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Ichikawa T, Okada H, Hamaguchi M, Nishioka N, Tateyama Y, Shimamoto T, Kurogi K, Murata H, Ito M, Iwami T, Fukui M. The transition of metabolic phenotypes and cardiovascular events: Panasonic cohort study 16. Obesity (Silver Spring) 2024; 32:999-1008. [PMID: 38444281 DOI: 10.1002/oby.23999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 12/16/2023] [Accepted: 01/06/2024] [Indexed: 03/07/2024]
Abstract
OBJECTIVE The study objective was to investigate whether changes in metabolic phenotype affect the risk of cardiovascular events. METHODS All 117,589 participants were included in this retrospective cohort study. The metabolic phenotypes of the participants were assessed at two points (the second evaluation was set 2 years after the first evaluation), and the incidence rate of cardiovascular events was observed for 11 years. The main outcome was 3-point major adverse cardiac events (MACE), which comprises cardiovascular death, nonfatal coronary artery disease, and nonfatal stroke incidence. RESULTS Of the participants, 2748 (2.3%) cases of 3-point MACE were identified during follow-up. The stable metabolically healthy obesity group had a higher risk of 3-point MACE than those with stable metabolically healthy nonobesity (MHNO). Additionally, the change from metabolically healthy obesity to MHNO for 2 years decreased the risk of 3-point MACE (hazard ratio [HR], 1.12: 95% CI: 0.84-1.47) to the same level as stable MHNO. However, the change from metabolically abnormal nonobesity and metabolically abnormal obesity to MHNO for 2 years maintained a higher risk of 3-point MACE (HR, 1.66 [95% CI: 1.36-2.01]; HR, 1.91 [95% CI: 1.22-2.81]) than those with stable MHNO. CONCLUSIONS Change in metabolic phenotype is associated with incident 3-point MACE.
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Affiliation(s)
- Takahiro Ichikawa
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Hiroshi Okada
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
- Department of Diabetes and Endocrinology, Matsushita Memorial Hospital, Moriguchi, Japan
| | - Masahide Hamaguchi
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Norihiro Nishioka
- Department of Preventive Services, Kyoto University School of Public Health, Kyoto, Japan
| | - Yukiko Tateyama
- Department of Preventive Services, Kyoto University School of Public Health, Kyoto, Japan
| | - Tomonari Shimamoto
- Department of Preventive Services, Kyoto University School of Public Health, Kyoto, Japan
| | - Kazushiro Kurogi
- Department of Health Care Center, Panasonic Health Insurance Organization, Moriguchi, Japan
| | - Hiroaki Murata
- Department of Orthopaedic Surgery, Matsushita Memorial Hospital, Moriguchi, Japan
| | - Masato Ito
- Department of Health Care Center, Panasonic Health Insurance Organization, Moriguchi, Japan
| | - Taku Iwami
- Department of Preventive Services, Kyoto University School of Public Health, Kyoto, Japan
| | - Michiaki Fukui
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
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Uchida K, Sugimoto T, Tange C, Nishita Y, Shimokata H, Saji N, Kuroda Y, Matsumoto N, Kishino Y, Ono R, Akisue T, Otsuka R, Sakurai T. Association between abdominal adiposity and cognitive decline in older adults: a 10-year community-based study. J Nutr Health Aging 2024; 28:100175. [PMID: 38308924 DOI: 10.1016/j.jnha.2024.100175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 01/22/2024] [Accepted: 01/23/2024] [Indexed: 02/05/2024]
Abstract
OBJECTIVES This study aimed to investigate the association between abdominal adiposity and change in cognitive function in community-dwelling older adults. DESIGN, SETTING, AND PARTICIPANTS This longitudinal study included older adults aged ≥60 years without cognitive impairment who participated in the National Institute for Longevity Sciences - Longitudinal Study of Aging. MEASUREMENTS Cognitive function was evaluated biennially using the Mini-Mental State Examination (MMSE) over 10 years. Waist circumference (WC) was measured at the naval level, and subcutaneous fat area (SFA) and visceral fat area (VFA) were assessed using baseline computed tomography scans. WC, SFA, and VFA areas were stratified into sex-adjusted tertiles. A linear mixed model was applied separately for men and women. RESULTS This study included 873 older adults. In men, the groups with the highest levels of WC, SFA, and VFA exhibited a greater decline in MMSE score than the groups with the lowest levels (β [95% confidence interval]: WC, -0.12 [-0.23 to -0.01]; SFA, -0.13 [-0.24 to -0.02]; VFA, -0.11 [-0.22 to -0.01]). In women, the group with the highest level of WC and SFA showed a greater decline in MMSE score than the group with the lowest level (WC, -0.12 [-0.25 to -0.01]; SFA, -0.18 [-0.30 to -0.06]), but VFA was not associated with cognitive decline. CONCLUSION Higher WC, SFA, and VFA in men and higher WC and SFA in women were identified as risk factors for cognitive decline in later life, suggesting that abdominal adiposity involved in cognitive decline may differ according to sex.
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Affiliation(s)
- Kazuaki Uchida
- Department of Prevention and Care Science, Research Institute, National Center for Geriatrics and Gerontology, Obu, Aichi 474-8511, Japan; Department of Rehabilitation Science, Graduate School of Health Sciences, Kobe University, Kobe, Hyogo 654-0142, Japan
| | - Taiki Sugimoto
- Department of Prevention and Care Science, Research Institute, National Center for Geriatrics and Gerontology, Obu, Aichi 474-8511, Japan; Center for Comprehensive Care and Research on Memory Disorders, Hospital, National Center for Geriatrics and Gerontology, Obu, Aichi 474-8511, Japan
| | - Chikako Tange
- Department of Epidemiology of Aging, Research Institute, National Center for Geriatrics and Gerontology, Obu, Aichi 474-8511, Japan
| | - Yukiko Nishita
- Department of Epidemiology of Aging, Research Institute, National Center for Geriatrics and Gerontology, Obu, Aichi 474-8511, Japan
| | - Hiroshi Shimokata
- Department of Epidemiology of Aging, Research Institute, National Center for Geriatrics and Gerontology, Obu, Aichi 474-8511, Japan; Graduate School of Nutritional Sciences, Nagoya University of Arts and Sciences, Nisshin, Aichi 470-0196, Japan
| | - Naoki Saji
- Center for Comprehensive Care and Research on Memory Disorders, Hospital, National Center for Geriatrics and Gerontology, Obu, Aichi 474-8511, Japan
| | - Yujiro Kuroda
- Department of Prevention and Care Science, Research Institute, National Center for Geriatrics and Gerontology, Obu, Aichi 474-8511, Japan
| | - Nanae Matsumoto
- Department of Prevention and Care Science, Research Institute, National Center for Geriatrics and Gerontology, Obu, Aichi 474-8511, Japan
| | - Yoshinobu Kishino
- Department of Prevention and Care Science, Research Institute, National Center for Geriatrics and Gerontology, Obu, Aichi 474-8511, Japan; Department of Cognitive and Behavioral Science, Graduate School of Medicine, Nagoya University, Nagoya, Aichi 466-855, Japan
| | - Rei Ono
- Department of Physical Activity Research, National Institutes of Biomedical Innovation, Health and Nutrition, Settsu, Osaka 566-0002, Japan; Department of Public Health, Graduate School of Health Sciences, Kobe University, Kobe, Hyogo 654-0142, Japan
| | - Toshihiro Akisue
- Department of Rehabilitation Science, Graduate School of Health Sciences, Kobe University, Kobe, Hyogo 654-0142, Japan
| | - Rei Otsuka
- Department of Epidemiology of Aging, Research Institute, National Center for Geriatrics and Gerontology, Obu, Aichi 474-8511, Japan
| | - Takashi Sakurai
- Department of Prevention and Care Science, Research Institute, National Center for Geriatrics and Gerontology, Obu, Aichi 474-8511, Japan; Department of Cognitive and Behavioral Science, Graduate School of Medicine, Nagoya University, Nagoya, Aichi 466-855, Japan; Research Institute, National Center for Geriatrics and Gerontology, Obu, Aichi 474-8511, Japan.
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Seo DH, Kim M, Suh YJ, Cho Y, Ahn SH, Hong S, Kim SH. Association between age at diagnosis of type 2 diabetes and cardiovascular morbidity and mortality risks: A nationwide population-based study. Diabetes Res Clin Pract 2024; 208:111098. [PMID: 38242293 DOI: 10.1016/j.diabres.2024.111098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 12/23/2023] [Accepted: 01/16/2024] [Indexed: 01/21/2024]
Abstract
AIMS We aimed to investigate the association between the age at diagnosis of type 2 diabetes and the risk of cardiovascular (CVD) outcomes in comparison with nondiabetic counterparts. METHODS A total of 634,350 patients with newly diagnosed type 2 diabetes between January 1, 2012, and December 31, 2014 were included in a Korean population cohort study. Nondiabetic matched controls were selected from the general population in a 1:2 ratio. Participants were followed until the end of 2019 for CVD outcomes and mortality. RESULTS During 5.7 years of follow-up, patients with type 2 diabetes diagnosed at ≤40 years of age had the highest excess risk for most outcomes relative to controls, with an adjusted hazard ratio (HR) (95 % CI) of 6.08 (5.51-6.70) for total mortality, 7.10 (6.66-7.58) for hospitalization for heart failure, and 5.04 (4.86-5.24) for coronary heart disease. All risks attenuated progressively with each increasing decade of diagnostic age. CONCLUSION In this population-based cohort study, a younger age at diagnosis of type 2 diabetes was associated with a higher relative risk of mortality and CVD outcomes. Therefore, primary prevention of type 2 diabetes is desirable at all ages but is particularly important at younger ages.
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Affiliation(s)
- Da Hea Seo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Inha University College of Medicine, Incheon, Republic of Korea
| | - Mina Kim
- Department of Data Science, Hanmi Pharm. Co., Ltd, Seoul, Republic of Korea
| | - Young Ju Suh
- Department of Biomedical Sciences, Inha University College of Medicine, Incheon, Republic of Korea
| | - Yongin Cho
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Inha University College of Medicine, Incheon, Republic of Korea
| | - Seong Hee Ahn
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Inha University College of Medicine, Incheon, Republic of Korea
| | - Seongbin Hong
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Inha University College of Medicine, Incheon, Republic of Korea
| | - So Hun Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Inha University College of Medicine, Incheon, Republic of Korea.
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Wakisaka K, Matsuo R, Irie F, Wakisaka Y, Ago T, Kamouchi M, Kitazono T. Association between abdominal adiposity and clinical outcomes in patients with acute ischemic stroke. PLoS One 2024; 19:e0296833. [PMID: 38206990 PMCID: PMC10783725 DOI: 10.1371/journal.pone.0296833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 12/20/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND It is unclear whether abdominal adiposity has an additional effect on post-stroke outcomes. This study aimed to determine whether waist circumference (WC) is independently associated with clinical outcomes after acute ischemic stroke. METHODS We enrolled patients with acute ischemic stroke from a multicenter hospital-based stroke registry in Fukuoka, Japan. We measured WC on admission and categorized patients into four groups (Q1-Q4) according to the quartiles in females and males. The clinical outcomes were poor functional outcome (modified Rankin scale score 2-6) and death from any cause. Logistic regression analysis was performed to estimate the odds ratio and 95% confidence interval of the outcomes of interest after adjusting for potential confounding factors, including body mass index (BMI). RESULTS A total of 11,989 patients (70.3±12.2 years, females: 36.1%) were included in the analysis. The risk of poor functional outcome significantly decreased for Q2-Q4 (vs. Q1) at discharge and Q2-Q3 (vs. Q1) at 3 months, even after adjusting for potential confounders, including BMI. In contrast, adjustment of BMI eliminated the significant association between WC and all-cause death at discharge and 3 months. The association between high WC and favorable functional outcome was not affected by fasting insulin levels or homeostatic model assessment for insulin resistance and was only found in patients without diabetes (P = 0.02 for heterogeneity). CONCLUSIONS These findings suggest that abdominal adiposity has an additional impact on post-stroke functional outcome, independent of body weight and insulin action.
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Affiliation(s)
- Kayo Wakisaka
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Department of Neurology, Steel Memorial Yawata Hospital, Kitakyushu, Japan
| | - Ryu Matsuo
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Fumi Irie
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoshinobu Wakisaka
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tetsuro Ago
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masahiro Kamouchi
- Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takanari Kitazono
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Higo Y, Hisamatsu T, Nakagawa Y, Sawayama Y, Yano Y, Kadota A, Fujiyoshi A, Kadowaki S, Torii S, Kondo K, Watanabe Y, Ueshima H, Miura K. Association of Anthropometric and CT-Based Obesity Indices with Subclinical Atherosclerosis. J Atheroscler Thromb 2024; 31:48-60. [PMID: 37558497 PMCID: PMC10776301 DOI: 10.5551/jat.64096] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 06/07/2023] [Indexed: 08/11/2023] Open
Abstract
AIM Few studies have compared the strength in the associations of anthropometric and computed tomography (CT)-based obesity indices with coronary artery calcification (CAC), aortic artery calcification (AoAC), and aortic valve calcification (AVC). METHODS We assessed cross-sectcional associations of anthropometric and CT-based obesity indices with CAC, AoAC, and AVC. Anthropometric measures included body mass index (BMI), waist circumference, hip ircumference, waist-to-hip circumference ratio, and waist-to-height ratio in 931 men (mean age, 63.7 years) from a population-based cohort. CT images at the L4/5 level were obtained to calculate the areas of abdominal visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), total adipose tissue (TAT), VAT-to-SAT ratio (VSR), and VAT-to-TAT ratio (VTR). CAC, AoAC, and AVC were quantified using the Agatston score based on CT scanning. RESULTS CAC, AVC, and AoAC were present in 348 (62.6%), 173 (18.6%), and 769 (82.6%) participants, respectively. In multivariable models adjusting for age, lifestyle factors, and CT types (electron beam CT and multidetector row CT), anthropometric and CT-based obesity indices were positively associated with CAC (p<0.01). Conversely, VAT-to-SAT ratio and VAT-to-TAT ratio were positively associated with AoAC (p<0.01). Any obesity indices were not associated with AVC. CONCLUSIONS The strength of the associations of obesity indices with subclinical atherosclerosis varied according to the anatomically distinct atherosclerotic lesions, among men.
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Affiliation(s)
- Yosuke Higo
- Department of Cardiovascular Medicine, Shiga University of Medical Science, Shiga, Japan
| | - Takashi Hisamatsu
- NCD Epidemiology Research Center, Shiga University of Medical Science, Shiga, Japan
- Department of Public Health, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yoshihisa Nakagawa
- Department of Cardiovascular Medicine, Shiga University of Medical Science, Shiga, Japan
| | - Yuichi Sawayama
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, Okayama, Japan
| | - Yuichiro Yano
- NCD Epidemiology Research Center, Shiga University of Medical Science, Shiga, Japan
| | - Aya Kadota
- NCD Epidemiology Research Center, Shiga University of Medical Science, Shiga, Japan
- Department of Public Health, Shiga University of Medical Science, Shiga Japan
| | - Akira Fujiyoshi
- NCD Epidemiology Research Center, Shiga University of Medical Science, Shiga, Japan
- Department of Hygiene, Wakayama Medical University, Wakayama, Japan
| | - Sayaka Kadowaki
- NCD Epidemiology Research Center, Shiga University of Medical Science, Shiga, Japan
- Department of Pediatrics, Uji Tokushukai Hospital, Kyoto, Japan
| | - Sayuki Torii
- NCD Epidemiology Research Center, Shiga University of Medical Science, Shiga, Japan
- Department of Public Health, Shiga University of Medical Science, Shiga Japan
| | - Keiko Kondo
- NCD Epidemiology Research Center, Shiga University of Medical Science, Shiga, Japan
- Department of Public Health, Shiga University of Medical Science, Shiga Japan
| | - Yoshiyuki Watanabe
- Department of Radiology, Shiga University of Medical Science, Shiga, Japan
| | - Hirotsugu Ueshima
- NCD Epidemiology Research Center, Shiga University of Medical Science, Shiga, Japan
- Department of Public Health, Shiga University of Medical Science, Shiga Japan
| | - Katsuyuki Miura
- NCD Epidemiology Research Center, Shiga University of Medical Science, Shiga, Japan
- Department of Public Health, Shiga University of Medical Science, Shiga Japan
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Zhao W, Ma X, Ju J, Zhao Y, Wang X, Li S, Sui Y, Sun Q. Association of visceral adiposity index with asymptomatic intracranial arterial stenosis: a population-based study in Shandong, China. Lipids Health Dis 2023; 22:64. [PMID: 37198613 DOI: 10.1186/s12944-023-01831-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 05/09/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND AND OBJECTIVE The visceral adiposity index (VAI), as a composite indictor to evaluate visceral adipose function, has been demonstrated to be correlated with atherosclerosis. The study objective was to explore the association between asymptomatic intracranial arterial stenosis (aICAS) and VAI in Chinese rural dwellers. METHODS The cross-sectional study consisted of 1942 participants ≥ 40 years old who were living in Pingyin County, Shandong Province and free from history of clinical stroke and transient ischemic attack. The aICAS in the study was diagnosed by transcranial doppler ultrasound combined with magnetic resonance angiography. The multivariate logistic regression models were deployed to explore the correlation of VAI with aICAS, and receiver operating characteristic (ROC) curve were plotted to compare the performance of models. RESULTS The participants with aICAS comparing to those without had a significantly higher VAI. After adjusting for confounding factors including age, hypertension, DM, sex, drinking habit, LDL-C, hsCRP, and smoking habit, the VAI-Tertile 3 (vs. VAI-Tertile 1) was positively associated with aICAS (OR, 2.15; 95% CI, 1.25-3.65; P = 0.005). The VAI-Tertile 3 was still markedly associated with aICAS among the underweight and normal weight (BMI ≤ 23.9 kg/m2) participants (OR, 3.17; 95% CI, 1.15-8.71; P = 0.026) with an AUC = 0.684. A similar relationship between VAI and aICAS was obtained among the participants with no abdominal obesity (WHR < 1, OR, 2.03; 95% CI, 1.14-3.62; P = 0.017). CONCLUSIONS The possible correlation between VAI and aICAS was found to be positive for the first time among Chinese rural residents over 40 years old. A higher VAI was found to be significantly associated with aICAS among the participants who were underweight or normal weight, and these results may provide additional risk stratification information for aICAS.
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Affiliation(s)
- Weihua Zhao
- Department of Neurology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
| | - Xiaotong Ma
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324 Jingwu Weiqi Road, Jinan, Shandong, 250021, P.R. China
| | - Jiachen Ju
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324 Jingwu Weiqi Road, Jinan, Shandong, 250021, P.R. China
| | - Yuanyuan Zhao
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324 Jingwu Weiqi Road, Jinan, Shandong, 250021, P.R. China
| | - Xiang Wang
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324 Jingwu Weiqi Road, Jinan, Shandong, 250021, P.R. China
| | - Shan Li
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324 Jingwu Weiqi Road, Jinan, Shandong, 250021, P.R. China
| | - Yanling Sui
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324 Jingwu Weiqi Road, Jinan, Shandong, 250021, P.R. China
| | - Qinjian Sun
- Department of Neurology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China.
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324 Jingwu Weiqi Road, Jinan, Shandong, 250021, P.R. China.
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Body composition reference values in Singaporean adults using dual-energy X-ray absorptiometry-The Yishun study. PLoS One 2022; 17:e0276434. [PMID: 36269751 PMCID: PMC9586348 DOI: 10.1371/journal.pone.0276434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 10/07/2022] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES This study establishes age- and sex-specific reference values for fat mass index (FMI), lean mass index (LMI), appendicular LMI (aLMI), and body fat distribution indices including Android/Gynoid % fat ratio and Trunk/Limb % fat ratio in multi-ethnic Singaporean adults. METHODS A population-based cross-sectional study using dual-energy X-ray absorptiometry (Hologic Discovery Wi) was carried out to measure whole body and regional fat and lean mass in community-dwelling adults. A total of 537 adults (57.5% women), aged from 21 to 90 years, were recruited from the large north-eastern residential town of Yishun. Age- and sex-specific percentile reference values were generated for FMI, LMI, aLMI, Android/Gynoid % fat ratio and Trunk/Limb % fat ratio using the Lambda-Mu-Sigma method. The relationship between the parameters and age were assessed through the Pearson's correlation coefficient. RESULTS All parameters demonstrated significant correlation with age (p < 0.05) for both men and women, except for LMI in women, with the strength of r ranging from 0.12 (weak correlation) to 0.54 (strong correlation). LMI (r = -0.45) and appendicular LMI (r = -0.54) were negatively associated with age in men while none (r = -0.06) to weak correlation (r = -0.14) were shown in women for the same parameters respectively. The Android/Gynoid % fat ratio and Trunk/Limb % fat ratio were positively related to age for both men (r = 0.37 & 0.43, p < 0.001) and women (r = 0.52 & 0.48, p < 0.001). CONCLUSION We have established DXA-based body composition reference data for the Singapore adult population. These reference data will be particularly useful in geriatric, obesity and oncology clinics, enabling the prescription of appropriate therapy to individuals at risk of morbidity from unfavorable body composition phenotypes. It also adds on to the limited reference database on Southeast Asian body composition.
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Huang H, Jin J, Chen Y, Wang L, Zhong J, Chen Z, Xu L. Visceral fat might impact left ventricular remodeling through changes in arterial stiffness in type 2 diabetes: A cross-sectional study. Int J Cardiol 2022; 368:78-84. [PMID: 35988671 DOI: 10.1016/j.ijcard.2022.08.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 07/22/2022] [Accepted: 08/15/2022] [Indexed: 11/28/2022]
Abstract
AIMS Visceral fat (VF) influences left ventricular (LV) structure and diastolic function in type 2 diabetes (T2DM). However, there are limited data on the association among them based on different BMI levels as well as accounting for arterial stiffness. This study investigated the association of fat distribution, arterial stiffness, left ventricular (LV) structure and diastolic function in T2DM patients. MATERIALS AND METHODS This cross-sectional study comprised 905 patients. VF area (VFA) and subcutaneous fat area (SFA) were assessed by a dual bioelectrical impedance analyzer. Brachial-ankle pulse wave velocity (baPWV) was measured by a volume-plethysmographic apparatus and LV structure and diastolic function were echocardiography. Patients were divided into three groups based on BMI levels. Linear and logistic regression analysis were used to investigate the association. RESULTS In multivariate linear regression, relative wall thickness (RWT) was negatively correlated with E/A in obese patients (β = -0.203, p = 0.004). LV mass/height2.7 was positively correlated with E/E' in normal weight (β = 0.232, p = 0.002) and obese patients (β = 0.232, p = 0.008). In multivariate logistic regression, baPWV was an independent determinant of LV remodeling (LVRM) in normal weight (OR = 1.001; 95% CI, 1.000, 1.002; P = 0.006), overweight (OR = 1.001; 95% CI, 1.000, 1.002; P = 0.008) and obese groups (OR = 1.003; 95% CI, 1.001, 1.004; P = 0.001), while VFA was correlated with arterial stiffness in normal weight (OR = 1.032; 95% CI, 1.017, 1.047; P < 0.001) and overweight groups (OR = 1.011; 95% CI, 1.002, 1.021; P = 0.015). CONCLUSIONS VF might impact LVRM through changes in baPWV in T2DM patients, thus influencing diastolic function.
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Affiliation(s)
- Haishan Huang
- Shenzhen Hospital, Southern Medical University, Shenzhen, China; The Third School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Jing Jin
- Shenzhen Hospital, Southern Medical University, Shenzhen, China; The Third School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Yanshan Chen
- Shenzhen Hospital, Southern Medical University, Shenzhen, China; The Third School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Lina Wang
- Shenzhen Hospital, Southern Medical University, Shenzhen, China; The Third School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Jingyi Zhong
- Shenzhen Hospital, Southern Medical University, Shenzhen, China; The Third School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Zhenguo Chen
- Shenzhen Hospital, Southern Medical University, Shenzhen, China; The Third School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Lingling Xu
- Shenzhen Hospital, Southern Medical University, Shenzhen, China; The Third School of Clinical Medicine, Southern Medical University, Guangzhou, China.
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Kibirige D, Sekitoleko I, Lumu W, Jones AG, Hattersley AT, Smeeth L, Nyirenda MJ. Understanding the pathogenesis of lean non-autoimmune diabetes in an African population with newly diagnosed diabetes. Diabetologia 2022; 65:675-683. [PMID: 35138411 PMCID: PMC8894297 DOI: 10.1007/s00125-021-05644-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 11/12/2021] [Indexed: 11/25/2022]
Abstract
AIMS/HYPOTHESIS Apparent type 2 diabetes is increasingly reported in lean adult individuals in sub-Saharan Africa. However, studies undertaking robust clinical and metabolic characterisation of lean individuals with new-onset type 2 diabetes are limited in this population. This cross-sectional study aimed to perform a detailed clinical and metabolic characterisation of newly diagnosed adult patients with diabetes in Uganda, in order to compare features between lean and non-lean individuals. METHODS Socio-demographic, clinical, biophysical and metabolic (including oral glucose tolerance test) data were collected on 568 adult patients with newly diagnosed diabetes. Participants were screened for islet autoantibodies to exclude those with autoimmune diabetes. The remaining participants (with type 2 diabetes) were then classified as lean (BMI <25 kg/m2) or non-lean (BMI ≥25 kg/m2), and their socio-demographic, clinical, biophysical and metabolic characteristics were compared. RESULTS Thirty-four participants (6.4%) were excluded from analyses because they were positive for pancreatic autoantibodies, and a further 34 participants because they had incomplete data. For the remaining 500 participants, the median (IQR) age, BMI and HbA1c were 48 years (39-58), 27.5 kg/m2 (23.6-31.4) and 90 mmol/mol (61-113) (10.3% [7.7-12.5]), respectively, with a female predominance (approximately 57%). Of the 500 participants, 160 (32%) and 340 (68%) were lean and non-lean, respectively. Compared with non-lean participants, lean participants were mainly male (60.6% vs 35.3%, p<0.001) and had lower visceral adiposity level (5 [4-7] vs 11 [9-13], p<0.001) and features of the metabolic syndrome (uric acid, 246.5 [205.0-290.6] vs 289 [234-347] μmol/l, p<0.001; leptin, 660.9 [174.5-1993.1] vs 3988.0 [1336.0-6595.0] pg/ml, p<0.001). In addition, they displayed markedly reduced markers of beta cell function (oral insulinogenic index 0.8 [0.3-2.5] vs 1.6 [0.6-4.6] pmol/mmol; 120 min serum C-peptide 0.70 [0.33-1.36] vs 1.02 [0.60-1.66] nmol/l, p<0.001). CONCLUSIONS/INTERPRETATION Approximately one-third of participants with incident adult-onset non-autoimmune diabetes had BMI <25 kg/m2. Diabetes in these lean individuals was more common in men, and predominantly associated with reduced pancreatic secretory function rather than insulin resistance. The underlying pathological mechanisms are unclear, but this is likely to have important management implications.
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Affiliation(s)
- Davis Kibirige
- Non-Communicable Diseases Program, Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Isaac Sekitoleko
- Non-Communicable Diseases Program, Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - William Lumu
- Department of Medicine, Mengo Hospital, Kampala, Uganda
| | - Angus G. Jones
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, UK
- Department of Diabetes and Endocrinology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Andrew T. Hattersley
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, UK
- Department of Diabetes and Endocrinology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Liam Smeeth
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Moffat J. Nyirenda
- Non-Communicable Diseases Program, Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
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10
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Kadowaki T, Isendahl J, Khalid U, Lee SY, Nishida T, Ogawa W, Tobe K, Yamauchi T, Lim S. Semaglutide once a week in adults with overweight or obesity, with or without type 2 diabetes in an east Asian population (STEP 6): a randomised, double-blind, double-dummy, placebo-controlled, phase 3a trial. Lancet Diabetes Endocrinol 2022; 10:193-206. [PMID: 35131037 DOI: 10.1016/s2213-8587(22)00008-0] [Citation(s) in RCA: 69] [Impact Index Per Article: 34.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 12/23/2021] [Accepted: 12/23/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Semaglutide 2·4 mg once weekly has been investigated for weight management in global populations. Differences exist between Asian and non-Asian populations in terms of body composition and definitions of obesity. In the Semaglutide Treatment Effect in People with obesity (STEP) 6 trial, we assessed the effect of semaglutide versus placebo for weight management in adults from east Asia with obesity, with or without type 2 diabetes. METHODS This randomised, double-blind, double-dummy, placebo-controlled, phase 3a superiority trial was done at 28 outpatient clinics in Japan and South Korea. Eligible participants were adults (aged ≥18 years in South Korea; ≥20 years in Japan) with a BMI of at least 27·0 kg/m2 with two or more weight-related comorbidities or a BMI of 35·0 kg/m2 or more with one or more weight-related comorbidity (one comorbidity had to be either hypertension, dyslipidaemia, or, in Japan only, type 2 diabetes) who had at least one self-reported unsuccessful dietary attempt to lose bodyweight. Participants were randomly assigned (4:1:2:1) to once-weekly subcutaneous semaglutide 2·4 mg or matching placebo, or semaglutide 1·7 mg or matching placebo, plus lifestyle recommendations for 68 weeks. Data for the placebo groups were pooled in statistical analyses. The primary endpoints were percentage change in bodyweight from baseline at week 68 and the proportion of participants who had achieved a reduction of at least 5% of baseline bodyweight at week 68. Change in abdominal visceral fat area was assessed as a supportive secondary endpoint using computed tomography scanning in a subset of participants. Efficacy outcomes were assessed in the full analysis set, which included all randomly assigned participants according to the intention-to-treat principle. Safety was assessed in all participants who received at least one dose of the study drug. This trial was registered with ClinicalTrials.gov, NCT03811574. FINDINGS Between Jan 21, 2019 and June 4, 2019, 437 participants were screened, of whom 401 were randomly assigned to semaglutide 2·4 mg (n=199), semaglutide 1·7 mg (n=101), or placebo (n=101) and included in the intention-to-treat analysis. Estimated mean change in bodyweight from baseline to week 68 was -13·2% (SEM 0·5) in the semaglutide 2·4 mg group and -9·6% (0·8) in the semaglutide 1·7 mg group versus -2·1% (0·8) in the placebo group (estimated treatment difference [ETD] -11·1 percentage points [95% CI -12·9 to -9·2] for semaglutide 2·4 mg vs placebo; -7·5 percentage points [95% CI -9·6 to -5·4] for semaglutide 1·7 mg vs placebo; both p<0·0001). At week 68, a larger proportion of participants had achieved a 5% or higher reduction in baseline bodyweight in the semaglutide 2·4 mg group (160 [83%] of 193 participants) and semaglutide 1·7 mg group (71 [72%] of 98 participants) than in the placebo group (21 [21%] of 100 participants); odds ratio [OR] 21·7 [95% CI 11·3 to 41·9] for semaglutide 2·4 mg vs placebo; OR 11·1 [95% CI 5·5 to 22·2] for semaglutide 1·7 mg vs placebo; both p<0·0001). Abdominal visceral fat area was reduced by 40·0% (SEM 2·6) among participants in the semaglutide 2·4 mg group and 22·2% (3·7) among participants in the semaglutide 1·7 mg group versus 6·9% (3·8) in the placebo group (ETD -33·2% [95% CI -42·1 to -24·2] for semaglutide 2·4 mg vs placebo; -15·3% [95% CI -25·6 to -4·9] for semaglutide 1·7 mg vs placebo). 171 (86%) of 199 participants in the semaglutide 2·4 mg group, 82 (82%) of 100 participants in the semaglutide 1·7 mg group, and 80 (79%) of 101 participants in the placebo group reported adverse events. Gastrointestinal disorders, which were mostly mild to moderate, were reported in 118 (59%) of 199 participants in the semaglutide 2·4 mg group, 64 (64%) of 100 participants in the semaglutide 1·7 mg group, and 30 (30%) of 101 participants in the placebo group. Adverse events leading to trial product discontinuation occurred in five (3%) of 199 participants in the semaglutide 2·4 mg group, three (3%) of 100 participants in the semaglutide 1·7 mg group, and one (1%) of 101 participants in the placebo group. INTERPRETATION Adults from east Asia with obesity, with or without type 2 diabetes, given semaglutide 2·4 mg once a week had superior and clinically meaningful reductions in bodyweight, and greater reductions in abdominal visceral fat area compared with placebo, representing a promising treatment option for weight management in this population. FUNDING Novo Nordisk. TRANSLATIONS For the Korean and Japanese translations of the abstract see Supplementary Materials section.
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Affiliation(s)
| | | | | | - Sang Yeoup Lee
- Family Medicine Clinic and Biomedical Research Institute, Pusan National University Yangsan Hospital, Yangsan, South Korea; Department of Medical Education, Pusan National University School of Medicine, Yangsan, South Korea
| | | | - Wataru Ogawa
- Department of Internal Medicine, Division of Diabetes and Endocrinology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kazuyuki Tobe
- First Department of Internal Medicine, Graduate School of Medicine and Pharmaceutical Science for Research, University of Toyama, Toyama, Japan
| | - Toshimasa Yamauchi
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Soo Lim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea.
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Kim NH, Kim KJ, Choi J, Kim SG. Metabolically unhealthy individuals, either with obesity or not, have a higher risk of critical coronavirus disease 2019 outcomes than metabolically healthy individuals without obesity. Metabolism 2022; 128:154894. [PMID: 34600905 PMCID: PMC8482539 DOI: 10.1016/j.metabol.2021.154894] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 09/22/2021] [Accepted: 09/26/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND This study aimed to determine the relative and independent contributions of impaired metabolic health and obesity to critical coronavirus disease 2019 (COVID-19). METHODS We analyzed 4069 COVID-19 patients between January and June 2020 in South Korea, classified into four groups according to metabolic health status and body mass index (BMI): metabolically healthy normal weight (MHNW), metabolically unhealthy normal weight (MUNW), metabolically healthy obesity (MHO), and metabolically unhealthy obesity (MUO). The primary outcome was a composite of intensive care unit (ICU) admission, invasive mechanical ventilation (IMV), extracorporeal membrane oxygenation (ECMO), and death. Multivariable Cox proportional hazard regression models were used to estimate the hazard ratio (HR) for the outcome. RESULTS The incidence rate (per 100 person-months) of critical COVID-19 was the lowest in the MHNW group (0.90), followed by the MHO (1.64), MUNW (3.37), and MUO (3.37) groups. Compared with MHNW, a significantly increased risk of critical COVID-19 was observed in MUNW (HR, 1.41; 95% CI, 1.01-1.98) and MUO (HR, 1.77; 95% CI, 1.39-2.44) but not in MHO (HR, 1.48; 95% CI, 0.98-2.23). The risk of ICU admission or IMV/ECMO was increased only in MUO; however, the risk of death was significantly higher in MUNW and MUO. The risk of critical COVID-19 increased insignificantly by 2% per 1 kg/m2 BMI increase but significantly by 13% per 1 metabolically unhealthy component increase, even after mutually adjusting for BMI and metabolic health status. CONCLUSIONS Metabolic health is more important to COVID-19 outcomes than obesity itself, suggesting that metabolic health status should be considered for a precise and tailored management of COVID-19 patients.
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Affiliation(s)
- Nam Hoon Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Kyeong Jin Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Jimi Choi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Sin Gon Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea.
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12
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Tirandi A, Carbone F, Montecucco F, Liberale L. The role of metabolic syndrome in sudden cardiac death risk: Recent evidence and future directions. Eur J Clin Invest 2022; 52:e13693. [PMID: 34714544 PMCID: PMC9286662 DOI: 10.1111/eci.13693] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 08/23/2021] [Accepted: 09/28/2021] [Indexed: 12/14/2022]
Abstract
Metabolic syndrome (MetS) is a frequent condition whose deleterious effects on the cardiovascular system are often underestimated. MetS is nowadays considered a real pandemic with an estimated prevalence of 25% in general population. Individuals with MetS are at high risk of sudden cardiac death (SCD) as this condition accounts for 50% of all cardiac deaths in such a population. Of interest, recent studies demonstrated that individuals with MetS show 70% increased risk of SCD even without previous history of coronary heart disease (CHD). However, little is known about the interplay between the two conditions. MetS is a complex disease determined by genetic predisposition, unhealthy lifestyle and ageing with deleterious effects on different organs. MetS components trigger a systemic chronic low-grade pro-inflammatory state, associated with excess of sympathetic activity, cardiac hypertrophy, arrhythmias and atherosclerosis. Thus, MetS has an important burden on the cardiovascular system as demonstrated by both preclinical and clinical evidence. The aim of this review is to summarize recent evidence concerning the association between MetS and SCD, showing possible common aetiological processes, and to indicate prospective for future studies and therapeutic targets.
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Affiliation(s)
- Amedeo Tirandi
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Federico Carbone
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino Genoa - Italian Cardiovascular Network, Genoa, Italy
| | - Fabrizio Montecucco
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino Genoa - Italian Cardiovascular Network, Genoa, Italy
| | - Luca Liberale
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy.,Center for Molecular Cardiology, University of Zürich, Schlieren, Switzerland
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13
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Min J, Chang JS, Choi JY, Kong ID. Association Between Skeletal Muscle Mass, Physical Activity, and Metabolic Syndrome: the Korean National Health and Nutrition Examination Survey 2008-2011. Metab Syndr Relat Disord 2021; 20:156-165. [PMID: 34941432 DOI: 10.1089/met.2021.0080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Skeletal muscle mass (SM) and physical activity (PA) are major modifiable factors that can moderate and prevent the occurrence of metabolic syndrome (MetS). However, the joint association between SM and PA guidelines in MetS remains unclear. Therefore, we aimed to examine the relationship between SM and PA with MetS among Korean adults. Methods: This cross-sectional study analyzed 18,090 adults from the Korean National Health and Nutrition Examination Survey 2008-2011. We used the value of appendicular skeletal muscle mass divided by body mass index as SM. We decided on the PA guidelines using the American College of Sports Medicine guidelines. After adjusting for confounding factors, we performed logistic regression analysis to calculate the odds ratio and 95% confidence interval of MetS associated with SM and PA guidelines. Results: Participants from the highest SM quartile showed a decreased MetS risk of 58%-75%. Those who met both aerobic and resistance exercise guidelines were more likely to have lower MetS risk than those who neither. In addition, even with the same PA guideline status, participants with the highest muscle mass decreased MetS risk by 29%-81% compared with participants with the lowest muscle mass. Conclusions: Our results showed that increased SM and meeting PA guidelines are significantly associated with a decreased risk of MetS. To prevent MetS, customized strategies are needed for improving muscle mass and PA according to age and gender.
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Affiliation(s)
- Jihee Min
- Department of Physiology, Yonsei University Wonju College of Medicine, Wonju, South Korea.,Yonsei Institute of Sports Science and Exercise Medicine, Wonju, South Korea
| | - Jae Seung Chang
- Department of Physiology, Yonsei University Wonju College of Medicine, Wonju, South Korea.,Yonsei Institute of Sports Science and Exercise Medicine, Wonju, South Korea.,Mitohormesis Research Center, Wonju College of Medicine, Yonsei University, Wonju, South Korea
| | - Ji Yeong Choi
- Department of Physiology, Yonsei University Wonju College of Medicine, Wonju, South Korea.,Yonsei Institute of Sports Science and Exercise Medicine, Wonju, South Korea
| | - In Deok Kong
- Department of Physiology, Yonsei University Wonju College of Medicine, Wonju, South Korea.,Yonsei Institute of Sports Science and Exercise Medicine, Wonju, South Korea
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14
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Kalimeri M, Totman JJ, Baum T, Diefenbach MN, Hauner H, Makowski MR, Subburaj K, Cameron-Smith D, Henry CJ, Karampinos DC, Junker D. Postmenopausal Chinese-Singaporean Women Have a Higher Ratio of Visceral to Subcutaneous Adipose Tissue Volume than Caucasian Women of the Same Age and BMI. Diagnostics (Basel) 2021; 11:diagnostics11112127. [PMID: 34829474 PMCID: PMC8623581 DOI: 10.3390/diagnostics11112127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 11/10/2021] [Accepted: 11/11/2021] [Indexed: 12/04/2022] Open
Abstract
Central fat accumulation is a significant determinant of cardio-metabolic health risk, known to differ between ethnically distinct human populations. Despite evidence for preferential central adiposity in Asian populations, the proportional distribution between the subcutaneous and visceral compartments in Chinese postmenopausal women has not been thoroughly investigated. For this analysis, volumetrically quantified subcutaneous and visceral adipose tissue (SAT, VAT) in the pelvic and abdominal regions of postmenopausal Asian (Chinese-Singaporean) and Caucasian (German) women matched for age and Body Mass Index (BMI) was undertaken, to examine such differences between the two groups. Volumes were calculated from segmentations of magnetic resonance imaging datasets of the abdomen and pelvis. Despite SAT, VAT, and the corresponding total adipose tissue (TAT) being similar between the groups, VAT/SAT and VAT/TAT were higher in the Asian group (by 24.5% and 18.2%, respectively, each p = 0.02). Further, VAT/SAT and VAT/TAT were positively correlated with BMI in the Caucasian group only (p = 0.02 and p = 0.01, respectively). We concluded that VAT is proportionally higher in the non-obese Asian women, compared to the Caucasian women of matched age and BMI. This conclusion is in agreement with existing literature showing higher abdominal adiposity in Asian populations. Additionally, in the Asian group, BMI did not correlate with visceral adiposity on a significant level. Further analysis is required to examine the extent to which this increased VAT may impact cardio-metabolic health. There is, however, a need to emphasize healthy lifestyle behaviors in non-obese post-menopausal women of Chinese ancestry.
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Affiliation(s)
- Maria Kalimeri
- Clinical Imaging Research Centre, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117599, Singapore; (M.K.); (J.J.T.)
| | - John J. Totman
- Clinical Imaging Research Centre, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117599, Singapore; (M.K.); (J.J.T.)
- The Institute of Medical Imaging and Visualisation (IMIV), Bournemouth University, Bournemouth BH12 5BB, UK
| | - Thomas Baum
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Technical University of Munich, 81675 Munich, Germany;
| | - Maximilian N. Diefenbach
- Department of Diagnostic and Interventional Radiology, School of Medicine, Technical University of Munich, 81675 Munich, Germany; (M.N.D.); (M.R.M.); (D.C.K.)
- Division of Infectious Diseases and Tropical Medicine, University Hospital, Ludwig Maximilian University of Munich, 80802 Munich, Germany
| | - Hans Hauner
- Institute for Nutritional Medicine, School of Medicine, Technical University of Munich, 80992 Munich, Germany;
- Else Kroener-Fresenius-Center of Nutritional Medicine, ZIEL Institute for Food and Health, Technical University of Munich, 85354 Freising, Germany
| | - Marcus R. Makowski
- Department of Diagnostic and Interventional Radiology, School of Medicine, Technical University of Munich, 81675 Munich, Germany; (M.N.D.); (M.R.M.); (D.C.K.)
| | - Karupppasamy Subburaj
- Engineering Product Development Pillar, Singapore University of Technology and Design, Singapore 487372, Singapore;
| | - David Cameron-Smith
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore 117609, Singapore;
- Riddet Institute, Massey University, Palmerston North 4442, New Zealand
- Liggins Institute, The University of Auckland, Auckland 1023, New Zealand
| | - Christiani Jeyakumar Henry
- Clinical Nutrition Research Centre, Singapore Institute for Food and Biotechnology Innovation, Agency for Science, Technology and Research, Singapore 117599, Singapore;
| | - Dimitrios C. Karampinos
- Department of Diagnostic and Interventional Radiology, School of Medicine, Technical University of Munich, 81675 Munich, Germany; (M.N.D.); (M.R.M.); (D.C.K.)
| | - Daniela Junker
- Department of Diagnostic and Interventional Radiology, School of Medicine, Technical University of Munich, 81675 Munich, Germany; (M.N.D.); (M.R.M.); (D.C.K.)
- Correspondence: ; Tel.: +49-894-1407-058
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15
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Association between Carbohydrate Intake and the Prevalence of Metabolic Syndrome in Korean Women. Nutrients 2021; 13:nu13093098. [PMID: 34578975 PMCID: PMC8465012 DOI: 10.3390/nu13093098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 09/01/2021] [Accepted: 09/01/2021] [Indexed: 12/19/2022] Open
Abstract
Carbohydrates consist of a large proportion of calories in the Asian diet. Therefore, we aimed to investigate the association between carbohydrate intake and metabolic syndrome in Korean women. A cross-sectional analysis was conducted with a total of 4294 Korean women aged 40–69 years from the Korean Genomic and Epidemiology Study (KoGES). Carbohydrate intake was calculated based on a validated food frequency questionnaire. Metabolic syndrome was defined by using the National Cholesterol Education Program, Adult Treatment Panel III (NCEPIII). Logistic regression was used to estimate the association of carbohydrate intake with metabolic syndrome and its components. In this study, high carbohydrate intake seemed to be associated with low socioeconomic status and an imbalanced diet. After adjusting for confounding factors, subjects with higher carbohydrate intake showed an increased risk of metabolic syndrome (odds ratio (OR) 1.34, 95% confidence interval (CI) 1.08–1.66, p-trend = 0.004, highest vs. lowest quartile [≥75.2 vs. <67.0% of energy]), particularly elevated waist circumference. This association was stronger among those with low levels of C-reactive protein (CRP) and those with low dairy intake. In conclusion, higher carbohydrate intake is associated with a higher risk of metabolic syndrome, particularly abdominal obesity, in Korean women. This association may differ according to individuals’ CRP level and dairy intake.
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Imai Y, Lee SW, Kawai M, Tashiro K, Kawashima S, Tanaka R, Honda K, Matsuo K, Uchiyama K. Visceral fat area is a better indicator of surgical outcomes after laparoscopic gastrectomy for cancer than the body mass index: a propensity score-matched analysis. Surg Endosc 2021; 36:3285-3297. [PMID: 34382123 DOI: 10.1007/s00464-021-08642-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 07/16/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND The number of overweight gastric cancer patients who are undergoing laparoscopic gastrectomy (LG) has increased in Japan. However, the relationship between obesity and surgical outcomes of LG remains unclear. Therefore, this study aimed to evaluate the effect of visceral fat area (VFA) on surgical outcomes of LG for gastric cancer compared to the body mass index (BMI). METHODS This study was a retrospective, cohort study that included 587 patients who underwent LG in our institution between January 2015 and December 2019. The patients were divided into two groups according to VFA (< 100 cm2 and ≥ 100 cm2) and BMI (< 25 kg/m2 and ≥ 25 kg/m2) values, respectively. Surgical outcomes and postoperative complications were compared between the low and high groups for each VFA and BMI value. Propensity score matching was used to minimize potential selection bias. RESULTS After propensity score matching, 144 pairs of patients in the VFA group and 82 pairs of patients in the BMI group were extracted. Operative time (p = 0.003), intraoperative blood loss (p = 0.0006), and CRP levels on postoperative day 1 (p = 0.002) and on postoperative day 3 (p = 0.004) were significantly higher in the high-VFA group than in the low-VFA group. However, these surgical outcomes were not significantly different between the high-BMI and low-BMI groups. There was no strong correlation between VFA and BMI (R2 = 0.64). There were no significant differences in postoperative complications between the high and low groups for both VFA and BMI values. On multivariate analysis, high VFA was an independent predictor of operative time, but it was not significantly associated with the incidence of postoperative complications. CONCLUSION VFA is a better indicator of longer operative time than BMI. However, increased VFA did not affect postoperative complications.
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Affiliation(s)
- Yoshiro Imai
- Department of General and Gastroenterological Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi, Takatsuki, 569-8686, Japan
| | - Sang-Woong Lee
- Department of General and Gastroenterological Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi, Takatsuki, 569-8686, Japan.
| | - Masaru Kawai
- Department of Gastroenterological Surgery, Hirakata City Hospital, Hirakata, Japan
| | - Keitaro Tashiro
- Department of General and Gastroenterological Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi, Takatsuki, 569-8686, Japan
| | - Satoshi Kawashima
- Department of General and Gastroenterological Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi, Takatsuki, 569-8686, Japan
| | - Ryo Tanaka
- Department of General and Gastroenterological Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi, Takatsuki, 569-8686, Japan
| | - Kotaro Honda
- Department of General and Gastroenterological Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi, Takatsuki, 569-8686, Japan
| | - Kentaro Matsuo
- Department of General and Gastroenterological Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi, Takatsuki, 569-8686, Japan
| | - Kazuhisa Uchiyama
- Department of General and Gastroenterological Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi, Takatsuki, 569-8686, Japan
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17
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Liu F, Liu Y, Liu M, Wu G, Zhang M, Zhang X, Cui N, Yin H, Chen L. Efficacy of once-daily glucagon-like peptide-1 receptor agonist lixisenatide as an add-on treatment to basal insulin in Asian and white adults with type 2 diabetes mellitus: An individual-level pooled analysis of phase III studies. J Diabetes Investig 2021; 12:1386-1394. [PMID: 33475222 PMCID: PMC8354505 DOI: 10.1111/jdi.13504] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/11/2020] [Accepted: 01/01/2021] [Indexed: 11/29/2022] Open
Abstract
AIMS/INTRODUCTION The prevalence and pathophysiological background of type 2 diabetes mellitus vary across ethnicities, and can affect treatment responses. Adding lixisenatide to basal insulin (BI) in type 2 diabetes mellitus patients has shown improvements in glycated hemoglobin (HbA1c) and postprandial glycemic (PPG) excursions, without increasing hypoglycemic events. We aim to compare the efficacy of lixisenatide in Asian and white patients inadequately controlled with basal insulin. MATERIALS AND METHODS An individual-level pooled analysis of two multi-national phase III studies, GetGoal-L and GetGoal-L-C, was carried out to assess the efficacy of lixisenatide versus placebo as an add-on treatment to BI ± metformin in Asian and white patients with type 2 diabetes mellitus. Change in HbA1c, 2-h PPG and PPG excursion were analyzed, along with possible predictors of glycemic control. RESULTS Pooled data showed that baseline characteristics were similar between Asian and white patients with the exception of bodyweight, body mass index and BI dose being higher in white patients. After 24 weeks, lixisenatide reduced HbA1c in both ethnic groups, with no statistically significant difference between the two groups (Asian patients least squares mean difference -0.49, 95% confidence interval -0.68 to - 0.30 and white patients least squares mean difference -0.45, 95% confidence interval -0.63 to - 0.26; P = 0.6287). Similarly, no significant difference was found in 2-h PPG reduction between both groups (least squares mean difference for Asian vs white patients: -3.37 vs -3.93; P = 0.3203). Treatment with lixisenatide contributed to HbA1c reduction of -0.56% after adjustment of baseline HbA1c level in Asian patients, and -0.41% in white patients. CONCLUSIONS Adding lixisenatide to BI significantly reduced HbA1c and 2-h PPG levels in both Asian and white participants with type 2 diabetes mellitus. No differences in treatment effect were observed between the two populations.
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Affiliation(s)
- Fuqiang Liu
- Department of EndocrinologyQilu Hospital of Shandong UniversityJinanChina
| | - Yuan Liu
- Department of EndocrinologyQilu Hospital of Shandong UniversityJinanChina
| | - Minzhi Liu
- BDM Consulting, Inc.SomersetNew JerseyUSA
| | - Guangyu Wu
- Sanofi Investment Co., Ltd.ShanghaiChina
| | | | - Xia Zhang
- Sanofi Investment Co., Ltd.ShanghaiChina
| | - Nan Cui
- Sanofi Investment Co., Ltd.ShanghaiChina
| | - Huiqiu Yin
- Sanofi Investment Co., Ltd.ShanghaiChina
| | - Li Chen
- Department of EndocrinologyQilu Hospital of Shandong UniversityJinanChina
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Mechanisms and disease consequences of nonalcoholic fatty liver disease. Cell 2021; 184:2537-2564. [PMID: 33989548 DOI: 10.1016/j.cell.2021.04.015] [Citation(s) in RCA: 736] [Impact Index Per Article: 245.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 03/21/2021] [Accepted: 04/09/2021] [Indexed: 02/07/2023]
Abstract
Nonalcoholic fatty liver disease (NAFLD) is the leading chronic liver disease worldwide. Its more advanced subtype, nonalcoholic steatohepatitis (NASH), connotes progressive liver injury that can lead to cirrhosis and hepatocellular carcinoma. Here we provide an in-depth discussion of the underlying pathogenetic mechanisms that lead to progressive liver injury, including the metabolic origins of NAFLD, the effect of NAFLD on hepatic glucose and lipid metabolism, bile acid toxicity, macrophage dysfunction, and hepatic stellate cell activation, and consider the role of genetic, epigenetic, and environmental factors that promote fibrosis progression and risk of hepatocellular carcinoma in NASH.
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Narisada A, Shibata E, Hasegawa T, Masamura N, Taneda C, Suzuki K. Sex differences in the association between fatty liver and type 2 diabetes incidence in non-obese Japanese: A retrospective cohort study. J Diabetes Investig 2021; 12:1480-1489. [PMID: 33411970 PMCID: PMC8354510 DOI: 10.1111/jdi.13496] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 12/21/2020] [Accepted: 01/05/2021] [Indexed: 12/25/2022] Open
Abstract
Aims/Introduction Asians develop type 2 diabetes at a lower body mass index (BMI) compared with other races, which is partly because of Asian‐specific fat depots. Sex plays a role in fat deposition, regardless of race. This retrospective cohort study aimed to investigate the association among fatty liver, sex and type 2 diabetes in non‐obese Japanese. Materials and Methods The participants in this study (13,596 men and 6,037 women) were aged 30–64 years, and had undergone health checkups between 2013 and 2015, in Aichi, Japan. Baseline BMI was categorized as follows: <18.5, 18.5–19.9, 20–22.9, 23–24.9, 25–27.4 and ≥27.5 kg/m2. Fatty liver was diagnosed by abdominal ultrasonography. The joint effect of BMI and fatty liver on the incidence of type 2 diabetes was assessed, stratified by sex. Results During follow up, 738 men and 138 women developed type 2 diabetes. Compared with the BMI of 20–22.9 kg/m2 without fatty liver group, the BMI of 20–22.9 kg/m2 with fatty liver was associated with a higher risk of type 2 diabetes in men, but not in women. Furthermore, men with a BMI of 23–24.9 and 25–27.4 kg/m2 without fatty liver had no significant type 2 diabetes risk, whereas women with a BMI of 23–24.9 and 25–27.4 kg/m2, regardless of fatty liver, had an increased risk. Conclusions These results suggest the association between fatty liver and type 2 diabetes in non‐obese Asians is different by sex; fatty liver increases diabetes risk among male, not female, non‐obese Asians.
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Affiliation(s)
- Akihiko Narisada
- Institute for Occupational Health Science, Aichi Medical University, Nagakute, Japan
| | - Eiji Shibata
- Department of Health and Psychosocial Medicine, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Tomomi Hasegawa
- Institute of Physical Fitness, Sports Medicine and Rehabilitation, Aichi Medical University, Nagakute, Japan
| | | | | | - Kohta Suzuki
- Institute for Occupational Health Science, Aichi Medical University, Nagakute, Japan.,Department of Health and Psychosocial Medicine, Aichi Medical University School of Medicine, Nagakute, Japan
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Otsubo A, Miyata Y, Matsuo T, Mukae Y, Mitsunari K, Ohba K, Sakai H. Excessive accumulation of visceral fat is associated with lower urinary symptoms including overactive bladder in female patients. Int J Urol 2020; 28:397-403. [PMID: 33377223 PMCID: PMC8048866 DOI: 10.1111/iju.14476] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 11/29/2020] [Indexed: 11/26/2022]
Abstract
Objective To assess the relationship between visceral fat accumulation and lower urinary tract symptoms in female patients. Methods In this single‐center study, we enrolled all women who underwent screening abdominal computed tomography 3 months before the study, irrespective of whether they experienced lower urinary tract symptoms. The Overactive Bladder Symptom Score was used to assess subjective symptoms. Uroflowmetry and ultrasound assessment of post‐void residual urine were carried out to assess objective signs. We analyzed the relationship between lower urinary tract symptoms and various body fat accumulation parameters, including visceral fat area, visceral fat volume and total abdominal fat volume, assessed using computed tomography scans. Results A total of 182 patients were divided into the overactive bladder (n = 71, 39.0%) and the non‐overactive bladder (n = 111, 61.0%) groups. The visceral fat area, visceral fat volume and visceral fat volume/total abdominal fat volume values were all significantly higher in the overactive bladder group than in the non‐overactive bladder group (P < 0.001). Of these parameters, the visceral fat volume/total abdominal fat volume ratio showed the strongest correlation with the total Overactive Bladder Symptom Score (r = 0.394, P < 0.001). The maximum urine flow rate correlated negatively with the visceral fat volume/total abdominal fat volume value (visceral fat volume/total abdominal fat volume r = –0.289, P < 0.001). Subsequent multivariate analysis showed that a high visceral fat volume/total abdominal fat volume value, age and metabolic syndrome‐related diseases were independent risk factors for the presence of overactive bladder. Conclusions Excessive accumulation of visceral fat is independently associated with overactive bladder in females.
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Affiliation(s)
- Asato Otsubo
- Department of Urology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Yasuyoshi Miyata
- Department of Urology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Tomohiro Matsuo
- Department of Urology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Yuta Mukae
- Department of Urology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Kensuke Mitsunari
- Department of Urology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Kojiro Ohba
- Department of Urology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Hideki Sakai
- Department of Urology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Kawabata R, Soma Y, Kudo Y, Yokoyama J, Shimizu H, Akaike A, Suzuki D, Katsuragi Y, Totsuka M, Nakaji S. Relationships between body composition and pulmonary function in a community-dwelling population in Japan. PLoS One 2020; 15:e0242308. [PMID: 33201904 PMCID: PMC7671549 DOI: 10.1371/journal.pone.0242308] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 11/01/2020] [Indexed: 11/18/2022] Open
Abstract
Pulmonary diseases, including chronic obstructive pulmonary disease (COPD), are major chronic diseases that result in decreased pulmonary function. Relationships between body composition and pulmonary function have been reported. However, few epidemiological studies have used the visceral fat area (VFA) to measure body composition. This study aimed to examine the relationship between body composition and pulmonary function. A cross-sectional study was conducted between 2015 and 2016, using data obtained from 1,287 residents aged between 19 and 91 years living in the Iwaki area of Hirosaki City, a rural region in Aomori Prefecture, Japan. Pulmonary function was evaluated using the forced vital capacity (FVC) as a percentage of the predicted value (predicted FVC%) and the ratio of forced expiratory volume in one second (FEV1) to FVC. The measurements for evaluating body composition included the body fat percentage (BFP) of the whole body and trunk, skeletal muscle index (SMI), body mass index (BMI), VFA, waist circumference (WC) at the navel level, and waist-to-hip ratio (WHR). To adjust for potential confounders, Spearman's partial correlation analysis was used to examine the relationship between the measurements of body composition and pulmonary function. There were significant correlations between the predicted FVC% and the following parameters: BFP (whole body and trunk) in younger males; SMI in older males; WC, VFA, BMI, and SMI in younger females; and BFP (whole body and trunk) and VFA in older females. Contrastingly, WC and VFA in younger males and WC in younger females were correlated with the FEV1/FVC ratio. VFA was correlated with the FEV1/FVC ratio in younger males and predicted FVC% in older females. These findings suggest that visceral fat accumulation may increase the development of obstructive pulmonary disease in young males and accelerate the decline of pulmonary function (predicted FVC%) in older females.
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Affiliation(s)
- Ryosuke Kawabata
- Department of Social Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
- Department of General Science Education, National Institute of Technology, Hachinohe College, Hachinohe, Aomori, Japan
- * E-mail:
| | - Yuki Soma
- Department of Life Science, Morioka Junior College, Iwate Prefectural University, Takizawa, Iwate, Japan
| | - Yutaro Kudo
- Department of Social Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Junichi Yokoyama
- Department of Social Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
- Department of Physical Education, Nippon Sport Science University, Setagaya-ku, Tokyo, Japan
| | - Hiroyasu Shimizu
- Department of Social Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Arata Akaike
- Department of Social Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Daisuke Suzuki
- Department of Social Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Yoshihisa Katsuragi
- Department of Active Life Promotion Sciences, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
- Health Care Food Research Laboratories, Kao Corporation, Sumida-ku, Tokyo, Japan
| | - Manabu Totsuka
- Department of Education, Hirosaki University, Hirosaki, Aomori, Japan
| | - Shigeyuki Nakaji
- Department of Social Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
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Usui C, Kawakami R, Tanisawa K, Ito T, Tabata H, Iizuka S, Kawamura T, Midorikawa T, Sawada SS, Torii S, Sakamoto S, Suzuki K, Ishii K, Oka K, Muraoka I, Higuchi M. Visceral fat and cardiorespiratory fitness with prevalence of pre-diabetes/diabetes mellitus among middle-aged and elderly Japanese people: WASEDA'S Health Study. PLoS One 2020; 15:e0241018. [PMID: 33079960 PMCID: PMC7575118 DOI: 10.1371/journal.pone.0241018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 10/06/2020] [Indexed: 12/29/2022] Open
Abstract
The relationships between cardiorespiratory fitness (CRF) measurements not confounded by adiposity and the prevalence of pre-diabetes mellitus (pre-DM) and diabetes mellitus (DM) are not well known. Thus, we aimed to investigate the associations of visceral fat (VF) and CRF with the prevalence of pre-DM/DM among Japanese adults. The study included 970 individuals (327 women and 643 men) who were 40-87 years old and had complete health examinations, abdominal fat area, and fitness data from WASEDA'S Health Study during 2015-2018. The VF area was measured using magnetic resonance imaging. CRF was measured using a cycle ergometer and was defined as VO2peak divided by fat free mass. The pre-DM/DM was identified based on the questionnaire and fasting blood tests. The odds ratios (ORs) and 95% confidence intervals (CIs) for prevalence of pre-DM/DM were calculated. Seventy-three participants had pre-DM and 48 participants had DM. Compared to the low VF group, the high VF group had a higher prevalence of pre-DM/DM (OR: 1.87, 95% CI: 1.18-2.96), although no significant relationship was observed between CRF and pre-DM/DM prevalence (P for trend = 0.239). The sub-group analyses also revealed no significant relationship between CRF and pre-DM/DM prevalence in the low VF group (P for trend = 0.979), although CRF values were inversely related to the prevalence of pre-DM/DM in the high VF group (P for trend = 0.024). Although CRF was not independently related to the prevalence of pre-DM/DM after adjusting for adiposity, higher VF values were related to a higher prevalence of pre-DM/DM. In addition, CRF levels were inversely associated with the prevalence of pre-DM/DM only among high VF individuals.
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Affiliation(s)
- Chiyoko Usui
- Faculty of Sport Sciences, Waseda University, Saitama, Japan
- * E-mail:
| | - Ryoko Kawakami
- Faculty of Sport Sciences, Waseda University, Saitama, Japan
| | - Kumpei Tanisawa
- Faculty of Sport Sciences, Waseda University, Saitama, Japan
| | - Tomoko Ito
- Waseda Institute for Sport Sciences, Waseda University, Saitama, Japan
| | - Hiroki Tabata
- Waseda Institute for Sport Sciences, Waseda University, Saitama, Japan
- Sportology Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Satoshi Iizuka
- Waseda Institute for Sport Sciences, Waseda University, Saitama, Japan
- Department of Sport Sciences, Japan Institute of Sports Sciences, Tokyo, Japan
| | - Takuji Kawamura
- Faculty of Sport Sciences, Waseda University, Saitama, Japan
| | - Taishi Midorikawa
- Waseda Institute for Sport Sciences, Waseda University, Saitama, Japan
- College of Health and Welfare, J. F. Oberlin University, Tokyo, Japan
| | | | - Suguru Torii
- Faculty of Sport Sciences, Waseda University, Saitama, Japan
| | - Shizuo Sakamoto
- Faculty of Sport Sciences, Waseda University, Saitama, Japan
| | | | - Kaori Ishii
- Faculty of Sport Sciences, Waseda University, Saitama, Japan
| | - Koichiro Oka
- Faculty of Sport Sciences, Waseda University, Saitama, Japan
| | - Isao Muraoka
- Faculty of Sport Sciences, Waseda University, Saitama, Japan
| | - Mitsuru Higuchi
- Faculty of Sport Sciences, Waseda University, Saitama, Japan
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Rønn PF, Andersen GS, Lauritzen T, Christensen DL, Aadahl M, Carstensen B, Grarup N, Jørgensen ME. Abdominal visceral and subcutaneous adipose tissue and associations with cardiometabolic risk in Inuit, Africans and Europeans: a cross-sectional study. BMJ Open 2020; 10:e038071. [PMID: 32928857 PMCID: PMC7490939 DOI: 10.1136/bmjopen-2020-038071] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES Abdominal fat has been identified as a risk marker of cardiometabolic disease independent of overall adiposity. However, it is not clear whether there are ethnic disparities in this risk. We investigated the associations of visceral adipose tissue (VAT) and abdominal subcutaneous adipose tissue (SAT) with cardiometabolic risk factors in three ethnic diverse populations of Inuit, Africans and Europeans. DESIGN Cross-sectional pooled study. SETTING Greenland, Kenya and Denmark. METHODS A total of 5113 participants (2933 Inuit, 1397 Africans and 783 Europeans) from three studies in Greenland, Kenya and Denmark were included. Measurements included abdominal fat distribution assessed by ultrasound, oral glucose tolerance test, hepatic insulin resistance, blood pressure and lipids. The associations were analysed using multiple linear regressions. RESULTS Across ethnic group and gender, an increase in VAT of 1 SD was associated with higher levels of hepatic insulin resistance (ranging from 14% to 28%), triglycerides (8% to 16%) and lower high-density lipoprotein cholesterol (HDL-C, -1.0 to -0.05 mmol/L) independent of body mass index. VAT showed positive associations with most of the other cardiometabolic risk factors in Inuit and Europeans, but not in Africans. In contrast, SAT was mainly associated with the outcomes in Inuit and Africans. Of notice was that higher SAT was associated with higher HDL-C in African men (0.11 mmol/L, 95% CI: 0.03 to 0.18) and with lower HDL-C in Inuit (-0.07 mmol/L, 95% CI: -0.12 to -0.02), but not in European men (-0.02 mmol/L, 95% CI: -0.09 to 0.05). Generally weaker associations were observed for women. Furthermore, the absolute levels of several of the cardiometabolic outcomes differed between the ethnic groups. CONCLUSIONS VAT and SAT were associated with several of the cardiometabolic risk factors beyond overall adiposity. Some of these associations were specific to ethnicity, suggesting that ethnicity plays a role in the pathway from abdominal fat to selected cardiometabolic risk factors.
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Affiliation(s)
- Pernille Falberg Rønn
- Clinical Epidemiology, Steno Diabetes Center Copenhagen, Gentofte, Denmark
- Department of Public Health, Centre for Arctic Health, Aarhus University, Aarhus, Denmark
| | | | - Torsten Lauritzen
- Department of Public Health, General Practice, Aarhus University, Aarhus, Denmark
| | - Dirk Lund Christensen
- Department of Public Health, Global Health Section, University of Copenhagen, Copenhagen, Denmark
| | - Mette Aadahl
- Center for Clinical Research and Prevention, Frederiksberg and Bispebjerg Hospital, Frederiksberg, Denmark
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Bendix Carstensen
- Clinical Epidemiology, Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Niels Grarup
- Novo Nordisk Foundation, Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Kobenhavn, Denmark
| | - Marit Eika Jørgensen
- Clinical Epidemiology, Steno Diabetes Center Copenhagen, Gentofte, Denmark
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
- Greenland University, Nuuk, Greenland
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Bazyar H, Zare Javid A, Dasi E, Sadeghian M. Major dietary patterns in relation to obesity and quality of sleep among female university students. Clin Nutr ESPEN 2020; 39:157-164. [PMID: 32859311 DOI: 10.1016/j.clnesp.2020.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 07/03/2020] [Accepted: 07/05/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Few studies reported the association of dietary patterns with obesity, central adiposity, and quality of sleep. We aimed to investigate the association between major dietary patterns and anthropometric indices in relation to obesity and quality of sleep among female students of Ahvaz Jundishapur University of Medical Sciences (AJUMS). METHODS This cross-sectional study was conducted on 245 female university students aged 18-38 years. To assess sleep quality, we used a self-reported Pittsburgh sleep quality index (PSQI). Usual dietary intakes were assessed with the use of a 168 items food frequency questionnaire (FFQ). We used factor analysis to identify dietary patterns. RESULTS Four major dietary patterns were identified: mixed, high protein, Western, and healthy dietary patterns. After adjustment for energy intake, subjects in the upper tertile of the mixed dietary pattern were more likely to have a high quality of sleep than those in the first tertile (odds ratio [OR]: 0.27; 95% CI: 0.13, 0.55). Individuals with greater adherence to Western dietary pattern had greater odds of having low quality of sleep compared to those in the first tertile (OR: 1.99; 95% CI: 1.04, 3.82). A healthy dietary pattern was associated with a higher quality of sleep; however, the association was no longer significant after adjustment for dietary energy intake. No significant association was found for high protein dietary patterns. Compared to the first tertile of the healthy dietary pattern, individuals in the upper tertile were less likely to be centrally obese (OR = 0.15; 95% CI = 0.50-0.52). Participants in the last tertile of the high protein dietary pattern were less likely to be generally obese (OR = 0.34; 95% CI = 0.12-0.99), whereas those in the upper tertile of the Western dietary pattern were more likely to be generally obese (OR = 1.84; 95% CI = 1.08-4.93). CONCLUSIONS Adherence to a mixed dietary pattern was associated with a high quality of sleep; however, the result was not significant for a high protein dietary pattern. While the high protein dietary pattern was negatively associated with general and central obesity, students in the upper tertile of the Western dietary pattern were more likely to be generally obese.
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Affiliation(s)
- Hadi Bazyar
- Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; Department of Nutrition, School of Allied Medical Sciences, Ahvaz Jundishapur University of Medical Science, Ahvaz, Iran
| | - Ahmad Zare Javid
- Department of Nutrition, School of Allied Medical Sciences, Ahvaz Jundishapur University of Medical Science, Ahvaz, Iran
| | - Elham Dasi
- Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; Department of Nutrition, School of Allied Medical Sciences, Ahvaz Jundishapur University of Medical Science, Ahvaz, Iran
| | - Mehdi Sadeghian
- Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; Department of Nutrition, School of Allied Medical Sciences, Ahvaz Jundishapur University of Medical Science, Ahvaz, Iran.
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Evaluation of Ethnic Variations in Visceral, Subcutaneous, Intra-Pancreatic, and Intra-Hepatic Fat Depositions by Magnetic Resonance Imaging among New Zealanders. Biomedicines 2020; 8:biomedicines8060174. [PMID: 32630574 PMCID: PMC7344761 DOI: 10.3390/biomedicines8060174] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/22/2020] [Accepted: 06/24/2020] [Indexed: 01/04/2023] Open
Abstract
Anthropometric indices, such as body mass index (BMI), waist circumference (WC), and waist to height ratio (WHtR), have limitations in accurately predicting the pathophysiology of diabetes mellitus, cardiovascular diseases, and metabolic syndrome due to ethnic differences in fat distribution. Recent studies showed that the visceral adipose tissue (VAT) deposition and fat content of internal organs, most notably intra-hepatic and intra-pancreatic fat, has emerged as a more important parameter. In this study, we aimed to assess the coordination between the traditional anthropometric indices and the various fat depositions within different ethnicities in New Zealand. We recruited 104 participants with different ethnic backgrounds, including New Zealand Europeans, Māori (the indigenous people of New Zealand), Pacific Islanders (PI), and Asians. Their weight, height, and WC were measured, and subcutaneous, visceral, intra-hepatic, and intra-pancreatic fat depositions were obtained by magnetic resonance imaging (MRI). The result showed VAT, but not subcutaneous adipose tissue (SAT) depositions at all levels were significantly varied among the three groups. BMI was associated best with L23SAT in NZ Europeans (30%) and L45VAT in Māori/PI (24.3%). WC and WHtR were correlated well with L45SAT in the total population (18.8% and 12.2%, respectively). Intra-pancreatic fat deposition had a positive Pearson relationship with NZ European BMI and Māori/PI WC, but no regression correlation with anthropometric indices. Conventional anthropometric indices did not correspond to the same fat depositions across different ethnic groups.
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The Incidence of Postoperative Complications after Gastrectomy Increases in Proportion to the Amount of Preoperative Visceral Fat. JOURNAL OF ONCOLOGY 2019; 2019:8404383. [PMID: 31929799 PMCID: PMC6942899 DOI: 10.1155/2019/8404383] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 10/23/2019] [Accepted: 10/30/2019] [Indexed: 12/12/2022]
Abstract
Background Visceral obesity is a risk factor for complications after gastrectomy in patients with gastric cancer. However, it is unclear whether postoperative complications decrease with preoperative reduction of visceral fat without the achievement of a nonobese state. This is because previous studies have performed categorical comparisons of obesity and nonobesity. The current study was performed to estimate the impact of the preoperative visceral fat area (VFA) as a continuous variable on postoperative complications after gastrectomy. Methods Consecutive patients with gastric cancer who underwent curative gastrectomy between June 2006 and August 2017 at the Kyoto University Hospital were included in this retrospective study. The VFA at the level of the umbilicus was measured using preoperative computed tomography. The relationship between postoperative complications and VFA was investigated with univariate and multivariate analyses. Results total of 566 patients were included in the study. Their mean VFA was 110 ± 58 cm2, and postoperative complications occurred in 121 patients (21.4%). The larger the VFA (<50, 50–99, 100–149, and ≥150 cm2), the higher the incidence of postoperative complications (11%, 14%, 21%, and 38%, respectively, P < 0.001). Multivariate logistic regression analyses showed that the VFA was associated with postoperative complications (odds ratio: 1.009, 95% confidence interval (CI): 1.004–1.013, P < 0.001), with an incidence of postoperative complications that was 9% (95% CI: 4%–12%) higher for every 10 cm2 increase in the VFA. Conclusion The incidence of postoperative complications after gastrectomy increases in proportion to an increase in the preoperative VFA.
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Siegel RL, Torre LA, Soerjomataram I, Hayes RB, Bray F, Weber TK, Jemal A. Global patterns and trends in colorectal cancer incidence in young adults. Gut 2019; 68:2179-2185. [PMID: 31488504 DOI: 10.1136/gutjnl-2019-319511] [Citation(s) in RCA: 376] [Impact Index Per Article: 75.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 08/16/2019] [Accepted: 08/21/2019] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Early-onset colorectal cancer (CRC) is increasing in the USA despite rapid declines in older ages. Similar patterns are reported in Australia and Canada, but a comprehensive global analysis of contemporary data is lacking. DESIGN We extracted long-term data from Cancer Incidence in Five Continents and supplemental sources to report on worldwide CRC incidence rates and trends by age (20-49 years and ≥50 years) through diagnosis year 2012 or beyond (Australia, Finland, New Zealand, Norway, Sweden, USA). RESULTS During 2008-2012, age-standardised CRC incidence rates in adults <50 ranged from 3.5 per 100 000 (95% CI 3.2 to 3.9) in India (Chennai) to 12.9 (95% CI 12.6 to 13.3) in Korea. During the most recent decade of available data, incidence in adults <50 was stable in 14 of 36 countries; declined in Austria, Italy and Lithuania; and increased in 19 countries, nine of which had stable or declining trends in older adults (Australia, Canada, Denmark, Germany, New Zealand, Slovenia, Sweden, UK and USA). In Cyprus, Netherlands and Norway, inclines in incidence in young adults were twice as rapid as those in older adults (eg, Norway average annual per cent change (AAPC), 1.9 (95% CI 1.4 to 2.5) vs 0.5 (95% CI 0.3 to 0.7)). Among most high-income countries with long-term data, the uptick in early-onset disease began in the mid-1990s. The steepest increases in young adults were in Korea (AAPC, 4.2 (95% CI 3.4 to 5.0)) and New Zealand (AAPC, 4.0 (95% CI 2.1 to 6.0)). CONCLUSION CRC incidence increased exclusively in young adults in nine high-income countries spanning three continents, potentially signalling changes in early-life exposures that influence large bowel carcinogenesis.
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Affiliation(s)
- Rebecca L Siegel
- Intramural Research Department, American Cancer Society, Atlanta, Georgia, USA
| | - Lindsey A Torre
- Intramural Research Department, American Cancer Society, Atlanta, Georgia, USA
| | - Isabelle Soerjomataram
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - Richard B Hayes
- Department of Population Health, New York University School of Medicine, New York, New York, USA
| | - Freddie Bray
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - Thomas K Weber
- Department of Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
- Department of Surgical Oncology, Northwell Health Cancer Institute, Great Neck, New York, USA
| | - Ahmedin Jemal
- Intramural Research Department, American Cancer Society, Atlanta, Georgia, USA
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30
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Tanaka M. Improving obesity and blood pressure. Hypertens Res 2019; 43:79-89. [PMID: 31649313 DOI: 10.1038/s41440-019-0348-x] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 09/28/2019] [Accepted: 09/30/2019] [Indexed: 01/09/2023]
Abstract
Obesity-associated hypertension is a serious public health concern. Sympathetic nervous system (SNS) overactivity, especially in the kidneys, is an important mechanism linking obesity to hypertension. Some adipokines play important roles in elevating blood pressure (BP). Hyperinsulinemia caused by insulin resistance stimulates sodium reabsorption, enhances sodium retention, and increases circulating plasma volume. Hyperinsulinemia also stimulates both the renin-angiotensin-aldosterone system (RAAS) and the SNS, resulting in the acceleration of atherosclerosis through the hypertrophy of vascular smooth muscle cells, which contributes to increased peripheral vascular resistance. Obesity is associated with increased RAAS activity despite volume overload, as the tissue RAASs are stimulated in obese hypertensive individuals. Mineralocorticoid receptor-associated hypertension must also be considered in obese patients with resistant hypertension. Obstructive sleep apnea syndrome (OSAS) is the most common cause of secondary hypertension. Some components of the gut microbiota contribute to BP control; therefore, gut dysbiosis caused by obesity might lead to increased BP. The ratio of visceral fat to subcutaneous fat is higher in Japanese patients than in Caucasian patients, which may explain why Japanese patients are more susceptible to metabolic disorders even though they are less obese than Caucasian individuals. Obesity-associated kidney dysfunction directly increases BP, leading to further deterioration of kidney function. A bodyweight reduction of more than 3% or 5 kg significantly lowers BP. Gastrointestinal bypass surgery is an effective treatment for morbid obesity and its related metabolic disorders, including hypertension. Because both obesity and hypertension are representative lifestyle-related disorders, lifestyle modification, especially to improve obesity, should be performed first as a treatment for hypertension.
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Affiliation(s)
- Masami Tanaka
- Department of Endocrinology, Metabolism, and Nephrology, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
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Ayabe M, Kumahara H, Yamaguchi-Watanabe A, Chiba H, Kobayashi N, Sakuma I, Ishii K. Appendicular muscle mass and exercise/sports participation history in young Japanese women. Ann Hum Biol 2019; 46:335-339. [DOI: 10.1080/03014460.2019.1641221] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Makoto Ayabe
- Laboratory of Physical Fitness and Sports Medicine, Graduate School of Education, Hokkaido University, Sapporo, Japan
- Faculty of Computer Science and Systems Engineering, Okayama Prefectural University, Okayama, Japan
| | - Hideaki Kumahara
- Laboratory of Physical Fitness and Sports Medicine, Graduate School of Education, Hokkaido University, Sapporo, Japan
- Faculty of Nutritional Sciences, Nakamura Gakuen University, Fukuoka, Japan
| | - Ayako Yamaguchi-Watanabe
- Laboratory of Physical Fitness and Sports Medicine, Graduate School of Education, Hokkaido University, Sapporo, Japan
| | - Hitoshi Chiba
- Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Noriko Kobayashi
- Department of Gynecology, Hokkaido University Hospital, Sapporo, Japan
| | - Ichiro Sakuma
- Caress Sapporo, Hokko Memorial Clinic, Sapporo, Japan
| | - Kojiro Ishii
- Laboratory of Physical Fitness and Sports Medicine, Graduate School of Education, Hokkaido University, Sapporo, Japan
- Faculty of Health and Sports Science, Doshisha University, Kyoto, Japan
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32
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Nishizawa H, Shimomura I. Population Approaches Targeting Metabolic Syndrome Focusing on Japanese Trials. Nutrients 2019; 11:nu11061430. [PMID: 31242621 PMCID: PMC6627423 DOI: 10.3390/nu11061430] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 06/21/2019] [Accepted: 06/23/2019] [Indexed: 12/02/2022] Open
Abstract
The clinical importance of assessment of metabolic syndrome lies in the selection of individuals with multiple risk factors based on visceral fat accumulation, and helping them to reduce visceral fat. Behavioral modification by population approach is important, which adds support to the personal approach. The complexity of visceral fat accumulation requires multicomponent and multilevel intervention. Preparation of food and physical environments could be useful strategies for city planners. Furthermore, actions on various frameworks, including organizational, community, and policy levels, have been recently reported. There are universal public health screening programs and post-screening health educational systems in Japan, and diseases management programs in Germany. Understanding one’s own health status is important for motivation for lifestyle modification. The U.S. Preventive Services Task Force recommends that primary care practitioners screen all adults for obesity and offer behavioral interventions and intensive counseling. Established evidence-based guidelines for behavioral counseling are needed within the primary care setting.
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Affiliation(s)
- Hitoshi Nishizawa
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, 2-2-B5, Yamada-oka, Suita, Osaka 565-0871, Japan.
| | - Iichiro Shimomura
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, 2-2-B5, Yamada-oka, Suita, Osaka 565-0871, Japan.
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Panizza CE, Lim U, Yonemori KM, Cassel KD, Wilkens LR, Harvie MN, Maskarinec G, Delp EJ, Lampe JW, Shepherd JA, Le Marchand L, Boushey CJ. Effects of Intermittent Energy Restriction Combined with a Mediterranean Diet on Reducing Visceral Adiposity: A Randomized Active Comparator Pilot Study. Nutrients 2019; 11:E1386. [PMID: 31226790 PMCID: PMC6627434 DOI: 10.3390/nu11061386] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 06/18/2019] [Accepted: 06/18/2019] [Indexed: 02/07/2023] Open
Abstract
Intermittent energy restriction combined with a Mediterranean diet (IER+MED) has shown promise to reduce body fat and insulin resistance. In the Multiethnic Cohort Adiposity Phenotype Study, Japanese Americans had the highest visceral adipose tissue (VAT) when adjusting for total adiposity. We conducted this pilot study to demonstrate feasibility and explore efficacy of following IER+MED for 12 weeks to reduce VAT among East Asians in Hawaii. Sixty volunteers (aged 35-55, BMI 25-40 kg/m2, VAT ≥ 90 cm2 for men and ≥ 80 cm2 for women) were randomized to IER+MED (two consecutive days with 70% energy restriction and 5 days euenergetic MED) or an active comparator (euenergetic Dietary Approaches to Stop Hypertension (DASH) diet). Participants and clinic staff (except dietitians) were blinded to group assignments. IER+MED had significantly larger reductions in DXA-measured VAT and total fat mass (-22.6 ± 3.6 cm2 and -3.3 ± 0.4 kg, respectively) vs. DASH (-10.7 ± 3.5 cm2 and -1.6 ± 0.4 kg) (p = 0.02 and p = 0.005). However, after adjusting for total fat mass, change in VAT was not statistically different between groups; whereas, improvement in alanine transaminase remained significantly greater for IER+MED vs. DASH (-16.2 ± 3.8 U/L vs. -4.0 ± 3.6 U/L, respectively, p = 0.02). Attrition rate was 10%, and participants adhered well to study prescriptions with no reported major adverse effect. Results demonstrate IER+MED is acceptable, lowers visceral and total adiposity among East Asian Americans, and may improve liver function more effectively than a healthful diet pattern. ClinicalTrials.gov Identifier: NCT03639350.
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Affiliation(s)
- Chloe E Panizza
- University of Hawaii Cancer Center, Honolulu, HI 96813, USA.
| | - Unhee Lim
- University of Hawaii Cancer Center, Honolulu, HI 96813, USA.
| | - Kim M Yonemori
- University of Hawaii Cancer Center, Honolulu, HI 96813, USA.
| | - Kevin D Cassel
- University of Hawaii Cancer Center, Honolulu, HI 96813, USA.
| | - Lynne R Wilkens
- University of Hawaii Cancer Center, Honolulu, HI 96813, USA.
| | - Michelle N Harvie
- Prevent Breast Cancer Research Unit, Manchester University Hospital Foundation, National Health Service Trust, Wythenshawe, Manchester M23 9LT, UK.
| | | | - Edward J Delp
- School of Electrical and Computer Engineering, Purdue University, West Lafayette, IN 47907-2025, USA.
| | - Johanna W Lampe
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA.
| | - John A Shepherd
- University of Hawaii Cancer Center, Honolulu, HI 96813, USA.
| | | | - Carol J Boushey
- University of Hawaii Cancer Center, Honolulu, HI 96813, USA.
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Zhai TS, Kang Y, Ren WH, Liu Q, Liu C, Mao WZ. Elevated visceral fat area is associated with adverse postoperative outcome of radical colectomy for colon adenocarcinoma patients. ANZ J Surg 2019; 89:E368-E372. [PMID: 31206986 DOI: 10.1111/ans.15283] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 04/09/2019] [Accepted: 04/14/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To assess the impact of visceral obesity quantified by preoperative computed tomography on short-term postoperative outcomes compared with body mass index (BMI) in stage I-III colon adenocarcinoma patients. METHODS In this retrospective study, 107 patients treated with radical colectomy for stage I-III colon adenocarcinoma were classified as obese or non-obese by computed tomography-based measures or BMI (obese: BMI ≥28 kg/m2 , visceral fat area (VFA) to subcutaneous fat area ratio (V/S) ≥0.4, and VFA ≥100 cm2 ). Clinical variables, operation time, estimated blood loss, pathologic stage, histologic grade, postoperative complications, postoperative stay and hospitalization expenses were compared. RESULTS Obese patients by VFA were more likely to have higher postoperative complication rate (32.9 versus 11.8%, P = 0.021), have longer operation time (184.6 ± 49.5 versus 163.1 ± 44.1 min, P = 0.033), postoperative stay (15.21 ± 7.59 versus 12.29 ± 5.40 days, P = 0.047) and cost more ($10 758.7 ± 3271.7 versus $9232.0 ± 2994.6, P = 0.023) than non-obese. CONCLUSION Visceral obesity graded by VFA is associated with increased postoperative morbidity, operation time, postoperative stay and hospitalization expenses for colon adenocarcinoma patients and may be superior to BMI or V/S for the prediction of colon surgery.
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Affiliation(s)
- Ting-Shuai Zhai
- Department of General Surgery, Qingdao Municipal Hospital, Dalian Medical University, Qingdao, China.,Department of Urology, Shanghai Tenth People's Hospital of Tongji University, School of Medicine, Shanghai, China
| | - Yuan Kang
- Department of Clinical Medicine, The First Affiliated Hospital of Henan University of Science and Technology, Luoyang, China
| | - Wen-Hao Ren
- Department of General Surgery, Qingdao Municipal Hospital, Dalian Medical University, Qingdao, China
| | - Qi Liu
- Department of General Surgery, Qingdao Municipal Hospital, Dalian Medical University, Qingdao, China
| | - Chao Liu
- Department of General Surgery, Qingdao Municipal Hospital, Dalian Medical University, Qingdao, China
| | - Wei-Zheng Mao
- Department of General Surgery, Qingdao Municipal Hospital, Dalian Medical University, Qingdao, China
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35
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Cervantes A, Singh RG, Kim JU, DeSouza SV, Petrov MS. Relationship of Anthropometric Indices to Abdominal Body Composition: A Multi-Ethnic New Zealand Magnetic Resonance Imaging Study. J Clin Med Res 2019; 11:435-446. [PMID: 31143311 PMCID: PMC6522232 DOI: 10.14740/jocmr3820] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 04/10/2019] [Indexed: 02/07/2023] Open
Abstract
Background Conventional anthropometric indices (body mass index (BMI) and waist circumference (WC)) have limitations, in part, due to ethnic differences in fat distribution. Assessment of abdominal body composition using magnetic resonance imaging (MRI) is increasingly used to gain deeper insights into the pathophysiology of diabetes mellitus, cardiovascular diseases and metabolic syndrome, but the knowledge of abdominal volumes in indigenous populations is scarce. This study aimed to assess abdominal fat distribution and total abdominal volume using MRI in a multi-ethnic cohort that includes Maori (the indigenous people of New Zealand) and Pacific Islanders (PI). Methods MRI was used to quantify subcutaneous adipose tissue (SAT) volume, visceral adipose tissue (VAT) volume and total abdominal (TAb) volume by two independent raters in a blinded fashion. WC and BMI were also measured. Multinomial regression was used to compare the volumes between ethnic groups. Linear regression was used to investigate the ethnicity-specific associations between anthropometric indices and abdominal volumes. Three statistical models were built to adjust for age, sex, prediabetes/diabetes status and other covariates. Results A total of 87 individuals (37 Caucasians, 24 Maori/PI and 26 others) were studied. Maori/PI had a significantly higher VAT volume compared with Caucasians across all statistical models, with the highest odds ratio of 2.1 (95% confidence interval: 1.1 - 4.2; P = 0.026). SAT and TAb volumes did not differ significantly between the groups. WC explained up to 72.9% of variance in VAT volume among Maori/PI and up to 50.7% among Caucasians. BMI explained up to 67.6% of variance in VAT volume among Maori/PI and up to 52.1% among Caucasians. Conclusions Greater visceral fat deposition among Maori/PI might go some way towards explaining the increased rates of metabolic disorders observed in this ethnic group. Conventional anthropometric indices do not correspond to the same abdominal volumes across different ethnic groups.
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Affiliation(s)
- Aya Cervantes
- School of Medicine, University of Auckland, Auckland, New Zealand
| | - Ruma G Singh
- School of Medicine, University of Auckland, Auckland, New Zealand
| | - Jin U Kim
- School of Medicine, University of Auckland, Auckland, New Zealand
| | - Steve V DeSouza
- School of Medicine, University of Auckland, Auckland, New Zealand
| | - Maxim S Petrov
- School of Medicine, University of Auckland, Auckland, New Zealand
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36
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Kadowaki S, Miura K, Kadowaki T, Fujiyoshi A, El-Saed A, Masaki KH, Okamura T, Edmundowicz D, Rodriguez BL, Nakamura Y, Barinas-Mitchell EJM, Kadota A, Willcox BJ, Abbott RD, Kuller LH, Choo J, Shin C, Ueshima H, Sekikawa A. International Comparison of Abdominal Fat Distribution Among Four Populations: The ERA-JUMP Study. Metab Syndr Relat Disord 2019; 16:166-173. [PMID: 29715072 DOI: 10.1089/met.2017.0132] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Abdominal fat distribution varies across groups with different races or environments. Whether environmental factors, apart from racial differences, affect abdominal fat distribution is unknown. METHODS We compared the abdominal fat distribution of four groups; different races with similar environments (Caucasians vs. Japanese Americans), different environments with an identical race (Japanese Americans vs. Japanese), and similar races with similar environments (Japanese vs. Koreans). A population-based sample of 1212 men aged 40-49 were analyzed: 307 Caucasians and 300 Japanese Americans in the United States, 310 Japanese in Japan, and 295 Koreans in Korea. We compared the proportion of visceral adipose tissue area to total abdominal adipose tissue area (VAT%) and other factors that can affect abdominal fat distribution (smoking, alcohol use, physical activity levels, and metabolic factors). RESULTS VAT% was significantly higher in Japanese and Koreans than in Japanese Americans and Caucasians (50.0, 48.5, 43.2, 41.0%, respectively, P < 0.001). Even after adjustment for possible confounders, the significant VAT% difference remained in comparing groups with identical race but different environments (i.e., Japanese vs. Japanese Americans). In contrast, comparing groups with different races but similar environments (i.e., Caucasians vs. Japanese Americans), VAT% was not significantly different. Comparing groups with similar races and similar environments (i.e., Japanese vs. Koreans), VAT% did not significantly differ. CONCLUSIONS Environmental differences, apart from racial differences, affect the difference in abdominal fat distribution across different groups in middle-aged men.
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Affiliation(s)
- Sayaka Kadowaki
- 1 Department of Public Health, Shiga University of Medical Science , Otsu, Japan
| | - Katsuyuki Miura
- 1 Department of Public Health, Shiga University of Medical Science , Otsu, Japan .,2 Center for Epidemiologic Research in Asia, Shiga University of Medical Science , Otsu, Japan
| | - Takashi Kadowaki
- 1 Department of Public Health, Shiga University of Medical Science , Otsu, Japan
| | - Akira Fujiyoshi
- 1 Department of Public Health, Shiga University of Medical Science , Otsu, Japan
| | - Aiman El-Saed
- 3 Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Kamal H Masaki
- 4 Department of Geriatric Medicine, John A. Burns School of Medicine, University of Hawaii , Honolulu, Hawaii.,5 Kuakini Medical Center , Honolulu, Hawaii
| | - Tomonori Okamura
- 6 Department of Preventive Medicine and Public Health, School of Medicine, Keio University , Tokyo, Japan
| | - Daniel Edmundowicz
- 7 Section of Cardiology, Department of Medicine, School of Medicine, Temple University , Philadelphia, Pennsylvania
| | - Beatriz L Rodriguez
- 4 Department of Geriatric Medicine, John A. Burns School of Medicine, University of Hawaii , Honolulu, Hawaii
| | - Yasuyuki Nakamura
- 8 Department of Food Science and Human Nutrition, Faculty of Agriculture, Ryukoku University , Kyoto, Japan
| | - Emma J M Barinas-Mitchell
- 3 Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Aya Kadota
- 1 Department of Public Health, Shiga University of Medical Science , Otsu, Japan .,2 Center for Epidemiologic Research in Asia, Shiga University of Medical Science , Otsu, Japan
| | - Bradley J Willcox
- 2 Center for Epidemiologic Research in Asia, Shiga University of Medical Science , Otsu, Japan .,4 Department of Geriatric Medicine, John A. Burns School of Medicine, University of Hawaii , Honolulu, Hawaii.,5 Kuakini Medical Center , Honolulu, Hawaii
| | - Robert D Abbott
- 2 Center for Epidemiologic Research in Asia, Shiga University of Medical Science , Otsu, Japan
| | - Lewis H Kuller
- 3 Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Jina Choo
- 9 College of Nursing, Korea University , Seoul, South Korea
| | - Chol Shin
- 10 Department of Internal Medicine, Korea University Medical Center , Seoul, South Korea
| | - Hirotsugu Ueshima
- 1 Department of Public Health, Shiga University of Medical Science , Otsu, Japan .,2 Center for Epidemiologic Research in Asia, Shiga University of Medical Science , Otsu, Japan
| | - Akira Sekikawa
- 3 Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh , Pittsburgh, Pennsylvania
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Koike Y, Shirabe SI, Maeda H, Yoshimoto A, Arai K, Kumakura A, Hirao K, Terauchi Y. Effect of canagliflozin on the overall clinical state including insulin resistance in Japanese patients with type 2 diabetes mellitus. Diabetes Res Clin Pract 2019; 149:140-146. [PMID: 30716347 DOI: 10.1016/j.diabres.2019.01.029] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 12/27/2018] [Accepted: 01/28/2019] [Indexed: 02/08/2023]
Abstract
AIMS Information on the clinical efficacy of SGLT2 inhibitors in the Japanese population is limited. The aim of this single-arm, single-center, open-label study was to confirm the body weight- and fat mass-lowering effects of canagliflozin (CANA) and the accompanying improvement in insulin resistance in Japanese patients with Type 2 diabetes mellitus (T2DM). METHODS Thirty-eight patients were enrolled and administered 100 mg CANA once daily for 24 weeks. Blood and anthropometric parameters were examined before and after treatment. In a subset of patients, insulin sensitivity was assessed based on the glucose infusion rate (GIR) during a hyperinsulinemic euglycemic clamp test. RESULTS CANA treatment significantly decreased hemoglobin A1c, fasting plasma glucose, and plasma liver enzyme levels, and increased plasma adiponectin levels. In addition, a significant reduction in body weight, visceral and subcutaneous fat area, fat and lean mass, and liver steatosis was also observed. The change in plasma adiponectin levels significantly correlated with the changes in both body fat mass and visceral fat area. GIR increased from 3.25 ± 1.53 to 4.11 ± 1.30 mg/kg/min (P < 0.05). CONCLUSIONS CANA improved insulin resistance and decreased visceral fat mass in Japanese patients with T2DM.
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Affiliation(s)
| | | | | | | | | | | | | | - Yasuo Terauchi
- Department of Endocrinology and Metabolism, Yokohama City University School of Medicine, Yokohama, Japan.
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38
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Affiliation(s)
- Motoko Kawashima
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
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39
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Zhang XM, Li PF, Hou JN, Ji LN. Blood glucose profiles in East Asian and Caucasian injection-naive patients with type 2 diabetes inadequately controlled on oral medication: a pooled analysis. Diabetes Metab Res Rev 2018; 34:e3062. [PMID: 30112855 PMCID: PMC6585807 DOI: 10.1002/dmrr.3062] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 06/12/2018] [Accepted: 07/19/2018] [Indexed: 11/09/2022]
Abstract
AIM The primary objective of this study was to compare blood glucose (BG) excursions between East Asian and Caucasian patients with type 2 diabetes mellitus (T2DM) who were injection-naive, had inadequate glycemic control with oral antihyperglycemic medications, and who required initiation with injectable therapy. METHODS This retrospective pooled analysis included individual patient data from completed clinical trials (Insulin lispro injection/dulaglutide development programs, first patient visit ≥1997). All included patients were ≥18 years, were East Asian or Caucasian, and had data for self-monitored BG at baseline. The primary outcome, BG excursion at baseline (least-squares mean, standard error), was compared between patient groups using an analysis of covariance with race as the fixed effect. Independent covariates included baseline body weight, baseline HbA1c, age, and duration of T2DM. RESULTS Caucasian (n = 6779) and East Asian (n = 1638) patients from 21 trials were included. BG excursions were significantly higher for East Asian than Caucasian patients at breakfast (4.03 [0.075] vs 2.59 [0.045] mmol/L), lunch (3.37 [0.080] vs 1.43 [0.049] mmol/L), and dinner (3.16 [0.080] vs 1.74 [0.047] mmol/L) (P < 0.001 adjusted analyses). Similar findings were observed for the unadjusted analyses. At each time point, postprandial BG was significantly higher for East Asian than Caucasian patients (with adjusted and unadjusted analyses). CONCLUSION These findings suggest that BG excursion and postprandial BG are higher among East Asian patients with T2DM than Caucasian patients. In addition, these findings may help clinicians select appropriate treatments for East Asian patients with T2DM who require injection therapy.
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Affiliation(s)
- Xiao Mei Zhang
- Department of Endocrinology and MetabolismPeking University International HospitalBeijingChina
| | - Peng Fei Li
- Medical DepartmentLilly Suzhou Pharmaceutical Co. LtdShanghaiChina
| | - Jia Ning Hou
- Medical DepartmentLilly Suzhou Pharmaceutical Co. LtdShanghaiChina
| | - Li Nong Ji
- Department of Endocrinology and MetabolismPeking University People's HospitalBeijingChina
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Harada K, Suzuki H, Matsunaga S, Onishi T, Nishikawa Y, Funakubo H, Mamiya K, Nagao T, Shinoda N, Sakai S, Kato M, Marui N, Ishii H, Amano T, Matsubara T, Murohara T. Clinical Characteristics of Nonobese Patients with Acute Coronary Syndrome and Increased Epicardial Fat Volume. J Atheroscler Thromb 2018; 25:1044-1052. [PMID: 29386421 PMCID: PMC6193182 DOI: 10.5551/jat.42663] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Aim: Increased epicardial fat volume (EFV) is an independent risk factor for acute coronary syndrome (ACS). Although EFV increases with body mass index (BMI), some ACS patients have an increased EFV but normal BMI. We here investigated the clinical characteristics of nonobese ACS patients with an increased EFV. Methods: A total of 197 Japanese patients hospitalized for ACS was evaluated for EFV, abdominal visceral fat area (VFA), and lipid and glucose profiles. Control subjects comprised 141 individuals who were suspected of having ACS but whose coronary computed tomography findings were normal. Results: EFV was increased in ACS patients compared with control subjects (120 ± 47 versus 95 ± 45 mL, P < 0.01). ACS patients were divided into four groups based on average EFV (120 mL) and a BMI obesity cutoff of 25 kg/m2. For the 30 nonobese ACS patients with an above-average EFV, EFV was positively correlated with VFA (r = 0.23, P = 0.031). These individuals were significantly older (74 ± 10 years) and tended to have a higher homeostasis model assessment–insulin resistance value (5.5 ± 3.8) compared with other ACS patients. Among nonobese study subjects, EFV was independently associated with ACS (odds ratio= 2.01, P = 0.021) and correlated with abdominal circumference (r = 0.26, P = 0.017). Conclusion: Nonobese ACS patients with an increased EFV were elderly and tended to manifest insulin resistance. Measurement of EFV may prove informative for evaluation of ACS risk among elderly nonobese individuals with an increased abdominal girth.
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Affiliation(s)
- Ken Harada
- Department of Cardiology, Chubu Rosai Hospital
| | | | | | | | | | | | | | | | | | | | | | | | - Hideki Ishii
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Tetsuya Amano
- Department of Cardiology, Aichi Medical University Hospital
| | | | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine
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41
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Dietary patterns and abdominal obesity in middle-aged and elderly Japanese adults: Waseda Alumni's Sports, Exercise, Daily Activity, Sedentariness and Health Study (WASEDA'S Health Study). Nutrition 2018; 58:149-155. [PMID: 30396031 DOI: 10.1016/j.nut.2018.05.029] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Revised: 05/17/2018] [Accepted: 05/22/2018] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the associations between dietary patterns and abdominal obesity among middle-aged and elderly Japanese people, using both waist circumference (WC) and visceral fat (VF) as indices. METHODS A cross-sectional study was conducted with 829 adults (534 men and 295 women), 40 to 79 y of age, who participated in the Waseda Alumni's Sports, Exercise, Daily Activity, Sedentariness and Health Study (WASEDA'S Health Study). Dietary patterns were derived from principal component analysis. VF was measured using magnetic resonance imaging. To examine the associations of each dietary pattern with WC and VF, we calculated multivariate-adjusted means and 95% confidence intervals (CIs) of WC and VF for the tertile of each dietary pattern score. RESULTS Two main dietary patterns were identified: "healthy Japanese" and "seafood and alcohol." The healthy Japanese dietary pattern score was inversely associated with WC and VF in men only. WC measurements were 84.9 cm (95% CI, 83.7-86.1), 83.9 cm (95% CI, 82.7-85.1), and 82.4 cm (95% CI, 81.2-83.6); Ptrend = 0.006, and VF measurements were 94.0 cm2 (95% CI, 85.6-102.4), 89.4 cm2 (95% CI, 81.1-97.7), and 80.4 cm2 (95% CI, 72.5-88.4); Ptrend = 0.027 for the lowest through the highest tertile of healthy Japanese dietary pattern scores in men. The seafood and alcohol dietary pattern was not associated with WC and VF. CONCLUSION The healthy Japanese dietary pattern was negatively associated with WC and VF in middle-aged and elderly Japanese men.
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Abstract
PURPOSE OF REVIEW Overweight and obesity are well-established risk factors for type 2 diabetes. However, a substantial number of individuals develop the disease at underweight or normal weight. In this review, we discuss the epidemiology of type 2 diabetes in non-overweight adults; pose questions about etiology, pathophysiology, diagnosis, and prognosis; and examine implications for prevention and treatment. RECENT FINDINGS In population-based studies, the prevalence of type 2 diabetes ranged from 1.4-10.9%. However, the prevalence of type 2 diabetes in individuals with BMI < 25 kg/m2 ranged from 1.4-8.8%. In countries from Asia and Africa, the proportion of individuals with diabetes who were underweight or normal weight ranged from 24 to 66%, which is considerably higher than the US proportion of 10%. Impairments in insulin secretion, in utero undernutrition, and epigenetic alterations to the genome may play a role in diabetes development in this subgroup. A substantial number of individuals with type 2 diabetes, particularly those with recent ancestry from Asia or Africa, are underweight or normal weight. Future research should consist of comprehensive studies of the prevalence of type 2 diabetes in non-overweight individuals; studies aimed at understanding gaps in the mechanisms, etiology, and pathophysiology of diabetes development in underweight or normal weight individuals; and trials assessing the effectiveness of interventions in this population.
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Affiliation(s)
- Unjali P Gujral
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Room 7040-L, Atlanta, GA, 30322, USA.
- Emory Global Diabetes Research Center, Emory University, Atlanta, GA, USA.
| | - Mary Beth Weber
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Room 7040-L, Atlanta, GA, 30322, USA
- Emory Global Diabetes Research Center, Emory University, Atlanta, GA, USA
| | - Lisa R Staimez
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Room 7040-L, Atlanta, GA, 30322, USA
- Emory Global Diabetes Research Center, Emory University, Atlanta, GA, USA
| | - K M Venkat Narayan
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Room 7040-L, Atlanta, GA, 30322, USA
- Emory Global Diabetes Research Center, Emory University, Atlanta, GA, USA
- School of Medicine, Emory University, Atlanta, GA, USA
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Chen LW, Tint MT, Fortier MV, Aris IM, Shek LPC, Tan KH, Rajadurai VS, Gluckman PD, Chong YS, Godfrey KM, Kramer MS, Henry JK, Yap F, Lee YS. Body composition measurement in young children using quantitative magnetic resonance: a comparison with air displacement plethysmography. Pediatr Obes 2018; 13:365-373. [PMID: 29024557 PMCID: PMC5805128 DOI: 10.1111/ijpo.12250] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 08/23/2017] [Accepted: 09/18/2017] [Indexed: 12/27/2022]
Abstract
BACKGROUND Quantitative magnetic resonance (QMR) has been increasingly used to measure human body composition, but its use and validation in children is limited. OBJECTIVE We compared body composition measurement by QMR and air displacement plethysmography (ADP) in preschool children from Singapore's multi-ethnic Asian population (n = 152; mean ± SD age: 5.0 ± 0.1 years). METHODS Agreements between QMR-based and ADP-based fat mass and fat mass index (FMI) were assessed using intraclass correlation coefficient (ICC), reduced major axis regression and Bland-Altman plot analyses. Analyses were stratified for the child's sex. RESULTS Substantial agreement was observed between QMR-based and ADP-based fat mass (ICC: 0.85) and FMI (ICC: 0.82). Reduced major axis regression analysis suggested that QMR measurements were generally lower than ADP measurements. Bland-Altman analysis similarly revealed that QMR-based fat mass were (mean difference [95% limits of agreement]) -0.5 (-2.1 to +1.1) kg lower than ADP-based fat mass and QMR-based FMI were -0.4 (-1.8 to +0.9) kg/m2 lower than ADP-based FMI. Stratification by offspring sex revealed better agreement of QMR and ADP measurements in girls than in boys. CONCLUSIONS QMR-based fat mass and FMI showed substantial agreement with, but was generally lower than, ADP-based measures in young Asian children.
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Affiliation(s)
- Ling-Wei Chen
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Mya-Thway Tint
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Marielle V Fortier
- Department of Diagnostic and Interventional Imaging, KK Women’s and Children’s Hospital, Singapore
| | - Izzuddin M Aris
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore
| | - Lynette Pei-Chi Shek
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kok Hian Tan
- Department of Maternal Fetal Medicine, KK Women’s and Children’s Hospital, Singapore,Duke-National University of Singapore Graduate Medical School, Singapore
| | | | - Peter D Gluckman
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore,Liggins Institute, University of Auckland, New Zealand
| | - Yap-Seng Chong
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore,Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore
| | - Keith M Godfrey
- MRC Lifecourse Epidemiology Unit & NIHR Southampton Biomedical Research Centre, University of Southampton & University Hospital Southampton NHS Foundation Trust, UK
| | - Michael S Kramer
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore,Departments of Pediatrics and of Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Canada
| | - Jeya K Henry
- Clinical Nutrition Research Centre, Singapore Institute for Clinical Sciences, A*STAR, Singapore
| | - Fabian Yap
- Duke-National University of Singapore Graduate Medical School, Singapore,Department of Pediatric Endocrinology, KK Women’s and Children’s Hospital, Singapore,Address correspondence and requests for reprints to: Yung Seng Lee (to whom the proofs should be sent), Department of Paediatrics, Yong Loo Lin School of Medicine, NUHS Tower Block, Level 12, 1E Kent Ridge Road, Singapore 119228; Phone: (65) 67724420; Fax: (65) 67797486; ; Fabian Yap, Department of Paediatrics, KK Women’s and Children’s Hospital, Singapore Children’s Tower Level 3, 100 Bukit Timah Road, S229899; Phone: (65) 6394 8841 Fax: (65) 6394 1700;
| | - Yung Seng Lee
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore,Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore,Khoo Teck Puat- National University Children’s Medical Institute, National University Health System, Singapore,Address correspondence and requests for reprints to: Yung Seng Lee (to whom the proofs should be sent), Department of Paediatrics, Yong Loo Lin School of Medicine, NUHS Tower Block, Level 12, 1E Kent Ridge Road, Singapore 119228; Phone: (65) 67724420; Fax: (65) 67797486; ; Fabian Yap, Department of Paediatrics, KK Women’s and Children’s Hospital, Singapore Children’s Tower Level 3, 100 Bukit Timah Road, S229899; Phone: (65) 6394 8841 Fax: (65) 6394 1700;
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Sumi M, Hisamatsu T, Fujiyoshi A, Kadota A, Miyagawa N, Kondo K, Kadowaki S, Suzuki S, Torii S, Zaid M, Sato A, Arima H, Terada T, Miura K, Ueshima H. Association of Alcohol Consumption With Fat Deposition in a Community-Based Sample of Japanese Men: The Shiga Epidemiological Study of Subclinical Atherosclerosis (SESSA). J Epidemiol 2018; 29:205-212. [PMID: 29848904 PMCID: PMC6522392 DOI: 10.2188/jea.je20170191] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Background Excessive alcohol intake has been shown to be associated with cardiovascular disease via metabolic pathways. However, the relationship between alcohol intake and obesity has not been fully elucidated. We aimed to examine the association of alcohol consumption with fat deposition and anthropometric measures. Methods From 2006–2008, we conducted a cross-sectional study in a population-based sample of Japanese men aged 40 through 79 years. Areas of abdominal visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) were calculated using computed tomography imaging. Based on a questionnaire, we classified participants into five groups according to weekly alcohol consumption, excluding former drinkers: non-drinkers (0 g/week), 0.1–160.9, 161–321.9, 322–482.9, and ≥483 g/week. Multivariable linear regression was used to estimate adjusted means of obesity indices for each group. Results We analyzed 998 men (mean age and body mass index [BMI], 63.8 years and 23.6 kg/m2, respectively). Higher weekly alcohol consumption was strongly and significantly associated with higher abdominal VAT area, percentage of VAT, and VAT-to-SAT ratio (all P for trend <0.001), and also with waist circumferences and waist-to-hip ratio (P for trend = 0.042 and 0.007, respectively). These associations remained significant after further adjustment for BMI, whereas alcohol consumption had no significant association with abdominal SAT area. Conclusions Higher alcohol consumption was associated with higher VAT area, VAT%, and VAT-to-SAT ratio, independent of confounders, including BMI, in general Japanese men. These results suggest that alcohol consumption may have a potential adverse effect on visceral fat deposition.
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Affiliation(s)
- Masaki Sumi
- Department of Public Health, Shiga University of Medical Science.,Department of Pharmacy, Shiga University of Medical Science Hospital
| | - Takashi Hisamatsu
- Department of Public Health, Shiga University of Medical Science.,Department of Environmental Medicine and Public Health, Faculty of Medicine, Shimane University
| | - Akira Fujiyoshi
- Department of Public Health, Shiga University of Medical Science
| | - Aya Kadota
- Center for Epidemiologic Research in Asia, Shiga University of Medical Science
| | - Naoko Miyagawa
- Department of Public Health, Shiga University of Medical Science
| | - Keiko Kondo
- Department of Public Health, Shiga University of Medical Science
| | - Sayaka Kadowaki
- Department of Public Health, Shiga University of Medical Science
| | - Sentaro Suzuki
- Department of Public Health, Shiga University of Medical Science
| | - Sayuki Torii
- Department of Public Health, Shiga University of Medical Science
| | - Maryam Zaid
- Center for Epidemiologic Research in Asia, Shiga University of Medical Science
| | - Atsushi Sato
- Department of Public Health, Shiga University of Medical Science
| | - Hisatomi Arima
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University
| | - Tomohiro Terada
- Department of Pharmacy, Shiga University of Medical Science Hospital
| | - Katsuyuki Miura
- Department of Public Health, Shiga University of Medical Science.,Center for Epidemiologic Research in Asia, Shiga University of Medical Science
| | - Hirotsugu Ueshima
- Department of Public Health, Shiga University of Medical Science.,Center for Epidemiologic Research in Asia, Shiga University of Medical Science
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Elevated visceral obesity quantified by CT is associated with adverse postoperative outcome of laparoscopic radical nephrectomy for renal clear cell carcinoma patients. Int Urol Nephrol 2018; 50:845-850. [DOI: 10.1007/s11255-018-1858-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 03/27/2018] [Indexed: 12/11/2022]
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46
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Deshpande-Joshi SS, Rao S. Differential Risk of Hypertension Among Lean and Nonlean Rural Subjects in Relation to Decadal Changes in Anthropometry. J Am Coll Nutr 2018; 37:380-386. [DOI: 10.1080/07315724.2017.1405750] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
| | - Shobha Rao
- Society for Initiatives in Nutrition and Development, Aundh, Pune, India
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47
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Tatsukawa Y, Misumi M, Kim YM, Yamada M, Ohishi W, Fujiwara S, Nakanishi S, Yoneda M. Body composition and development of diabetes: a 15-year follow-up study in a Japanese population. Eur J Clin Nutr 2018; 72:374-380. [PMID: 29362458 DOI: 10.1038/s41430-017-0077-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Revised: 12/04/2017] [Accepted: 12/05/2017] [Indexed: 11/09/2022]
Abstract
BACKGROUND/OBJECTIVES Few longitudinal studies have examined the association between diabetes risk and body composition in Asians. The aim of this prospective cohort study was to determine the role of body composition, estimated by whole-body dual-energy X-ray absorptiometry, in the development of diabetes and to examine the impact of body composition on diabetes risk in normal weight (body mass index (BMI) <23 kg/m2) and overweight/obese groups (≥23 kg/m2). SUBJECTS/METHODS We measured the body composition for 1532 diabetes-free subjects (463 men and 1069 women), aged 48-79 years, at the baseline examination period from 1994-96 and followed-up to detect new cases of diabetes over the next 15 years (median 13.4 years). RESULTS After being adjusted for BMI and other potential confounding factors, body fat distribution was associated with diabetes risk. Percentage of trunk fat was positively associated with the development of diabetes (hazards ratio (HR) per 1 SD (95% confidential interval (CI)), 1.58 (1.10-2.28) in men, and 1.34 (0.99-1.83) in women), and percentage of leg fat was negatively associated with the development of diabetes (HR per 1 SD (95% CI), 0.68 (0.50-0.91) in men and 0.68 (0.55-0.85) in women). The estimated HRs of % trunk and leg fat on the development of diabetes differed little between normal weight and overweight/obese subjects. Appendicular lean mass was also negatively associated with diabetes risk only in normal weight men. CONCLUSIONS Opposite associations of trunk fat and leg fat with diabetes risk were observed. Assessment of body composition might help in the evaluation of diabetes risk.
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Affiliation(s)
- Yoshimi Tatsukawa
- Department of Clinical Studies, Radiation Effects Research Foundation, Hiroshima, Japan.
| | - Munechika Misumi
- Department of Statistics, Radiation Effects Research Foundation, Hiroshima, Japan
| | - Young Min Kim
- Department of Statistics, Radiation Effects Research Foundation, Hiroshima, Japan.,Department of Statistics, Kyungpook National University, Daegu, Korea
| | - Michiko Yamada
- Department of Clinical Studies, Radiation Effects Research Foundation, Hiroshima, Japan
| | - Waka Ohishi
- Department of Clinical Studies, Radiation Effects Research Foundation, Hiroshima, Japan
| | - Saeko Fujiwara
- Hiroshima Atomic Bomb Casualty Council, Hiroshima, Japan
| | - Shuhei Nakanishi
- Division of Diabetes, Metabolism and Endocrinology, Kawasaki Medical School, Kurashiki, Japan
| | - Masayasu Yoneda
- Department of Molecular and Internal Medicine, Institute of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
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48
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Samuel VT, Shulman GI. Nonalcoholic Fatty Liver Disease as a Nexus of Metabolic and Hepatic Diseases. Cell Metab 2018; 27:22-41. [PMID: 28867301 PMCID: PMC5762395 DOI: 10.1016/j.cmet.2017.08.002] [Citation(s) in RCA: 445] [Impact Index Per Article: 74.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 07/01/2017] [Accepted: 08/01/2017] [Indexed: 12/15/2022]
Abstract
NAFLD is closely linked with hepatic insulin resistance. Accumulation of hepatic diacylglycerol activates PKC-ε, impairing insulin receptor activation and insulin-stimulated glycogen synthesis. Peripheral insulin resistance indirectly influences hepatic glucose and lipid metabolism by increasing flux of substrates that promote lipogenesis (glucose and fatty acids) and gluconeogenesis (glycerol and fatty acid-derived acetyl-CoA, an allosteric activator of pyruvate carboxylase). Weight loss with diet or bariatric surgery effectively treats NAFLD, but drugs specifically approved for NAFLD are not available. Some new pharmacological strategies act broadly to alter energy balance or influence pathways that contribute to NAFLD (e.g., agonists for PPAR γ, PPAR α/δ, FXR and analogs for FGF-21, and GLP-1). Others specifically inhibit key enzymes involved in lipid synthesis (e.g., mitochondrial pyruvate carrier, acetyl-CoA carboxylase, stearoyl-CoA desaturase, and monoacyl- and diacyl-glycerol transferases). Finally, a novel class of liver-targeted mitochondrial uncoupling agents increases hepatocellular energy expenditure, reversing the metabolic and hepatic complications of NAFLD.
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Affiliation(s)
- Varman T Samuel
- Department of Medicine, Yale University School of Medicine, New Haven, CT 06510, USA; Veterans Affairs Medical Center, West Haven, CT 06516, USA.
| | - Gerald I Shulman
- Department of Medicine, Yale University School of Medicine, New Haven, CT 06510, USA; Department of Cellular and Molecular Physiology, Yale University School of Medicine, New Haven, CT 06510, USA; Howard Hughes Medical Institute, Yale University School of Medicine, New Haven, CT 06510, USA.
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49
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Matsuoka R, Kamachi K, Usuda M, Wang W, Masuda Y, Kunou M, Tanaka A, Utsunomiya K. Lactic-fermented egg white improves visceral fat obesity in Japanese subjects-double-blind, placebo-controlled study. Lipids Health Dis 2017; 16:237. [PMID: 29216922 PMCID: PMC5721610 DOI: 10.1186/s12944-017-0631-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 11/29/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It was reported that egg white protein (EWP) reduced body fat in rats. We developed a lactic-fermented egg white (LE) that facilitates the consumption of egg whites by fermenting them with lactobacillus, and were able to study their intake in humans. In this double-blind, placebo-controlled design, we evaluated the effect of LE on visceral fat area (VFA). METHODS Participants included 37 adult males and females aged ≥40 years (VFA at navel ≥100 cm2). They were divided into two groups: the control group and the LE group. The control and LE groups consumed drinks containing whey and LE, respectively, for 12 weeks (providing 8 g protein/day). VFA was measured at baseline and at week 12 of intake. Abdominal girth was measured at baseline and at weeks 6 and 12. RESULTS LE intake decreased VFA significantly compared with baseline (-8.89 cm2, p < 0.05), and VFA was significantly lower than that in the control group (+1.71 cm2, p < 0.05). The LE group showed significant improvement in the ratio of visceral to subcutaneous fat area compared with baseline and the control group (p < 0.05). CONCLUSIONS The results demonstrated that LE reduces VFA and improves the ratio of visceral to subcutaneous fat area. As other measurement items were not influenced, we concluded that LE improves visceral fat obesity. TRIAL REGISTRATION This clinical trial was retrospectively registered with the University hospital Medical Information Network (UMIN) Center, ( UMIN000026949 ; registered on 11/04/2017; http://www.umin.ac.jp /).
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Affiliation(s)
- Ryosuke Matsuoka
- R&D Division, Kewpie Corporation, 2-5-7 Sengawa Kewport, Sengawa-Cho, Chofu-Shi, Tokyo, 182-0002, Japan.
| | - Keiko Kamachi
- Nutrition Clinic, Kagawa Nutrition University, 3-24-3, Komagome, Toshima-ku, Tokyo, 170-8481, Japan
| | - Mika Usuda
- R&D Division, Kewpie Corporation, 2-5-7 Sengawa Kewport, Sengawa-Cho, Chofu-Shi, Tokyo, 182-0002, Japan
| | - Wei Wang
- R&D Division, Kewpie Corporation, 2-5-7 Sengawa Kewport, Sengawa-Cho, Chofu-Shi, Tokyo, 182-0002, Japan
| | - Yasunobu Masuda
- R&D Division, Kewpie Corporation, 2-5-7 Sengawa Kewport, Sengawa-Cho, Chofu-Shi, Tokyo, 182-0002, Japan
| | - Masaaki Kunou
- R&D Division, Kewpie Corporation, 2-5-7 Sengawa Kewport, Sengawa-Cho, Chofu-Shi, Tokyo, 182-0002, Japan
| | - Akira Tanaka
- Nutrition Clinic, Kagawa Nutrition University, 3-24-3, Komagome, Toshima-ku, Tokyo, 170-8481, Japan
| | - Kazunori Utsunomiya
- Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
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50
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Gong W, Li J. Combat with esophagojejunal anastomotic leakage after total gastrectomy for gastric cancer: A critical review of the literature. Int J Surg 2017; 47:18-24. [PMID: 28935529 DOI: 10.1016/j.ijsu.2017.09.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 08/14/2017] [Accepted: 09/10/2017] [Indexed: 02/06/2023]
Abstract
Esophagojejunal anastomotic leakage (EJAL) is considered to be one of the most serious complications after total gastrectomy (TG), despite improvements in surgical instruments and technique. The occurrence of EJAL would cause poorer quality of life, prolonged hospital stay, and increased surgery-related costs and mortality. Although there is ever-increasing knowledge about EJAL, the optimal management is controversial. In the present review, we aim to demonstrate the effective management by focus on the possible risk factors, potentially useful preventive strategies, and several kinds of treatments in esophagojejunal anastomotic leakage after total gastrectomy for gastric cancer.
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Affiliation(s)
- Wenbin Gong
- School of Medicine, Southeast University, Nanjing, China.
| | - Junsheng Li
- Department of General Surgery, Affiliated Zhongda Hospital, Nanjing, China
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