Coexistence of visceral fat and multiple risk factor accumulations is strongly associated with coronary artery disease in Japanese (the VACATION-J study)

Stearic acid alleviates aortic medial degeneration through maintaining mitochondrial dynamics homeostasis via inhibiting JNK/MAPK signaling

Aortic dissection is characterized pathologically by aortic medial degeneration (AMD) where disturbance of mitochondrial dynamics may be involved. Stearic acid (SA) can promote mitochondrial fusion and improve mitochondrial function. Here, we established an AMD mouse model through oral administration of β-aminopropionitrile (BAPN) and a cellular model by treating primary vascular smooth muscle cells (VSMCs) with Angiotensin-II to explore the potential role of SA in AMD. Our results showed SA reduced AMD and prolonged survival of BAPN-treated mice. Excessive mitochondrial fission was observed during AMD both in vivo and in vitro, and SA reduced mitochondrial fission and increased fusion. Additionally, SA promoted expression of contractile phenotype markers of VSMCs. At the molecular level, SA reduced AMD by inhibiting JNK/MAPK signaling. Our study suggests SA can promote mitochondrial fusion and increase the contractile phenotype of VSMCs by inhibiting JNK/MAPK signaling, thereby reducing AMD formation and possibly the consequent risk of aortic dissection.

A body shape index is useful for BMI-independently identifying Japanese patients with obesity at high risk of cardiovascular disease

BACKGROUND AND AIM

Obesity with multiple metabolic syndrome (MetS) components and/or with skeletal muscle loss is at high risk of cardiovascular disease (CVD). This study aimed to clarify the utility of anthropometric indices for identifying patients with overweight/obese at high risk of CVD based on having multiple MetS components and skeletal muscle loss.

METHODS & RESULTS

This cross-sectional study included 188 overweight/obese (BMI ≥25 kg/m2, Japanese patients; 73 men and 115 women, mean age 55.7 years). First, we performed correlation analysis among seven anthropometric indices, body mass index (BMI), percentage body fat, waist circumference (WC), waist-to-hip ratio (WHpR), waist-to-height ratio (WHtR), a body shape index (ABSI), and body roundness index (BRI). Unlike the others, only ABSI was not correlated with BMI. Then, we conducted receiver operating characteristic analysis to assess the predictive abilities of anthropometric indices for having multiple MetS components. WC, WHpR, WHtR, BRI, and ABSI had significant predictive abilities for having multiple MetS components. Furthermore, multiple regression analysis showed that only ABSI had significantly negative associations with all sarcopenia-evaluated indices (skeletal muscle mass index [SMI], handgrip strength [HGS], and muscle quality [MQ]), irrespective of sex and age. Finally, an analysis of covariance showed that the high ABSI group had significantly lower SMI and HGS than the low ABSI group, irrespective of sex and age.

CONCLUSION

ABSI was deemed useful for BMI-independently identifying Japanese patients with overweight/obese at high risk of CVD based on having multiple MetS components and skeletal muscle loss. Clinical trials (the unique trial number and the name of the registry) ID: UMIN000042726.

Epicardial and thoracic subcutaneous fat texture analysis in patients undergoing cardiac CT

Introduction

The aim of our study was to evaluate the feasibility of texture analysis of epicardial fat (EF) and thoracic subcutaneous fat (TSF) in patients undergoing cardiac CT (CCT).

Materials and methods

We compared a consecutive population of 30 patients with BMI ≤25 kg/m² (Group A, 60.6 ± 13.7 years) with a control population of 30 patients with BMI >25 kg/m² (Group B, 63.3 ± 11 years). A dedicated computer application for quantification of EF and a texture analysis application for the study of EF and TSF were employed.

Results

The volume of EF was higher in group B (mean 116.1 cm³ vs. 86.3 cm³, p = 0.014), despite no differences were found neither in terms of mean density (-69.5 ± 5 HU vs. -68 ± 5 HU, p = 0.28), nor in terms of quartiles distribution (Q1, p = 0.83; Q2, p = 0.22, Q3, p = 0.83, Q4, p = 0.34). The discriminating parameters of the histogram class were mean (p = 0.02), 0,1st (p = 0.001), 10_th (p = 0.002), and 50_th percentiles (p = 0.02). DifVarnc was the discriminating parameter of the co-occurrence matrix class (p = 0.007).The TSF thickness was 15 ± 6 mm in group A and 19.5 ± 5 mm in group B (p = 0.003). The TSF had a mean density of -97 ± 19 HU in group A and -95.8 ± 19 HU in group B (p = 0.75). The discriminating parameters of texture analysis were 10_th (p = 0.03), 50_th (p = 0.01), 90_th percentiles (p = 0.04), S(0,1)SumAverg (p = 0.02), S(1,-1)SumOfSqs (p = 0.02), S(3,0)Contrast (p = 0.03), S(3,0)SumAverg (p = 0.02), S(4,0)SumAverg (p = 0.04), Horzl_RLNonUni (p = 0.02), and Vertl_LngREmph (p = 0.0005).

Conclusions

Texture analysis provides distinctive radiomic parameters of EF and TSF. EF and TSF had different radiomic features as the BMI varies.

Habitual night sleep duration is associated with general obesity and visceral obesity among Chinese women, independent of sleep quality

Purpose

Research on the relationship between sleep duration and obesity defined using multiple anthropometric and bioelectrical indices in women remains scarce. We aimed to explore the association between sleep duration and body mass index (BMI), waist-hip ratio (WHR), body fat percentage (PBF) and visceral fat area (VFA) among females.

Methods

We recruited women for medical examination using multistage cluster sampling. Sleep was assessed using Pittsburgh Sleep Quality Index (PSQI) and sleep duration was categorized into short (<7 h), optimal (7 <9 h) and long sleep (≥ 9 h). Weight and height were measured using a calibrated stadiometer. Waist circumference was manually measured. PBF, and VFA were estimated by bioelectrical impedance analysis. Data on sociodemographic characteristics and lifestyle factors were also collected and included in the logistic regression models to explore the independent association between sleep duration and obesity defined by different indices.

Results

A total of 7,763 women with a mean age of 42.6 ± 13.5 years were included. The percentage of women reporting short and long sleep was 10.3 and 13.4% respectively. The mean BMI, WHR, PBF and VFA were 23.07 ± 3.30 kg/m², 0.78 ± 0.06, 32.23 ± 6.08% and 91.64 ± 35.97cm², respectively. Short sleep was independently associated with 35% (95% CI: 1.05-1.75) increased odds of general obesity (BMI ≥ 28 kg/cm²), and long sleep was associated with 18% (95% CI: 1.01-1.37) increased odds of visceral obesity (VFA > 100 cm²). No association was observed between sleep deprivation or excessive sleep and high WHR or high PBF.

Conclusion

In women, short sleep was associated with an increased odds of general obesity, whereas long sleep was associated with an increased odds of visceral obesity. Longitudinal observations are needed to confirm this cross-sectional relationship.

Visceral fat and attribute-based medicine in chronic kidney disease

Visceral adipose tissue plays a central role in obesity and metabolic syndrome and is an independent risk factor for both cardiovascular and metabolic disorders. Increased visceral adipose tissue promotes adipokine dysregulation and insulin resistance, leading to several health issues, including systemic inflammation, oxidative stress, and activation of the renin-angiotensin-aldosterone system. Moreover, an increase in adipose tissue directly and indirectly affects the kidneys by increasing renal sodium reabsorption, causing glomerular hyperfiltration and hypertrophy, which leads to increased proteinuria and kidney fibrosis/dysfunction. Although the interest in the adverse effects of obesity on renal diseases has grown exponentially in recent years, the relationship between obesity and renal prognosis remains controversial. This may be attributed to the long clinical course of obesity, numerous obesity-related metabolic complications, and patients' attributes. Multiple individual attributes influencing the pathophysiology of fat accumulation make it difficult to understand obesity. In such cases, it may be effective to elucidate the pathophysiology by conducting research tailored to individual attributes from the perspective of attribute-based medicine/personalized medicine. We consider the appropriate use of clinical indicators necessary, according to attributes such as chronic kidney disease stage, level of visceral adipose tissue accumulation, age, and sex. Selecting treatments and clinical indicators based on individual attributes will allow for advancements in the clinical management of patients with obesity and chronic kidney disease. In the clinical setting of obesity-related nephropathy, it is first necessary to accumulate attribute-based studies resulting from the accurate evaluation of visceral fat accumulation to establish evidence for promoting personalized medicine.

A Body Shape Index and Aortic Disease-Related Mortality in Japanese General Population

AIMS

Aortic diseases (ADs), including aortic dissection, aortic aneurysm, and aortic rupture, are fatal, with extremely high mortality rates. A body shape index (ABSI), an anthropometric measure calculated as waist circumference adjusted by height and weight, improves the predictive capacity for mortality. However, whether ABSI is a risk factor for AD-related mortality in the general population remains unclear.

METHODS

We used a nationwide database of 630,842 individuals (aged 40-75 years) who participated in the annual "Specific Health Check and Guidance in Japan" between 2008 and 2010.

RESULTS

During the follow-up period of 3.8 years, 159 AD-related deaths occurred, including 105 aortic dissections and 54 aortic aneurysm ruptures. The subjects were divided into three groups based on ABSI tertiles. Kaplan-Meier analysis demonstrated that the 3^rd tertile (with the highest ABSI) had the greatest risk among the three groups. Multivariate Cox proportional hazard regression analysis demonstrated that ABSI was significantly associated with AD-related death after adjusting for confounding risk factors. Neither waist circumference nor body mass index consistently predicted AD-related death in the multivariate model. The prediction capacity was significantly improved by the addition of ABSI to the confounding risk factors.

CONCLUSIONS

We demonstrated for the first time that ABSI, a surrogate marker for abdominal visceral fat tissue, was associated with AD-related deaths in the general population, suggesting the importance of central adiposity in the development of AD.

A combined index of waist circumference and muscle quality is associated with cardiovascular disease risk factor accumulation in Japanese obese patients: a cross-sectional study

PURPOSE

To identify obese patients at high risk of cardiovascular disease (CVD) using a combined index of obesity and sarcopenia.

METHODS

In this cross-sectional study, we firstly conducted analysis of covariance to select each index most associated with the CVD risk score, the number of concomitant CVD risk factors, among obesity- (body mass index, percentage body fat, or waist circumference [WC]) and sarcopenia-evaluated indices (skeletal muscle mass index, handgrip strength, or muscle quality [MQ]), respectively in 188 Japanese obese patients (BMI ≥ 25 kg/m², 73 men and 115 women). Next, we conducted multivariate logistic regression analysis to compare the four groups (Group A-D) classified by medians of the selected indices.

RESULTS

WC and MQ were selected as the indices most associated with the CVD risk scores, respectively. The CVD risk score was significantly higher in Group B (low WC and low MQ) and Group D (high WC and low MQ) with higher prevalence of diabetes as compared with Group A (low WC and high MQ). Adjusted for sex and age, odds ratios for CVD risk scores = 2 were significantly higher in Group B, Group C (high WC and high MQ), and Group D compared with Group A. Furthermore, odds ratios for CVD risk scores = 3 were significantly higher only in Group D compared with Group A (4.29 [95% confidence interval: 1.49-12.33], p = 0.007).

CONCLUSION

Combined index of WC and MQ was useful in Japanese obese patients at high risk of CVD, regardless sex and age.

Predictive Value of Abdominal Fat Distribution on Coronary Artery Disease Severity Stratified by Computed Tomography-Derived SYNTAX Score

This study aimed to evaluate the association between abdominal fat distribution (AFD) and coronary artery disease (CAD) complexities using the computed tomography (CT)-derived SYNTAX score (CT-SXscore). Coronary computed tomographic angiography (CCTA) was performed in patients with suspected CAD. Plain abdominal CT was performed to measure visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) areas. To assess AFD, VAT/SAT (V/S) ratios were calculated. The CT-SXscore was calculated in patients with significant stenoses assessed by CCTA. Of 942 enrolled patients, 310 (32.9%) had 1 or more significant stenoses. The CT-SXscore showed a positive correlation with the V/S ratio (r = 0.33, p < 0.001). In the multivariate regression analysis, the V/S ratio was the only independent predictor for CAD severity based on the CT-SXscore (β = 0.25; t = 4.14; p < 0.001), even though the absolute SAT and VAT areas showed no relationship to the CT-SXscore. Regarding the 4 CAD-patient groups divided according to their median VAT and SAT areas, the CT-SXscore was significantly higher for the high VAT/low SAT group than for any other group (19.6 ± 11.5 vs 13.3 ± 9.6 in the low VAT/low SAT, 10.1 ± 8.5 in the low VAT/high SAT, and 12.2 ± 8.7 in the high VAT/high SAT groups; p < 0.001 for all). In conclusion, it was found that the V/S ratio is a useful index for predicting CAD severity and that AFD may be a more important risk factor for CAD than the absolute amount of each abdominal fat.

The Association of Body Composition Parameters and Simultaneously Measured Inter-Arm Systolic Blood Pressure Differences

Background and Objectives: An inter-arm systolic blood pressure difference (IASBPD) is defined as a blood pressure (BP) disparity of ≥10 mmHg between arms. IASBPDs are associated with an increased risk of cardiovascular disease (CVD). Similarly, visceral fat accumulation (VFA) is clinically important because it is associated with higher cardiovascular disease risk. Accordingly, this study compared the body composition parameters of IASBPD individuals with individuals who did not express an IASBPD. Materials and Methods: The analysis included 104 patients. The blood pressures of all participants were measured simultaneously in both arms using automated oscillometric devices. Then patients were divided into two groups according to their IASBPD status: Group 1 (IASBPD- (<10 mmHg)); Group 2 (IASPPD+ (≥10 mmHg)). Body composition parameters were measured using bioelectrical impedance analysis. Results: In 42 (40%) patients, the simultaneously measured IASBPD was equal to or higher than 10 mmHg. The right brachial SBP was higher in 63% of patients. There were no differences between the groups in terms of demographic and clinical characteristics. Regarding the two groups' body composition parameter differences, VFA was significantly higher in group 2 (p = 0.014). Conclusions: The IASBPD is known to be associated with an increased risk of cardiovascular events. Although the body mass indexes (BMIs) of the two groups were similar, VFA levels in those with a greater than 10 mmHg IASBPD were found to be significantly higher. This finding may explain the increased cardiovascular risk in this group.

Impact of visceral fat area in patients with chronic kidney disease

Longitudinal studies evaluating the association between visceral fat area (VFA) and kidney function decline in patients with chronic kidney disease (CKD) are limited, and little is known about VFA interactions contributing to the kidney prognosis (e.g. interactions between VFA ≥ 100 cm² and age, sex, and CKD category). In this study, we stratified patients with CKD according to VFA category, as well as age, sex, CKD category, hyperglycemia, and diabetes mellitus, and determined the ability of obesity-related indicators (body mass index, waist circumference, subcutaneous fat area, visceral-to-subcutaneous fat ratio) to predict the renal prognosis. Kidney outcomes (≥ 50% estimated glomerular filtration rate decline or end-stage kidney disease) were examined in 200 patients with CKD (median follow-up, 12.3 years). On multivariable Cox analysis, an increase in VFA (10-cm² increase) was significantly associated with kidney outcomes in the entire cohort, and VFA was significantly associated with kidney disease progression even in the VFA < 100 cm² sub-cohort. Interestingly, the hazard ratio (HR) was higher for VFA (10-cm² increase) than for the VFA ≥ 100 cm² sub-cohort (HR 1.33 vs. 1.07). Overall, VFA was found to be the most versatile obesity-related indicator associated with kidney disease progression. VFA was associated with the primary outcome in the sub-cohorts of CKD stages 1-2, hyperglycemia, and diabetes mellitus. A high VFA was a significant kidney prognostic factor in the entire CKD cohort, with greater significance in patients with VFA < 100 cm² than in patients with VFA ≥ 100 cm². Our results may provide new insights into strategies for treating CKD.

Visceral to subcutaneous fat ratio as an indicator of a ≥30% eGFR decline in chronic kidney disease

Whether the visceral-to-subcutaneous fat ratio (V/S ratio) is associated with renal prognosis in patients with chronic kidney disease (CKD) remains unclear. Furthermore, little is known about the effect of sex and the absolute amount of visceral fat accumulation such as visceral fat area (VFA) ≥100 cm² on the V/S ratio in relation to renal prognosis. In this study, 200 patients with CKD were evaluated for renal prognosis. Survival analyses and logistic regression analyses were conducted, generating time-series pseudo-R² values. The mean and percent change of the pseudo-R² values from the 6^th year to the 10^th year (6Y–10Y Mean and 6Y–10Y Change, respectively) were calculated for determining the cut-off points for the medium-term renal prognosis. Multivariate Cox regression analysis revealed that the V/S ratio was significantly associated with renal outcomes and that the VFA category (VFA ≥ 100 cm²) had significant interactions with the V/S ratio regarding renal prognosis. The hazard ratio (HR) of the V/S ratio was higher in the sub-cohort of VFA < 100 cm² than in the sub-cohort of VFA ≥ 100 cm² (HR: 6.42 vs. 1.00). Regarding sex differences, a strong association was noted between the V/S ratio and renal prognosis in women but not in men (HR: 2.40 vs. 1.10). On the other hand, 6Y–10Y Mean of the pseudo-R² values indicated differences in the cut-off points of the V/S ratio between men and women (V/S ratio: 0.75 vs. 0.5). Our findings indicate that it may be clinically meaningful to consider the differences in sex and the amount of VFA ≥100 cm² for the V/S ratio in relation to renal outcomes in patients with CKD. The 6Y–10Y Mean of the pseudo-R² values contributed to determining the cut-off points of the V/S ratio according to the sex difference.

Clinical impact of visceral-to-subcutaneous fat ratio in patients with acute aortic dissection

Background

Obesity has increased worldwide. Although the visceral-to-subcutaneous fat ratio (VS ratio) is an established risk factor for cardiovascular disease, its clinical impact on the long-term prognosis of patients with acute aortic dissection (AAD) remains unclear.

Materials and methods

This retrospective study included 111 patients with AAD admitted to our hospital from 2013 to 2016. Patients who died during hospitalization, and those diagnosed with Marfan’s syndrome were excluded. Visceral and subcutaneous fat accumulation (VFA, SFA) at umbilical level were calculated on a dedicated workstation. Major Adverse Cardiovascular and Cerebrovascular Events (MACCE) and worsening renal function (WRF) at 3 years were evaluated.

Results

Patient characteristics were as below: age, 73 ± 13; male, 55%; Stanford type A, 53%. Average VFA, SFA, and VS ratio on admission were 98 (52–145) cm², 141 (90–185) cm², and 0.75 (0.47–0.97), respectively. VFA was higher in male than in female (male, 134 [84–179] cm²; female, 71 [46–99] cm²; p < 0.001), whereas SFA was similar (male, 141 [91–174] cm²: female, 134 [90–205] cm²; p = 0.687). VS ratio was also higher in male (male, 0.88 [0.75–1.17]; female, 0.49 [0.39–0.65]; p < 0.001). Both MACCE and WRF at 3 years were observed in 17 (15%) and 32 (29%) patients, respectively. Multivariate Cox regression analysis demonstrated that VS ratio tended to be associated with the 3-year MACCE (HR for an increase of 0.5 unit, 1.49; 95% CI, 0.99–2.24; p = 0.056). This result persisted in male (HR for an increase of 0.5 unit, 1.54; 95% CI, 0.96–2.48; p = 0.073) but not female. The VS ratio was not related to the 3-year WRF.

Conclusion

The VS ratio tends to be associated with the 3-year MACCE in patients with AAD. This finding is inconclusive owing to a small sample and low incidence of adverse events. Further studies with larger samples are needed to confirm the clinical significance of VS ratio.

Efficacy of visceral fat estimation by dual bioelectrical impedance analysis in detecting cardiovascular risk factors in patients with type 2 diabetes

Background

Visceral fat area (VFA) is a good surrogate marker of obesity-related disorders, such as hypertension, dyslipidemia and glucose intolerance. Although estimating the VFA by X-ray computed tomography (CT) is the primary index for visceral obesity, it is expensive and requires invasive radiation exposure. Dual bioelectrical impedance analysis (BIA) is a simple and reliable method to estimate VFA; however, the clinical usefulness of dual BIA remains unclear in patients with type 2 diabetes (T2D).

Methods

We estimated the VFAs by dual BIA and CT in 98 patients with T2D and assessed anthropometric parameters, blood test results, and the presence of comorbid hypertension and dyslipidemia. We compared the correlation between the VFAs examined by dual BIA and CT. Furthermore, we performed the receiver operating characteristic (ROC) analyses for the VFAs to detect the presence of comorbid hypertension and/or dyslipidemia with T2D, which are major comorbidities of visceral obesity, and estimated the area under the curve (AUC).

Results

The measurement error between the VFAs by dual BIA and CT was significantly higher among patients with brain natriuretic peptide (BNP) ≥ 100 pg/mL than those with BNP < 100 pg/mL (39.2% ± 31.1% vs. 24.1% ± 18.6%, P < 0.05). After excluding patients with BNP ≥ 100 pg/mL, the VFA by dual BIA significantly correlated with the VFA by CT (r = 0.917; P < 0.0001). The AUC in the ROC analysis for the VFA by dual BIA to detect the presence of comorbid hypertension and/or dyslipidemia with T2D was almost equivalent to that for the VFA by CT.

Conclusions

In patients with T2D without elevated BNP > 100 pg/mL as indicator for fluid accumulation interfering with BIA, estimation of the VFA by dual BIA significantly correlated with that by CT and also detected comorbid hypertension and/or dyslipidemia with T2D equivalent to those detected by CT. Hence, dual BIA could be an alternative to CT as a standard method for estimating the VFA in patients with diabetes.

Impact of Discrepancies in General and Abdominal Obesity on Major Adverse Cardiac Events

Background

Body mass index and waist circumference (WC) are commonly used metrics that reflect general obesity and abdominal obesity. However, the impact of general and abdominal obesity discrepancies on the risk for major adverse cardiac events (MACE) is less explored.

Methods and Results

The study population was derived from the Korean National Health Insurance Service‐Health Screening Cohort. Among 315 982 participants aged 40 years or older who underwent health examinations between 2008 and 2009, body mass index and WC were used to determine the obesity status. The participants were followed from January 1, 2010 for MACE until December 31, 2015. Cox proportional hazards models were used to evaluate the association of obesity and the risk of MACE. Compared with men who were not obese, those with abdominal obesity without general obesity (adjusted hazard ratio (aHR) 1.29, 95% CI 1.16–1.43), and general and abdominal obesity (aHR 1.20, 95% CI 1.12–1.29) had elevated risk of MACE, while those with general obesity without abdominal obesity (aHR 1.06, 95% CI 0.98–1.16) did not. Similarly, women with abdominal obesity without general obesity (aHR 1.13, 95% CI 1.03–1.24) and those with general and abdominal obesity (aHR 1.15, 95% CI 1.06–1.25) had increased risk of MACE, while those with general obesity without abdominal obesity (aHR 1.07, 95% CI 0.88–1.30) did not.

Conclusions

Abdominal obesity without general obesity was associated with an elevated risk of major cardiovascular outcomes while general obesity without abdominal obesity did not. Concurrent determination of body mass index and WC may be beneficial for the accurate determination of future cardiovascular risk.

Prognostic Value of the Modified Atherogenic Index of Plasma during Body Mass Reduction in Polish Obese/Overweight People

Although weight loss is recommended for obese patients, it remains questionable how much weight loss is optimal. A novel index that accurately determines the risk of cardiovascular diseases (CVDs) in terms of weight loss is needed. The modified Atherogenic Index of Plasma (AIP), presented here is unique in the literature. It is calculated based on data for anti-atherogenic, high-density lipoprotein cholesterol (HDL-C) fractions, instead of the total HDL-C. This study investigates whether weight loss correlates with CVD risk, and whether the modified AIP allows more accurate diagnostics in obese/overweight people. According to the increase or decrease of AIP during weight loss, 52 Polish patients were subdivided into two groups: group I (increased AIP; n = 16) and group II (decreased AIP; n = 36). The patients' body mass composition and fasting serum lipid parameters (total cholesterol, triglycerides, HDL-C, and LDL-C (low-density lipoprotein cholesterol)), and cholesterol in 21 lipoprotein sub-fractions were determined. Over six months, all patients reduced their body mass by about 10%. There were no significant differences in anthropometric measures between groups. Increases in large and intermediate HDL-C fractions 1 to 6 and decreases in smaller fractions 7 to 10 were observed in group II. In group I, HDL-C fractions 1 and 10 decreased, while cholesterol in other fractions increased. Increases were observed in the antiatherogenic HDL-C of 52% of group II and 4% of group I. As for atherogenic HDL-C, a decrease of 24% was observed in group II and an increase of 9% in group I. In group I, increases of very-low-density lipoprotein (VLDL), intermediate-density lipoprotein (IDL), and large LDL fractions were noticed, and the reverse in group II. The results show that the modified AIP is a more accurate indicator of CVD risk than existing indices, and that uncontrolled weight reduction does not necessarily have a beneficial influence, and may adversely affect the cardiovascular system.

Proposed cut-off values of the waist circumference for metabolic syndrome based on visceral fat volume in a Japanese population

Aim/Introduction

Waist circumference (WC) is the most important parameter for diagnosis of metabolic syndrome. The present study was carried out to obtain optimal WC cut‐off values for diagnosis of metabolic syndrome in a Japanese population based on the measurement of total intra‐abdominal visceral fat volume (VFV), which could be expected to reflect visceral obesity more precisely than visceral fat area.

Materials and Methods

A total of 405 Japanese persons undergoing health screening were investigated. visceral fat volume was calculated from the data in 700–800 computed tomography slices from the top of the liver to the floor of the pelvic cavity. Then, receiver operating characteristic analysis was used to determine the cut‐off value of the VFV/height ratio. Subsequently, the corresponding WC value was obtained by linear regression analysis.

Results

The cut‐off value of the VFV/height ratio was 2,317 cm³/m in men and 1,425 cm³/m in women. The sensitivity and specificity of the ratio were 52.9 and 86.4% in men vs 63.4 and 82.2% in women, respectively. The corresponding cut‐off value of WC was 86.0 cm in men and 80.9 cm in women.

Conclusions

The proposed cut‐off values of WC for metabolic syndrome are 85 cm in Japanese men and 80 cm in Japanese women.

Daily intake of rosehip extract decreases abdominal visceral fat in preobese subjects: a randomized, double-blind, placebo-controlled clinical trial

BACKGROUND

Obesity has become a great problem all over the world. We repeatedly screened to find an effective food to treat obesity and discovered that rosehip extract shows potent anti-obesity effects. Investigations in mice have demonstrated that rosehip extract inhibits body weight gain and decreases visceral fat. Thus, the present study examined the effect of rosehip extract on human body fat in preobese subjects.

METHODS

We conducted a 12-week, single-center, double-blind, randomized, placebo-controlled study of 32 subjects who had a body mass index of ≥25 but <30. The subjects were assigned to two random groups, and they received one tablet of placebo or rosehip that contained 100 mg of rosehip extract once each day for 12 weeks with no dietary intervention. Abdominal fat area and body fat percent were measured as primary outcomes. The other outcomes were body weight and body mass index.

RESULTS

Abdominal total fat area, abdominal visceral fat area, body weight, and body mass index decreased significantly in the rosehip group at week 12 compared with their baseline levels (P<0.01) after receiving the rosehip tablet intake, and the decreases in these parameters were significantly higher when compared with those in the placebo group. Additionally, body fat percent tended to decrease compared with the placebo group and their baseline level. Moreover, the abdominal subcutaneous fat area was significantly lower in the rosehip group than in the placebo group at week 12 after the initiation of intake (P<0.05). In addition, there were no abnormalities, subjective symptoms, and findings that may indicate clinical problems during the study period.

CONCLUSION

These results suggest that rosehip extract may be a good candidate food material for preventing obesity.

Clinical significance of visceral adiposity assessed by computed tomography: A Japanese perspective

Abdominal obesity, rather than total amount of fat, is linked to obesity-related disorders. Visceral adiposity is an important component of obesity-related disorders in Japanese individuals with a mild degree of adiposity compared with Western subjects. In 1983, our group reported techniques for body fat analysis using computed tomography (CT) and established the concept of visceral fat obesity in which intra-abdominal fat accumulation is an important factor in the development of obesity-related complications, such as diabetes, lipid disorders, hypertension and atherosclerosis. Our group also established ideal imaging conditions for determining abdominal fat area at the umbilical level CT scan. Visceral fat area (VFA) measured in a single slice at L4 level correlated significantly with the total abdominal visceral fat volume measured on multislice CT scan. In a large-scale study of a Japanese population, the mean number of obesity-related cardiovascular risk factors (hypertension, low high-density lipoprotein cholesterolemia and/or hypertriglyceridemia, and hyperglycemia) was greater than 1.0 at 100 cm² of VFA, irrespective of gender, age and body mass index. Our group also demonstrated that reduction of visceral fat accumulation subsequent to voluntary lifestyle modification, “Hokenshido”, correlated with a decrease in the number of obesity-related cardiovascular risk factors. It is important to select the most appropriate subjects from the general population (e.g., non-obese subjects with a cluster of risk factors for the metabolic syndrome) that are most suitable for body weight reduction, with the goal of preventing atherosclerotic cardiovascular diseases.

The utility of dual bioelectrical impedance analysis in detecting intra-abdominal fat area in obese patients during weight reduction therapy in comparison with waist circumference and abdominal CT

An increase in intra-abdominal fat area (IAFA) is an essential component of metabolic syndrome (MetS). Waist circumference (WC) is not a precise measure of IAFA, and computed tomography (CT) is unsuitable for frequent monitoring. Here, we examined utility of a dual bioelectrical impedance analysis (Dual BIA) for measuring IAFA in obese patients during weight reduction. Fat distribution was measured by Dual BIA and CT in 100 obese outpatients. All fat areas including total, IAFA, and subcutaneous fat by Dual BIA were more closely correlated with those by CT than WC. Estimated IAFA by Dual BIA was significantly correlated with number of MetS components as well as CT, but WC was not. Furthermore, in 61 obese patients who received 6-month weight reduction therapy, estimated IAFA by Dual BIA showed an earlier and greater decrease as well as that by CT than WC and BMI. In addition, decrease in estimated IAFA by Dual BIA through weight reduction had a higher correlation with decrease in IAFA by CT, than WC. This study is the first to demonstrate that the change in estimated IAFA by Dual BIA was highly correlated with that in IAFA by CT during weight reduction therapy. Our findings also indicate that estimated IAFA by Dual BIA is, potentially, a better indicator of severity of MetS, cardiovascular risk factors, and effectiveness of weight reduction than WC, and equal to IAFA by CT. Estimated IAFA by Dual BIA may be useful for monitoring the effectiveness of weight reduction therapy in obese patients.

Association between abdominal fat distribution and atherosclerotic changes in the carotid artery

AIM

We aimed to evaluate the association between abdominal fat distribution (e.g., abdominal visceral fat area [VFA], subcutaneous fat area [SFA], and total fat area [TFA]), waist circumference (WC), or body mass index (BMI) and atherosclerotic changes in the carotid artery after adjusting for common risk factors.

METHODS

The present study is a hospital-based, cross-sectional study. Study participants included 223 Japanese individuals who underwent a medical health checkup at Juntendo University Hospital, Tokyo, between December 2005 and August 2011. Multivariate logistic regression analysis was used to examine the association between abdominal VFA, SFA, TFA, the VFA/SFA ratio, WC, or BMI and intima-media thickness [IMT] (mean IMT≥1.1mm or maximum IMT≥1.2mm) as atherosclerotic changes in the carotid artery.

RESULTS

Multivariate logistic regression analysis showed that VFA (OR for ≥150cm(2) versus <100cm(2), 3.88; 95% CI, 1.39-10.85), BMI (OR for ≥27.6kg/m(2) versus <25kg/m(2), 5.22; 95% CI, 1.69-16.16), and TFA (OR for 200-285cm(2) versus <200cm(2), 4.15; 95% CI, 1.34-12.86: OR for ≥285cm(2) versus <200cm(2), 5.53; 95% CI, 1.76-17.35) were significantly associated with atherosclerotic changes in men. After adjustment for BMI, only TFA (OR for ≥285cm(2) versus <200cm(2), 3.76; 95%CI, 1.03-13.79) in men was significantly associated with atherosclerotic changes in the carotid artery.

CONCLUSIONS

Our results indicate that VFA, TFA, and BMI are independently associated with atherosclerotic changes in Japanese men. TFA may be considered as a valuable measure of atherosclerotic changes.

Plasma adiponectin is a more specific marker of fatty liver than a marker of metabolic syndrome in Japanese men

BACKGROUND

The association of plasma cardiovascular risk markers and metabolic syndrome (MetS) with non-alcoholic fatty liver disease (NAFLD) has not been well defined.

METHODS

Japanese men (n = 809) had standard anthropometric measurements done, and had their liver fat quantitated by ultrasound. Three groups were identified: (1) normal controls without significant disease, (2) preliminary-metabolic syndrome (pre-MetS) cases and (3) MetS cases. Plasma adiponectin, high sensitivity-C reactive protein (hs-CRP), HOMA-IR, lipids, lipoproteins and liver enzymes were evaluated among the three groups.

RESULTS

The prevalence of fatty liver was 13% in controls, 39% in pre-MetS and 62% in MetS. Plasma adiponectin and high density lipoprotein cholesterol (HDL-C) were significantly decreased, and HOMA-IR, hs-CRP, TG, remnant lipoproteins (RLPs) and small dense-LDL-C (sd LDL-C) were significantly increased in subjects with fatty liver compared to those without fatty liver. Multivariate analyses of serum parameters associated with fatty liver revealed that adiponectin and hs-CRP were more strongly associated with the presence of fatty liver than waist circumference. However, HOMA-IR, HDL-C, TG, RLP-C, RLP-TG and sd LDL-C were more strongly associated with waist circumference than with fatty liver. Factor analysis revealed that adiponectin and HDL-C were linked to liver enzymes, lipoproteins and HOMA-IR associated with fatty liver, but not with waist circumference.

CONCLUSIONS

Adiponectin was found to be a more specific diagnostic marker for the presence of fatty liver regardless of MetS status, and was inversely correlated with liver enzyme concentrations. However, RLPs were found to be more specifically associated with the presence of MetS.

Visceral obesity as a risk factor for left-sided diverticulitis in Japan: a multicenter retrospective study

Background/Aims

Left-sided diverticulitis is increasing in Japan, and many studies report that left-sided diverticulitis is more likely to be severe. Therefore, it is important to identify the features and risk factors for left-sided diverticulitis. We hypothesized that left-sided diverticulitis in Japan is related to obesity and conducted a study of the features and risk factors for this disorder in Japan.

Methods

Right-sided diverticulitis and left-sided diverticulitis patients (total of 215) were compared with respect to background, particularly obesity-related factors to identify risk factors for diverticulitis.

Results

There were 166 (77.2%) right-sided diverticulitis patients and 49 (22.8%) left-sided diverticulitis patients. The proportions of obese patients (body mass index ≥25 kg/m², p=0.0349), viscerally obese patients (visceral fat area ≥100 cm², p=0.0019), patients of mean age (p=0.0003), and elderly patients (age ≥65 years, p=0.0177) were significantly higher in the left-sided-diverticulitis group than in the right-sided-diverticulitis group. The proportion of viscerally obese patients was significantly higher in the left-sided-diverticulitis group than in the left-sided-diverticulosis group (p=0.0390).

Conclusions

This study showed that obesity, particularly visceral obesity, was a risk factor for left-sided diverticulitis in Japan.

Determinants of extraaortic arterial 18F-FDG accumulation in asymptomatic cohorts: sex differences in the association with cardiovascular risk factors and coronary artery stenosis

The objective of this study was to evaluate extraaortic arterial (18)F-FDG accumulation in asymptomatic cohorts by sex and to clarify the association between extraaortic arterial (18)F-FDG accumulation and cardiovascular risk factors (CRFs) and coronary artery stenosis (CAS).

METHODS

Five hundred twenty-one asymptomatic individuals (351 men and 170 women) who underwent cancer and CAS screening were enrolled. We evaluated extraaortic arterial (18)F-FDG accumulation in the carotid artery (CA) and iliofemoral artery (IFA) and classified the accumulation patterns into 3 types. Type 1 patients had no extraaortic arterial (18)F-FDG accumulation, type 2 had accumulation in either the CA or the IFA, and type 3 had accumulation in both the CA and IFA. CRFs (age, low-density lipoprotein [LDL] and high-density lipoprotein [HDL] cholesterol, triglyceride concentration, visceral abdominal fat, hypertension, diabetes, and smoking) and significant CAS were examined in relation to each accumulation type.

RESULTS

The men showed more extensive extraaortic arterial (18)F-FDG accumulation than the women. Type 3 accumulation (60.4% vs. 37.1%, P < 0.0001) was more frequently observed in men, whereas type 2 (34.2% vs. 44.7%, P = 0.02) and type 1 (5.4% vs. 18.2%, P < 0.0001) accumulation were more frequent in women. The CRFs other than smoking tended to be worse with extensive extraaortic arterial (18)F-FDG accumulation. A multivariate logistic regression analysis showed that hypertension, age, LDL cholesterol, triglyceride, and visceral abdominal fat were significantly associated with type 3 accumulation in men, and LDL cholesterol and HDL cholesterol (inversely) were significantly associated with type 3 accumulation in women. CAS was found in 4.2% (9/212) of male patients and in 1.6% (1/63) of female patients with type 3 accumulation, whereas no CAS was found in the other 2 types.

CONCLUSION

The men showed more extensive extraaortic arterial (18)F-FDG accumulation than the women. LDL cholesterol was associated with extensive extraaortic arterial (18)F-FDG accumulation in both sexes, but the other CRFs associated with extensive extraaortic (18)F-FDG arterial accumulation differed between the sexes. The type 3 accumulation was considered to pose a risk of CAS, especially in male patients, whereas non-type 3 accumulation presented little risk.