Association of carotid intima-media thickness with mesenteric, preperitoneal and subcutaneous fat thickness

Sonographic Measurement of Mesenteric Fat Thickness Is a Better Predictor of Aortic Stiffness Compared With Conventional Obesity Indexes

Increased aortic stiffness is closely associated with central obesity whereas mesenteric fat is the key adipose tissue in central obesity. We investigated the associations of mesenteric fat thickness with aortic stiffness, with comparison to conventional obesity measures. We used ultrasound to measure mesenteric, pre-peritoneal and subcutaneous fat thickness, carotid intima-media thickness (CIMT) and carotid-femoral pulse wave velocity (c-f PWV), an index of central aortic stiffness. Anthropometric indexes, blood pressure, fasting plasma glucose and lipid profile were measured. One hundred forty-seven healthy volunteers (age [mean ± standard deviation]: 43.2 ± 13.3 y; 41.5% men) were assessed. On univariate analysis, mesenteric, preperitoneal and subcutaneous fat thickness, body mass index (BMI), waist circumference (WC), waist/hip ratio (WHR) and waist/height ratio (WHtR) were associated with c-f PWV with or without adjustment for age. The mesenteric fat thickness had the highest correlation coefficient (r = 0.48, p < 0.001) with c-f PWV among all the investigated obesity indexes. Using multiple linear regression analysis, only mesenteric fat thickness remained to be an independent determinant of c-f PWV after adjustments for other abdominal fat thickness, anthropometric and metabolic indexes and CIMT. In conclusion, mesenteric fat thickness is an independent risk factor for aortic stiffness and has a stronger association with aortic stiffness compared with conventional obesity indexes.

Radial Artery Calcification in Predicting Coronary Calcification and Atherosclerosis Burden

Background

Atherosclerosis is a systemic arterial disease with heterogeneous involvement in all vascular beds; however, studies examining the relationship between coronary and radial artery calcification are lacking. The purpose of this study was to assess the relationship between the two sites and the prognostic value of radial artery calcification (RC) for coronary artery disease.

Methods

This is a single-center, retrospective cross-sectional study based on Doppler ultrasound of radial artery (RUS) and coronary artery angiography (CAG). We included a total of 202 patients undergoing RUS during distal radial access and CAG at the same procedure, between December 2020 and May 2021, from which 103 were found having RC during RUS (RC group) and 99 without (NRC group). Coronary calcifications were evaluated either by angiography examination (moderate and severe), positive CT (>100 Agatson units), or intracoronary imaging (IVUS, OCT).

Results

A significant correlation was observed between radial calcification and coronary calcification variables (67.3% vs. 32.7%, p=0.001). The correlation between risk factors such as age, smoking, chronic kidney disease, and diabetes mellitus was higher while sex did not play a role. The need of PCI and/or CABG was higher in the RC group (60% vs. 44%, p=0.02). RC, therefore, predicts the extent and severity of coronary artery disease.

Conclusion

RC may be frequently associated with calcific coronary plaques. These findings highlight the potential beneficial examination of radial arteries whenever CAD is suspected.

Associations of Renal Augmented Velocity Index with Arterial Stiffness, Carotid Intima-Media Thickness and Blood Pressure, in Comparison with Renal Resistive Index

The augmented velocity index (Avi) is a new Doppler index associated with arterial stiffness. We examined associations of renal Avi with blood pressure (BP), aortic stiffness and carotid intima-media thickness (IMT), and compared its performance with that of resistive index (RI). One hundred forty-seven volunteers were recruited. Renal Avi had significant positive correlations with systolic BP (r = 0.37, p < 0.001), diastolic BP (r = 0.2, p = 0.016), mean arterial pressure (r = 0.29, p < 0.001), pulse pressure (r = 0.31, p < 0.001), carotid-femoral pulse wave velocity (r = 0.49, p < 0.001) and carotid IMT (r = 0.23, p = 0.005). RI correlated positively with pulse pressure (r = 0.3, p < 0.001) only. After adjustments for co-variables, the associations remained similar. Patients with abnormal BP values (≥130/80 mm Hg), IMT and aortic stiffness (≥1 standard deviation of mean value) had higher Avi than those with normal values, but not RI. In conclusion, renal Avi had stronger associations with BP, arterial stiffness and carotid IMT than RI in apparently healthy volunteers, and was significantly increased in abnormal patients.

Abdominal visceral adipose tissue over the menopause transition and carotid atherosclerosis: the SWAN heart study

OBJECTIVES

To characterize abdominal visceral adipose tissue (VAT) trajectory relative to the final menstrual period (FMP), and to test whether menopause-related VAT accumulation is associated with greater average, common carotid artery intima-media thickness (cIMT) and/or internal carotid artery intima-media thickness (ICA-IMT).

METHODS

Participants were 362 women (at baseline: age was (mean ± SD) 51.1 ± 2.8 y; 61% White, 39% Black) with no cardiovascular disease from the Study of Women's Health Across the Nation Heart study. Women had up to two measurements of VAT and cIMT over time. Splines revealed a nonlinear trajectory of VAT with two inflection points demarcating three time segments: segment 1: >2 years before FMP; segment 2: 2 years before FMP to FMP; and segment 3: after FMP. Piecewise-linear random-effects models estimated changes in VAT. Random-effects models tested associations of menopause-related VAT with each cIMT measure separately. Estimates were adjusted for age at FMP, body mass index, and sociodemographic, lifestyle, and cardiovascular disease risk factors.

RESULTS

VAT increased significantly by 8.2% (95% CI: 4.1%-12.5%) and 5.8% (3.7%-7.9%) per year in segments 2 and 3, respectively, with no significant change in VAT within segment 1. VAT predicted greater ICA-IMT in segment 2, such that a 20% greater VAT was associated with a 2.0% (0.8%-3.1%) greater ICA-IMT. VAT was not an independent predictor of ICA-IMT in the other segments or of the other cIMT measures after adjusting for covariates.

CONCLUSIONS

Women experience an accelerated increase in VAT starting 2 years before menopause. This menopause-related increase in VAT is associated with greater risk of subclinical atherosclerosis in the internal carotid artery.

Development of genome-wide polygenic risk scores for lipid traits and clinical applications for dyslipidemia, subclinical atherosclerosis, and diabetes cardiovascular complications among East Asians

Background

The clinical utility of personal genomic information in identifying individuals at increased risks for dyslipidemia and cardiovascular diseases remains unclear.

Methods

We used data from Biobank Japan (n = 70,657–128,305) and developed novel East Asian-specific genome-wide polygenic risk scores (PRSs) for four lipid traits. We validated (n = 4271) and subsequently tested associations of these scores with 3-year lipid changes in adolescents (n = 620), carotid intima-media thickness (cIMT) in adult women (n = 781), dyslipidemia (n = 7723), and coronary heart disease (CHD) (n = 2374 cases and 6246 controls) in type 2 diabetes (T2D) patients.

Results

Our PRSs aggregating 84–549 genetic variants (0.251 < correlation coefficients (r) < 0.272) had comparably stronger association with lipid variations than the typical PRSs derived based on the genome-wide significant variants (0.089 < r < 0.240). Our PRSs were robustly associated with their corresponding lipid levels (7.5 × 10^− 103 < P < 1.3 × 10^− 75) and 3-year lipid changes (1.4 × 10^− 6 < P < 0.0130) which started to emerge in childhood and adolescence. With the adjustments for principal components (PCs), sex, age, and body mass index, there was an elevation of 5.3% in TC (β ± SE = 0.052 ± 0.002), 11.7% in TG (β ± SE = 0.111 ± 0.006), 5.8% in HDL-C (β ± SE = 0.057 ± 0.003), and 8.4% in LDL-C (β ± SE = 0.081 ± 0.004) per one standard deviation increase in the corresponding PRS. However, their predictive power was attenuated in T2D patients (0.183 < r < 0.231). When we included each PRS (for TC, TG, and LDL-C) in addition to the clinical factors and PCs, the AUC for dyslipidemia was significantly increased by 0.032–0.057 in the general population (7.5 × 10^− 3 < P < 0.0400) and 0.029–0.069 in T2D patients (2.1 × 10^− 10 < P < 0.0428). Moreover, the quintile of TC-related PRS was moderately associated with cIMT in adult women (β ± SE = 0.011 ± 0.005, P_trend = 0.0182). Independent of conventional risk factors, the quintile of PRSs for TC [OR (95% CI) = 1.07 (1.03–1.11)], TG [OR (95% CI) = 1.05 (1.01–1.09)], and LDL-C [OR (95% CI) = 1.05 (1.01–1.09)] were significantly associated with increased risk of CHD in T2D patients (4.8 × 10^− 4 < P < 0.0197). Further adjustment for baseline lipid drug use notably attenuated the CHD association.

Conclusions

The PRSs derived and validated here highlight the potential for early genomic screening and personalized risk assessment for cardiovascular disease.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13073-021-00831-z.

Noninvasive prediction of carotid artery atherosclerosis by multiple abdominal fat indices measured via ultrasonography

PURPOSE

The purpose of this study was to evaluate the efficiency of multiple abdominal fat indices as measured via ultrasonography for predicting the presence and severity of carotid artery atherosclerosis and to compare the predictive capacity of ultrasonographic measurements to that of anthropometric measurements.

METHODS

A total of 92 patients were included in this study. All participants underwent clinical and laboratory assessments, and anthropometric measurements were obtained. Ultrasound examinations were performed to measure the values of all abdominal fat indices and the intimamedia thickness, as well as to detect the presence of atherosclerotic plaques. Univariate and multivariate logistic regression analyses were performed.

RESULTS

In the multivariate analysis, significant associations were detected between carotid artery atherosclerosis and posterior right perinephric fat thickness (PRPFT) (hazard ratio [HR], 15.23; P<0.001), preperitoneal fat thickness (PPFT) (HR, 4.31; P=0.003), visceral adipose tissue volume (VAT) (HR, 7.61; P<0.001), visceral fat thickness (VFT) (HR, 8.84; P<0.001), the ratio of VFT to subcutaneous fat thickness (VFT/SCFT) (HR, 9.39; P<0.001), and waist-to-height ratio (WHtR) (HR, 2.65; P=0.046). In the multivariate analysis, significant associations were also detected between carotid artery plaque and PRPFT (HR, 7.09; P<0.001), the abdominal wall fat index (AFI) (HR, 3.58; P=0.010), and VFT/SCFT (HR, 4.17; P=0.006).

CONCLUSION

Many abdominal fat indices as measured by ultrasound were found to be strong predictors of carotid artery atherosclerosis, including PRPFT, VFT/SCFT, VFT, VAT, PPFT, and WHtR. Moreover, PRPFT, VFT/SCFT, and AFI were identified as strong predictors of the presence of carotid artery plaque.

Thickness of carotid artery intima is an independent risk factor for psoriasis

Psoriasis (PsO) has been associated with lipoprotein abnormalities, visceral adiposity, atherosclerosis, and coronary artery disease (CAD) in several studies; however, data concerning the risk of psoriasis relevant to these parameters is not well established. We aimed to evaluate the relation between PsO and small dense low-density lipoprotein cholesterol (sd-LDL-C), serum lipid profile (SLP), blood pressures, anthropometric measurements, intima media thickness of the common carotid artery (CIMT), distribution of visceral adipose tissue (VAT; evaluated at 3 different measurement sites including VATa, VATb, VATc) along with subcutaneous (Sc-d1) and preperitoneal (Pre-d2) adipose tissue, and disease characteristics, so as to define relevant risk factors for PsO. In this cross-sectional and observational study, 62 patients with plaque-type PsO and 31 age- and sex-matched controls were enrolled. Data about metabolic profile, CIMT and VAT were obtained. There was a significant association between PsO and hypertension, smoking, diastolic blood pressure, sd-LDL-C/LDL-C ratio, CIMT, VATc, and Pre-d2. Following adjustments for hypertension and smoking, sd-LDL-C/LDL-C ratio, CIMT, and Pre-d2 still remained different between patients and controls (P = 0.03, P = 0.043, and P = 0.05, respectively). Each 0.1 unit increase in the CIMT increased the risk of PsO 1.51-fold (95%CI: 1.08 - 2.12, P = 0.016). PsO associates with a predisposition to develop thick preperitoneal fat tissue and thick intima of carotid arteries, all of which contribute to the increased risk of atherosclerosis and subsequent CAD. CIMT was considered as an independent risk factor for PsO.

Abdominal Fat Tissue Echogenicity: A Marker of Morbid Obesity

PURPOSE

Menopause-related changes may affect regional but also morphological characteristics of adipose tissue. We sought to assess the clinical value of echogenicity of subcutaneous adipose tissue (SAT) and preperitoneal adipose tissue (pPAT) in postmenopausal women without cardiovascular disease.

METHODS

In 244 consecutively recruited postmenopausal women, subclinical atherosclerosis was assessed in the femoral and carotid arteries by intima-media thickness (IMT) and atheromatous plaques using high-resolution ultrasonography. In 41 women with a second visit (median follow-up 41.5 months), carotid atherosclerosis was re-evaluated. Images of SAT and pPAT were ultrasonographically acquired, and their echogenicity was evaluated by grayscale mean (GSMn) using a dedicated software. A control group of 20 healthy premenopausal women was used for comparisons in fat echogenicity.

RESULTS

SAT GSMn but not pPAT was higher in postmenopausal as compared with healthy premenopausal women and was independently associated with metabolic markers of adiposity including body mass index (BMI) and waist circumference (WC). SAT GSMn was associated with carotid IMT and the presence and number of atheromatous plaques [adjusted OR 2.44 and 2.32 per 1-SD increase in GSMn (95% CIs 1.55 to 3.93 and 1.55 to 3.45), respectively]. SAT GSMn conferred incremental value over traditional risk factors, insulin resistance, BMI, and WC for the detection of subclinical atherosclerosis. Increased baseline SAT GSMn was associated with increased rate of progression in carotid IMT.

CONCLUSIONS

SAT echogenicity may serve as a qualitative marker of adiposity, conferring incremental clinical value over BMI and WC in postmenopausal women. Further investigation is warranted to assess the utility of ultrasonography-derived fat echogenicity as a screening method for morbid obesity.

Detecting people at high risk of type 2 diabetes- How do we find them and who should be treated?

Diabetes is a chronic disease characterized by its silent and progressive nature. The prevalence of type 2 diabetes (T2DM) increases with age but with a worrying trend of increasingly young age of diagnosis. Compared to their counterparts with late onset of disease, these younger subjects face long disease duration with increased risk of diabetes-related complications. Besides, there is marked phenotypic heterogeneity which can interact with different interventions to give rise to variable clinical outcomes. Recognized at-risk groups include those with known atherosclerosis and vascular disease, genetic background (family history and non-White ethnic groups), phenotypes of insulin resistance (obesity, metabolic syndrome, women with gestational diabetes or polycystic ovarian syndrome, and men with androgen deficiency) and "pre-diabetes" (impaired glucose tolerance and impaired fasting glucose). These risk factors interact to amplify the risk for diabetes, thus emphasizing the importance of comprehensive assessment. Raising awareness and health literacy, regular screening of high risk subjects, structured lifestyle modification program including early use of pharmacological agents, targeting at predominant pathophysiological defects offers a personalized approach to prevent this global hazard.

New developments in the pathogenesis of obesity-induced hypertension

Obesity is a disorder that develops from the interaction between genotype and environment involving social, behavioral, cultural, and physiological factors. Obesity increases the risk for type 2 diabetes mellitus, hypertension, cardiovascular disease, cancer, musculoskeletal disorders, chronic kidney and pulmonary disease. Although obesity is clearly associated with an increased prevalence of hypertension, many obese individuals may not develop hypertension. Protecting factors may exist and it is important to understand why obesity is not always related to hypertension. The aim of this review is to highlight the knowledge gap for the association between obesity, hypertension, and potential genetic and racial differences or environmental factors that may protect obese patients against the development of hypertension and other co-morbidities. Specific mutations in the leptin and the melaninocortin receptor genes in animal models of obesity without hypertension, the actions of α-melanocyte stimulating hormone, and SNS activity in obesity-related hypertension may promote recognition of protective and promoting factors for hypertension in obesity. Furthermore, gene-environment interactions may have the potential to modify gene expression and epigenetic mechanisms could also contribute to the heritability of obesity-induced hypertension. Finally, differences in nutrition, gut microbiota, exposure to sun light and exercise may play an important role in the presence or absence of hypertension in obesity.

Visceral Adiposity is Preferentially Associated with Vascular Stiffness Rather than Thickness in Men with Type 2 Diabetes

Aim: Visceral fat accumulation is known to underlie the clustering of cardiovascular risk factors. However, it is not completely understood how visceral fat accumulation influences the development of cardiovascular disease. In this study, we investigated the clinical impact of visceral adiposity on vascular stiffness and thickness in patients with type 2 diabetes (T2D).

Methods: One hundred and sixty-one patients with T2D, including 92 men and 69 women, were included in this cross-sectional study. Visceral fat area (VFA) and subcutaneous fat area (SFA) were measured by dual bioelectrical impedance analysis. Stiffness parameter β and intima-media thickness (IMT) of the common carotid artery were measured by ultrasonography.

Results: The mean age and duration of diabetes in the study population were 61 years and 13.9 years, respectively. In men, VFA and waist circumference (WC) were positively correlated with stiffness parameter β, whereas body mass index (BMI), WC, and SFA were negatively correlated with IMT. In contrast, in women, none of the obesity-related indices were significantly correlated with stiffness parameter β or IMT. In multiple regression analyses, VFA as well as WC, BMI, and SFA were independently associated with stiffness parameter β after adjustment for age and other potential confounders in men but not in women. None of the obesity-related indices were independently associated with IMT for either sex.

Conclusion: In men with T2D, visceral adiposity is associated with carotid arterial stiffness but not thickness.

Mesenteric fat thickness is associated with increased risk of obstructive sleep apnoea

BACKGROUND AND OBJECTIVE

Mesenteric fat is a type of intraperitoneal adipose tissue draining into portal circulation. The objective of this study was to investigate the relationships between mesenteric fat thickness and obstructive sleep apnoea (OSA) in patients with suspected OSA.

METHODS

One hundred forty-nine subjects (men: 114; women: 35) with suspected OSA underwent ultrasound examinations of mesenteric, preperitoneal and subcutaneous fat thickness after overnight polysomnography. Body mass index (BMI) and neck circumference were recorded.

RESULTS

The subjects with OSA (n = 130, apnoea/hypopnoea index (AHI) >5/h) had greater neck circumference, higher BMI, and greater mesenteric and preperitoneal fat thickness than those without OSA (n = 19, AHI ≤ 5/h). There was positive correlation of AHI with mesenteric (r = 0.43, P < 0.001) and preperitoneal fat thickness (r = 0.3, P < 0.001), whereas no significant association was observed between AHI and subcutaneous fat thickness (r = 0.09, P = 0.27). On multivariate logistic regression, after adjustments for gender, age, BMI, neck circumference, and preperitoneal and subcutaneous fat thickness, the mesenteric fat thickness had a positive association with the presence of moderate OSA and severe OSA, with odds ratios of 7.18 and 7.45 for every 1 cm increase in mesenteric fat thickness when AHI was defined as ≥15/h and AHI ≥ 30/h, respectively.

CONCLUSIONS

Mesenteric fat thickness is associated with increased risk of OSA, independent of other abdominal fat thickness, BMI and neck circumference. Sonographic measurement is potentially a useful tool for further evaluating the complex association of visceral fat, metabolic syndrome and OSA.

Role of adiponectin and proinflammatory gene expression in adipose tissue chronic inflammation in women with metabolic syndrome

BACKGROUND

The purpose of this research was to study the gene expression of interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), nuclear factor kappa B (NF-κB), vascular endothelial growth factor A (VEGF-A) and adiponectin (AdipoQ) genes in the visceral (omental, mesenteric) and subcutaneous adipose tissue depots in metabolic syndrome (MS). We studied 23 women with MS, with a mean age of 50.7 ± 4.5 years and mean body mass index (BMI) of 45.6 ± 9.8 kg/m(2). The control group included 10 women, with a mean age of 40.6 ± 8.7 years and normal BMI (22.3 ± 3.7 kg/m(2)). The gene expression levels in the omental (OAT), mesenteric (MAT) and subcutaneous (SAT) adipose tissues were assessed by quantitative real-time PCR.

FINDINGS

Increased gene expression levels of IL-6 and TNF-α were detected in MAT in patients with MS, compared with the control group (p < 0.05 and p < 0.005, respectively). Significant positive correlations were observed between IL-6 mRNA expression levels in OAT and the content of CD14 + cells in the peripheral blood (r = 0.55, p < 0.05), as well as between NF-κB and VEGF-A mRNA levels in OAT (r = 0.43, p < 0.05) in patients with MS. The AdipoQ gene expression levels in OAT were significantly decreased in women with MS compared with the control group (p < 0.05). In addition, there were inverse correlations between AdipoQ gene levels in MAT and serum CRP levels (r = -0.63, p < 0.05), as well as between AdipoQ gene levels in MAT and serum IL-6 levels (r = -0.46, p < 0.05).

CONCLUSION

These data demonstrate that proinflammatory gene expression of MAT in women with MS was increased compared with the control group. The AdipoQ gene expression levels in OAT were significantly decreased in women with MS compared with the control group.

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

RATIONALE AND OBJECTIVES

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSION

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

The Norwegian Stroke in the Young Study (NOR-SYS): rationale and design

BACKGROUND

Ischemic stroke in young adults is a major health problem being associated with a higher vascular morbidity and mortality compared to controls, and a stroke recurrence rate of 25% during the first decade. The assumed cause of infarction and the detected risk factors determine the early- and long-term treatment. However, for many patients the cause of stroke remains unknown. Risk factor profile and etiology differ in young and elderly ischemic stroke patients, and atherosclerosis is the determined underlying condition in 10 to 15%. However, subclinical atherosclerosis is probably more prevalent and may go unrecognized.

METHODS/DESIGN

NOR-SYS is a prospective long-term research program. Standardized methods are used for anamnestic, clinical, laboratory, imaging, and ultrasound data collection in ischemic stroke patients aged ≤60 years, their partners and joint adult offspring. The ultrasound protocol includes the assessment of intracranial, carotid and femoral arteries, abdominal aorta, and the estimation of VAT. To date, the study is a single centre study with approximately 400 patients, 250 partners and 350 adult offspring expected to be recruited at our site.

DISCUSSION

NOR-SYS aims to increase our knowledge about heredity and the development of arterial vascular disease in young patients with ischemic stroke and their families. Moreover, optimization of diagnostics, prophylaxis and early intervention are major targets with the intention to reduce stroke recurrence and other clinical arterial events, physical disability, cognitive impairment and death.

Pathophysiology of human visceral obesity: an update

Excess intra-abdominal adipose tissue accumulation, often termed visceral obesity, is part of a phenotype including dysfunctional subcutaneous adipose tissue expansion and ectopic triglyceride storage closely related to clustering cardiometabolic risk factors. Hypertriglyceridemia; increased free fatty acid availability; adipose tissue release of proinflammatory cytokines; liver insulin resistance and inflammation; increased liver VLDL synthesis and secretion; reduced clearance of triglyceride-rich lipoproteins; presence of small, dense LDL particles; and reduced HDL cholesterol levels are among the many metabolic alterations closely related to this condition. Age, gender, genetics, and ethnicity are broad etiological factors contributing to variation in visceral adipose tissue accumulation. Specific mechanisms responsible for proportionally increased visceral fat storage when facing positive energy balance and weight gain may involve sex hormones, local cortisol production in abdominal adipose tissues, endocannabinoids, growth hormone, and dietary fructose. Physiological characteristics of abdominal adipose tissues such as adipocyte size and number, lipolytic responsiveness, lipid storage capacity, and inflammatory cytokine production are significant correlates and even possible determinants of the increased cardiometabolic risk associated with visceral obesity. Thiazolidinediones, estrogen replacement in postmenopausal women, and testosterone replacement in androgen-deficient men have been shown to favorably modulate body fat distribution and cardiometabolic risk to various degrees. However, some of these therapies must now be considered in the context of their serious side effects. Lifestyle interventions leading to weight loss generally induce preferential mobilization of visceral fat. In clinical practice, measuring waist circumference in addition to the body mass index could be helpful for the identification and management of a subgroup of overweight or obese patients at high cardiometabolic risk.

Correlation between mesenteric fat thickness and serum apolipoproteins in patients with peripheral arterial occlusive disease

BACKGROUND

Visceral fat possesses the most detrimental potential for cardiovascular morbidity through the release of adipokines, as well as metabolic and proinflammatory mediators, which adversely affect metabolic and vascular homeostasis. Among the different types of visceral adipose tissue, mesenteric fat is considered particularly detrimental, due to its close proximity to the portal circulation, affecting directly the liver, which is the main regulator of body metabolic homeostasis. Mesenteric fat can be reliably estimated using abdominal ultrasonography, the only available imaging method able to depict individual mesenteric leaves. Aim of the present study was to investigate the correlation of mesenteric fat thickness (MFT) with serum apolipoprotein levels in patients undergoing digital subtraction angiography in a single center.

METHODS

35 male patients with peripheral arterial disease were examined. After careful examination of the periumbilical area, the mesenteric leaves were identified. The maximal distance between each pair of sequential leaves was measured, and the mean value of the three thickest leaves was determined as the mesenteric fat thickness. Six apolipoprotein fasting serum concentrations were measured using a Luminex proteomics platform (xMAP Multiplex immunoassay): apolipoprotein A-I (apoAI), apolipoprotein A-II (apoAII), apolipoprotein B (apoB), apolipoprotein C-II (apoCII), apolipoprotein C-III (apoCIII) and apolipoprotein E (apoE).

RESULTS

MFT correlated with apoAII and apoB serum concentrations. The correlations with apoAII and apoB remained significant following correction for BMI. No correlations were noted between MFT and serum apoAI, apoCII, apoCIII or apoE levels before or after adjustment for BMI.

CONCLUSIONS

Our study indicates that MFT is significantly correlated with the concentration of atherogenic low density lipoproteins particles, as well as with apoAII, a determinant of free fatty acids levels. No correlation was observed between mesenteric fat thickness and very low density lipoprotein or chylomicron particles concentration.

Body adipose distribution among patients with type 2 diabetes mellitus

SUMMARY

Both diabetes mellitus (DM) and obesity are prevalent in adults. The relationship between DM and body adipose tissue (AT) distribution is complex and although it has been investigated extensively, the subject remains controversial. Although a causal association between DM and obesity and AT distribution cannot be established on the basis of existing data, it is possible to conclude from many studies that gene, serum sex steroids level, daily physical activity and food supply can be the risk of obesity and AT redistribution factor among type 2 DM patients (T2DM). Obesity and AT redistribution of T2DM patients can increase the risk of insulin resistant (IR), cardiovascular disease and many other disorders. Even though obesity and AT redistribution screening or prophylactic treatment in all patients with T2DM is not being recommended at present, such patient populations should be given general guidelines regarding exercise, food intake control, and even medicinal treatment. The extent of diagnostic and therapeutic interventions should be based on the individual's risk profile.:

Repeatability and reproducibility of ultrasonographic measurement of carotid intima thickness

PURPOSE

To evaluate the repeatability and reproducibility of intima thickness (IT) measurements at different sites along the common carotid artery and compare with intima-media thickness (IMT) measurements.

METHODS

Ultrasound examinations of common carotid artery were performed in 30 healthy subjects and 20 patients with diabetes mellitus. Carotid IT and IMT were measured at 10 mm, 13 mm, and 16 mm upstream from the carotid bulb. Each subject was scanned by three operators to evaluate inter-operator reproducibility. Each operator scanned the subjects twice to evaluate intra-operator repeatability. Inter-equipment reproducibility of the measurements was evaluated.

RESULTS

The inter-operator reproducibility for measuring carotid IT at the three sites was 81.5%, 81.9% and 69.1%, respectively, slightly lower than carotid IMT measurement (89.7%, 86.5%, 75.2%, respectively). The intra-operator repeatability for carotid IT measurement at the three sites ranged 76.9-89.5%, 67.4-90.3%, and 55.2-70.5%, respectively, and was lower than for IMT measurement (86.5-96.9%, 87.6-95.7%, 79.9-86.5%, respectively). The inter-equipment reproducibility of IMT (75.7-86.6%) was slightly better than for IT measurement (71.4-75.9%).

CONCLUSIONS

Ultrasonographic measurement of carotid IT is repeatable and reproducible, although not as good as IMT. Measurements preformed 10 mm to 13 mm upstream from the carotid bulb yield more repeatable and reproducible results.

The association between intima media thickness, central obesity and diastolic blood pressure in obese and overweight children: a cross-sectional school-based study

OBJECTIVE

To examine relationship between carotid intima-media thickness (IMT) and central obesity, cardiovasculary risk factors, and chronic inflammation markers in overweight and obese schoolchildren in Eastern Turkey.

METHODS

A cross-sectional school-based survey on 2765 schoolchildren was performed. We collected the clinical data (age, sex, percentage of body fat, and measured systolic blood pressure [BP] and diastolic BP, triglycerides, high- and low-density lipoprotein cholesterol, glucose, insulin, homocysteine and high-sensitivity C-reactive protein) in 67 obese and 24 overweight children. The control group was composed of nonobese children of similar age and sex.

RESULTS

Mean systolic and diastolic BP values in the cases of overweight and obese groups were higher than those in the control group cases (p=0.001). Obese and overweight children demonstrated a significantly thicker intima media as compared with the control group (p=0.001). Carotid IMT was significantly correlated to the body mass index (r=0.396, p=0.001), fat mass percentage (r=0.257, p=0.036), waist circumference (r=0.390, p=0.001), diastolic BP (r=0.266, p=0.030), glucose (r=0.250, p=0.042), and high-sensitivity C-reactive protein levels (r=0.269, p=0.001) in the obese group. In multiple linear regression analysis, carotid IMT correlated significantly to waist circumference (p=0.045), and diastolic BP (p=0.031) in obese group.

CONCLUSIONS

Obesity is related to cardiovascular risk factors leading to early atherosclerosis in schoolchildren. There is a relationship between atherosclerosis, and central obesity, diastolic BP, and chronic inflammation. Waist circumference measurement is more sensitive than other anthropometric measurements in predicting obesity and associated complications.

Accuracy, reproducibility and repeatability of ultrasonography in the assessment of abdominal adiposity

RATIONALE AND OBJECTIVES

Despite improvements in the methods used in body composition analysis, some goals remain far from clinical practice. Among them, the most important is the quantification of intra-abdominal adipose tissue. Fat distribution is a key point in the assessment of cardiovascular and metabolic risk status. The aim of this study was to define the accuracy, reproducibility, and repeatability of ultrasonography in the evaluation of abdominal adiposity.

MATERIALS AND METHODS

Twenty-six nonobese patients (group A) who underwent computed tomographic (CT) abdominal imaging and 29 obese patients (group B) were enrolled. Patients from both groups were independently evaluated using ultrasound by three radiologists; computed tomography-like conditions were reproduced, and six main parameters of subcutaneous and internal adiposity were measured (as well as three derived indexes) with both linear and convex probes. In group A, the same measurements were also obtained on CT images. Time spent for every ultrasound session was recorded. Results were analyzed using Lin's concordance correlation (ρ), intraclass correlation, and linear regression analysis (and analysis of variance).

RESULTS

Three patients were excluded from group A after CT scans because of technical problems. Mesenteric fat thickness did not show significant correlations and reliability. Strong correlations between ultrasound and CT measurements were observed for all other visceral and subcutaneous parameters (ρ = 0.85-0.96). Intraobserver and interobserver agreement was excellent in both groups (repeatability: ρ = 0.83-0.99 for group A, ρ = 0.90-0.99 for group B; reproducibility: intraclass correlation coefficient = 0.90-0.99 for groups A and B). The mean time spent was 95 ± 21 seconds for group A (mean body mass index, 27.4 ± 2.4 kg/m(2)) and 129 ± 33 seconds for group B (mean body mass index, 37.3 ± 11.9 kg/m(2)).

CONCLUSIONS

Ultrasound is accurate, reproducible, and fast in the analysis of abdominal adiposity. It offers a regional, easy, and close-at-hand evaluation of subcutaneous and visceral fat compartments. This should be taken into consideration when clinical routine examinations are performed or to evaluate patients with specific metabolic diseases before and after treatment.

Associations of intra-renal arterial resistance index with chronic kidney disease and carotid intima-media thickness in type 2 diabetes mellitus

Renal dysfunction can be evaluated by increased intra-renal arterial resistance index (RI). We evaluated 113 Chinese men with type 2 diabetes on their RI. Results suggest that RI is associated with chronic kidney disease and subclinical arteriosclerosis. RI may help monitoring the deterioration of intra-renal hemodynamics.

Waist circumference and mesenteric fat in neonates: negative correlation

OBJECTIVE

To measure mesenteric fat thickness with ultrasound scan in neonates and to assess the correlation with waist circumference.

METHODS

Ninety five healthy newborns had the maximum thickness of mesenteric leaves measured by ultrasound examinations of abdomen with an Envisor scanner (Philips Ultrasound, Bothell, Wash) and a L12-5 transducer (Philips Ultrasound). The correlation between the thickness of mesenteric leaves with abdominal waist was calculated.

RESULTS

Maximum thickness of mesenteric leaves ranged from 0.24 to 1.00 mm (x = 0.57 ± 0.17) . There was a significant negative correlation between abdominal waist (AW) and mesenteric fat thickness (r = -0.384; p < 0.001).

CONCLUSIONS

Mesenteric fat thickness in newborns is inversely associated with waist circumference. Higher visceral adiposity in neonates may be a protective mechanism from intrauterine growth restriction however this could persist into adulthood life.

Relação entre estado nutricional e atividade inflamatória em pacientes com doença inflamatória intestinal

RACIONAL: As doenças inflamatórias intestinais caracterizam-se por diversos sintomas que afetam o aparelho digestório e, consequentemente, podem interferir sobre o estado nutricional. OBJETIVO: Avaliar o estado nutricional de pacientes com doença inflamatória intestinal em diferentes estágios de atividade inflamatória. MÉTODOS: Foram avaliados 55 pacientes com doença inflamatória intestinal, por meio de dados antropométricos, com aferição de peso, altura, circunferência do braço e prega cutânea do tríceps e tiveram sua composição corporal determinada por impedância bioelétrica. Para determinação de atividade inflamatória da doença foram utilizados os níveis séricos de proteína C reativa e o índice de Harvey e Bradshaw. Para comparação de médias foi usado o teste t não pareado, e para as médias não paramétricas, o teste de Mann-Whitney, considerando nível de significância valor de p<0,05. RESULTADOS: Entre os pacientes avaliados, 28 apresentavam doença de Crohn e 27 retocolite ulcerativa inespecífica, com idade entre 19 e 63 anos e tempo de diagnóstico de 1 a 22 anos. Não houve diferença nas medidas antropométricas e na composição corporal dos pacientes cuja doença inflamatória estava em atividade ou em remissão. Os que usaram glicocorticóides nos seis meses anteriores à avaliação apresentaram percentual de gordura corporal de 23,4±8,2%, enquanto para os que não usaram o percentual foi de 30,7±11,3 (p<0,0199). Os sintomas gastrintestinais mais comuns foram distensão abdominal (41%), diarréia (18%), náusea (13%), obstipação (12%), inapetência (11%) e vômito (5%). Todos os sintomas foram mais frequentes nos pacientes com maior índice de massa corporal e de gordura corporal. CONCLUSÃO: Houve maior número de pacientes com excesso de peso e de gordura corporal, sendo que esses pacientes foram mais sintomáticos e apresentaram maiores valores de proteína C reativa.

Anti-inflammatory effects of nicotinic acid in adipocytes demonstrated by suppression of fractalkine, RANTES, and MCP-1 and upregulation of adiponectin

OBJECTIVE

A major site of action for the atheroprotective drug nicotinic acid (NA) is adipose tissue, via the G-protein-coupled receptor, GPR109A. Since, adipose tissue is an active secretory organ that contributes both positively and negatively to systemic inflammatory processes associated with cardiovascular disease, we hypothesized that NA would act directly upon adipocytes to alter the expression of pro-inflammatory chemokines, and the anti-inflammatory adipokine adiponectin.

METHODS AND RESULTS

TNF-alpha treatment (1.0ng/mL) of 3T3-L1 adipocytes resulted in an increase in gene expression of fractalkine (9+/-3.3-fold, P<0.01); monocyte chemoattractant protein-1 (MCP-1) (24+/-1.2-fold, P<0.001), 'regulated upon activation, normal T cell expressed and secreted' (RANTES) (500+/-55-fold, P<0.001) and inducible nitric oxide synthase (iNOS) (200+/-70-fold, P<0.05). The addition of NA (10(-4)M) to TNF-alpha-treated adipocytes attenuated expression of fractalkine (50+/-12%, P<0.01); MCP-1 (50+/-6%, P<0.01), RANTES (70+/-3%, P<0.01) and iNOS (60+/-16%). This pattern was mirrored in protein released from the adipocytes into the surrounding media. The effect on gene expression was neutralised by pre-treatment with pertussis toxin. NA attenuated macrophage chemotaxis (by 27+/-3.5%, P<0.001) towards adipocyte conditioned media. By contrast, NA, (10(-6)-10(-3)M) increased, in a dose-dependent manner, mRNA of the atheroprotective hormone adiponectin (3-5-fold n=6, P<0.01).

CONCLUSIONS

NA suppresses pro-atherogenic chemokines and upregulates the atheroprotective adiponectin through a G-protein-coupled pathway. Since adipose tissue has the potential to contribute to both systemic and local (perivascular) inflammation associated with atherosclerosis our results suggest a new "pleiotropic" role for NA.

Obesity and cardiovascular disease: from pathophysiology to risk stratification

Obesity is associated with numerous co-morbidities such as cardiovascular diseases (CVD), type 2 diabetes, hypertension and others. As obesity is considered to be a major risk factor for atherosclerosis, understanding of the underlying mechanisms leading to obesity and linking obesity with atherogenesis is necessary, for the development of therapeutic strategies against atherosclerosis. The pathophysiology of CVD linked to obesity is an area of intensive research. In this review we examine the role of obesity on CVD, and we focus on specific mechanisms of major importance in atherogenesis, such as the role of adipokines, insulin resistance, endothelial function and cardiac structure with emphasis on the effects of obesity on vascular endothelium and atherosclerosis. We then proceed from the pathophysiology of obesity to clinical practice, and we discuss clinical studies linking obesity with subclinical or overt CVD. We highlight that obesity is an easily assessed cardiovascular risk factor in the clinical setting and strategies to promote optimal body weight should be encouraged.

Carotid arterial elasticity is a sensitive atherosclerosis value reflecting visceral fat accumulation in obese subjects

BACKGROUND

We previously reported the arterial elasticity value we measured to reflect the characteristic features of vessel walls, and to possibly be useful for detecting early stage atherosclerosis in type 2 diabetes. Obesity, especially visceral adiposity, is well known to play a crucial role in the development of metabolic disorders and atherosclerosis. To assess whether arterial elasticity value reflects the effect of obesity on atherosclerosis, we examined the associations of obesity characteristics with atherosclerosis values including arterial elasticity, carotid intima-media thickness (IMT) and pulse wave velocity (PWV).

METHODS

Three atherosclerosis values were measured in 78 obese subjects (body mass index >/=30). We investigated the associations of atherosclerosis values with obesity-related parameters including abdominal fat accumulation determined by computed tomography.

RESULTS

Arterial elasticity values were positively related to established atherosclerosis values, carotid IMT and PWV, in obese subjects. Age, systolic blood pressure and hypertension also correlated with these atherosclerosis values. Single regression analysis showed all three atherosclerosis values to correlate significantly with visceral fat area. Intriguingly, visceral fat area is an independent variable affecting arterial elasticity, but not IMT or PWV. Furthermore, multiple regression analysis revealed that arterial elasticity correlates strongly with visceral fat area.

CONCLUSIONS

Arterial elasticity value we measure is a new parameter for evaluating atherosclerosis in subjects with visceral adiposity and more sensitive than the currently established atherosclerosis values, carotid IMT and PWV. Measuring arterial elasticity has the potential to reveal minute vascular changes, and may have broad clinical applications for evaluating early stage atherosclerosis.

Visceral adipose tissue, a potential risk factor for carotid atherosclerosis: results of the Multicultural Community Health Assessment Trial (M-CHAT)

BACKGROUND AND PURPOSE

The association between abdominal obesity and atherosclerosis is believed to be due to excess visceral adipose tissue (VAT), which is associated with traditional risk factors. We hypothesized that VAT is an independent risk factor for atherosclerosis.

METHODS

Healthy men and women (N=794) matched for ethnicity (aboriginal, Chinese, European, and South Asian) and body mass index range (<25, 25 to 29.9, or > or =30 kg/m(2)) were assessed for VAT (by computed tomography scan), carotid atherosclerosis (by ultrasound), total body fat, cardiovascular risk factors, lifestyle, and demographics.

RESULTS

VAT was associated with carotid intima-media thickness (IMT), plaque area, and total area (IMT area and plaque area combined) after adjusting for demographics, family history, smoking, and percent body fat in men and women. In men, VAT was associated with IMT and total area after adjusting for insulin, glucose, homocysteine, blood pressure, and lipids. This association remained significant with IMT after further adjustment for either waist circumference or the waist-to-hip ratio. In women, VAT was no longer associated with IMT or total area after adjusting for risk factors.

CONCLUSIONS

VAT is the primary region of adiposity associated with atherosclerosis and likely represents an additional risk factor for carotid atherosclerosis in men. Most but not all of this risk can be reflected clinically by either the waist circumference or waist-hip ratio measures.

The relative impact of different measures of adiposity on markers of early atherosclerosis

BACKGROUND

Although there are several methods available to assess adiposity, there is still controversy on the relative clinical utility of each of these methods. This study examines the relative impact of different measures of adiposity on markers of early atherosclerosis. In particular weight changes over time have been poorly assessed in this setting.

METHODS

Eighty-six healthy individuals (31 men, age 36.5+/-8.9 years) with a wide range of body-mass index (28.7+/-7.0, 18.9-57.9 kg/m2) without hypertension, diabetes or smoking were examined. In addition to waist circumference and waist-to-hip ratio self-reported weight change since adolescence was also calculated. Ultrasonography was used to measure abdominal fat layers and their ratio. Flow-mediated dilatation of the brachial artery, serum levels of intercellular adhesion molecule (sICAM-1) and mean intima-media thickness of the carotid artery were measured as markers of early atherosclerosis.

RESULTS

Stepwise multivariate regression analysis showed waist circumference and waist-to-hip ratio as the only independent predictor of flow-mediated dilatation. Waist circumference and weight change but not current body-mass index were independent predictors of intima-media thickness. These correlations were not influenced by ultrasonographically measured fat layers, C-reactive protein and basal insulin resistance. Body-mass index and weight gain were associated with sICAM-1 but not independently of basal insulin resistance and C-reactive protein.

CONCLUSIONS

Waist circumference and weight gain were the strongest predictors of early atherosclerosis in a population of apparently healthy adults. The ultrasonographically measured fat layers did not provide additional information in this population.

Effect of oral magnesium sulfate administration on blood pressure and lipid profile in streptozocin diabetic rat

Approximately one-third of patients with type 1 diabetes develop a variety of complications as a result of mechanisms that are not completely understood. However, insufficient metabolic control seems to play a major role. Other factors such as magnesium (Mg) could also be of importance. We designed this study to elucidate the effect of oral magnesium administration on plasma lipid profile and mesenteric fat in male Wistar rats. Animals were divided into 4 groups (n=10 in each group): one group served as control, while the other groups were made diabetic with a single i.v. injection of 40 mg/kg streptozocin. Animals in which the diabetic state lasted for 10 days were referred as acute diabetic rats, whereas those in which the diabetes lasted for 8 weeks were defined as chronic diabetics. Mg-treated chronic diabetic received 10 g/l of MgSO(4) added to the drinking water (0.46 g/24 h) for eight weeks following which the left common carotid artery was cannulated for continuous recording of blood pressure. Blood glucose, magnesium and lipid profiles levels were also determined. Diabetes induction caused plasma glucose, high density lipoprotein (HDL), low density lipoprotein (LDL), very low density lipoprotein (VLDL), total cholesterol and triglyceride concentrations to increase, however plasma Mg level was decreased. Administration of MgSO(4) for eight weeks caused the return of the above factors to their normal levels. Mg concentrations also increased but failed to reach normal levels. Diabetes induction caused mesenteric fat/body weight ratio to increase, but administration of MgSO(4) reduced the ratio to normal levels. In addition, Mg administration returned systolic blood pressure to the normal level. Our results support the hypothesis that Mg may play a part in the management of diabetes and the prevention of its vascular complications in streptozocin-induced diabetic rats and it may be useful in the treatment of hyperlipidaemia in diabetic case.

Impact of obesity in intima media thickness of carotid arteries

OBJECTIVE

To explore differences in intima media thickness (IMT) of the carotid arteries induced by differences in BMI.

RESEARCH METHODS AND PROCEDURES

Data from 3173 consecutive subjects, who were referred to our Hypertension Center from 1998 to 2004, were reviewed. Criteria for patients to be considered for further analysis included no past or concurrent antihypertensive medication, no concurrent medication with the potential to raise blood pressure (BP) (e.g., prednisone), and no clinical signs or laboratory evidence of secondary causes of hypertension. Our population was divided into four groups according to NIH criteria for obesity: underweight, normal weight, overweight, and obese. BMI, mean IMT of internal carotid arteries, and 24-hour BP values were available for all subjects. Five hundred thirty six subjects of the four groups, matched for age, gender, and mean 24-hour BP values, were included in the analysis.

RESULTS

Mean IMT of internal carotid arteries was increased with increasing BMI. Mean IMT was significantly higher in obese subjects compared with normal-weight (p < 0.01) and underweight (p < 0.001) subjects. Mean IMT was significantly higher in overweight subjects compared with normal-weight ones (p < 0.05). Furthermore, multivariate regression analysis in obese subjects revealed that fasting serum glucose was independently associated with IMT.

DISCUSSION

Obesity may be an important factor for carotid atherosclerosis, and at least some of the effects of obesity are independent of the BP levels. Fasting serum glucose levels in obese subjects may play an important role in carotid atherosclerosis.

Metabolic syndrome by the international diabetes federation definition in Hong Kong Chinese

In this report, we aimed to examine the impact of the new International Diabetes Federation (IDF) definition on the prevalence and clinical characteristics of subjects with metabolic syndrome (MES). Data were obtained from a prevalence survey for cardiovascular risk factors in a Hong Kong Chinese working population. There were 1513 subjects well representing all occupational groups from managers to general laborers [910 (60.1%) men and 603 (39.9%) women (mean age 37.5+/-9.2, median 37.0, range 18-66 years)]. The crude prevalence of MES defined by the IDF criterion was 7.4% (compared to other criteria: NCEP, 9.6%; WHO, 13.4% and EGIR, 8.9%). The age-standardized prevalence of MES by the IDF criterion was 8.8% in women and 7.3% in men. Subjects with MES defined by IDF criterion had higher body mass index and waist compared to those with MES defined by NCEP or WHO criteria, and lower triglyceride compared to those with MES defined by NCEP criterion after adjustment for age, gender and smoking. Non-MES subjects defined by IDF criterion had higher 2h glucose and insulin resistance compared to non-MES subjects defined by WHO. In conclusion, the new IDF criterion for MES is easy to implement in clinical practice. It may be potentially more 'specific' in identifying subjects with MES although compared to the NCEP criterion, it may have missed a proportion of subjects, especially men, who have metabolic derangement. Prospective and interventional studies are needed to validate the prognostic values of this new definition in comparison with other existing definitions.

Effects of obesity, body composition, and adiponectin on carotid intima-media thickness in healthy women

CONTEXT

Increased common carotid intima-media thickness (IMT) is predictive of coronary artery disease and stroke.

OBJECTIVE

In this study, we investigated common carotid IMT by obesity category in a cohort of healthy women without previously known cardiovascular disease.

DESIGN, SETTING, PARTICIPANTS, AND MAIN OUTCOME MEASURES

One hundred healthy women (aged 24-59 yr) from the general community enrolled in an observational study conducted at an academic medical center participated in the study. B-mode ultrasound imaging of the common carotid arteries was used to measure common carotid IMT in 99 subjects. Fat distribution was determined by computed tomography. Hormonal and inflammatory parameters related to cardiovascular disease and obesity were measured.

RESULTS

IMT was higher in obese [body mass index (BMI) >or= 30 kg/m(2)], compared with overweight women (BMI >or= 25 and < 30 kg/m(2)) [0.69 mm, interquartile range (IQR) 0.60-0.75 mm] vs. 0.62 mm [IQR 0.56-0.68 mm), P = 0.044] and in comparison with lean women (BMI < 25 kg/m(2)) [0.69 mm (IQR 0.60-0.75 mm) vs. 0.59 mm (IQR 0.54-0.67 mm), P = 0.016]. In multivariate modeling, age (beta = 0.0050 mm change in IMT per year of age, P = 0.003), smoking (beta = 0.0044 mm change in IMT per pack-year, P = 0.046), and sc abdominal adiposity (beta = 0.00026 mm change in IMT per square centimeter, P = 0.010) were positively associated with IMT, whereas adiponectin (beta = -0.0042 mm change in IMT per milligram per liter, P = 0.045) was negatively associated with IMT. Visceral adiposity (beta = 0.00048 mm change in IMT per square centimeter, P = 0.092) was not significantly associated with IMT after adjusting for age, race, smoking, sc abdominal adiposity, and adiponectin.

CONCLUSIONS

Obesity is associated with increased common carotid IMT in young and middle-aged women. Adiponectin and sc abdominal adiposity are associated with carotid IMT in this population.

Mesenteric fat thickness is an independent determinant of metabolic syndrome and identifies subjects with increased carotid intima-media thickness

OBJECTIVE

Mesenteric fat, a reflection of visceral adiposity, may play an important role in the pathogenesis of metabolic syndrome and cardiovascular diseases (CVD). In this study, we examined the independent relationship between mesenteric fat thickness and metabolic syndrome and defined its optimal cutoff value to identify high-risk subjects for metabolic syndrome and CVD.

RESEARCH DESIGN AND METHODS

A total of 290 Chinese subjects had an ultrasound examination for measurements of thickness of mesenteric, preperitoneal, and subcutaneous fat as well as carotid intima-media thickness (IMT). Anthropometric measurements and metabolic risk profile were assessed by physical examination and blood taking.

RESULTS

Twenty (6.9%) subjects had metabolic syndrome according to the National Cholesterol Education Panel Adult Treatment Panel III criteria with Asian definitions for central obesity (waist circumference >80 cm in women and >90 cm in men). Mesenteric fat thickness had significant correlations (P < 0.05) with various metabolic variables. On multivariate regression, mesenteric fat thickness was an independent determinant of all components of metabolic syndrome after adjustment for age, sex, homeostasis model assessment of insulin resistance, and other fat deposits. The odds ratio of metabolic syndrome was increased by 1.35 (95% CI 1.10-1.66)-fold for every 1-mm increase in mesenteric fat thickness. On receiver-operating characteristic curve analysis, mesenteric fat thickness of > or =10 mm was the optimal cutoff value to identify metabolic syndrome, with sensitivity of 70% and specificity of 75%. Subjects with mesenteric fat thickness > or =10 mm had higher carotid IMT than those with thickness <10 mm (0.73 +/- 0.19 vs. 0.64 +/- 0.16 mm, P = 0.001).

CONCLUSIONS

Mesenteric fat thickness was an independent determinant of metabolic syndrome and identified subjects with increased carotid IMT.