Comparison of robotic versus laparoscopic surgery for visceral obesity in mid-low rectal cancer: a propensity-matched analysis

Obesity is becoming more and more common, and measuring visceral fat area (VFA) is a useful diagnostic technique for visceral obesity (VO). The purpose of this research is to compare the surgical results of robotic versus laparoscopic rectal surgery, with a focus on assessing the benefits of the latter method for treating both VO and mid-low rectal cancer. Patients receiving laparoscopic or robotic anterior rectal excision at Northern Jiangsu People's Hospital's general surgery department were included in the retrospective analysis. 242 people in all took part in the study; 121 cases were assigned to the robotic surgery (RS) group and another 121 cases to the laparoscopic surgery (LS) group. In comparison to LS, our results show that RS led to a shorter period for the recovery of bowel function (p = 0.03), a shorter hospital stay (p < 0.001), a smaller intraoperative blood loss (p < 0.001), and a shorter time until the commencement of oral intake (p = 0.041). However, there were no statistically significant differences between the two groups in terms of the indices of histopathologic specimens, the proportion of temporary loop ileostomy, and the incidence of early postoperative problems (p > 0.05). When patients with VO undergo surgery for rectal cancer, RS has the added benefit of accelerating patient recovery while producing results that are similar to LS in the near run.

Increased visceral fat area to skeletal muscle mass ratio is positively associated with the risk of metabolic dysfunction-associated steatotic liver disease in a Chinese population

BACKGROUND

The diagnosis and comprehension of nonalcoholic fatty liver disease (NAFLD), recently redefined as metabolic dysfunction-associated steatotic liver disease (MASLD) are gaining a better understanding. In this study, we examined the association between visceral fat area and skeletal muscle mass ratio (VSR) and the prevalence of MASLD in a Chinese population.

METHODS

A cross-sectional study was conducted involving 10,916 individuals who underwent bioelectrical impedance analysis, along with anthropometric and biochemical measurements, from January 2022 to June 2023. According to the VSR distribution, sex-specific quartiles of VSR within the study population were defined. Linear trend tests were performed for the categorized VSR variables. Logistic regression models were performed to estimate the odds ratio and 95% confidence intervals between VSR distribution and MASLD prevalence stratified by sex.

RESULTS

The prevalence of MASLD was 37.94% in the overall population (56.34% male), and it gradually increased with higher VSR levels in both genders (P < 0.001). Logistic regression analysis demonstrated a significant association between VSR and MASLD prevalence after adjusting for confounders. The odds ratio (95% confidence interval) for MASLD, comparing the lowest to the highest VSR quartile, was 3.159 (2.671, 3.736) for men and 2.230 (1.764, 2.819) for women (all P < 0.001). Restricted cubic splines also indicated significant non-linear relationships between VSR and MASLD prevalence.

CONCLUSIONS

VSR is positively associated with the prevalence of MASLD in this Chinese population, with a notably higher risk for men as VSR increases compared to women.

Effect of low visceral fat area on long-term survival of stage I-III colorectal cancer

OBJECTIVE

The prognostic significance of a low visceral fat area (VFA) in colorectal cancer (CRC) remains unclear. The aim of this study was to evaluate the prognostic effects of a low VFA on the long-term outcomes of patients with CRC after laparoscopic surgery.

METHODS

This retrospective study included 306 patients with stages I-III CRC who underwent R0 resection. VFA was preoperatively measured via computed tomography using image processing software. Relapse-free survival (RFS) and overall survival (OS) rates were analyzed using the Cox proportional hazards model and Kaplan-Meier curves.

RESULTS

Low VFA was identified in 153 patients. The low VFA group had significantly lower RFS and OS rates than did the high VFA group (5-y RFS rates: 72 versus 89%, P = 0.0002; 5-y OS rates: 72 versus 92%, P = 0.0001). The independent significant predictors of RFS were T3 or T4 disease (hazard ratio [HR], 2.75; 95% confidence interval [CI], 1.12-6.76; P = 0.027), stage III CRC (HR, 3.49; 95% CI, 1.82-6.69; P < 0.001), low psoas muscle index (PMI; HR, 2.12; 95% CI, 1.19-3.79; P = 0.011), and low VFA (HR, 2.12; 95% CI, 1.16-3.86; P = 0.014). The independent significant predictors of OS were age ≥65 y (HR, 2.59; 95% CI, 1.13-5.92, P = 0.024), carbohydrate antigen 19-9 levels ≥37 ng/mL (HR, 2.32; 95% CI, 1.18-4.58; P = 0.015), stage III CRC (HR, 2.66; 95% CI, 1.37-5.17; P = 0.004), low PMI (HR, 2.00; 95% CI, 1.06-3.77; P = 0.031), and low VFA (HR, 2.42; 95% CI, 1.24-4.70; P = 0.009).

CONCLUSION

A low preoperative VFA was significantly associated with worse RFS and OS rates in patients who underwent CRC resection.

Reduced skeletal muscle mass to visceral fat area ratio is independently associated with reduced cognitive function in type 2 diabetes mellitus

AIM

Skeletal muscle mass to visceral fat area ratio (SVR) has been recognised as an index of sarcopenic obesity. SVR is associated with type 2 diabetes mellitus (T2DM), metabolic syndrome and arterial stiffness which are known risk factors for cognitive dysfunction. We aimed to investigate association between SVR and cognitive function in patients with T2DM.

METHODS

This was a cross-sectional study of 1326 patients with T2DM and mean age 61.3 ± 8.0 years. SVR was assessed based on bioelectrical impedance measurements of muscle mass and visceral fat area (VFA). Cognitive function was assessed using Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Linear regression was used to examine the association between SVR in quartiles and RBANS score, adjusting for demographics, education, presence of depressive symptoms, clinical covariates and medications.

RESULTS

The lower SVR quartiles were negatively associated with RBANS total score in the unadjusted analysis. The corresponding coefficients for Quartiles 1 and 2 SVR were -3.79 (95 % CI -5.39 to -2.19; p < 0.001) and -1.47 (95 % CI -2.86 to -0.07; p = 0.039) in fully adjusted analysis. The negative association between Quartile 1 SVR and RBANS score was evident in immediate memory, delayed memory, visuo-spatial construction, language and attention domains. Muscle mass and VFA alone had weaker associations with RBANS scores.

CONCLUSION

Our study demonstrated, for the first time, an independent association between reduced SVR and lower cognitive function. This is evident in global and multiple cognitive domains. The synergistic effects of reduced muscle mass and visceral obesity may be more pronounced than their independent effects on cognitive function.

Impact of visceral fat area on short-term outcomes in robotic surgery for mid and low rectal cancer

Rectal cancer is one of the most prevalent cancers that arise in the digestive tract. The purpose of this retrospective study was to investigate the impact of visceral fat area (VFA) on postoperative outcomes in mid and low rectal cancer patients undergoing robotic surgery (RS). Data were collected on patients who underwent robotic anterior rectal resection in a single center from December 2019 to October 2023. Clinical pathology information was analyzed. Statistical analysis was done on the computed tomography (CT) imaging data. A total of 277 patients were included in the study, including 121 cases with visceral obesity (VO) and 156 cases without VO. There was no statistically significant disparity in the lymph node dissection count, blood loss, duration of hospitalization, time to first liquid diet, early postoperative complications, histopathologic specimen indices (quality of TME and CRM involvement rate), and or the rate of conversion to open surgery between VO and non-VO group (P > 0.05). Nevertheless, the group of individuals with VO experienced a lengthier duration of surgery (P < 0.001) and a delayed time until the first passage of flatus (P < 0.001) in comparison to the group without VO. The study suggests that VO does not significantly impact early complications or the quality of surgical outcomes in mid and low rectal cancer patients undergoing robotic surgery. The findings support the continued use of RS as an optimal strategy for technically demanding patients.

Clusters of Body Fat and Nutritional Parameters are Strongly Associated with Diabetic Kidney Disease in Adults with Type 2 Diabetes

INTRODUCTION

Diabetic kidney disease (DKD) has become the leading cause of chronic kidney disease and end-stage renal failure in most developed and many developing countries. Strategies aimed at identifying potential modifiable risk factors for DKD are urgently needed. Here, we investigated the association between clusters of body fat and nutritional parameters with DKD in adults with type 2 diabetes mellitus (T2DM).

METHODS

This was a cross-sectional study of 184 participants with T2DM. Biochemical parameters including fasting blood glucose, hemoglobin A1c, hemoglobin, albumin, creatinine, and urinary albumin-to-creatinine ratio (UACR) were measured. The data for percentage of body fat mass (PBF), visceral fat area (VFA), phase angle at 50 kHz (PA50), and body cell mass (BCM) were obtained by bioelectrical impedance analysis (BIA). DKD was diagnosed by UACR and estimated glomerular filtration rate. Factor analysis was used for dimensionality reduction clustering among variables. The association of clusters with the presence of DKD was assessed using binary logistic regression analysis.

RESULTS

Factor analysis identified two clusters which were interpreted as a body fat cluster with positive loadings of VFA, body mass index, waist circumstance, and PBF and a nutritional parameters cluster with positive loadings of PA50, hemoglobin, BCM, and albumin. Participants were divided into the four groups based on the sex-specific cutoff value (median) of each cluster score calculated using the cluster weights and the original variable values. Only participants with high body fat and poor nutritional parameters (OR 3.43, 95% CI 1.25-9.42) were associated with increased odds of having DKD.

CONCLUSION

Body fat and nutritional parameters were strongly associated with and considerably contributed to the presence of DKD, suggesting that body fat and nutrition might be promising markers representing metabolic state in pathogenesis of DKD and clinical utility of BIA might provide valuable recommendations to patients with T2DM.

Neck circumference as a potential indicator of pre-sarcopenic obesity in a cohort of community-based individuals

BACKGROUND & AIMS

ESPEN/EASO advocates screening for sarcopenic obesity based on the concomitant presence of an elevated body mass index (BMI) or waist circumference. Neck circumference (NC) is another simple and reliable anthropometric measurement for estimating obesity; however, its ability to detect sarcopenic obesity has not yet been established. The aim of the present study was to explore the association between NC and sarcopenic obesity in a Shanghai community population.

METHODS

The study included 1542 participants (622 men and 920 women) with a mean age of 58 years who underwent an examination for the detection of obesity at baseline in 2013-2014 and received a re-examination in 2015-2016. An automatic bioelectric impedance analyzer was used to estimate body composition, and magnetic resonance imaging was used to measure abdominal fat distribution. The definition of pre-sarcopenic obesity combined low skeletal muscle mass adjusted by weight (SMM/W) with obesity which defined according to overall adiposity or fat distribution as BMI ≥25 kg/m2, fat percentage (fat%) ≥ 25% in men and 30% in women, or visceral fat area (VFA) ≥ 80 cm2, respectively.

RESULTS

In both men and women, subjects with low SMM/W had a higher level of NC than those without (both P < 0.01). In turn, participants with elevated NC had a higher proportion of pre-sarcopenic obesity in both men and women, regardless of adiposity status assessed by BMI, fat%, or VFA (all P < 0.01). During an average follow up of 2.1 years, for each 1 cm increase in NC, multivariable-adjusted hazard ratios of pre-sarcopenic obesity in which adiposity status assessed by high BMI were 1.40 (1.11-1.76) in men and 1.32 (1.13-1.56) in women; in addition, such association remained between NC and pre-sarcopenic obesity assessed by high fat% or high VFA.

CONCLUSION

NC is closely associated with the incidence of sarcopenic obesity, suggesting that it could be helpful for screening sarcopenic obesity in a community-based population.

Visceral fat area measured by electrical bioimpedance as an aggravating factor of COVID-19: a study on body composition

INTRODUCTION

Severe forms of COVID-19 are more common in patients with abnormal fat distribution, particularly high visceral adiposity. The patient's muscle strength may be reduced during the acute phase of the infection. Electrical bioimpedance (BIA) is a non-invasive method for measuring body compartments and estimating visceral fat area (VFA) that can be used at the bedside.

OBJECTIVE

To assess the association between several body composition parameters, primarily high adipose tissue and high VFA, in patients with and without a diagnosis of COVID-19 infection, and whether it worsened the severity parameters.

METHODS

This retrospective cohort study was conducted in a private hospital in the city of São Paulo from March 2020 to August 2021. The demographic and clinical data was collected from medical reports. Body composition is assessed using the InBODY® model S10 bioelectrical impedance device and a Jamar® digital hydraulic manual dynamometer with a scale from 0 to 90 kg is used to measure handgrip strength (HGS).

RESULTS

A total of 96 patients with a mean age of 69.1 years (SD 15) were divided into two groups of 48 individuals, with and without COVID-19 infection. Body mass index (odds ratio [OR]: 4.47, 95% confidence interval [CI]: 1.69, 11.83), fat mass (OR: 2.03, 95% CI: 0.48, 8.55), and VFA (OR: 1.08, 95% CI: 0.33, 3.53) were all higher in the infection group. When COVID-19 patients were evaluated, those with higher VFA had longer hospital stays (OR: 0.99, 95% CI: 0.97, 1.01) and used more vasoactive drugs (p = 0.043). Patients with COVID-19 with poor handgrip strength were 3.29 times more likely to require a prolonged intensive care unit (ICU) stay.

CONCLUSION

The study concluded that excess weight and body fat are significantly associated with COVID-19 involvement, but the severity is primarily related to a greater area of visceral fat. The use of bioimpedance for visceral fat measurement was effective, as it is a simple method performed in the hospital setting that does not require the use of radiation.

Development of a Nomogram to Predict Clinically Relevant Postoperative Pancreatic Fistula After Pancreaticoduodenectomy on the Basis of Visceral Fat Area and Magnetic Resonance Imaging

BACKGROUND

The aim of this study was to develop a nomogram to predict the risk of developing clinically relevant postoperative pancreatic fistula (CR-POPF) after pancreaticoduodenectomy (PD) using preoperative clinical and imaging data.

METHODS

The data of 205 patients were retrospectively analyzed, randomly divided into training (n = 125) and testing groups (n = 80). The patients' preoperative laboratory indicators, preoperative clinical baseline data, and preoperative imaging data [enhanced computed tomography (CT), enhanced magnetic resonance imaging (MRI)] were collected. Univariate analyses combined with multivariate logistic regression were used to identify the independent risk factors for CR-POPF. These factors were used to train and validate the model and to develop the risk nomogram. The area under the curve (AUC) was used to measure the predictive ability of the models. The integrated discrimination improvement index (IDI) and decision curve analysis (DCA) were used to assess the clinical feasibility of the nomogram in relation to five other models established in literature.

RESULTS

CT visceral fat area (P = 0.014), the pancreatic spleen signal ratio on T1 fat-suppressed MRI sequences (P < 0.001), and CT main pancreatic duct diameter (P = 0.001) were identified as independent prognostic factors and used to develop the model. The final nomogram achieved an AUC of 0.903. The IDI and DCA showed that the nomogram outperformed the other five CR-POPF models in the training and testing cohorts.

CONCLUSION

The nomogram achieved a superior predictive ability for CR-POPF following PD than other models described in literature. Clinicians can use this simple model to optimize perioperative planning according to the patient's risk of developing CR-POPF.

Effect of visceral fat area on the accuracy of preoperative CT-N staging of colorectal cancer

OBJECTIVE

To investigate the effect of visceral fat area (VFA) on the accuracy of preoperative CT-N staging of colorectal cancer.

METHODS

We retrospectively reviewed the clinical and imaging data of 385 CRC patients who underwent surgical resection for colorectal cancer between January 2018 and July 2021. Preoperative CT-N staging and imaging features were determined independently by two radiologists. Using postoperative pathology as the gold standard, patients were divided into accurately and incorrectly staged groups, and clinical and imaging characteristics were compared between the two groups. VFA and subcutaneous fat area (SFA) at the L3 vertebral level, sex, age, BMI, tumor location, size, and tumor circumference ratio (TCR) were included. Logistic regression analysis was used to evaluate the independent factors influencing the accuracy of preoperative N staging of colorectal cancer.

RESULTS

Of the 385 patients enrolled, 259 (67.27%) were in the preoperative N-stage accurate staging group, and 126 (32.73%) were in the incorrectly staged group. Univariate analysis showed that there were significant differences in BMI, tumor location, VFA, SFA, size and TCR between the two groups (P<0.05). Logistic regression analysis showed that VFA (95% CI: 1.277, 3.813; P=0.005) and TCR (95% CI: 1.649, 17.545; P=0.005) were independent factors affecting the accuracy of N staging. The optimal cutoff points for VFA and TCR in predicting incorrect staging were 110 cm2 and 0.675, respectively.

CONCLUSIONS

Colorectal cancer patients with lower VFA and higher TCR and preoperative CT-N staging had an increased risk for diagnostic errors.

Interaction between serum neutrophil gelatinase associated lipocalin and visceral fat area on cardiovascular health in a cohort of community-based individuals

BACKGROUND

We assessed the predictive values of neutrophil gelatinase-associated lipocalin (NGAL), fat distribution, and their interaction on the development of major adverse cardiovascular events (MACE) in a community-based cohort of middle-aged and older individuals.

METHODS

This prospective study involved 1349 adults (43.2% men) aged 50-80 y, without baseline cardiovascular diseases, from communities in 2013-2014. All participants were followed up for a mean of 7.6 y via phone calls and medical records. Serum NGAL concentrations were analyzed at baseline. Fat distribution, including subcutaneous fat area and visceral fat area (VFA), was assessed by magnetic resonance imaging.

RESULTS

In fully-adjusted Cox regression models, baseline high NGAL concentrations were related to an increased risk of MACE in women [HR 1.75, 95% CI 1.03-2.99], compared with low NGAL concentrations. After stratification by VFA concentrations, the observed association was more predominant in women with baseline low VFA (HR 1.24, 95% CI 1.11-1.38). Moreover, the association between NGAL and MACE was interacted by VFA, strengthening the association at low VFA concentrations (Pinteraction < 0.05).

CONCLUSIONS

Serum NGAL determined at baseline predicts the development of MACE, and the association is modified by VFA in women.

CT findings of idiopathic mesenteric panniculitis and analysis of related factors

OBJECTIVES

To analyze the computed tomography (CT) findings of idiopathic mesenteric panniculitis and the factors related to its characteristics and to improve the understanding of the disease.

METHODS

The imaging findings of 121 patients with mesenteric panniculitis were retrospectively analyzed, along with related factors such as age, sex, and abdominal visceral fat area.

RESULTS

Among the 121 patients, two had midgut malrotation, and the lesions were located outside the mesentery on the right side of the abdominal cavity, while the lesions in the other patients were located around the mesentery on the left side of the abdominal cavity, presenting as patchy or patchy fuzzy high-density masses. Annulus fibrosus and/or fatty ring signs were also observed in some patients. Scattered soft tissue nodules were observed around the mesentery in 119 patients. Eight patients had intestinal tract traction and retraction, and one patient had secondary intestinal obstruction. Nearly half of the patients had mesenteric vascular changes, and three had mesenteric vascular thrombosis. Among the 121 patients, there were 89 males and 32 females, aged 22-83, with an average age of 52.14 ± 13.53 years. The distribution range of abdominal visceral fat area (VFA) in 121 patients was 79.85-331.65 cm2.

CONCLUSION

Mesenteric panniculitis has certain characteristic imaging findings that can be accompanied by often ignored changes in the mesenteric blood vessels and intestinal tubes. Intestinal obstruction and mesenteric vascular thrombosis are rare complications, and their primary causes are often overlooked. Mesenteric panniculitis was correlated with sex, age, and VFA.

The evaluation of subcutaneous and visceral adipose tissue changes by computed tomography in coronavirus disease 2019 and comparison with quantitative analysis of lung involvement

BACKGROUND

This study aims to reveal the relationship between lung involvement and visceral adipose tissue changes between chest-computed tomography (CT) scans taken in short intervals in COVID-19 patients.

METHODS

The retrospective study included 52 patients who tested positive for SARS-CoV-2. All patients had two chest CT exams. Lung involvement measurements were calculated by using an artificial intelligence tool. Visceral and subcutaneous fat tissue was measured at the level of the first lumbar vertebra on chest CT. Additionally, demographic and laboratory data were collected.

RESULTS

52 patients were included (36.5 % female, mean age 50). Visceral fat area and visceral fat thickness changes were significantly positive predictors of total lung involvement changes (p=0.033, p=0.00024). Subcutaneous fat area and subcutaneous fat thickness changes were not associated with lung involvement change (p>0.05). CRP, IL-6, d-dimer, and ferritin levels were higher in patients who need intensive care units.

CONCLUSION

Visceral adipose tissue changes may indicate that it can have a role as a reservoir of virus involvement.

Correlation analysis of the abdominal visceral fat area with the structure and function of the heart and liver in obesity: a prospective magnetic resonance imaging study

BACKGROUND

The differences in fat deposition sites exhibit varying degrees of systemic inflammatory responses and organ damage, especially in obese individuals with excessive visceral fat. Visceral fat, which is closely related to an increase in mortality rates related to heart and liver diseases. However, few studies have analysed the differences in heart and liver indicators and their correlation among groups based on the abdominal visceral fat area (AVFA).

OBJECTIVE

Clarifying the differences in and correlations of heart and liver indicators among groups with different severities of AVFA by magnetic resonance imaging (MRI).

METHODS

Sixty-nine subjects with obesity were enrolled. The study group consisted of forty-one individuals (AVFA ≥ 150 cm2), and the control group consisted of twenty-eight individuals (100 cm2 ≤ AVFA < 150 cm2). The differences in and correlations between clinical, laboratory, and MRI indicators of the heart and liver between the two groups were analysed.

RESULTS

In the study group, the incidences of type 2 diabetes mellitus (T2DM) and insulin resistance were higher, and liver function indicators were worse. The left ventricular eccentricity ratio (LVER), left ventricular mass (LVM) and global peak wall thickness (GPWT) were higher in the study group than in the control group (P = 0.002, P = 0.001, P = 0.03), and the left ventricle global longitudinal strain (LVGLS) was lower in the study group than in the control group (P = 0.016). The pericardiac adipose tissue volume (PATV) and myocardial proton density fat fraction (M-PDFF) were higher in the study group than in the control group (P = 0.001, P = 0.001). The hepatic proton density fat fraction (H-PDFF) and abdominal subcutaneous fat area (ASFA) were higher in the study group than in the control group (P < 0.001, P = 0.012). There was a moderate positive correlation (ρ = 0.39-0.59, P < 0.001) between the AVFA and LVER, LVM, GPWT, LVGLS, and H-PDFF. There was no difference in right ventricular and most left ventricular systolic and diastolic function between the two groups.

CONCLUSION

The high AVFA group had a larger LVM, GPWT and PATV, more obvious changes in LVER, impaired left ventricular diastolic function, an increased risk of heart disease, and more severe hepatic fat deposition and liver injury. Therefore, there is a correlation between the amount of visceral adipose tissue and subclinical cardiac changes and liver injury.

Does the visceral fat area impact the histopathology specimen metrics after total mesorectal excision for distal rectal cancer?

BACKGROUND

The aim of this study was to evaluate whether the visceral fat area (VFA) has an impact on the histopathology specimen metrics of male patients undergoing robotic total mesorectal resection (rTME) for distal rectal cancer.

METHODS

Prospectively collected data of patients undergoing rTME for resectable rectal cancer by five surgeons during a period of three years were extracted from the REgistry of Robotic SURgery for RECTal cancer (RESURRECT). VFA was measured in all patients at preoperative computed tomography. Distal rectal cancer was defined as <6cm from the anal verge. The histopathology metrics included circumferential resection margin (CRM) (in mm) and its involvement rate (if <1mm), distal resection margin (DRM), and quality of TME (complete, nearly-complete, incomplete).

RESULTS

Of 839 patients who underwent rTME, 500 with distal rectal cancer were included. One hundred and six (21.2%) males with VFA>100cm² were compared to 394 (78.8%) males or females with VFA≤100cm². The mean CRM of males with VFA>100cm² was not significantly different from its counterpart (6.6 ± 4.8 mm versus 7.1 ± 9.5mm; p=0.752). CRM involvement rates were 7.6% in both groups (p=1.000). The DRM was not significantly different: 1.8±1.9cm versus 1.8±2.6cm; p=0.996. The quality of TME did not significantly differ: complete TME 87.3% vs. 83.7%; nearly complete TME 8.9% vs. 12.8%; incomplete TME 3.8% vs. 3.6%. Complications and clinical outcomes did not significantly differ.

CONCLUSION

This study did not find evidence to support that increased VFA would result in suboptimal histopathology specimen metrics when performing rTME in males with distal rectal cancer.

Sex and race/ethnicity specific reference predictive equations for abdominal adiposity indices using anthropometry in US adults

BACKGROUND AND AIMS

Abdominal adiposity indices have stronger associations with cardiometabolic risk factors compared to anthropometric measures but are rarely used in large scale studies due to the cost and efficiency. The aim of this study is to establish sex and race/ethnicity specific reference equations using anthropometric measures.

METHODS AND RESULTS

A secondary data analysis (n = 6589) of healthy adults was conducted using data from National Health and Nutrition Examination Survey 2011-2018. Variables included in the analyses were anthropometric measures (height; weight; waist circumference, WC) and abdominal adiposity indices (android percent fat; android to gynoid ratio, A/G ratio; visceral adipose tissue area, VATA; visceral to subcutaneous adipose area ratio, VSR). Multivariable prediction models were developed using quantile regression. Bland-Altman was used for external validation of prediction models. Reference equations to estimate android percent fat, A/G ratio, VATA and VSR from anthropometric measurements were developed using a randomly selected subsample of 4613. These reference equations for four abdominal adiposity indices were then cross-validated in the remaining subsample of 1976. The measured and predicted android percent fat, A/G ratio, VATA and VSR were not statistically different (p > 0.05) except for the A/G ratio in Asian males and VSR in White females. The results of Bland-Altman further revealed that ≥93% of predicted abdominal adiposity indices fell within the limits of agreement (±1.96 standard deviation).

CONCLUSION

The sex and race/ethnicity specific reference equations for abdominal adiposity indices established using anthropometrics in the present study have strong predictive ability in US healthy adults.

Effect of different doses of Lacticaseibacillus paracasei K56 on body fat and metabolic parameters in adult individuals with obesity: a pilot study

BACKGROUND

Studies have shown that probiotics have an effect on reducing body fat on a strain-specific and dose-response bases. The purpose of this study was to evaluate the effect of a novel probiotic strain Lacticaseibacillus paracasei K56 on body fat and metabolic biomarkers in adult individuals with obesity.

METHODS

74 adult subjects with obesity (body mass index ≥ 30 kg/m², or percent body fat > 25% for men, percent body fat > 30% for women) were randomized into 5 groups and supplemented with different doses of K56 (groups VL_K56, L_K56, H_K56, and VH_K56: K56 capsules, 2 × 10⁷ CFU/day, 2 × 10⁹ CFU/day, 2 × 10¹⁰ CFU/day, 2 × 10¹¹ CFU/day, respectively) or placebo (group Pla: placebo capsule) for 60 days. Subjects were advised to maintain their original dietary intake and physical activity. Anthropometric measurements, body composition assessment, and metabolic parameters were measured at baseline and after 60 days of intervention.

RESULTS

The results showed that the L_K56 group had significant decreases in percent body fat (p = 0.004), visceral fat area (p = 0.0007), total body fat mass (p = 0.018), trunk body fat mass (p = 0.003), waist circumference (p = 0.003), glycosylated hemoglobin(p = 0.002) at the end of the study compared with baseline. There were non-significant reductions in Body weight and BMI in the L_K56, H_K56, VL_K56 groups, whereas increases were observed in the placebo and VH_K56 groups compared with baseline values. In addition, K56 supplementation modulated gut microbiota characteristics and diversity indices in the L-K56 group. However, mean changes in body fat mass, visceral fat area, weight, body mass index, waist circumference and hip circumference were not significantly different between groups.

CONCLUSIONS

The results suggest that supplementation with different doses of Lacticaseibacillus paracasei K56 has certain effect on reducing body fat and glycosylated hemoglobin, especially at a dose of 10⁹ CFU/day.

TRIAL REGISTRATION

clinicaltrials.gov Identifier: NCT04980599.

Application of food exchange portion method in home-based nutritional intervention for elderly patients with chronic heart failure

BACKGROUND

The home treatment of elderly patients with chronic heart failure (CHF) is often accompanied by malnutrition, which increases the risk of re-hospitalisation and affects the prognosis. Therefore, how to effectively improve the nutritional self-management of patients is a current focus of medical research. This study aims to test the effect of home-based nutritional intervention method on improving the nutritional status of elderly patients with CHF.

METHODS

A total of 90 hospitalised elderly patients with CHF were randomly divided into the experimental group (n = 45) and the control group (n = 45). The patients in both groups were given standardised drug therapy and their nutritional status was evaluated using a body composition analyser prior to discharge (protein, body fat percentage, visceral fat area, skeletal muscle, upper arm muscle circumference, left lower limb and right lower limb muscle mass), with the cardiopulmonary function evaluated using a six-minute walk test and the metabolic equivalents method. The control group was given general nutrition education and routine dietary guidance from cardiac rehabilitation nurses, while the experimental group was given an individualised nutrition prescription by dietitians based on the evaluation results, according to which one-to-one food exchange dietary intervention training was given until the patients mastered the process.

RESULTS

The nutritional indexes at the end of the study were significantly higher in the experimental group than in the control group and were higher than those before the intervention (P < 0.05). The muscle circumference of the upper arm, the muscle mass of the left lower limb and the right lower limb had no statistical significance following the intervention compared to the control group and before the intervention (P > 0.05). The cardiopulmonary function indexes were significantly better in the experimental group at the end of the study than before the intervention and were better than those in the control group, with statistically significant differences (P < 0.05), while no significant changes were observed in the control group before and after the intervention (P > 0.05).

CONCLUSION

The home-based nutritional intervention method of food exchange portions can effectively improve the nutritional status of elderly patients with CHF, with the distribution of visceral fat more reasonable and the cardiopulmonary function and exercise endurance improved.

Relationship between metabolic associated fatty liver disease and body fat ratio, visceral fat area, and resting metabolic rate estimated by bioelectrical impedance analysis

BACKGROUND

It is very important to identify the risk of metabolic associated fatty liver disease (MAFLD) in early stage, and body components measured by bioelectrical impedance analysis (BIA) would be a new way to achieve the prediction safely and noninvasively.

AIM

To measure the body composition by BIA, and explore the association of body fat ratio (BFR), visceral fat area (VFA), and resting metabolic rate (RMR) with MAFLD.

METHODS

A total of 509 subjects were divided into either a MAFLD group or a non-MAFLD group. Indicators of anthropo-metric measurements, BIA, and laboratory tests were collected. Spearman correlation analysis, receiver operating characteristic (ROC) curve analysis, and binary logistic regression analysis were used to explore the relationship of BFR, VFA, and RMR with MAFLD.

RESULTS

The differences in BFR, VFA, and RMR between the MAFLD group and the non-MAFLD group were statisti-cally significant both in male and female subjects (P < 0.05), and BFR, VFA, and RMR were significantly correlated with alanine aminotransferase, total bilirubin, triglyceride (TG), total cholesterol, fasting blood-glucose (FBG), and postprandial blood glucose (P < 0.05). The area under the ROC curve (AUC) values of BFR, VFA, and RMR were 0.800 (95% confidence interval [CI]: 0.752-0.875), 0.894 (95%CI: 0.847-0.941), and 0.715 (95%CI: 0.639-0.790), respectively, and VFA was the best indicator with a cutoff value of 87.10 cm² (87.25 cm² in males and 117.05 cm² in females). The odds ratio values of BFR, VFA, and RMR were 1.357 (95%CI: 1.214-1.517), 1.079 (95%CI: 1.049-1.111), and 1.009 (95%CI: 1.005-1.014), respectively, after adjsuting for gender, age, FBG, and TG.

CONCLUSION

BFR, VFA, and RMR estimated by BIA method can be well applied in the risk prediction of MAFLD, with VFA being the best indicator.

Obesity-Induced Hepatic Steatosis Is Partly Mediated by Visceral Fat Accumulation in Subjects with Overweight/Obesity: A Cross-Sectional Study

INTRODUCTION

We explored whether visceral fat accumulation mediates the development of hepatic steatosis in individuals living with overweight and obesity.

METHODS

This cross-sectional study enrolled 769 outpatients with overweight and obesity aged 18-65 years. The controlled attenuation parameter (CAP) was used to quantify the degree of hepatic steatosis. Visceral fat accumulation, represented by the visceral fat area (VFA), was measured using magnetic resonance imaging. The associations of body mass index (BMI), VFA, and CAP with each other were assessed by univariate analysis, multivariate linear regression, and mediation analysis, respectively.

RESULTS

Compared with women, male subjects had higher BMI, VFA, and CAP levels. In both sex, CAP was positively correlated with BMI and VFA by the univariate analysis. After adjusting for demographic and serum characteristics, the linear correlation coefficients between BMI and CAP were 1.738 (95% confidence interval (CI): 1.100, 2.377), 1.524 (95% CI: 0.798, 2.249), and 2.650 (95% CI: 1.292, 4.009) in all subjects, females, and males, respectively, while those between VFA and CAP were 0.190 (95% CI: 0.133, 0.247), 0.184 (95% CI: 0.117, 0.252), and 0.194 (95% CI: 0.086, 0.301). Mediation analysis showed that visceral fat accumulation contributed to 51.37%, 53.85%, and 26.51% of obesity-induced hepatic steatosis in the total, female, and male subjects, respectively.

CONCLUSION

Visceral fat accumulation partially mediates obesity-induced hepatic steatosis in individuals with overweight and obesity, especially in women. More focus on visceral fat reduction is needed in individuals with obesity.

Visceral fat area and body fat percentage measured by bioelectrical impedance analysis correlate with glycometabolism

BACKGROUND

Adiposity evaluated by body mass index (BMI) is associated with glycometabolism. The aim of the investigation was to explore the correlation of visceral fat area (VFA), body fat percentage (BFP), BMI and waist circumference (WC) with type 2 diabetes mellitus (T2DM) and pre-diabetes.

METHODS

A total of 18,458 participates underwent physical examination in Nanjing Drum Tower Hospital from January 2018 to April 2022 was included in this study. Data were collected retrospectively. Regression analysis was used to evaluate the relationship of VFA, BFP, WC and BMI with diabetes status, fasting blood glucose (FBG) and glycohemoglobin (HbA1c).

RESULTS

After fully adjusted for multiple covariates, VFA, BFP, WC and BMI in T2DM and pre-diabetes group exceeded compared with normal group. FBG was positively correlated with VFA, BFP, WC and BMI with βs of 2.221,0.306,0.606 and 0.175(p < 0.001). HbA1c was also positively correlated with the four indexes with βs of 2.645, 0.328, 0.685 and 0.255(p < 0.001). Subgroup analysis shown that FBG and HbA1c were positively correlated with VFA, BFP, BMI and WC in normal and pre-diabetes group (p < 0.001). FBG was negatively correlated with BMI in T2DM group (p = 0.023). In T2DM, there were non-linear relationships of HbA1c with VFA, BFP, WC and BMI with the inflection points for about 7%. Before the inflection point, HbA1c was positively correlated with obesity-related indicators, and it was reversed after the inflection point. In the individuals with excessive VFA and normal BMI, the risk for glycometabolism disorder exceed compared with normal VFA and normal BMI. Every per-standard deviation increasing in VFA, BFP, WC and BMI, the corresponding risk increasing of glycometabolism disorder was 16.4, 14.6, 22.6 and 22.2%.

CONCLUSION

The study demonstrated that in adults with T2DM or prediabetes, the VFA, BFP, WC and BMI were higher than with normal glycometabolism. In pre-diabetes and normal population, there were positive correlations of HbA1c and FBG with obesity-related indicators. In T2DM with poor glycemic control (HbA1c > 7%), there might be a trend of fat loss. VFA could negatively affect glycometabolism independently from BMI. The optimum to evaluate the risk of glycometabolism disorder was WC.

Estimation of visceral fat area using criteria for metabolic syndrome: A cross-sectional study

BACKGROUND AND AIMS

The aim of this study was to calculate the visceral fat area (VFA) based on the criteria for metabolic syndrome (MetS).

METHODS

A multiple regression analysis was performed to determine the estimated VFA using data from Japanese participants (2315 men and 1684 women). Receiver operating characteristic curve (ROC) analyses were performed to determine the optimal estimated VFA cutoff for the diagnosis of central obesity. The cutoff was also applied to a second cohort to validate the model.

RESULTS

The estimated VFA was calculated using the MetS criteria, age, and body mass index (adjusted coefficient of determination = 0.682 for men and 0.726 for women). The area under the ROC curve for waist circumference, VFA, and estimated VFA were 0.669, 0.741, and 0.749, respectively, for men and 0.711, 0.787, and 0.803, respectively, for women. The optimal cutoffs for estimated VFA were 128.1 cm² for men and 82.2 cm² for women. Multivariate logistic regression for heart disease revealed that estimated VFA, rather than waist circumference, was associated with a high risk of heart disease.

CONCLUSION

The estimated VFA is a better index of central obesity than waist circumference and VFA for the diagnosis of MetS.

Visceral obesity is associated with an increased risk of developing esophago-gastric junctional adenocarcinoma in Japan: a population-based case-control study in Akita Prefecture

BACKGROUND

While an association between esophago-gastric junctional adenocarcinomas (EGJACs) and obesity, especially visceral obesity, has been suggested in Western countries, the association remains unclear in Asia, including Japan. In this population-based case-control study, we investigated the association between EGJACs and obesity.

METHODS

To perform near-population-based data collection for all early-stage EGJACs occurring in Akita Prefecture from 2014 to 2019, clinical data, including endoscopic and computed tomography (CT) findings, were collected from 11 cancer treatment base hospitals in the area. Age- and gender-matched controls were extracted at a case-to-control ratio of 1:2 from healthy subjects who received health checkups in the same area. The visceral fat area (VFA) was calculated using CT images. Logistic regression analyses were performed to investigate the associations between EGJACs and obesity-related parameters.

RESULTS

In total, 74 EGJAC cases (62 males, median age of 70 years old) and 148 controls were extracted. Multivariable analyses showed a significantly negative association between the BMI and EGJACs and a significantly positive association between the VFA and EGJACs with odds ratios (ORs) (95% confidence intervals [CIs]) of 0.65 (0.53-0.80) and 1.01 (1.01-1.02), respectively. These findings were confirmed in another dataset (40 EGJACs and 80 controls). In addition, as a categorical variable, VFA ≥ 100 cm² showed a significantly positive association with EGJACs (OR [95% CI] 1.96 [1.02-3.76]).

CONCLUSIONS

We found paradoxical associations between EGJACs and obesity-related parameters (BMI vs. VFA) in a Japanese population, suggesting a potentially pivotal role of the VFA rather than the BMI as a risk factor for EGJACs.

PNPLA3 rs738409 C>G Variant Influences the Association Between Visceral Fat and Significant Fibrosis in Biopsy-proven Nonalcoholic Fatty Liver Disease

BACKGROUND AND AIMS

Intra-abdominal visceral fat accumulation and patatin-like phospholipase domain containing 3 (PNPLA3) rs738409 G/C gene polymorphism confer a greater susceptibility to nonalcoholic fatty liver disease (NAFLD). We examined whether the relationship between visceral fat accumulation and liver disease severity may be influenced by PNPLA3 rs738409 polymorphism.

METHODS

The variant of PNPLA3 rs738409 was genotyped within 523 Han individuals with biopsy-confirmed NAFLD. Visceral fat area (VFA) was measured by bioelectrical impedance. Significant liver fibrosis (SF), defined as stage F ≥2 on histology, was the outcome measure of interest.

RESULTS

The distribution of PNPLA3 genotypes was CC: 27.5%, CG: 48.2%, and GG: 24.3%. Higher VFA was associated with greater risk of having SF (adjusted-odds ratio [OR]: 1.03; 95% confidence interval [CI]: 1.02-1.04, p<0.05), independent of potential confounders. Among subjects with the same VFA level, the risk of SF was greater among carriers of the rs738409 G genotype than among those who did not. Stratified analysis showed that PNPLA3 rs738409 significantly influenced the association between VFA and SF. VFA remained significantly associated with SF only among the rs738409 G-allele carriers (adjusted-OR: 1.05; 95% CI: 1.03-1.08 for the GG group; and adjusted-OR:1.03; 95% CI: 1.01-1.04 for the GC group). There was a significant interaction between VFA and PNPLA3 rs738409 genotype (P _interaction =0.004).

CONCLUSIONS

PNPLA3 rs738409 G allele has a moderate effect on the association between VFA and risk of SF in adult individuals with biopsy-proven NAFLD. Existence of the PNPLA3 rs738409 G allele and VFA interact to increase risk of SF.

Sex influences the association between appendicular skeletal muscle mass to visceral fat area ratio and non-alcoholic steatohepatitis in patients with biopsy-proven non-alcoholic fatty liver disease

Sarcopenic obesity is regarded as a risk factor for the progression and development of non-alcoholic fatty liver disease (NAFLD). Since male sex is a risk factor for NAFLD and skeletal muscle mass markedly varies between the sexes, we examined whether sex influences the association between appendicular skeletal muscle mass to visceral fat area ratio (SVR), that is, an index of skeletal muscle mass combined with abdominal obesity, and the histological severity of NAFLD. The SVR was measured by bioelectrical impedance in a cohort of 613 (M/F = 443/170) Chinese middle-aged individuals with biopsy-proven NAFLD. Multivariable logistic regression and subgroup analyses were used to test the association between SVR and the severity of NAFLD (i.e. non-alcoholic steatohepatitis (NASH) or NASH with the presence of any stage of liver fibrosis). NASH was identified by a NAFLD activity score ≥5, with a minimum score of 1 for each of its categories. The presence of fibrosis was classified as having a histological stage ≥1. The SVR was inversely associated with NASH in men (adjusted OR 0·62; 95 % CI 0·42, 0·92, P = 0·017 for NASH, adjusted OR 0·65; 95 % CI 0·43, 0·99, P = 0·043 for NASH with the presence of fibrosis), but not in women (1·47 (95 % CI 0·76, 2·83), P = 0·25 for NASH, and 1·45 (95 % CI 0·74, 2·83), P = 0·28 for NASH with the presence of fibrosis). There was a significant interaction for sex and SVR (P_interaction = 0·017 for NASH and P_interaction = 0·033 for NASH with the presence of fibrosis). Our findings show that lower skeletal muscle mass combined with abdominal obesity is strongly associated with the presence of NASH only in men.

Advantages of a robotic approach compared with laparoscopy gastrectomy for patients with high visceral fat area

BACKGROUND

Gastric cancer surgery for obese patients is regarded as a technically challenging procedure. The morbidity after gastrectomy has been reported to be significantly higher in patients with high visceral fat area (VFA). Robotic gastrectomy (RG) is expected to be advantageous for complicated operations. However, whether RG is superior to conventional laparoscopic gastrectomy (LG) for patients with visceral fat obesity remains unclear. The present study aimed to clarify the impact of RG on the short- and long-term outcomes of patients with high VFAs.

METHODS

This study included 1306 patients with clinical stage I/II gastric cancer who underwent minimally invasive gastrectomy between January 2012 and December 2020. The patients were subclassified according to VFA. The short- and long-term outcomes of RG were compared with those of LG in two VFA categories.

RESULTS

This study included 394 (high-VFA, 151; low-VFA, 243) and 882 patients (high-VFA, 366; low-VFA, 516) in the RG and LG groups, respectively. RG was associated with a significantly longer operative time than LG (high-VFA, P < 0.001; low-VFA, P < 0.001). The incidence rates of overall and intra-abdominal infectious complications in the high-VFA patients were lower in the RG group than in the LG group (P = 0.019 and P = 0.048, respectively) but not significantly different from those in the low-VFA patients. In the multivariate analysis, LG was identified as the only independent risk factor of overall (odds ratio [OR] 3.281; P = 0.012) and intra-abdominal infectious complications (OR 3.462; P = 0.021) in the high-VFA patients. The overall survival of high-VFA patients was significantly better in the RG group than in the LG group (P = 0.045).

CONCLUSIONS

For patients with visceral fat obesity, RG appears to be advantageous to LG in terms of reducing the risk of complications and better long-term survival.

Computed tomography-defined body composition as prognostic markers for unfavourable outcomes and in-hospital mortality in coronavirus disease 2019

BACKGROUND

Low skeletal muscle mass (LSMM) and visceral fat areas can be assessed by cross-sectional images. These parameters are associated with several clinically relevant factors in various disorders with predictive and prognostic implications. Our aim was to establish the effect of computed tomography (CT)-defined LSMM and fat areas on unfavourable outcomes and in-hospital mortality in coronavirus disease 2019 (COVID-19) patients based on a large patient sample.

METHODS

MEDLINE library, Cochrane, and Scopus databases were screened for the associations between CT-defined LSMM as well as fat areas and in-hospital mortality in COVID-19 patients up to September 2021. In total, six studies were suitable for the analysis and included into the present analysis.

RESULTS

The included studies comprised 1059 patients, 591 men (55.8%) and 468 women (44.2%), with a mean age of 60.1 years ranging from 48 to 66 years. The pooled prevalence of LSMM was 33.6%. The pooled odds ratio for the effect of LSMM on in-hospital mortality in univariate analysis was 5.84 [95% confidence interval (CI) 1.07-31.83]. It was 2.73 (95% CI 0.54-13.70) in multivariate analysis. The pooled odds ratio of high visceral fat area on unfavourable outcome in univariate analysis was 2.65 (95% CI 1.57-4.47).

CONCLUSIONS

Computed tomography-defined LSMM and high visceral fat area have a relevant association with in-hospital mortality in COVID-19 patients and should be included as relevant prognostic biomarkers into clinical routine.

Gender differences in the association between sleep duration and body mass index, percentage of body fat and visceral fat area among chinese adults: a cross-sectional study

BACKGROUND

The relationship between sleep duration and anthropometric indices are still unclear. This study aimed to explore the association between sleep duration and body mass index (BMI), percentage of body fat (PBF) and visceral fat area (VFA) among Chinese adults, further to explore gender difference in it.

METHODS

We analyzed part of the baseline data of a cohort study among adult attendees at two health-screening centers in China. Sleep duration was self-reported and categorized into short (< 7 h/day), optimal (7-9 h/day) and long sleep (≥ 9 h/day). BMI, PBF and VFA were assessed by bioelectric impedance analysis. Demographic characteristics, chronic diseases and medication history, physical activity, smoking and alcohol drinking behaviors were measured by an investigator-administrated questionnaire.

RESULTS

A total of 9059 adult participants (63.08% were females) were included in the analysis. The participants aged from 19 to 91 years with the mean age of 45.0 ± 14.6 years. Short sleep was independently associated with elevated odds of general obesity (defined using BMI) and visceral obesity (defined using VFA) among the total study population, and gender differences were observed in these associations. Among women, short sleep was associated with 62% increased odds of general obesity (OR = 1.62, 95% CI: 1.24-2.12) and 22% increased odds of visceral obesity (OR = 1.22, 95% CI: 1.02-1.45). Among men, long sleep duration was associated with 21% decreased odds of visceral obesity (OR = 0.79, 95% CI: 0.64-0.99). No association was observed between sleep duration and PBF in both sexes.

CONCLUSIONS

Sleep duration was associated with increased odds of general and visceral obesity, and this association differed between men and women. No association was observed between sleep duration and PBF among either males or females.

Tsukushi and TSKU genotype in obesity and related metabolic disorders

PURPOSE

Whether Tsukushi (TSK) can protect against high-fat diet (HFD)-induced obesity and improve glucose metabolism remains controversial. Serum levels of TSK in the population have not been reported until now. We assessed the association among TSK level, TSKU genotype, and metabolic traits in humans.

METHODS

Associations between serum TSK levels and metabolic traits were assessed in 144 Han Chinese individuals. Loci in the TSKU gene region were further genotyped in 11,022 individuals. The association between the loci and serum TSK level was evaluated using the additive genetic model. The association between the loci and their metabolic traits in humans were also verified.

RESULTS

Lower TSK levels were observed in obese subjects than in control subjects (median and interquartile range 17.78:12.07-23.28 vs. 23.81:12.54-34.56, P < 0.05). However, in obese subjects, TSK was positively associated with BMI (β ± SE: 0.63 ± 0.31, P = 0.049), visceral fat area (β ± SE: 12.15 ± 5.94, P = 0.011), and deterioration of glucose metabolism. We found that rs11236956 was associated with TSK level in obese subjects (β 95% CI 0.17, 0.07-0.26; P = 0.0007). There was also a significant association between rs11236956 and metabolic traits in our population.

CONCLUSIONS

Our findings showed that serum TSK levels were associated with metabolic disorders in obese subjects. We also identified rs11236956 to be associated with serum TSK levels in obese subjects and with metabolic disorders in the total population.

Association Between Major Adverse Cardiovascular Events and the Ratio of Subcutaneous Fat Area to Visceral Fat Area in Patients Who Have Undergone Multidetector Row Computed Tomography

Background: Obesity is a critical cardiovascular risk factor that has been defined in terms of body mass index (BMI), abdominal circumference (AC), and fat area. In this study, we examined which markers of obesity are most closely associated with major adverse cardiovascular events (MACE).

Methods and Results: This prospective cohort study enrolled 529 consecutive patients who initially underwent coronary computed tomography angiography for screening of coronary atherosclerosis at Fukuoka University Hospital (FU-CCTA Registry) and either were clinically suspected of having coronary artery disease (CAD) or had at least 1 cardiovascular risk factor with a follow-up of up to 5 years. Measurements of subcutaneous fat area (SFA), visceral fat area (VFA), and AC were quantified using multidetector row computed tomography. The primary endpoint was MACE. SFA and the SFA to VFA ratio (SFA/VFA) were significantly lower in the MACE than non-MACE group. SFA, AC, BMI, and SFA/VFA were each independently associated with MACE. Receiver operating characteristic curve analysis revealed a greater area under the curve for SFA/VFA than for the other parameters. The cut-off level of SFA/VFA with the greatest sensitivity and specificity for the diagnosis of MACE was 1.45 (sensitivity 0.849, specificity 0.472).

Conclusions: Our results suggest that SFA/VFA may be a marker for evaluating the presence of MACE.

Sex-specific association of exposure to bedroom light at night with general and abdominal adiposity in young adults

Experimental animal studies and limited epidemiologic evidence among elder population suggest that exposure to light at night (LAN) may be obesogenic. Nevertheless, little is known about the possible impact of bedroom LAN exposure on subsequent adiposity and the distribution pattern of the accumulated fat, especially in younger population. Here, we estimated longitudinal associations of objectively assessed bedroom LAN exposure with general and abdominal adiposity among young adults. We measured 2-night bedroom LAN exposure using a portable illuminometer in a cohort of young adults (n = 482). Body composition using multifrequency bioelectrical impedance analysis was evaluated at baseline and 1-year follow-up visit. Significant increases in fat mass (2.4 kg, P = 0.015 in male; 1.9 kg, P < 0.001 in female), visceral fat area (10.7 cm², P < 0.001 in male; 5.0 cm², P = 0.01 in female), waist circumference (3.8 cm, P = 0.039 in male; 2.5 cm, P = 0.047 in female) and percentage of body fat (3.6%, P = 0.002 in male; 3.0%, P = 0.001 in female) were observed among individuals with bedroom LAN higher than 5 lx. Compared to the lowest quartile group of bedroom LAN exposure, the highest quartile group was associated with an increase of 0.64 kg/m² in BMI (95% CI: 0.18-1.09 kg/m²; P = 0.006) and 1.22 kg increase in fat mass (95% CI: 0.10-2.34 kg; P = 0.025) among female participants, and 10.58 cm² in visceral fat area (95% CI: 4.85-16.31 cm²; P = 0.001) and 2.59 cm in waist circumference (95% CI: 0.37-4.81 cm; P = 0.023) among male participants. In this cohort of Chinese young adults, significant associations were observed between bedroom LAN exposure and adiposity in a sex- and fat depot-specific fashion. Further intervention and longitudinal studies could help elucidate the actual effects and develop sex-specific strategies against lifetime obesity and related metabolic disorders.

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

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.

The Relationship Between Visceral Obesity and Post-operative Complications: A Meta-analysis

BACKGROUND

Body composition can have important influence on surgical outcome. There is substantial literature examining sarcopenia, however much less in known about the impact of fat. Visceral fat area (VFA) is a reliable measures of fat distribution that can be quantified with CT scan. The aim of this study is to determine the impact of VFA to predict complications and mortality after emergent or elective surgery.

MATERIALS AND METHODS

A systematic review and meta-analysis was performed in accordance with the Preferred.

Comparison of bioelectrical body and visceral fat indices with anthropometric measures and optimal cutoffs in relation to hypertension by age and gender among Chinese adults

Background

Few studies have compared bioelectrical body and visceral fat indices with anthropometric measures, or evaluated their optimal cutoffs in relation to hypertension among Asians. We compared the efficiencies of bioelectrical indices (percentage of body fat, PBF; visceral fat area, VFA) with anthropometric measures (body mass index, BMI; waist-hip ratio, WHR) for hypertension and re-evaluated the optimal cutoffs of each index by age and gender.

Methods

We conducted a cross-sectional survey among 8234 adults for health examination. PBF, VFA, BMI, WHR, and data on hypertension and behaviors were collected. Receiver operating characteristic (ROC) curve and areas under curves (AUCs) were used to analyze the efficiencies of the indices for hypertension, optimal cutoffs were estimated using the Youden index.

Results

A total of 8234 individuals aged 21–91 with median age 44 (interquartile range [IQR] 33–56) years were included and 40.56% were men. The overall prevalence of hypertension was 27.47%. The studied indices were all associated with hypertension in all age-specific groups both among men and women except for WHR in 21–29 years old men and PBF in in 21–29 years old women. Among males, there were no statistical differences in powers of four indices for hypertension in all age-specific groups, except for 40–49 years, in which WHR was better than VFA. Among females, no differences were found among the indices in 30–39 and 70–79 years groups, while WHR was the best in 21–29 years group, VFA was better than PBF in 30–39 and 50–59 years groups, BMI was better than PBF and WHR in 60–69 years group. The optimal cutoffs of PBF, VFA, BMI and WHR ranged from 23.9 to 28.7%, 86.4 to 106.9cm², 23.5 to 27.1 kg/m², 0.92 to 0.96 across the age categories in males, and 32.8 to 36.3%, 75.9 to 130.9cm², 21.9 to 26.4 kg/m², 0.84 to 0.95 across the age categories in females, respectively.

Conclusions

The obesity indices’ efficiencies for hypertension varied by age and gender, and their cutoff values varied across the age categories and gender. Specific indices and cutoffs based on person’s age and gender should be used to identify individuals with hypertension.

Decreased skeletal muscle density is an independent predictor of mortality in necrotizing pancreatitis- A single tertiary center experience in 507 patients

BACKGROUND AND AIMS

Necrotizing pancreatitis has a variable clinical course and it is essential to identify determinants associated with high risk of mortality and poor clinical outcomes. The aim of this study is to evaluate the association between CT-assessed body composition parameters such as visceral fat area (VFA), skeletal muscle index (SMI) and skeletal muscle density (SMD) and inpatient mortality in NP patients. Secondary outcomes include organ failure on admission, persistent organ failure, length of stay (LOS), need for ICU admission, need for endoscopic, percutaneous or surgical interventions for NP and 30-day unplanned readmission.

METHODS

All NP patients managed at a single center between 2009 and 2019 with a CT scan within a week of admission were included. SMI, SMD and VFA was calculated from CT imaging at the third lumbar vertebra and multivariable analysis was performed after correcting for age, sex, BMI, ASA classification, multi- organ failure on admission to determine independent association with inpatient mortality and secondary outcomes.

RESULTS

507 NP patients [males = 349 (68.8%), median age 53 (IQR 37-65) years were included in this study. The lowest tertile SMD was independently associated with inpatient mortality on multivariable analysis: adjusted OR 3.36 (1.57-7.2), P = 0.002. The lowest SMI tertile and highest VFA tertile were not independently associated with mortality. Lowest tertile SMD was significantly associated with persistent organ failure (OR 2.01, 95% CI 1.34-3.01, p = 0.001), need for percutaneous drainage (OR 1.84, 95% CI 1.21-2.8, p = 0.004), need for ICU admission (OR 2.32, 95% CI 1.59-3.38, p < 0.0001) and LOS.

CONCLUSION

Low SMD was independently associated with in-hospital mortality in NP patients and can be usefully incorporated in CT based predictive scoring models as a prognostic marker.

Visceral fat area is the measure of obesity best associated with mobility disability in community dwelling oldest-old Chinese adults

Background

Although obesity can be clinically defined by body mass index (BMI), waist circumference, percent body fat, or visceral fat area, it is unclear which specific measure is best associated with mobility disability in oldest-old adults.

Methods

Among 589 Chinese participants aged 85 years and older in a population-based cohort in Singapore, we measured waist circumference, computed BMI, estimated appendicular skeletal muscle mass, percent body fat, and visceral fat area using bioelectrical impedance analysis, and evaluated mobility disability using the Loco-Check questionnaire. We computed areas under the receiver operating characteristic curves (AUC_ROC) to compare how well these measures discriminated between those with and without mobility disability. Logistic regression models were used to estimate the odds ratios (OR) and 95% confidence intervals (CI) for the associations between obesity defined by these measures and mobility disability.

Results

Compared to BMI, which had an AUC_ROC (95% CI) of 0.68 (0.64–0.72) for the discrimination of mobility disability, only visceral fat area had a significantly higher discriminative performance [AUC_ROC (95% CI) of 0.71 (0.67–0.75) (P_adjusted = 0.002)]. The optimal cut-offs of visceral fat area for the discrimination of mobility disability were ≥ 104 cm² in men and ≥ 137 cm² in women. In fully adjusted models, only obesity defined by visceral fat area was significantly associated with mobility disability [OR (95% CI) of 2.04 (1.10–3.77)]; obesity defined by the other measures were not associated with mobility disability after adjusting for visceral fat.

Conclusion

In oldest-old adults, visceral fat area was the best discriminator for obesity associated with mobility disability.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-021-02226-6.

Visceral adiposity, subcutaneous adiposity, and severe coronavirus disease-2019 (COVID-19): Systematic review and meta-analysis

BACKGROUND AND AIMS

Body mass index (BMI) has previously been shown to increase mortality and disease severity in patients with COVID-19, but the pooled effect estimate was heterogeneous. Although BMI is widely used as an indicator, it cannot distinguish visceral from subcutaneous fat. This systematic review and meta-analysis aimed to investigate the association between visceral adiposity, subcutaneous fat, and severe COVID-19.

METHODS

We performed a systematic literature search using the databases: PubMed, Embase, and EuropePMC. Data on visceral fat area (VTA), subcutaneous fat area (SFA), and total fat area (TFA) were collected. The outcome of interest was severe COVID-19. We used a REML random-effects model to pool the mean differences and odds ratio (OR).

RESULTS

There were 5 studies comprising of 539 patients. Patients with severe COVID-19 have a higher VTA (mean difference 41.7 cm² [27.0, 56.4], p < 0.001; I²: 0%) and TFA (mean difference 64.6 cm² [26.2, 103.1], p = 0.001; I²: 0%). There was no significant difference in terms of SFA between patients with severe and non-severe COVID-19 (mean difference 9.3 cm² [-4.9, 23.4], p = 0.199; I²: 1.2%). Pooled ORs showed that VTA was associated with severe COVID-19 (OR 1.9 [1.1, 2.2], p = 0.002; I²: 49.3%).

CONCLUSION

Visceral adiposity was associated with increased COVID-19 severity, while subcutaneous adiposity was not.

PROSPERO ID

CRD42020215876.

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.

Preoperative skeletal muscle index and visceral-to-subcutaneous fat area ratio are associated with long-term outcomes of elderly gastric cancer patients after gastrectomy

PURPOSE

Sarcopenia is a risk factor of severe surgical complications, short-term outcomes, and long-term outcomes for patients with gastric cancer. Several computed tomography (CT) measurements have been performed to diagnose sarcopenia. However, the optimal CT measurements for determining long-term outcomes have not been revealed.

METHODS

A retrospective review of gastric cancer patients with clinical stage I, II, or III who underwent gastrectomy at age 75 years or more at Shizuoka General Hospital from 2007 to 2015 was performed. Using preoperative CT, skeletal muscle index (SMI), total psoas area, intramuscular adipose tissue content in multifidus muscle, morphologic change of psoas muscle, and visceral-to-subcutaneous adipose tissue area ratio (VSR) were measured in the third lumbar section. A Cox regression analysis was used to explore prognostic factors for overall survival.

RESULTS

A total of 257 patients were reviewed. There were 171, 53, and 33 patients with clinical stages I, II, and III, respectively. A multivariate analysis indicated that, in addition to age, performance status, clinical stage, and types of resection, which are known prognostic factors, SMI and VSR are prognostic factors (p = 0.016, 0.046, respectively). The prognostic score, which was the frequency of positive SMI and VSR values within the cutoff, also indicates overall survival. The five-year OS rates of patients with prognostic scores of 0, 1, and 2 were 90.9%, 62.3%, and 52%, respectively (p < 0.001).

CONCLUSION

Preoperative SMI and VSR were prognostic factors for the overall survival of elderly patients with gastric cancer after gastrectomy.

The visceral fat area to leg muscle mass ratio is significantly associated with the risk of hyperuricemia among women: a cross-sectional study

BACKGROUND

A significant positive association was found in previous studies among obesity, visceral fat accumulation, and hyperuricemia. The purpose of this study was to explore the association between the ratio of visceral fat area to leg muscle mass (VFA-to-LMM) and hyperuricemia, and verify the role of gender differences in the association.

METHODS

A total of 3393 (43.3% are men) participants from Tianjin Union Medical Center-Health Management Center were recruited for this cross-sectional study. The VFA-to-LMM ratio was used as the independent variable. Hyperuricemia, a serum uric acid level ≥ 416 μmol/L in men and in menopausal women and ≥ 357 μmol/L in premenopausal women, was used as the dependent variable. Multiple logistic regression analysis was used to estimate the odds ratio and the 95% confidence interval between the VFA-to-LMM ratio and hyperuricemia.

RESULTS

The overall prevalence of hyperuricemia was 14.8% (8.9% in women, and 22.5% in men). After adjustment by age, smoking status (for males), menopause status (for females), drinking status, exercise frequency, blood pressure, alanine aminotransferase, fasting plasma glucose, triglycerides, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, creatinine, and history of diseases, a strong positive association was found between the VFA-to-LMM ratio and hyperuricemia in both men (4th vs. 1st quartile 1.60, 95%CI: 1.03-2.49) and women (4th vs. 1st quartile 5.22, 95%CI: 2.44-12.56). After additional adjustment by BMI, there was still a significant positive association in women (4th vs. 1st quartile 2.57, 95%CI: 1.06-6.77). The results of subgroup analysis showed that pre-menopausal women (4th vs. 1st quartile OR: 3.61) have a higher risk of hyperuricemia than postmenopausal women (4th vs. 1st quartile OR: 1.94) with the increase of the VFA-to-LMM ratio. Besides, the interaction analysis results showed the highest risk of hyperuricemia when VFA and LMM were both in the highest quantile (OR: 11.50; 95% CI: 4.86-31.98).

CONCLUSION

The VFA-to-LMM ratio was positively associated with the risk of hyperuricemia in women after adjustment by confounders. Pre-menopausal women have a higher risk of hyperuricemia than postmenopausal women with the increase of the VFA-to-LMM ratio. In addition, the highest risk of hyperuricemia was demonstrated when both VFA and LMM were at the highest quartile.

Visceral fat obesity is the key risk factor for the development of reflux erosive esophagitis in 40-69-years subjects

BACKGROUND

Visceral fat obesity can be defined quantitatively by abdominal computed tomography, however, the usefulness of measuring visceral fat area to assess the etiology of gastrointestinal reflux disease has not been fully elucidated.

METHODS

A total of 433 healthy subjects aged 40-69 years (234 men, 199 women) were included in the study. The relationship between obesity-related factors (total fat area, visceral fat area, subcutaneous fat area, waist circumference, and body mass index) and the incidence of reflux erosive esophagitis was investigated. Lifestyle factors and stomach conditions relevant to the onset of erosive esophagitis were also analyzed.

RESULTS

The prevalence of reflux erosive esophagitis was 27.2% (118/433; 106 men, 12 women). Visceral fat area was higher in subjects with erosive esophagitis than in those without (116.6 cm² vs. 64.9 cm², respectively). The incidence of erosive esophagitis was higher in subjects with visceral fat obesity (visceral fat area ≥ 100 cm²) than in those without (61.2% vs. 12.8%, respectively). Visceral fat obesity had the highest odds ratio (OR) among obesity-related factors. Multivariate analysis showed that visceral fat area was associated with the incidence of erosive esophagitis (OR = 2.18), indicating that it is an independent risk factor for erosive esophagitis. In addition, daily alcohol intake (OR = 1.54), gastric atrophy open type (OR = 0.29), and never-smoking history (OR = 0.49) were also independently associated with the development of erosive esophagitis.

CONCLUSIONS

Visceral fat obesity is the key risk factor for the development of reflux erosive esophagitis in subjects aged 40-69 years.

Myopenic obesity determined by visceral fat area strongly predicts long-term mortality in cirrhosis

BACKGROUND

The impact of changes in body composition has proved to correlate with outcomes in cirrhosis, however, numerous issues remain elusive. The present study aimed to investigate the prognostic value of myopenic obesity (MO) on long-term mortality in cirrhosis.

METHODS

We retrospectively analyzed 200 patients with cirrhosis. Body composition parameters including skeletal muscle index (SMI) and visceral fat area (VFA) were estimated by computed tomography images at the third lumbar vertebra level. We defined MO as a low SMI (male: SMI < 46.96 cm²/m² and female: SMI < 32.46 cm²/m²) with BMI ≥ 25 kg/m² or VFA ≥ 100 cm² according to our previous publication. Patients were categorized into one of four body composition groups in terms of the presence or absence of myopenia and obesity.

RESULTS

On the basis of VFA or BMI, the four group comparison demonstrated the prognosis was poor in MO, followed by myopenic/nonobesity (MN), nonmyopenic/obesity and nonmyopenic/nonobesity, in that order (log-rank test). Multivariate Cox analysis identified that MO (HR 2.498; 95% CI, 1.214-5.140; P = 0.013), MN (HR 2.763; 95% CI, 1.244-6.134; P = 0.013), age (HR 3.035; 95% CI, 1.904-4.839; P < 0.001), neutrophil-to-lymphocyte ratio (HR 1.142; 95% CI, 1.082-1.207; P < 0.001) and MELD (HR 1.140; 95% CI, 1.066-1.219; P = 0.001) were independently associated with 2-year mortality according to VFA classification.

CONCLUSIONS

MO was an independent predictor of higher long-term mortality in cirrhosis. Prevention strategies by reducing visceral fat obesity rather than BMI should be the optimal target for MO management.

The mediating role of the visceral fat area in the correlation between the serum osteocalcin levels and a prolonged QTc interval

AIMS

Osteocalcin, a bone-derived factor, could be a feasible marker for metabolic disorders and adverse cardiovascular outcomes. This study aimed to explore the correlation between serum osteocalcin levels and correct QT interval (QTc) interval prolongation, a risk factor of cardiac morbidity and mortality.

METHODS

We recruited 1210 subjects (age range: 26-80 years) in communities in Shanghai. Serum osteocalcin levels were determined using an electrochemiluminescence immunoassay. The QTc interval was measured using a 12-lead electrocardiogram and was calculated by the Bazett formula. A prolonged QTc interval was defined as QTc > 440 ms. Visceral fat area (VFA) was assessed by magnetic resonance imaging. A VFA of 80 cm² was applied as a cut-off point for central obesity.

RESULTS

Subjects with diabetes, overweight/obesity, or central obesity had significantly lower serum osteocalcin levels than those without (all P < 0.01). In subjects with a normal QTc interval, QTc interval lengthening accompanied decreasing osteocalcin levels (P_{for trend} = 0.033), and the decline was more obvious in subjects with a prolonged QTc interval (P_{for trend} = 0.022). Serum osteocalcin levels were correlated with the QTc interval (standardized β = -0.082, P = 0.005). Neither diabetes nor overweight/obesity was correlated with the QTc interval, whereas central obesity was positively correlated (P = 0.032). In addition, the correlation between osteocalcin levels and the QTc interval was attenuated when central obesity was included in the model simultaneously (standardized β = -0.075, P = 0.010). Mediation analysis revealed that VFA played a mediating role in the aforementioned correlation, and the estimated percentage of the total effect mediated by VFA was 20.9% (P = 0.007).

CONCLUSIONS

VFA partially mediated the inverse correlation between the serum osteocalcin levels and QTc interval, suggesting that improving fat metabolism may be a mechanism by which osteocalcin protects against cardiovascular diseases.

Associations between visceral obesity and renal impairment in health checkup participants: a retrospective cohort study

BACKGROUND

Obesity is a risk factor for chronic kidney disease. Although body mass index (BMI) or waist circumference is indicators of obesity, actual measurements of visceral fat area (VFA) more accurately reflect the amount of visceral fat. We aimed to determine the most sensitive obesity indicator for predicting renal impairment among VFA, BMI, waist circumference, waist-to-height ratio, and visceral-to-subcutaneous fat ratio (VSR).

METHODS

Subjects who underwent VFA measurements during health checkups in 2012 were included. Obesity was defined using a separate baseline value for each indicator [VFA (100 cm²), BMI (25 kg/m²), waist circumference (85 cm for men and 90 cm for women), waist-to-height ratio (0.5), VSR (0.4)]. Changes in estimated glomerular filtration rate (eGFR_cr) and time to new-onset proteinuria were measured. The relationships between obesity indicators and eGFR_cr were evaluated using a linear mixed-effects model. The relationships between obesity indicators and new-onset proteinuria were evaluated using Poisson regression analysis.

RESULTS

Analysis was performed on 2753 subjects (mean age 50.3 years). The VFA ≥ 100 cm² group exhibited a larger annual difference in eGFR_cr compared to the < 100 cm² group (- 0.24 mL/min/1.73 m², P = 0.03). There was a statistically significant difference in the proteinuria incidence rate ratio, which was 1.54 times (95% confidence interval 1.01-2.35) in the VFA ≥ 100 cm² group. Statistically significant correlations were not observed with any of the other obesity indicators.

CONCLUSION

VFA is suggested to be the most sensitive obesity indicator for decline in kidney function and new-onset proteinuria.

Subcutaneous fat area as a risk factor for extraction site incisional hernia following gastrectomy for gastric cancer

PURPOSE

To identify the incidence of extraction site incisional hernia following gastrectomy for gastric cancer and its significant risk factors, including the subcutaneous fat area.

METHODS

We reviewed data gathered prospectively on patients with gastric cancer, who underwent gastrectomy between 2008 and 2012 at Kyushu University Hospital, Fukuoka, Japan. The subcutaneous fat area (SFA) and visceral fat area (VFA) were measured using axial computed tomography at the level of the L4 and L3 transverse processes, and the L2-L3 intervertebral disc. The primary endpoint of the rate of extraction site incisional hernia was based on the computed tomography and clinical data including hospital follow-up reports.

RESULTS

After applying the inclusion and exclusion criteria, 320 patients were included in this retrospective analysis: 3.1% (10/320) had extraction site incisional hernias after a mean follow-up of 11 months. Multivariate analysis revealed that age and the SFA were independent risk factors (age ≥ 70.5 years: P = .013, odds ratio: 9.116, 95% confidence interval 1.581-52.553; L4 SFA ≥ 124 cm²: P = .004, odds ratio: 13.752, 95% confidence interval 2.290-82.582).

CONCLUSION

Age and the SFA were independent risk factors for extraction site incisional hernia in patients undergoing gastrectomy for gastric cancer.

Relationship between body composition indicators and risk of type 2 diabetes mellitus in Chinese adults

BACKGROUND

Body composition is a crucial factor associated with the incidence of type 2 diabetes mellitus. However, no study on this relationship has been performed in the Chinese population. This study aimed to investigate the relationship between body composition indicators and risk of type 2 diabetes mellitus among Chinese adults undergoing medical examination.

METHODS

Between January 2018 and July 2018, a retrospective cross-sectional study was performed on 3367 (2307 male and 1060 female) participants aged ≥18 years undergoing medical examination in Zhengzhou. Logistic regression analysis was performed to explore the relationship between body composition indicators and risk of type 2 diabetes mellitus. A receiver operating characteristic curve was used to calculate cutoff points and the predictive power of each indicator.

RESULTS

Among the 3367 participants, 12.53% were diagnosed with type 2 diabetes mellitus. Multivariate logistic analysis indicated that male participants (odds ratio [OR] = 1.68, 95% confidence interval [CI]: 1.29-2.19), older participants (OR = 1.05, 95% CI: 1.04-1.06), participants with a waist-to-hip ratio above the reference value (OR = 1.56, 95% CI: 1.18-2.07), participants with body fat percentage above the reference value (OR = 1.62, 95% CI: 1.01-2.68), and participant with a large visceral fat area (OR = 1.01, 95% CI: 1.01-1.02) had a high risk of type 2 diabetes mellitus. Waist-to-hip ratio, body fat percentage, and visceral fat area were the best indicators of type 2 diabetes mellitus (P < 0.001) with cutoff values of 0.90, 25.02%, and 92.00 cm², respectively.

CONCLUSION

This study suggests a predictive relationship between type 2 diabetes mellitus and body composition indicators of waist-to-hip ratio, body fat percentage, and visceral fat area, which are valuable for screening diabetes and providing effective health education and behavioral intervention for high-risk populations.

Visceral adiposity is associated with the discrepancy between glycated albumin and HbA1c in type 2 diabetes

Aim

We investigated the association of visceral adiposity with glycated albumin (GA) as well as GA/hemoglobin A1c (HbA1c) in type 2 diabetes.

Methods

One hundred twenty-three patients (68 males, 55 females) with type 2 diabetes were enrolled in this cross-sectional study. Visceral fat area (VFA) was determined using an abdominal dual bioelectrical impedance analysis (dual BIA) instrument. The relationship of VFA with GA and GA/HbA1c was analyzed.

Results

Simple regression analysis showed that BMI was inversely correlated with GA as well as GA/HbA1c, but not with HbA1c, while VFA had a significant correlation with GA and GA/HbA1c. Furthermore, multiple regression analysis revealed VFA as an independent contributor to GA/HbA1c. These results suggest that visceral adiposity is a primary factor associated with GA and HbA1c level discrepancy in patients with type 2 diabetes.

Conclusions

GA is a useful indicator for glycemic control, while visceral obesity should also be taken into consideration in type 2 diabetes cases.

Sarcopenia and Visceral Adiposity Did Not Affect Efficacy of Immune-Checkpoint Inhibitor Monotherapy for Pretreated Patients With Advanced Non-Small Cell Lung Cancer

Background

This study aimed to investigate the association of computed tomography (CT)-assessed sarcopenia and visceral adiposity with efficacy and prognosis of immune-checkpoint inhibitor (ICI) therapy for pretreated non-small cell lung cancer (NSCLC).

Methods

We retrospectively collected 74 patients with pretreated NSCLC who had initiated programmed cell death protein 1 (PD-1) or programmed cell death ligand 1 (PD-L1) inhibitor monotherapy between December 2015 and November 2018 at our hospital. As CT-assessed pretreatment markers, we used psoas muscle index (PMI), intramuscular adipose tissue content (IMAC), visceral-to-subcutaneous ratio (VSR) and visceral fat area (VFA) at lumbar vertebra L3 level. We divided 74 patients into high and low groups according to each Japanese sex-specific cut-off value. Using Kaplan-Meier curves and log-rank tests, we compared overall survival (OS) and progression-free survival (PFS). Adjusted by serum albumin, neutrophil-to-lymphocyte ratio, performance status and driver mutations, multivariate Cox proportional hazard analyses evaluated various variables as independent prognostic factors of OS and PFS.

Results

We could not find significant difference in response rate (RR) and disease control rate (DCR) between low and high groups according to any factors. The OS of patients with body mass index (BMI) < 18.5 was significantly shorter than that of patients with BMI ≥ 18.5 (median 3.3 vs. 15.8 months, P < 0.01), while there was no significant difference in OS and PFS according to PMI, IMAC, VSR and VFA. Multivariate analyses detected no significant prognostic factor in OS and PFS, except for low IMAC (hazard ratio 0.43, 95% confidence interval 0.18 - 0.998, P = 0.0496) as a favorable prognostic factor of longer OS.

Conclusions

Neither PMI nor VSR, VFA might be a significant prognostic factor of PFS and OS of ICI monotherapy for pretreated NSCLC. According to our multivariate analyses, IMAC was a significant prognostic factor of OS, but not of PFS. Thus, neither sarcopenia nor visceral adiposity may be associated with the efficacy of ICI therapy.

Efficacy of Peak Hounsfield Units of the Visceral Fat Area in Predicting Postoperative Complications after Pancreaticoduodenectomy

BACKGROUND

Morbidity following pancreaticoduodenectomy (PD) has been reported to remain high. This study sought to measure the peak Hounsfield units (HUs) of visceral attenuation in patients undergoing PD and to assess the quality of adipocytes by comparing these measurements with perioperative factors.

METHODS

Patients undergoing PD were retrospectively identified (n = 108). Abdominal perimeter, subcutaneous fat area (SFA), visceral fat area (VFA), and peak HU of the VFA were measured. Logistic regression analysis was used to identify independent predictors of postoperative pancreatic fistula (POPF) or complications. Histopathological examination was performed for qualitative diagnosis of the stromal tissue.

RESULTS

The overall rate of POPF was 16%, and severe complications occurred in 23% of the cases. A criterion for peak HU of the VFA only independently predicted POPF (p = 0.007) in the multivariate analysis. A criterion for peak HU of the VFA (p = 0.015) was associated with an increased rate of postoperative severe complications in the univariate analysis. The peak HU of the VFA was significantly correlated with abdominal perimeter (p < 0.001) and VFA (p < 0.001). The peak HU of the VFA was significantly correlated with adipocyte diameter (p < 0.001) and the ratio of stromal connective tissue area around the adipocytes (p < 0.001).

CONCLUSION

The peak HU of the VFA was an independent factor contributing to severe complications, including POPF after PD. It reflects the amount of stromal connective tissue around the adipocytes.

Measurement of Visceral Fat, Abdominal Circumference and Waist-hip Ratio to Predict Health Risk in Males and Females

BACKGROUND AND OBJECTIVE

Obesity is a risk factor for a broad range of diseases. This study aimed to estimate association between selected variables (visceral fat, abdominal circumference and waist-hip ratio) and health risk in between male and female.

MATERIALS AND METHODS

The university student based cross-sectional study was conducted among male and female students. The anthropometric measurements were taken through the auto-calibrated digital scale. Bioelectrical impedance analyzer device was used to determine visceral fat area, abdominal circumference and waist-hip ratio. Independent t-test and Pearson Chi-Square was used for statistical analysis. To see the association among the all three variables, scatter plots were also drawn.

RESULTS

The results showed that 28.3% male and 9.4% female at risk for visceral fat, for the abdominal circumference 16.9% male and 6% female at risk and for waist-hip ratio 27.5% male and 6% female fell under risk category. There was a significant relationship among all variable for male and female.

CONCLUSION

Findings suggested that visceral fat area, abdominal circumference and waist-hip ratio were strong predictors of health risk. Male were more prone to health risk than female participants.