We aimed to identify structural and functional alterations of gut microbiota associated with visceral obesity in adult women with polycystic ovary syndrome (PCOS).

METHODS

Twenty-seven adults with PCOS underwent stool and fasting blood collection, oral glucose tolerance testing, and visceral fat area (VFA) measurement via dual-bioimpedance technique. Metagenomic analysis was used to analyze gut microbiota.

RESULTS

PCOS patients were divided into three groups: visceral obesity group (PCOS-VO, n=9, age 28.33±5.68 years, BMI 37.06±4.27 kg/m², VFA 128.67±22.45 cm²), non-visceral obesity group (PCOS-NVO, n=10, age 25.40±4.53, BMI 30.74±3.95, VFA 52.00±24.04), normal BMI group (PCOS-NB, n=8, age 27.88±2.53, BMI 21.56±2.20, VFA 27.00±21.18), with no statistical difference in age (P>0.05) and significantly statistical differences in BMI and VFA (P<0.05). The groups showed a significant difference in microbial β-diversity between PCOS-VO and PCOS-NVO (P=0.002) and no difference between PCOS-NVO and PCOS-NB (P=0.177). Bacteroidetes was the phylum with the highest relative abundance among all patients, followed by Firmicutes. Those with visceral obesity had a higher abundance of Prevotella, Megamonas, and Dialister genera, positively correlated with metabolic markers (r>0.4, P<0.05), and lower abundance of Phascolarctobacterium and Neisseria genera, negatively correlated with metabolic markers (r<-0.4, P<0.05). Functional annotation analysis showed significant differences in relative abundance of ribosome pathway, fatty acid biosynthesis pathway, and sphingolipid signaling pathway between groups, affecting lipid homeostasis and visceral fat accumulation.

CONCLUSION

Alteration in β-diversity of gut microbiota exists in PCOS with visceral obesity versus those without visceral obesity and relates to functional differences in ribosomes, fatty acid biosynthesis, and sphingolipid signaling pathways.

Can Nutritional Status in Adults Be Influenced by Health Locus of Control?

The external health locus of control (HLC) is based on an assumption that obtained health results depend on the influences of external factors. As for the internal HLC-that is the effect of our own actions and capabilities. Little is known regarding how the HLC can influence body weight or the occurrence of visceral obesity. The study aimed to assess the relationship between the health locus of control and nutritional status in adults. The study included 744 adults (452 women, 292 men; 2.8% underweight, 43.8% normal weight, 29.7% overweight, and 23.7% obese). In addition to anthropometric measurement and socio-demographic data, the health locus of control, using the Multidimensional Health Locus of Control Scale (MHLC) by Wallston K, Wallston B, and DeVellis R, was assessed. The percentage of subjects with an internal HLC did not differ significantly between obese, overweight, and normal-weight groups. However, the percentage of subjects with an external HLC-dependent on the impact of others-was significantly higher in both men and women with obesity than in corresponding overweight and normal-weight groups (p < 0.01). Yet, the percentage of subjects with an external HLC subject to the impact of chance was significantly higher among overweight and obese women than in those of normal weight (p < 0.05) only. Women with overweight or obesity, with external health locus of control, experienced both the impact of others and of chance more often than women with normal weight. However, men with overweight and with obesity more often had external health locus of control influenced only by others.

Association between Blood Manganese Levels and Visceral Adipose Tissue in the United States: A Population-Based Study

Background: Manganese (Mn) is an essential trace element with a narrow toxic margin for human health. The association between Mn exposure and adverse visceral adipose tissue (VAT) accumulation is unclear. Objective: This study aimed to estimate the associations of blood Mn levels with VAT mass or visceral obesity in the general population in the United States. Method: This cross-sectional study included data of 7297 individuals released by National Health and Nutrition Examination Survey (NHANES). VAT was quantified with dual-energy X-ray absorptiometry, and blood Mn was measured using inductively coupled plasma mass spectrometry. The generalized linear model and generalized additive model (GAM) were applied to estimate the linear and non-linear associations between Mn levels and VAT mass, respectively. Logistic regression was used to estimate the associations between blood Mn levels and the risk of visceral obesity. Results: Fully adjusted generalized linear regression revealed that individuals in the higher quantile of Mn had increased VAT mass compared with those in the lower quantile (β per quantile change = 0.025; 95% CI of 0.017, 0.033; p < 0.001). Positive associations were also observed in males and females (males: β per quantile change = 0.012, 95% CI of 0.002, 0.022 (p = 0.020); female: β per quantile change = 0.036; 95% CI of 0.023, 0.048 (p < 0.001)). The GAM illustrated that the non-linear associations between blood Mn levels and VAT mass were in U-shape patterns (effective degree of freedom >1 in total participants, males, and females). A stratified analysis found significant interactions between Mn and the family income-to-poverty ratio (PIR) in males, with stronger associations in males with a PIR < 1.3 (β = 0.109; 95% CI of 0.048, 0.170). Additional analyses revealed that individuals in the highest quantile of Mn had a 39% higher risk of visceral obesity (OR = 1.39; 95% CI of 1.15−1.69; p < 0.001). Conclusions: Higher blood Mn levels were positively associated with increased VAT mass and visceral obesity risk. The adverse VAT phenotype associated with excessive blood Mn levels should be further investigated.

Visceral fat loss by whole-body electromyostimulation is attenuated in male and absent in female older Non-Insulin-Dependent diabetes patients

INTRODUCTION

Type 2 diabetes and its reversal correlate with increases and decreases in visceral fat (VF). Resistance exercise reduces VF in healthy persons, but little is known in type 2 diabetes. Muscle contractions induced by whole-body electromyostimulation (WB-EMS) provide a very effective form of resistance training. We hypothesized that WB-EMS reduces VF and improves plasma glucose measures in older non-insulin dependent diabetes mellitus (NIDDM) males and females.

METHODS

A four-arm age-matched case control study was done on WB-EMS twice a week in older NIDDM patients (27 males, 18 females) compared with controls (15 males, 15 females). VAT area (VAT, cm² ), total fat mass (TFM, kg) and lean body mass (LBM, kg) were assessed by DEXA-scanning. HbA1c, fasting glucose and plasma lipoproteins were measured at baseline and after 4 months.

RESULTS

Baseline control VAT was higher in males than females (140.5 ± 35.6 vs. 96.7 ± 42.3, p < .001). In NIDDM, VAT was higher with no significant sex difference (206.5 ± 65.0 vs. 186.5 ± 60.5). In controls, WBEMS reduced VAT in males and females to similar extent (-16.9% and -16.4%, p < .001 vs. baseline) and in preference to TFM (-9.2% and -3.6%) or body weight loss (-2.8 and -2.1%). In NIDDM, VF loss was attenuated in males (-7.3%, p < .01) but completely absent in females. WBEMS reduced HbA1c and cholesterol and increased HDL levels (all p < .05) only in male NIDDM CONCLUSIONS: WBEMS induced VF loss in healthy older males and females an effect strongly attenuated in male and completely absent in female NIDDM patients. This questions the effectiveness of muscle contraction-induced VF lipolysis in NIDDM. Sex differences may dictate the success of resistance training in NIDDM, a subject that needs to be addressed in future studies.

Cardiometabolic profiles in women with adenomyosis

The aim of this study was to investigate the reproductive profiles, metabolic parameters and cardiometabolic risk assessed by surrogate indexes in women with adenomyosis. Ninety-six premenopausal women who were diagnosed with adenomyosis by transvaginal ultrasound and 97 age-body mass index (BMI) matched controls with normal ultrasound during routine examination were included. Women with adenomyosis were more likely to have higher gravidity and had more abortions than women without adenomyosis. Regarding the individual metabolic syndrome components, the adenomyosis group was more likely to have higher prevalence of hypertension, low HDL-C and central obesity. No significant difference was found between the groups in terms of visceral adiposity index, lipid accumulation product and fatty liver index. Only higher blood pressure (BP) remained statistically significant after adjustment for confounding factors in multivariate analysis. Women with adenomyosis had remarkably high risk of hypertension. It may be advisable to monitor their BP closely.Impact StatementWhat is already known on this subject? The only anthropometric characteristic assessed in women in relation to adenomyosis is body mass index (BMI). A case-control study showed that women who are obese are more likely to have adenomyosis. The gravidity, number of spontaneous abortions and previous uterine surgeries such as dilatation and curettage (D&C) and caesarean section were found significantly associated with adenomyosis.What do the results of this study add? A remarkable finding of our study was the increased incidence of higher systolic BP in women with adenomyosis. No difference was observed in adiposity indices between women with and without adenomyosis. Higher prevalence of central obesity and lower HDL-C levels were seen in women with adenomyosis.What are the implications of these findings for clinical practice and/or further research? The study identifies that adenomyosis is associated with an increased risk of hypertension, and women with adenomyosis may be monitored closely for blood pressure changes. Our report also provides novel information about the metabolic risk profiles associated with adenomyosis.

Association of body composition with clinical outcome in Chinese women diagnosed with breast cancer

Objective

This study aims to explore the association of body composition with clinical outcomes in Chinese women diagnosed with breast cancer.

Method

A total of 2,948 Chinese female patients with breast cancer have been included in this retrospective study. Body composition mainly includes the measurements of adiposity and muscle mass. Visceral fat area (VFA) is used to measure visceral obesity, while appendicular skeletal muscle mass index (ASMI) is utilized to evaluate sarcopenia. The endpoints of this study are disease-free survival (DFS) and overall survival (OS). The association of the body composition parameters with DFS and OS was statistically analyzed.

Result

The median follow-up time for survivors was 42 months (range, 3 to 70 months). In total, 194 patients (6.9%) had breast cancer recurrence, and 32 patients passed away (1.1%). Among the 2,948 patients included, 1,226 (41.6%) patients were viscerally obese, and 511 (17.3%) patients were sarcopenic. We found that visceral obesity had a significant prognostic impact on DFS (HR, 1.46; 95% CI, 1.10-1.95; p = 0.010) but not on OS (P = 0.173). Multivariate analysis revealed sarcopenia as an independent prognostic factor for DFS (HR, 1.44; 95% CI, 1.02-2.03; p = 0.038) and OS (HR, 2.13; 95% CI, 1.00-4.51; p = 0.049). Body mass index was not significantly associated with both DFS (P = 0.224) and OS (P = 0.544).

Conclusion

Visceral obesity is associated with a higher risk of disease recurrence, and sarcopenia is significantly associated with increased recurrence and overall mortality among Chinese women with breast cancer. Body composition assessment could be a simple and useful approach in breast cancer management. Further studies can focus on decreasing visceral fat and increasing skeletal muscle mass to improve prognosis in breast cancer survivors.

Metabolic Syndrome Ameliorated by 4-Methylesculetin by Reducing Hepatic Lipid Accumulation

Obesity is a chronic metabolic disease caused by an imbalance between energy intake and expenditure during a long period and is characterized by adipose tissue disfunction and hepatic steatosis. The aim of this study was to investigate the effect of 4-methylesculetin (4-ME), a coumarin derivative, upon adipose microenvironment and hepatic steatosis in mice induced by a high-fat diet (HFD), and to explore potential mechanisms of its beneficial effect on metabolic disorders. HFD-fed mice displayed visceral obesity, insulin resistance, and hepatic lipid accumulation, which was remarkably ameliorated by 4-ME treatment. Meanwhile, 4-ME ameliorated adipocyte hypertrophy, macrophage infiltration, hypoxia, and fibrosis in epididymal adipose tissue, thus improving the adipose tissue microenvironment. Furthermore, 4-ME reversed the increase in CD36, PPAR-γ, SREBP-1, and FASN, and the decrease in CPT-1A, PPAR-α, and Nrf2 translocation into the nucleus in livers of HFD mice and in FFA-incubated hepatocytes. Moreover, the beneficial effects of 4-ME upon lipid deposition and the expression of proteins related to lipid metabolism in FFA-induced LO2 cells were abolished by ML385, a specific Nrf2 inhibitor, indicating that Nrf2 is necessary for 4-ME to reduce hepatic lipid deposition. These findings suggested that 4-ME might be a potential lead compound candidate for preventing obesity and MAFLD.

The Prevalence of Diabetes among Hypertensive Polish in Relation to Sex-Difference in Body Mass Index, Waist Circumference, Body Fat Percentage and Age

Background: Little is known about sex differences in the risk of type 2 diabetes (DM2) development related to body fat depot. The main aim of this study was to assess sex-specific differences in the prevalence of diabetes in the relation to body mass, body mass index (BMI), waist circumference (WC), and calculated body fat percentage (BF), adjusted by physical activity, in younger and older hypertensive adults. Subjects/Methods: The survey enrolled 12,289 adult hypertensive outpatients with body weight, height, and WC reported by their physicians across Poland. Prevalence of diabetes was plotted against body mass, BMI, WC, and calculated BF and adjusted by the self-reported level of physical activity. Results: In our cohort, younger women (<60 years) with BMI < 25.0 kg/m2 had lower adjusted prevalence of diabetes than corresponding men (3.4% vs. 6.5%), while among older (≥60 years) with BMI < 25.0 kg/m2, the prevalence of diabetes was greater in women than in men (19.4% vs. 11.2%). A 25% probability of diabetes was observed for younger women with lower BMI than younger men (32.1 kg/m2 and 35.3 kg/m2, respectively) and WC (100.7 cm and 116.1 cm, respectively) but greater BF (45.5% and 38.9%, respectively). The corresponding differences in BMI and WC in older ones were much smaller (27.6 kg/m2 and 27.2 kg/m2, respectively; 83.7 cm and 85.6 cm, respectively), but not for BF (40.7% and 30.1%, respectively). A doubling of diabetes probability (from 25% to 50%), adjusted by physical activity, was attributable to the lower increase in BMI and WC and BF in women than in men (6.3 vs. 9.8 kg/m2, 25.0 vs. 36.1 cm, and 6.5 vs. 10.8%, for younger, and 8.1 vs. 11.3 kg/m2, 26.2 vs. 73.2 cm and 8.8 vs. 13.3%, for older). Conclusions: This study shows a lower probability of diabetes in younger women than younger men with normal weight BMI ranges, adjusted to physical activity. This probability is greater for hypertensive women, regardless of age, due to the increase in BMI/WC and BF values adjusted for physical activity.

Vitamin D and Visceral Obesity in Humans: What Should Clinicians Know?

The extraskeletal effect of vitamin D on adipose tissue biology and modulation in human obesity is of great interest and has been extensively investigated. Current evidence from preclinical and clinical studies in human adipose tissue suggests that the anti-inflammatory effects of vitamin D are evident and consistent, whereas the effects of vitamin D on adipocyte differentiation, adipogenesis, and energy metabolism and the effects of vitamin D supplementation on adipokine levels are inconclusive. Interventional studies related to medical and surgical weight loss in humans have shown small or no improvement in vitamin D status. Additionally, the benefit of vitamin D supplementation for the reduction in visceral adipose tissue has only been demonstrated in a few studies. Overall, the findings on the relationship between vitamin D and visceral adipose tissue in humans are still inconclusive. Further studies are required to confirm the beneficial effects of vitamin D on ameliorating adipose tissue dysfunction.

Assessing Visceral Obesity and Abdominal Adipose Tissue Distribution in Healthy Populations Based on Computed Tomography: A Large Multicenter Cross-Sectional Study

Objective

Abdominal adipose is closely related to many endocrine and metabolic diseases. The aim of this study was to analyze the distribution of abdominal adipose tissue in a healthy population in northern China determined by abdominal computed tomography (CT).

Methods

Data for this study were obtained from a multicenter, retrospective, cross-sectional study that collected abdominal CT scans of 1787 healthy individuals from 4 representative cities in northern China. Areas of visceral adipose tissue (VATA) and subcutaneous adipose tissue (SATA) were obtained by measuring CT images at the level of the 3rd lumbar vertebra. Visceral adipose tissue index (VATI) and subcutaneous adipose index (SATI) were obtained by normalizing the square of height to analyze the distribution of the above indexes and visceral obesity among different body mass index (BMI), gender and age.

Results

The mean age of this healthy population was 45.3 ± 15.2 years and the mean BMI was 23.5 ± 3.2 kg/m², with 902 men and 885 women. Compared with women, men had a significantly higher median VATA (120.9 vs. 67.2 cm²), VATI (39.1 vs. 25.6 cm²/m²) and a significantly higher percentage of visceral adiposity (VATA ≥ 100 cm²) (60.8 vs. 30.4%), while women had significantly higher SATA (116.9 vs. 146.7 cm²) and SATI (38.8 vs. 55.8 cm²/m²) than men. Whether men or women, VATI was positively correlated with age. Interestingly, SATI was weakly positively correlated with age in women, while SATI was weakly negatively correlated with age in men. In persons with a normal BMI, the proportion of visceral adiposity increases with age, whereas in men with a normal BMI, the proportion of visceral adiposity decreases after the age of 60 years but remains >50%.

Conclusions

The distribution of abdominal visceral and subcutaneous adipose tissue parameters measured by CT differed among gender, age, and BMI. Even men and women with normal BMI have a high proportion of visceral obesity.

Zebrafish obesogenic test identifies anti-adipogenic fraction in Moringa oreifera leaf extracts

The zebrafish obesogenic test (ZOT) is a powerful tool for identifying anti-adipogenic compounds for in vivo screening. In our previous study, we found that Moringa oleifera (MO) leaf powder suppressed the accumulation of visceral adipose tissue (VAT) in ZOT. MO demonstrates a wide range of pharmacological effects; however, little is known about its functional constituents. To identify the anti-adipogenic components of MO leaves, we prepared extracts using different extraction methods and tested the obtained extracts and fractions using ZOT. We found that the dichloromethane extract and its hexane:EtOAc = 8:2 fraction reduced VAT accumulation in young zebrafish fed a high-fat diet. We also performed gene expression analysis in the zebrafish VAT and found that CCAAT/enhancer-binding protein beta and CCAAT/enhancer-binding protein delta (associated with early stages of adipogenesis) gene expression was downregulated after fraction 2 administration. We identified a new MO fraction that suppressed VAT accumulation by inhibiting early adipogenesis using the ZOT. Phenotype-driven zebrafish screening is a reasonable strategy for identifying bioactive components in natural products.

High visceral adiposity index is associated with female orgasmic disorder in premenopausal women: a cross-sectional study

This study aimed to evaluate the association between the visceral adiposity index (VAI) and female sexual dysfunction (FSD). This cross-sectional study included 165 premenopausal, sexually active women admitted to the gynaecology outpatient clinic between January 2021 and April 2021. Female Sexual Function Index (FSFI) was used to assess the sexual function of the women. After measuring body mass index (BMI) and waist circumference (WC), biochemical serum analysis was performed. The VAI was calculated for all participants. The relationship between VAI and total FSFI and subdomain scores was investigated. Of the participants, FSD was detected in 65.5%. There was no relationship between the total FSFI scores and age, BMI, WC and VAI (p = .126, p = .675, p = .790, p = .220, respectively). Increased VAI levels were associated with dysfunction in orgasm (p = .008). Although VAI seems not to be directly related to FSD, it may predict the orgasmic disorder in women.Impact StatementWhat is already known on this subject? Obesity and female sexual dysfunction (FSD) are common health problems which adversely affect the biopsychosocial well-being. Although the relationship between FSD and obesity, body mass index (BMI) and waist circumference (WC) has been widely discussed in the literature to date, there is not enough evidence for the link between FSD and visceral adiposity index (VAI) which is a reliable indicator of visceral fat dysfunction.What do the results of this study add?The results of this study showed that none of the factors indicating obesity such as BMI, WC and VAI were correlated with the total FSFI scores. However, a significant positive correlation was found between the VAI and female orgasmic disorder (FOD).What are the implications of these findings for clinical practice and/or further research? The VAI may be a useful tool for detecting FOD patients. Diagnosis and treatment of orgasmic disorder would significantly improve the patient's quality of life and general well-being. Further large-scale and high-evidence studies are needed to clarify the impact of obesity on FSD and the relationship between VAI and FOD.

The relationship between the visceral adiposity index and carotid atherosclerosis in different genders and age groups

Objectives:

To investigate the possible relationship between visceral adiposity index (VAI) and carotid atherosclerosis(CAS) in different genders and age groups in China.

Methods:

This study was an observational cross-sectional study and included 1996 participants who were health examination . From January 2018 to June 2019, people over 18 years old who had physical examinations were included in the study. Each participant completed a standard questionnaire, anthropometric measurements, ultrasonic examination, and provided blood samples for biochemical measurements. Regression models were utilized to evaluate the relationship between VAI and the CAS risk. An receiver operating characteristic (ROC) was utilized to predict VAI diagnostic efficacy for CAS.

Results:

Adjusting for potential confounding factors, the risk of CAS increases as the level of VAI increases, and the odds ratio (OR) of the upper tertile is 3.09 (95% confidence interval [CI]:1.64-5.82, p<0.001) in female >44 years of age. In females aged >44 years, the AUC of the VAI (AUC=0.610, 95%CI: 0.57-0.65) was higher than body mass index, WC, and HC (AUC=0.538 [95%CI:0.49–0.58], 0.499 [95%CI:0.45-0.54], and 0.526 [95%CI:0.48-0.57], VAI demonstrated a better ability to predict CAS (in females >44 years of age). However, this correlation was not observed in males.

Conclusion:

The relationship between VAI and CAS, with gender and age differences. Visceral adiposity index could be selected as new and simple predictors of CAS for females (>44 years of age) in China.

Association Between Elevated Thyroid Peroxidase Antibody and Abdominal Fat Distribution in Patients with Type 2 Diabetes Mellitus

OBJECTIVE

Obesity and autoimmune thyroid disease (AITD) are both common disorders in the general population, which are major drivers for adverse medical conditions. While an interaction between thyroid function and visceral obesity is thought to exist, but very few studies have examined the relationship between AITD and visceral obesity, especially in the patients with type 2 diabetes mellitus (T2DM). In the present study, we investigated the association between elevated thyroid peroxidase antibody (TPOAb) titer and visceral fat area in T2DM patients.

METHODS

A total of 390 T2DM patients who met the criteria for admission and joined the National Metabolic Management Center (MMC) in the Zhejiang Provincial People's Hospital from April 2020 to December 2020 were enrolled in this study. The participants were divided into two groups based on visceral obesity. Thyroid function, thyroid associated antibody and other metabolic indicators were measured by blood tests. The visceral fat area (VFA) and the subcutaneous fat area (SFA) were measured by bioelectrical impedance analysis.

RESULTS

There were 185 participants (47.4%) had visceral obesity. The positive rate of TPOAb was significantly higher in T2DM patients with visceral obesity (12.97% vs 5.37%, p < 0.01). Free triiodothyronine (FT3) and thyroid-stimulating hormone (TSH) were both significantly higher in T2DM patients with visceral obesity (p < 0.05). The increased TPOAb titer was significantly positively correlated with visceral fat area (r = 0.175, p < 0.01). Binary logistic analysis showed that the positive rate of TPOAb was associated with an increased risk of visceral obesity [(OR) 4.258, 95% confidence interval (CI) 1.594, 11.375, p = 0.004].

CONCLUSION

TPOAb-positive is more common in T2DM patients with visceral obesity, which has some effects on visceral obesity independent of thyroid function. This suggests that elevated TPOAb titer is a predictor of visceral obesity in T2DM patients.

Metabolism Score for Visceral Fat (METS-VF): A New Predictive Surrogate for CKD Risk

PURPOSE

Metabolic disorders are closely related to the occurrence and development of chronic kidney disease (CKD). We explored the prospective association between the Metabolic Score for Visceral Fat (METS-VF) and CKD in a 5-year follow-up study.

PATIENTS AND METHODS

In this cohort study, 631 adults not suffering from CKD from Wanzhai Town, in China in 2012 were included at baseline and followed up in 2017 and 2018. Multivariable logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for the association between METS-VF and CKD risk. Area under the receiver operating characteristic curve (AUC) analyses were used to evaluate the ability of METS-VF, waist-to-height ratio (WhtR), visceral adiposity index (VAI), homeostatic model assessment of insulin resistance (HOMA-IR), body mass index (BMI) to predict CKD risk.

RESULTS

We identified 103 CKD cases during follow-up. After adjustment for confounding factors, comparing the lowest quartile of METS-VF, the OR (95% CI) of CKD risk in the highest quartile was 3.04 (1.39-6.64). The per Standard deviation (SD) increase in METS-VF was positively correlated with CKD risk. The AUC of METS-VF for predicting CKD risk was, in general, higher than that for WhtR, VAI, HOMA-IR, and BMI.

CONCLUSION

METS-VF may be an indicator for predicting CKD risk.

The association between a body shape index and elevated urinary albumin-creatinine ratio in Chinese community adults

BACKGROUND

Obesity, especially visceral obesity, seems to be one of the most decisive risk factors for chronic kidney disease. A Body Shape Index (ABSI) is an emerging body size measurement marker of visceral obesity. This study aimed to explore whether ABSI is associated with albuminuria in Chinese community adults.

METHODS

This cross-sectional study enrolled 40,726 participants aged 40 or older from seven provinces across China through a cluster random sampling method. ABSI was calculated by body mass index, waist circumference, and height. Increased albuminuria was defined as urinary albumin-creatinine ratio (UACR) ≥ 30 mg/g, indicating kidney injury. For ABSI, we divided it by quartile cutoff points and tried to determine the association between ABSI levels and UACR by multiple regression analysis. DAG (Directed Acyclic Graph) was plotted using literature and expert consensus to identify potential confounding factors.

RESULTS

The average age of subjects with elevated UACR was 61.43 ± 10.07, and 26% were men. The average age of subjects with normal UACR was 57.70 ± 9.02, and 30.5% were men. Multiple logistic regression analysis was conducted and demonstrated that the ABSI quartiles were related to elevated UACR positively (OR [95% CI] Q2 vs. Q1: 1.094 [1.004, 1.197]; OR [95% CI] Q3 vs. Q1: 1.126 [1.030, 1.231]; OR [95% CI] Q4 vs. Q1: 1.183 [1.080, 1.295], p for trend < 0.001) after adjustments for confounding factors. The stratified analysis further showed that with the mounting for ABSI levels, elevated UACR more easily occurred in the people characterized by the elderly, men, and hypertension.

CONCLUSIONS

In Chinese community adults, people with higher ABSI levels can be deemed as high-risk individuals with UACR elevation, and it will be beneficial for them to lose weight and significantly reduce visceral fat.

A Reliable Estimate of Visceral Fat Area From Simple Anthropometric Measurements in Chinese Overweight and Obese Individuals

OBJECTIVE

Visceral obesity, reflected by the amount of visceral adipose tissue (VAT), is associated with multiple chronic diseases and metabolic disorders. The visceral fat area (VFA), measured by MRI, is the 'gold standard' for diagnosis of visceral obesity. In this study, a simple model to predict VFA was constructed to facilitate the identification and monitoring of patients who are at high risk of visceral obesity.

METHODS

The 721 overweight and obese participants were divided into two groups according to sex, then randomly assigned to derivation and validation cohorts in a 1:2 ratio. Data from the derivation group were used to construct a multiple linear regression model; data from the validation group were used to verify the validity of the model.

RESULTS

The following prediction equations, applicable to both sexes, were developed based on age, waist circumference (WC) and neck circumference (NC) that exhibited strong correlations with the VFA: VFA=3.7×age+2.4×WC+5.5×NC-443.6 (R² = 0.511, adjusted R² = 0.481, for men) and VFA=2.8×age+1.7×WC+6.5×NC-367.3 (R² = 0.442, adjusted R² = 0.433, for women). The data demonstrated good fit for both sexes. A comparison of the predicted and actual VFA in the verification group confirmed the accuracy of the equations: for men, R² = 0.489, adjusted R² = 0.484 and intra-class correlation coefficient (ICC) = 0.653 (p < 0.001) and for women: R² = 0.538, adjusted R²= 0.536 and ICC = 0.672 (p < 0.001). The actual and predicted VFAs also showed good agreement in a Bland-Altman plot, indicating the significant correlations of both equations with the actual VFA.

CONCLUSIONS

Based on readily available anthropometric data, VFA prediction equations consisting of age, WC and NC were developed. The equations are robust, with good predictive power in both sexes; they provide ideal tools for the early detection of visceral obesity in Chinese overweight and obese individuals.

Factors Related to Metabolic Syndrome Development and Recovery in Chinese Adults: A Prospective Longitudinal Study

OBJECTIVE

This study was a prospective assessment of the epidemiological characteristics of metabolic syndrome (MetS) in cities in Northeast China. We explored the factors that affect the occurrence and outcome of MetS according to sex.

DESIGN AND METHODS

This was a longitudinal survey assessing MetS status among 750 urban community residents in China. At baseline, the intra-abdominal fat area was measured by MRI, simple anthropometric parameters (body mass index (BMI), waist circumference (WC), etc.) were used to evaluate fat distribution; blood pressure and blood lipid profile were measured; an oral glucose tolerance test (OGTT) was used to detect blood glucose; questionnaires were used to investigate lifestyles. Follow-up was conducted after 1.5 years (follow-up rate was 66.93%) to analyze the incidence of MetS and the influencing factors of MetS outcomes according to sex.

RESULTS

The 1.5-year cumulative incidence of MetS in the survey area was 25.40%. Men with visceral obesity were more likely to develop MetS than those with subcutaneous obesity (OR=9.778, p<0.05). Increased BMI (OR=1.379) and blood uric acid (BUA)>416 mmol/L (OR=2.318) were associated with the occurrence of MetS in men (all p<0.05). At the initial visit, BUA>356.9 mmol/L (OR=3.538), increased BMI (OR=1.212), and increased HbA1c (OR=2.577) were associated with the occurrence of MetS in women (all p<0.05). After 1.5 years, 25.37% of MetS patients no longer had MetS. Elevated diastolic blood pressure (DBP) (OR=1.097) and increased visceral fat (OR=1.023) at the initial visit made men with MetS less likely to recover from MetS (all p<0.05). Higher High-density lipoprotein cholesterol (HDL-C) at the initial visit made women with MetS more likely to recover from MetS (β: -3.509, OR=0.003, p<0.05).

CONCLUSION

There are different risk factors for MetS in different genders. Hyperuricemia is a risk factor for the onset of MetS in both men and women.

Serum Arylsulfatase and Acid Phosphatase Activity in Patients with Metabolic Syndrome as a Result of Oxidative Damage to Lysosomes

BACKGROUND

Metabolic and clinical disorders forming the complex of interrelated abnormalities is known as metabolic syndrome (METs).

OBJECTIVE

Our goal was to assess the dependence of serum arylsulfatase (AS) and acid phosphatase (ACP) activities on anthropometric and biochemical parameters in patients with METs.

METHODS

In 142 patients with METs (IDF criteria), consisting of different components in different sequences (hypertension, diabetes, lipid disorders), and in 65 healthy participants, basic biochemical parameters were determined in laboratory tests. The activity of serum hydrolases was determined using Bessey's (ACP) and Roy's (AS) methods.

RESULTS

The AS activity is correlated with waist-to-hip ratio (WHR) (more strongly in women and in most advanced METs), BMI (in men), and triglycerides (TG) (in women, participants with I degree obesity, and those with three METs components). The ACP activity correlated with the WHR of patients with II degree obesity, TG in those with III degree of obesity, and total cholesterol (TC) in those with four METs components.

CONCLUSION

Increased AS activity in patients with METs compared to lower AS activity in the control group may be due to decreased lysosomal function and related to the amount of adipose tissue. Low activity of ACP in the blood serum of patients with METs compared to high activity of ACP in the control group may indicate exhaustion of the lysosomal apparatus and loss of hydrolytic activity. The increase in TG and TC in groups with an increasing number of METs-defining components may be due to the abnormal lysosomal degradation of these compounds.

Binge-eating disorder is associated with an unfavorable body mass composition in patients with non-alcoholic fatty liver disease

The interaction between eating disorders and non-alcoholic fatty liver disease (NAFLD) remains unexplored, especially with regards to binge-eating disorder (BED). Our team conducted a service evaluation project in order to assess risk factors for the presence of BED among patients with NAFLD and the impact of BED on body mass composition. The overall prevalence of patients screening positive to BED Screener-7 (BEDS-7) was 28.4%, while a previous diagnosis of depression and marital status (as single or separated) were independently associated with positive BED. Furthermore, patients with positive BEDS-7 had higher BMI, with greater visceral component and overall lower muscle mass. There was no difference in terms of liver disease severity as assessed by noninvasive markers of fibrosis. However, as body mass composition and sarcopenia have been shown to be associated to disease progression in patients with NAFLD, further studies are required to ascertain the long-term impact of BED in these patients. Moreover, further work is warranted to identify to implement multidisciplinary approach within clinical psychology for the management of patients with BED, who may be particularly challenging in terms of achieving lifestyle modifications. As a hepatology community, we should address NAFLD with a more holistic approach.

Multidirectional facets of obesity management in the metabolic syndrome population after liver transplantation

The obesity pandemic has resulted in an increasing demand for liver transplantation and has significantly altered the profile of liver transplant candidates in addition to affecting posttransplantation outcomes. In this review, we discuss a broad range of clinical approaches that warrant attention to provide comprehensive and patient‐centred medical care to liver transplant recipients, and to be prepared to confront the rapidly changing clinical challenges and ensuing dilemmas. Adipose tissue is a complex and metabolically active organ. Visceral fat deposition is a key predictor of overall obesity‐related morbidity and mortality. Limited pharmacological options are available for the treatment of obesity in the liver transplant population. Bariatric surgery may be an alternative in eligible patients. The rapidly increasing prevalence of nonalcoholic fatty liver disease (NAFLD) is a global concern; NAFLD affects both pre‐ and posttransplantation outcomes. Numerous studies have investigated pharmacological and nonpharmacological management of NAFLD and some of these have shown promising results. Liver transplant recipients are constantly exposed to numerous factors that result in intestinal microbiota alterations, which were linked to the development of obesity, diabetes type 2, metabolic syndrome (MS), NAFLD, and hepatocellular cancer. Microbiota modifications with probiotics and prebiotics bring gratifying results in the management of metabolic complications. Fecal microbiota transplantation (FMT) is successfully performed in many medical indications. However, the safety and efficacy profiles of FMT in immunocompromised patients remain unclear. Obesity together with immunosuppressive treatment, may affect the pharmacokinetic and/or pharmacodynamic properties of coadministered medications. Individualized immunosuppressive regimens are recommended following liver transplantation to address possible metabolic concerns. Effective and comprehensive management of metabolic complications is shown to yield multiple beneficial results in the liver transplant population and may bring gratifying results in improving long‐term survival rates.

Management of Obesity in Cardiovascular Practice: JACC Focus Seminar

Obesity contributes to reduced life expectancy because of its link with type 2 diabetes and cardiovascular disease. Yet, targeting this poorly diagnosed, ill-defined, and underaddressed modifiable risk factor remains a challenge. In this review, we emphasize that the tendency among health care professionals to amalgam all forms of obesity altogether as a single entity may contribute to such difficulties and discrepancies. Obesity is a heterogeneous condition both in terms of causes and health consequences. Attention should be given to 2 prevalent subgroups of individuals: 1) patients who are overweight or moderately obese with excess visceral adipose tissue; and 2) patients with severe obesity, the latter group having distinct additional health issues related to their large body fat mass. The challenge of tackling high-cardiovascular-risk forms of obesity through a combination of personalized clinical approaches and population-based solutions is compounded by the current obesogenic environment and economy.

Sex steroids and adiposity in a prospective observational cohort of youth

OBJECTIVE

Adiposity, particularly visceral adipose tissue (VAT), predicts adverse cardiovascular risk factor profiles in children as well as adults. Although endogenous sex steroids likely influence VAT in adults, such an association has not been established in youth. The association between childhood and adolescent sex steroids with adiposity, specifically VAT, was examined before and after adjustment for other hormone changes.

METHODS

These analyses examined longitudinal associations between sex steroids (testosterone, estradiol, dehydroepiandrosterone [DHEA]) and magnetic resonance imaging assessments of VAT in 418 children, 49% of whom were non-White, at approximately 10 years old at Visit 1 (V1) and 17 years old at Visit 2 (V2). Linear mixed effects models adjusted for maternal education, household income, child caloric intake, physical activity, fasting insulin and leptin, and hepatic fat fraction. Differences in associations by race and pubertal stage were also assessed.

RESULTS

At V1, mean body mass index (BMI) for boys was 19.1 (4.7) kg/m2 and for girls was 18.5 (4.1) kg/m2. At V2, mean BMI for boys was 23.7 (5.5) kg/m2 and for girls was 23.6 (5.7) kg/m2. For each ng/dl (0.035 nmol/L) increase in testosterone at V1, there was a 0.25 cm2 increase in concurrent and future VAT in non-White (p = 0.04) but not White girls (p = 0.78). Higher levels of testosterone and DHEA at V1 were associated with greater concurrent and future VAT at V2. These associations were consistent regardless of pubertal stage. In boys, higher testosterone predicted higher future VAT but lower concurrent VAT. Estradiol and DHEA did not predict future VAT in boys. In girls, DHEA predicted future subcutaneous adipose tissue (SAT), and no sex steroids predicted future SAT in boys.

CONCLUSIONS

Testosterone levels predict VAT in boys and girls, and DHEA predicts VAT in girls, even after adjustment for other hormone changes.