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Beyond obesity, visceral adipose tissue (VAT) has emerged as an important predictor of chronic disease, but the role of diet quality patterns (DQP) in VAT development is not well defined. Therefore, we conducted a systematic review of how various DQP are associated with VAT via literature searches in PubMed and EMBASE. We included observational investigations in disease-free adults/adolescents that related DQP to VAT assessed by imaging methods. The studies were evaluated separately for a priori and a posteriori DQP and according to design differences. Study quality was assessed using the Risk of Bias in Non-randomised Studies of Interventions tool. Of the 1807 screened articles, thirty-five studies met the inclusion criteria. The majority of a priori indices, for example, the Healthy Eating Index, showed significant inverse associations with VAT, while only a small proportion of a posteriori patterns were related to VAT. Results did not differ substantially by the method of exposure and outcome assessment or between studies with (n 20) or without (n 15) body-size adjustment, but significant findings were more common in younger v. older individuals, USA v. other populations and investigations with moderate v. serious risk of bias. The heterogeneity of the existing literature limited the ability to quantify the magnitude of the associations across studies. These findings suggest that a high-quality diet, as assessed by a priori DQP, is generally inversely associated with VAT, but results for a posteriori DQP are less consistent. As associations persisted after adjusting for body size, diet quality may beneficially influence VAT beyond its association with obesity. [ABSTRACT FROM AUTHOR]

Highlights: 1. This study emphasizes the significance of understanding professional football players' various somatotype structures and body fat compositions as an important contribution to the area of sports science. This study lays the groundwork for future research to better understand the intricate interactions between somatotype structures, body composition, and athletic performance. 2. Since a one-size-fits-all approach may not be successful, this study advocates for tailored evaluations of training regimens to cater to athletes' unique requirements and skills, which may lead to higher overall performance. Abstract This study investigated the effects of somatotype structures and body fat composition on professional football athletes' aerobic capacities and running speed. This study used an analytical observational design with a cross-sectional approach. The subjects comprised 27 professional football athletes from Bhayangkara Football Club, located in Bekasi, Indonesia. This study measured several variables, i.e., players' age, playing position, somatotype structures assessed using the Somatotype Rating Form and Heath-Carter Somatochart, body fat composition measured using Brozek and Siri formulas, aerobic capacities determined by the maximum rate of oxygen (VO2 max) through the Yo-Yo Intermittent Recovery Test Level 2, and running speed over a 30 m distance. The data were presented as mean ± standard deviation (SD), frequency (n), and percentage. The Shapiro-Wilk was used to determine the normality of the data distribution. The statistical analyses were conducted using one-way analysis of variance (ANOVA) followed by the post-hoc least significant difference (LSD) test, the Kruskal-Wallis test followed by the post-hoc Mann-Whitney test, as well as the independent t-test, the Mann-Whitney test, and Pearson's or Spearman's correlation tests. A value of p

Objective To explore the clinical efficacy of dulaglutide combined with metformin in the treatment of obese patients with type 2 diabetes mellitus（T2DM）. Methods A total of 200 obese patients with T2DM who were treated in Shanghai Jiading District Anting Hospital from January 2021 to January 2023 were randomly divided into liraglutide group（ n=100） and dulaglutide group（n= 100）. The liraglutide group was treated with liraglutide combined with metformin, and the dulaglutide group was treated with dulaglutide combined with metformin. Both groups were treated for 3 months. The body metabolic indexes [fasting blood glucose（FBG）, 2 h postprandial blood glucose（2 h PBG）, hemoglobin（HbA1 c）, total cholesterol（TC）, triglyceride（TG）], body fat composition [body fat rate, body mass index, subcutaneous fat rate of limbs, visceral fat index] and serum adipokines（ adiponectin, neuropeptide Q（ NPQ）, asprosin, irisin） levels were compared before treatment and 3 months after treatment. The clinical efficacy and adverse reactions of the two groups were observed. Results After 3 months of treatment, FBG, 2 h PBG, HbAlc, TC, TG, body fat rate, body mass index, subcutaneous fat rate of limbs, visceral fat index and asprosin in the two groups were lower than those before treatment, and those in the dulaglutide group were lower than those in the liraglutide group（P<0.05）. After 3 months of treatment, the levels of serum adiponectin, NPQ and irisin in the two groups were higher than those before treatment, and the increase in the dulaglutide group was greater than that in the liraglutide group（ P<0.05） . The effective rate of dulaglutide group（98.00%）was higher than that of liraglutide group（91.00 %）（P<0.05）. There was no significant difference in the incidence of adverse reactions between the two groups（11.00%, 14.00%） （P>0.05）. Conclusion Dulaglutide combined with metformin could improve the metabolic status of obese T2 DM patients, regulate body fat composition and serum adipokines, with significant clinical efficacy and safety. ［作者简介］ 毛智毅，本科，主管药师，研究方向：糖尿病合理用 [ABSTRACT FROM AUTHOR]

The increased prevalence of Type 2 diabetes mellitus (T2DM) and related complications in India has been related to rising obesity. Purpose: To evaluate the BMI, waist circumference (WC), body fat composition, and glycated hemoglobin (HbA1c) levels and explore the gender differences and association between these parameters. A total of 155 T2DM patients (89 males and 66 females) from Coastal Karnataka, India, participated in this study. Waist circumference (WC) and body mass index (BMI) were measured using standard procedure, and Body Fat Composition was measured using a bioelectric impedance analyzer. The mean BMI, WC, and HbA1c visceral fat values were higher, whereas skeletal muscle mass was lower than the reference range in both males and females. In age-matched males and females, the total body fat, WC and subcutaneous fat were significantly higher in females. In contrast, the skeletal muscle mass in males was significantly higher. The HbA1c levels were found to be higher in males compared to females. Total body fat and subcutaneous fat were negatively correlated, whereas visceral fat and skeletal muscle mass were positively correlated with HbA1c. There was slightly poor glycemic control in males compared to females, related to higher visceral fat. Hence, measuring the body fat composition and currently used clinical and laboratory parameters helps monitor and prevent T2DM-related complications. The study highlights the low skeletal muscle and high visceral fat in the Indian population. The study also relates the high visceral fat and poor muscle mass contributing to insulin resistance, which causes poor glycemic control and T2-DM-related complications. [ABSTRACT FROM AUTHOR]

Abstract Background Body fat composition is believed to be associated with the progression, medical response, and prognosis of inflammatory bowel disease (IBD). Hence, we conducted this study to explore if fat metrics were associated with the disease activity of severe IBD and the response to intravenous corticosteroids (IVCS). Methods We included 69 patients with ulcerative colitis (UC) and 72 patients with Crohn's disease (CD) who had previously received IVCS during hospitalization. We quantified individual fat distribution using abdominal computed tomography slices. The correlations between fat parameters and disease activity were available with Spearman correlation analysis. The prediction model was developed using independent risk factors derived from multivariable logistic regression analysis. Model discrimination was evaluated leveraging the receiver operating characteristic curve. 1000 bootstrap resamples internally validated the model's prediction performance. Results Notable differences in age, nutritional status, serum cytomegalovirus replication, stool condition, and extraintestinal involvement between UC and CD patients were observed. UC subjects who responded to IVCS had higher subcutaneous adipose tissue index (SATI), visceral adipose tissue index (VATI), and mesorectal adipose tissue index (MATI) than non-responders. IVCS-responding CD individuals had lower VATI and mesenteric fat index (MFI) than non-responders. CD patients with a prolonged disease duration had a decreased SATI and an elevated MFI. VATI and MATI were reduced as UC clinically progressed, while more prominent clinical activity in CD correlated with increased VATI, MATI, and MFI. A high SATI indicated that patients with UC were more prone to be IVCS responders. For patients with CD, levels of VATI and MFI were negatively associated with effective IVCS treatment. The established models showed a discriminative accuracy of 0.834 [95% confidence interval (CI) 0.740–0.928] in the UC cohort and 0.871 (95% CI 0.793–0.949) in the CD cohort. Repeated samples supported the reliability of the developed models (AUCUC = 0.836, 95% CI 0.735–0.919; AUCCD = 0.876, 95% CI 0.785–0.946). Conclusion Human fat indexes represent novel imaging biomarkers for identifying IBD patients who respond to IVCS, thus building accelerated therapy regimens and avoiding the adverse effects of ineffective IVCS.

Summary: Coronary artery disease (CAD) affects millions of individuals worldwide and results in a substantial burden to healthcare systems. Although it is established that CAD affects females differently than males, differences between the sexes are not routinely accounted for. Body mass index is a known risk factor for CAD. However, more accurate metrics of body fat, including waist-to-hip circumference ratio (WHR), could be more meaningful clinically. WHR exhibits sex differences due to sex hormones, differing effects at genetic risk loci, and other factors. It is unclear if WHR is a causal factor for CAD in one or both sexes, but this information will be crucial for improving heart health. Causal inference, however, can be challenging. Large-scale cohorts with genetic data allow for Mendelian randomization, which, given certain assumptions, tests whether there is a causal relationship between an exposure and the outcome using genetic variants.We conducted sex-specific, one-sample MR analyses using two-stage least-squares regression in the UK Biobank with genetic variants robustly associated with WHR. We found evidence of a causal relationship between WHR and CAD risk in females (OR [95% CI] = 1.16 [1.06–1.26]; p value = 7.5E-4), whereas in males, we did not find evidence of a causal relationship (OR [95% CI] = 1.40 [0.98–2.01]; p value = 0.063). Results were supported by two additional MR approaches (using a genetic risk score and two-sample MR using the inverse variance weighted approach).We encourage future work assessing sex-specific effects using causal inference techniques to better understand factors contributing to complex disease risk.

Background: Body fat composition is believed to be associated with the progression, medical response, and prognosis of inflammatory bowel disease (IBD). Hence, we conducted this study to explore if fat metrics were associated with the disease activity of severe IBD and the response to intravenous corticosteroids (IVCS). Methods: We included 69 patients with ulcerative colitis (UC) and 72 patients with Crohn's disease (CD) who had previously received IVCS during hospitalization. We quantified individual fat distribution using abdominal computed tomography slices. The correlations between fat parameters and disease activity were available with Spearman correlation analysis. The prediction model was developed using independent risk factors derived from multivariable logistic regression analysis. Model discrimination was evaluated leveraging the receiver operating characteristic curve. 1000 bootstrap resamples internally validated the model's prediction performance. Results: Notable differences in age, nutritional status, serum cytomegalovirus replication, stool condition, and extraintestinal involvement between UC and CD patients were observed. UC subjects who responded to IVCS had higher subcutaneous adipose tissue index (SATI), visceral adipose tissue index (VATI), and mesorectal adipose tissue index (MATI) than non-responders. IVCS-responding CD individuals had lower VATI and mesenteric fat index (MFI) than non-responders. CD patients with a prolonged disease duration had a decreased SATI and an elevated MFI. VATI and MATI were reduced as UC clinically progressed, while more prominent clinical activity in CD correlated with increased VATI, MATI, and MFI. A high SATI indicated that patients with UC were more prone to be IVCS responders. For patients with CD, levels of VATI and MFI were negatively associated with effective IVCS treatment. The established models showed a discriminative accuracy of 0.834 [95% confidence interval (CI) 0.740–0.928] in the UC cohort and 0.871 (95% CI 0.793–0.949) in the CD cohort. Repeated samples supported the reliability of the developed models (AUCUC = 0.836, 95% CI 0.735–0.919; AUCCD = 0.876, 95% CI 0.785–0.946). Conclusion: Human fat indexes represent novel imaging biomarkers for identifying IBD patients who respond to IVCS, thus building accelerated therapy regimens and avoiding the adverse effects of ineffective IVCS. [ABSTRACT FROM AUTHOR]

Introduction: Left ventricular global longitudinal strain (GLS) is considered to be the first marker of diabetes mellitus-related subclinical cardiac dysfunction, but whether it is attributable to fat mass and distribution remains uncertain. In this study, we explored whether fat mass, especially fat mass in the android area, is associated with subclinical systolic dysfunction before the onset of cardiac disease. Methods: We conducted a single-center prospective cross-sectional study between November 2021 and August 2022 on inpatients of the Department of Endocrinology, Nanjing Drum Tower Hospital. We included 150 patients aged 18–70 years with no signs, symptoms, or history of clinical cardiac disease. Patients were evaluated with speckle tracking echocardiography and dual energy X-ray absorptiometry. The cutoff values for subclinical systolic dysfunction were set at a global longitudinal strain (GLS) < 18%. Results: After adjusting for sex and age, patients with GLS < 18% had a higher mean (± standard deviation) fat mass index (8.06 ± 2.39 vs. 7.10 ± 2.09 kg/m2, p = 0.02), higher mean trunk fat mass (14.9 ± 4.9 vs. 12.8 ± 4.3 kg, p = 0.01), and higher android fat mass (2.57 ± 1.02 vs. 2.18 ± 0.86 kg, p = 0.02) than those in the GLS ≥ 18%. Partial correlation analysis showed that the fat mass index, truck fat mass, and android fat mass were negatively correlated with GLS after adjusting for sex and age (all p < 0.05). Adjusted for traditional cardiovascular metabolic factors, fat mass index (odds ratio [OR] 1.27, 95% confidence interval [CI] 1.05–1.55, p = 0.02), trunk fat mass (OR 1.13, 95% CI 1.03–1.24, p = 0.01), and android fat mass (OR 1.77, 95% CI 1.16–2.82, p = 0.01) were independent risk factors for GLS < 18%. Conclusion: Among patients with type 2 diabetes mellitus without established clinical cardiac disease, fat mass, especially android fat mass, was associated with subclinical systolic dysfunction independently of age and sex. [ABSTRACT FROM AUTHOR]

Abstract Background The objective of this study was to increase understanding of the complex interactions between diet, obesity, and the gut microbiome of adult female non-human primates (NHPs). Subjects consumed either a Western (n=15) or Mediterranean (n=14) diet designed to represent human dietary patterns for 31 months. Body composition was determined using CT, fecal samples were collected, and shotgun metagenomic sequencing was performed. Gut microbiome results were grouped by diet and adiposity. Results Diet was the main contributor to gut microbiome bacterial diversity. Adiposity within each diet was associated with subtle shifts in the proportional abundance of several taxa. Mediterranean diet-fed NHPs with lower body fat had a greater proportion of Lactobacillus animalis than their higher body fat counterparts. Higher body fat Western diet-fed NHPs had more Ruminococcus champaneliensis and less Bacteroides uniformis than their low body fat counterparts. Western diet-fed NHPs had significantly higher levels of Prevotella copri than Mediterranean diet NHPs. Western diet-fed subjects were stratified by P. copri abundance (P. copri HIGH versus P. copri LOW), which was not associated with adiposity. Overall, Western diet-fed animals in the P. copri HIGH group showed greater proportional abundance of B. ovatus, B. faecis, P. stercorea, P. brevis, and Faecalibacterium prausnitzii than those in the Western P. copri LOW group. Western diet P. copri LOW subjects had a greater proportion of Eubacterium siraeum. E. siraeum negatively correlated with P. copri proportional abundance regardless of dietary consumption. In the Western diet group, Shannon diversity was significantly higher in P. copri LOW when compared to P. copri HIGH subjects. Furthermore, gut E. siraeum abundance positively correlated with HDL plasma cholesterol indicating that those in the P. copri LOW population may represent a more metabolically healthy population. Untargeted metabolomics on urine and plasma from Western diet-fed P. copri HIGH and P. copri LOW subjects suggest early kidney dysfunction in Western diet-fed P. copri HIGH subjects. Conclusions In summary, the data indicate diet to be the major influencer of gut bacterial diversity. However, diet and adiposity must be considered together when analyzing changes in abundance of specific bacterial taxa. Interestingly, P. copri appears to mediate metabolic dysfunction in Western diet-fed NHPs. Video abstract

Walking can affect the muscles to stretch which can improve physical fitness for prevention in elderly women. Galoba contains flavonoids that have anti-oxidative properties and play a role in preventing damage to cells and their cellular components by reactive free radicals. The aim of the study was to determine the effectiveness of the physical exercise model walking by giving galoba juice on body fat composition and antioxidant status in women aged > 55 years. This study was a true experiment with a pre-posttest with a control group. Consecutive admission sampling technique, as many as 20 people. Data collection was carried out by observing mothers who did walking sports by giving galoba juice for 14 consecutive days with a walking time of 25 minutes. Statistical was using the Independent t-test. The results obtained that the average value of body fat composition after walking was 38,1% 0,05). The average value of total anti-oxidants after walking was 1,58 µg/mL 0,05). The conclusion is that there is no effect of walking physical exercise on body fat composition and there is no effect of the physical exercise model walking with the provision of galoba juice on total antioxidant levels.

The purpose of the present study is to evaluate anthropometric, biochemical, hormonal and performance differences among physically active individuals who utilize (or not) Tribulus terrestris (TT) supplementation. The cohort is composed of 32 subjects divided into two groups: 1) 8 males and 8 females individuals who are physically active and utilize Tribulus terrestres; 2) 8 males and 8 females individuals who are physically active and utilize placebo. Inclusion criteria for all subjects consisted of age requirement within the range of 18 and 40 years old, a history of at least 6 months of physical activity and absence of any drug treatment/consumption. Analysis of body composition, physical performance test and blood collection for subsequent hormonal and biochemical tests were collected. Data were processed and analyzed based on descriptive statistical tests and one-way-ANOVA. Results were considered statistically significant when p

Introduction: In a normal healthy adult, sympathetic and parasympathetic system should be in synergy. Measuring resting heart rate is a one of the methods to assess health condition. It can be affected by different factors such as exercise, mental health, any disease, etc. Normal subjects with reduced heart rate are associated with better cardiovascular health. Physical inactivity is associated with high level of inflammatory markers. Increased inflammatory markers are related to inflammation and chronic diseases. The C-Reactive Protein (CRP) is a biomarker of inflammatory diseases. High CRP level is a potent risk factor for obesity, diabetes, atherosclerosis, etc. Aim: To study the effect of short term resistance and endurance exercise training on resting heart rate in healthy young adults, CRP, Body Mass Index (BMI) and also to compare the changes between two exercise groups. Materials and Methods: A cross-sectional study was conducted from May 2019 to May 2020 in the Department of Physiology at King George’s Medical University, Lucknow, Uttar Pradesh, India. The study included 60 healthy young adults with normal BMI (18.5-24.9 kg/m2 ) and age between 18-25 years. Subjects were equally divided into Group IResistance exercise and Group II endurance groups. Subjects did moderate intensity exercise (based on maximum heart rate) for five days in a week for eight weeks. Endurance group did jogging. Resistance group did push-up, pull-up and squats. Target heart rate during moderate intensity of activities was 64- 76% of maximum heart rate. Heart rate measurement was done before the start of exercise and after five to seven minutes of exercise when it reached 64-76% of maximum heart rate. It was measured by pulse oximeter. Follow-up was done after eight weeks of exercise training in both the groups. Evaluation was done by comparing resting heart rate and CRP level before the start of training and after the completion of training programme. Statistical analysis was done using student t-test and paired t-test. Results: Mean age of subjects of group I was found to be higher (19.98±1.26 years) as compared to group II (19.97±0.98 years). Mean pre intervention BMI of both the groups was found to be similar (21.97±1.78 kg/m2 ). No statistically significant change in resting heart rate was found in both resistance group (p=0.096) and endurance group (p=0.326) after exercise training. Statistically significant increase in CRP was found in resistance group (p

Introduction: In a normal healthy adult, sympathetic and parasympathetic system should be in synergy. Measuring resting heart rate is a one of the methods to assess health condition. It can be affected by different factors such as exercise, mental health, any disease, etc. Normal subjects with reduced heart rate are associated with better cardiovascular health. Physical inactivity is associated with high level of inflammatory markers. Increased inflammatory markers are related to inflammation and chronic diseases. C-Reactive Protein (CRP) is a biomarker of inflammatory diseases. High CRP level is a potent risk factor for obesity, diabetes, atherosclerosis, etc. Aim: To study the effect of short-term endurance and resistance exercises in healthy young adults on resting heart rate, CRP body mass index and also to compare the changes between two exercise groups. Materials and Methods: A cross-sectional study was conducted from May 2019 to May 2020 in the Department of Physiology at King George's Medical University, Lucknow, Uttar Pradesh, India. The study included 60 healthy young subjects with normal Body Mass Index (BMI) (18.5-24.9 kg/m2) and age between 18-25 years participated. Subjects were equally divided into endurance (group I) and resistance exercise (group II) groups. Subjects did moderate intensity exercise (based on maximum heart rate) for five days in a week for eight weeks. Endurance group did jogging. Resistance group did pushup, pull-up and squats. Target heart rate during moderate intensity of activities is 64-76% of maximum heart rate. Heart rate measurement was done before the start of exercise and after five to seven minutes of exercise when it reached 64-76% of maximum heart rate. It was measured by pulse oximeter. Follow-up was done after eight weeks of exercise training in both the groups. Evaluation was done by comparing resting heart rate and CRP level before the start of training and after the completion of training programme. Statistical analysis was done using student t-test and paired t-test. Results: Mean age of subjects of group I was found to be higher (19.98±1.26 years) as compared to group II (19.97±0.98 years). Mean pre-intervention BMI of both the groups was found to be similar (21.97±1.78 kg/m2). No statistically significant change in resting heart rate was found in both resistance group (p-value=0.096) and endurance group (p-value=0.326) after exercise training. Statistically significant increase in CRP was found in resistance group (p-value<0.001) and endurance group (p-value<0.001). The increment in CRP was more in endurance group (55.04%) than resistance group (35.34%). Conclusion: Short duration of exercises increase inflammation but no significant effect on resting heart rate was seen. [ABSTRACT FROM AUTHOR]

Abstract Background Obesity in the United States is a serious and preventable health concern. Previous research suggests that habitual short sleep may influence obesity-risk behaviors, such as increased caloric intake, decreased physical activity and increased engagement in sedentary activities (e.g., media consumption, computer usage). Given that existing longitudinal research studies have methodological concerns preventing conclusive interpretations, Project STARLIT was designed to address these limitations and identify future intervention targets. Methods A sample of young adults (n = 300) will be recruited during the summer prior to entering college. Participants will be screened for eligibility requirements prior to the inclusion in the Time 1 assessment though phone and in-person interviews. Once enrolled, participants will complete four assessments over a two year period (i.e., approximately 8, 16 and 24 months after Time 1). Each assessment will consist of one week of data collection including both objective (i.e., habitual sleep, physical activity, body fat composition) and subjective (i.e., sleep diary, 24-h food recall, technology use, and sleep-related beliefs/behaviors) measures. Discussion Project STARLIT is designed to address methodological concerns of previous research. In addition to clarifying the relationship between habitual short sleep and weight gain among young adults, the proposed study will identify problematic obesity risk behaviors associated with habitual short sleep (e.g., increased caloric intake, physical/sedentary activity). The results will identify prevention or intervention targets related to obesity risk. Trial registration ClinicalTrials.gov NCT04100967, 9/23/19, Retrospectively registered.

Background: The objective of this study was to increase understanding of the complex interactions between diet, obesity, and the gut microbiome of adult female non-human primates (NHPs). Subjects consumed either a Western (n=15) or Mediterranean (n=14) diet designed to represent human dietary patterns for 31 months. Body composition was determined using CT, fecal samples were collected, and shotgun metagenomic sequencing was performed. Gut microbiome results were grouped by diet and adiposity. Results: Diet was the main contributor to gut microbiome bacterial diversity. Adiposity within each diet was associated with subtle shifts in the proportional abundance of several taxa. Mediterranean diet-fed NHPs with lower body fat had a greater proportion of Lactobacillus animalis than their higher body fat counterparts. Higher body fat Western diet-fed NHPs had more Ruminococcus champaneliensis and less Bacteroides uniformis than their low body fat counterparts. Western diet-fed NHPs had significantly higher levels of Prevotella copri than Mediterranean diet NHPs. Western diet-fed subjects were stratified by P. copri abundance (P. copriHIGH versus P. copriLOW), which was not associated with adiposity. Overall, Western diet-fed animals in the P. copriHIGH group showed greater proportional abundance of B. ovatus, B. faecis, P. stercorea, P. brevis, and Faecalibacterium prausnitzii than those in the Western P. copriLOW group. Western diet P. copriLOW subjects had a greater proportion of Eubacterium siraeum. E. siraeum negatively correlated with P. copri proportional abundance regardless of dietary consumption. In the Western diet group, Shannon diversity was significantly higher in P. copriLOW when compared to P. copriHIGH subjects. Furthermore, gut E. siraeum abundance positively correlated with HDL plasma cholesterol indicating that those in the P. copriLOW population may represent a more metabolically healthy population. Untargeted metabolomics on urine and plasma from Western diet-fed P. copriHIGH and P. copriLOW subjects suggest early kidney dysfunction in Western diet-fed P. copriHIGH subjects. Conclusions: In summary, the data indicate diet to be the major influencer of gut bacterial diversity. However, diet and adiposity must be considered together when analyzing changes in abundance of specific bacterial taxa. Interestingly, P. copri appears to mediate metabolic dysfunction in Western diet-fed NHPs. 6J_wxx79_1pf52UFxoCxzk Video abstract [ABSTRACT FROM AUTHOR]

Recently, a simple, accurate and non-age-related index “Systolic/Diastolic Blood Pressure to Height Ratio (SBPHR/DBPHR)” is started to try for diagnosing hypertension in childhood. The aim of this study was to investigate the possible cut-off points and diagnostic value of BPHR for identifying prehypertension/hypertension in children and adolescent, and evaluation of the relationship between body fat composition and BP. The community-based descriptive cross-sectional study was carried out with 2730 students in 17 elementary and high school. Total body fat composition was analyzed with bioelectrical impedance analysis method. The ROC curve analysis indicated that SBPHR/DBPHR was a good predictor for identifying hypertension (AUC = 0.937, p < 0.0001; AUC = 0.880, p < 0.0001, respectively). The optimal cut-off values of SBPHR/DBPHR for hypertension were detected as 0.7767, 0.4688; respectively. Although, optimal cut-off points of SBPHR/DBPHR were statistically significant for discriminating prehypertension (0.6849, p < 0.0001; 0.4425, p < 0.0001, respectively), but the diagnostic value was lower (AUC = 0.738; AUC = 0.751, respectively). An increase of 1 unit in total body fat (%) leads to an average 0.38/0.26 mmHg increase in SBP/DBP values (p < 0.001). The results suggest that BPHR may be a useful diagnostic marker for screening elevated BP in childhood, and SBP/DBP values affected by the increase in total body fat percentage in obese and non-obese children.

Background: Obesity in the United States is a serious and preventable health concern. Previous research suggests that habitual short sleep may influence obesity-risk behaviors, such as increased caloric intake, decreased physical activity and increased engagement in sedentary activities (e.g., media consumption, computer usage). Given that existing longitudinal research studies have methodological concerns preventing conclusive interpretations, Project STARLIT was designed to address these limitations and identify future intervention targets.Methods: A sample of young adults (n = 300) will be recruited during the summer prior to entering college. Participants will be screened for eligibility requirements prior to the inclusion in the Time 1 assessment though phone and in-person interviews. Once enrolled, participants will complete four assessments over a two year period (i.e., approximately 8, 16 and 24 months after Time 1). Each assessment will consist of one week of data collection including both objective (i.e., habitual sleep, physical activity, body fat composition) and subjective (i.e., sleep diary, 24-h food recall, technology use, and sleep-related beliefs/behaviors) measures.Discussion: Project STARLIT is designed to address methodological concerns of previous research. In addition to clarifying the relationship between habitual short sleep and weight gain among young adults, the proposed study will identify problematic obesity risk behaviors associated with habitual short sleep (e.g., increased caloric intake, physical/sedentary activity). The results will identify prevention or intervention targets related to obesity risk.Trial Registration: ClinicalTrials.gov NCT04100967, 9/23/19, Retrospectively registered. [ABSTRACT FROM AUTHOR]

Introduction: High blood pressure (BP) is one of the most common chronic medical problems prompting visits to primary health-care providers. The incidence of lifestyle diseases over the years has shown an upward trend in developing countries too, which is a cause of grave concern for the health care professionals. Research suggests that undesirable body composition has a major bearing on health, fitness and lifestyle diseases such as hypertension, ischemic heart disease, and diabetes. Study: The aim of the study was to compare the body composition of hypertensive patients with normal subjects using state of the art impedance based noninvasive body composition analyzer. The study evaluated the body composition of hypertensive patients and compared the same with subjects with normal BP. The study was carried out at a tertiary care hospital in Pune. Body composition variables considered for the study were anthropometry, percent body fat, lean body mass, fat distribution, and visceral fat composition. Results: The analysis of body fat included obesity degree, visceral fat area (VFA), body fat mass, and percent body fat. The mean body fat mass was found to be 21.7Kg. The mean percent Body Fat was 28.9%, which was much higher than the normal. Various parameters depicting body fat were compared. All of them, namely body fat mass, percent body fat, obesity degree, and VFA were found to be significantly higher in hypertensives as compared to the other group. Conclusion: Besides other anthropometric parameters, assessment of VFA may be included as an essential measure to assess and even predict hypertension. Those with high VFA must be monitored closely for developing hypertension and other lifestyle diseases.

Recently, a simple, accurate and non-age-related index "Systolic/Diastolic Blood Pressure to Height Ratio (SBPHR/DBPHR)" is started to try for diagnosing hypertension in childhood. The aim of this study was to investigate the possible cut-off points and diagnostic value of BPHR for identifying prehypertension/hypertension in children and adolescent, and evaluation of the relationship between body fat composition and BP. The community-based descriptive cross-sectional study was carried out with 2730 students in 17 elementary and high school. Total body fat composition was analyzed with bioelectrical impedance analysis method. The ROC curve analysis indicated that SBPHR/DBPHR was a good predictor for identifying hypertension (AUC = 0.937, p < 0.0001; AUC = 0.880, p < 0.0001, respectively). The optimal cut-off values of SBPHR/DBPHR for hypertension were detected as 0.7767, 0.4688; respectively. Although, optimal cut-off points of SBPHR/DBPHR were statistically significant for discriminating prehypertension (0.6849, p < 0.0001; 0.4425, p < 0.0001, respectively), but the diagnostic value was lower (AUC = 0.738; AUC = 0.751, respectively). An increase of 1 unit in total body fat (%) leads to an average 0.38/0.26 mmHg increase in SBP/DBP values (p < 0.001). The results suggest that BPHR may be a useful diagnostic marker for screening elevated BP in childhood, and SBP/DBP values affected by the increase in total body fat percentage in obese and non-obese children. [ABSTRACT FROM AUTHOR]

This study aims to evaluate the effect of Daud Fasting (Islamic alternate-day fasting for 13-15 hours) on body weight, body fat, and skeletal muscle percentage. Twenty-nine obese young adults (19-29 years old) in Dramaga, Bogor, Indonesia, were randomized to fasting and control groups. Participants in the fasting group were asked to fast from dawn to sunset for four weeks. Anthropometric measurements (body weight, body fat, and skeletal muscle percentage) were performed. Body weight, BMI, and trunk fat percentage levels decreased significantly in fasting group without reduction of skeletal muscle, within four weeks. In conclusion, Daud fasting can be a solution to obesity. [ABSTRACT FROM AUTHOR]

Objective: To investigate the parental physical and lifestyle determinants of newborn body composition.Design: Prospective cohort study.Setting: Cork University Maternity Hospital, a tertiary referral hospital in Cork, Ireland.Population: All babies were recruited as part of a prospective birth cohort, Babies AfterScope: Evaluating the Longitudinal Impact Using Neurological and Nutritional Endpoints (BASELINE). These babies were recruited from women who had participated in the Screening of Pregnancy Endpoints (SCOPE) study Ireland, a prospective, multicentre cohort studyMethods: Multivariate linear regression was used to analyse the effect of a range of maternal and paternal physical and lifestyle features on neonatal body fat percentage (BF%).Main Outcome Measures: Neonatal BF%. Neonatal adiposity was assessed within 48 hours of birth using air displacement plethysmography (PEAPOD(®) ).Results: In all, 1243 infants were enrolled in the study. Increasing maternal body mass index (adjusted mean difference 0.09; 0.04, 0.15) and waist height ratio (adjusted mean difference 6.59; 0.27, 12.92) were significantly associated with increased neonatal BF%. In contrast, maternal smoking was associated with reduced neonatal BF% compared with non smokers (adjusted mean difference -0.55; -1.07, -0.03). Infant sex significantly altered neonatal BF%, with female infants having higher neonatal BF% compared with male infants (adjusted mean difference 1.98; 1.54, 2.53). No association was observed between paternal body mass index (BMI), paternal age or paternal smoking and neonatal BF%.Conclusions: Maternal smoking, BMI, waist height ratio and infant sex were associated with altered BF%.Tweetable Abstract: Maternal smoking, BMI, waist height ratio and infant sex are associated with altered neonatal body fat percentage. [ABSTRACT FROM AUTHOR]

Atypical antipsychotic drugs such as olanzapine induce weight gain and metabolic changes associated with the development of type 2 diabetes. The mechanisms underlying these metabolic side-effects are unknown at the moment. In this study, we investigated the metabolic changes induced by a chronic treatment, as well as the influence of a preceding chronic treatment on the acute effects of olanzapine on glucose metabolism. The effect of chronic olanzapine treatment (±6.5 mg/kg/day, administered via drinking water) on body weight, locomotor activity, body temperature, fat distribution and energy expenditure was investigated in male rats. After 5 weeks, the animals received an acute olanzapine challenge (intragastric, IG) at 3 mg/kg/h during 160 min to investigate the acute effects of olanzapine on glucose metabolism. Chronic olanzapine-treated animals showed a slight decrease in nocturnal body temperature, and increased perirenal fat pad weights as well as plasma leptin. In addition, chronic olanzapine-treated animals showed hyperinsulinaemia with unchanged blood glucose concentrations. The acute challenge with IG olanzapine elevated blood glucose levels and endogenous glucose production in control animals, but not in chronic olanzapine-pre-treated rats. Chronic olanzapine-treated animals also showed reduced locomotor activity and a higher respiratory exchange ratio. Thus, chronic treatment with olanzapine in rats causes desensitization to its acute effects on glucose metabolism but promotes adiposity probably due to a shift from lipids to carbohydrates as an energy source. Chronic exposure to olanzapine changes body fat distribution and insulin sensitivity in an unfavourable direction, but it is still unclear what the primary mechanism is. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: Body fat distribution changes are associated with multiple alterations in metabolism. Therefore, the assessment of body fat compartments by MRI in animal models is a promising approach to obesity research. Standard T1-weighted (T1w) whole body MRI was used here to quantify different effects in the subcutaneous and visceral fat compartments in rats under treatment with an anorexiant. Materials and methods: Twenty rats on a high caloric diet were investigated by the identical MRI protocol at baseline and after seven weeks. Ten rats received a treatment with sibutramine, 10 rats served as vehicle control group. To longitudinally assess body fat components, MRI analysis was used with two approaches: 2D slicewise graphic analysis (SGA) was compared with an automated 3D analysis algorithm (3DA). Results: At the group level, fat volume differences showed a longitudinal increase of subcutaneous and visceral fat volumes for the control group, whereas the sibutramine group showed stable subcutaneous fat volumes and decrease in visceral fat volumes. SGA and 3DA volume determination showed significant correlations for subcutaneous fat volume (C=0.85, p<0.001), visceral fat volume (C=0.87, p<0.001), and total fat volume (C=0.90, p<0.001). Conclusion: It could be demonstrated that computer-based analysis of T1w MRI could be used to longitudinally assess changes in body fat compartments in rats at the group level. In detail, it was possible to investigate the effect of sibutramine separate on the fat compartments in rats. [Copyright &y& Elsevier]

Type 2 diabetes (T2D) is a chronic condition where the body is resistant to insulin, leading to an elevated blood glucose state. Obesity is a main factor leading to T2D. Many clinical studies, however, have described a proportion of obese individuals who express a metabolically healthy profile, whereas some lean individuals could develop metabolic disorders. To study obesity as a risk factor, body fat distribution needs to be considered rather than crude body weight. Different individuals' bodies favor storing fat in different depots; some tend to accumulate more fat in the visceral depot, while others tend to store it in the femoral depot. This tendency relies on different factors, including genetic background and lifestyle. Consuming some types of medications can cause a shift in this tendency, leading to fat redistribution. Fat distribution plays an important role in the progression of risk of insulin resistance (IR). Apple-shaped individuals with enhanced abdominal obesity have a higher risk of IR compared to BMI-matched pear-shaped individuals, who store their fat in the gluteal-femoral depots. This is related to the different adipose tissue physiology between these two depots. In this review, we will summarize the recent evidence highlighting the underlying protective mechanisms in gluteal-femoral subcutaneous adipose tissues compared to those associated with abdominal adipose tissue, and we will revise the recent evidence showing antidiabetic drugs that impact fat distribution as they manage the T2D condition.

Summary Obesity is a health issue for people in Asia, and many studies support that childbearing may contribute to women's obesity. However, most studies of post-partum weight retention (PWR) focus on Western countries. This paper aimed to review recent data on PWR and discuss the related factors of PWR for women in Asia. Three electronic databases - MEDLINE, CINAHL and PsycINFO - were searched for data from January 1990 to August 2010. Twelve studies were identified as containing information related to PWR. Chinese, Taiwanese and Korean women tend to have higher gestational weight gain and PWR than women in other Asian countries in this review. The average reported gestational weight gain in these studies ranged from 8.3 kg to 18.0 kg, and the average weight retention at 6 months post partum in various countries ranged from 1.56 kg to 4.1 kg. Gestational weight gain had a positive effect on PWR, but there were no consistent conclusions for other factors. Only a few psychosocial and behavioural factors have been studied. Moreover, no one has assessed changes in waist circumference and waist-to-hip ratio for measuring central obesity and ensuring risk of chronic disease. Focusing on changes in maternal weight and body composition, and considering the impact of psychological and behavioural factors are suggested for future studies in Asia. [ABSTRACT FROM AUTHOR]

Objective: To develop a magnetic resonance imaging (MRI)-based approach for quantifying absolute fat mass in organs, muscles, and adipose tissues, and to validate its accuracy against reference chemical analysis (CA). Methods: Chemical-shift imaging can accurately decompose water and fat signals from the acquired MRI data. A proton density fat fraction (PDFF) can be computed from the separated images, and reflects the relative fat content on a voxel-by-voxel basis. The PDFF is mathematically closely related to the fat mass fraction and can be converted to absolute fat mass in grams by multiplying by the voxel volume and the mass density of fat. In this validation study, 97 freshly excised and unique samples from four pigs, comprising of organs, muscles, and adipose and lean tissues were imaged by MRI and then analyzed independently by CA. Linear regression was used to assess correlation, agreement, and measurement differences between MRI and CA. Results: Considering all 97 samples, a strong correlation and agreement was obtained between MRI and CA-derived fat mass (slope = 1.01, intercept = 1.99g, r2 = 0.98, P < 0.01). The mean difference d between MRI and CA was 2.17±3.40g. MRI did not exhibit any tendency to under or overestimate CA (P > 0.05). When considering samples from each pig separately, the results were (slope = 1.05, intercept = 1.11g, r2 = 0.98, d = 2.66±4.36g), (slope = 0.99, intercept = 2.33g, r2 = 0.99, d = 1.88±2.68g), (slope = 1.07, intercept = 1.52g, r2 = 0.96, d = 2.73±2.50g), and (slope = 0.92, intercept = 2.84g, r2 = 0.97, d = 1.18±3.90g), respectively. Conclusion: Chemical-shift MRI and PDFF provides an accurate means of determining absolute fat mass in organs, muscles, and adipose and lean tissues. [ABSTRACT FROM AUTHOR]

To evaluate the effects of intensive insulin therapy alone and with added pioglitazone on body weight, fat distribution, lean body mass (LBM) and liver fat in type 2 diabetic patients. Twenty-five insulin-treated, obese patients with type 2 diabetes were randomized to addition of pioglitazone 45 mg (n = 12) or placebo (n = 13) and treated intensively for 12-16 weeks. Dual-energy X-ray absorptiometry/abdominal computed tomography scans were performed before/after treatment. LBM, visceral/subcutaneous adipose tissue (VAT/SAT) and liver/spleen (L/S) attenuation ratios were measured pre-/posttreatment (a ratio <1 represents fatty liver). Intensive insulin alone and insulin + pioglitazone significantly improved glycaemic control (7.8 ± 0.3 to 7.2 ± 0.3% and 7.6 ± 0.3 to 7.1 ± 0.4%, respectively). Body weight gain was greater with insulin + pioglitazone (4.9 ± 4.5 kg) versus insulin therapy alone (1.7 ± 0.7 kg). SAT increased significantly with pioglitazone + insulin therapy (393.9 ± 48.5 to 443.2 ± 56.7 cm, p < 0.01) compared to a non-significant increase with insulin therapy alone (412.9 ± 42.5 to 420.8 ± 43.8 cm). VAT decreased non-significantly in both groups (240.3 ± 41.7 to 223.8 ± 38.1 cm with insulin + pioglitazone and 266.6 ± 27.4 to 250.5 ± 22.2 cm with insulin therapy). LBM increased significantly by 1.92 ± 0.74 kg with insulin + pioglitazone treatment. The L/S attenuation ratio in the placebo + insulin group decreased from 1.08 ± 0.1 to 1.04 ± 0.1 (p = ns) and increased from 1.00 ± 0.1 to 1.08 ± 0.05 (p = 0.06) in the pioglitazone + insulin group. Intensification of insulin therapy in type 2 diabetic patients causes modest weight gain and no change in body fat distribution, LBM or liver fat. In contrast, the addition of pioglitazone, at equivalent glycaemia, increases weight gain, fat mass and SAT; increases LBM and tends to decrease liver fat. These changes in fat distribution may contribute to the beneficial effects of pioglitazone, despite greater weight gain. [ABSTRACT FROM AUTHOR]

Abstract: Aims: The present study evaluated the relationship between metabolic syndrome (MS), body fat composition and epicardial adipose tissue (EAT) in type 1 diabetes. Epicardial adipose tissue is a new independent marker of coronary artery disease (CAD). Methods: Forty-five type 1 diabetic women were evaluated (age 36±9 years; body mass index 24.6±4.4kg/m2). Metabolic syndrome was defined by the World Health Organization criteria. Body fat composition and EAT were analyzed by dual-energy-X-ray absorptiometry and echocardiogram, respectively. Results: Twenty patients (45%) had MS. Patients with MS had greater android (central) fat deposition than patients without MS (41.9±2.0% vs. 33.7±1.8%, p =0.004). Total body fat and gynoid (peripheric) fat distribution were similar between the groups. Mean EAT was higher in patients with MS (6.15±0.34mm vs. 4.96±0.25mm; p =0.006) and EAT was positively correlated with android (central) fat distribution (r =0.44; p =0.002), however no correlation was found with gynoid (peripheric) fat distribution. Conclusions: There was a high incidence of MS in type 1 diabetes related to increased central adiposity, despite the absence of obesity. Metabolic syndrome and central obesity were associated with increased EAT. Thus, young non-obese type 1 diabetic women with central adiposity and/or MS may have increased EAT, what may predict CAD risk. [ABSTRACT FROM AUTHOR]

The article presents a study which examines the effect of protein supplementation (PRO) prior the heavy resistance training (HRT) to post exercise resting energy expenditure (REE) and respiratory exchange ratio (RER). It mentions the measurement of body composition such as height, body mass, and body fat percentage of subjects, and their performance for preliminary exercises for five minutes using a stationary cycle ergometer. The study also includes measurement of one-repetition maximum (1RM) on several weight exercises which include squat, bench press, and lateral raise. Results of the study reveal a significant increase of REE in while RER in 24 hours after HRT decreased PRO and carbohydrate supplementation (CHO).

Objective: To compare changes in maternal weight and body fat composition from early to late pregnancy and 6–8 months postnatally between primiparous and multiparous patients Methods: Maternal weight and body fat percentage were assessed in a cohort of low-risk uncomplicated women in a general antenatal clinic at 14–20 weeks gestation, after 36 weeks, and around six to eight months after delivery using a Tanita TBF 105 Fat Analyser. Maternal epidemiological and anthropometric data, as well as pregnancy characteristics and perinatal outcome, were derived from standard antenatal records after delivery. The cohort was stratified into primiparous and multiparous women for comparison. Results: In a cohort of 104 women, 55 (52.8%) were primiparous and 49 (47.1%) were multiparous. A relatively good overall correlation between body fat percentage gain and weight gain was observed (correlation coefficient 0.33) from early to late pregnancy. Primiparous women had higher weight gain (12 kg) and higher body fat gain (7.7%) during the pregnancy compared to multiparous women (10.8 kg and 6%, respectively), and they also retained more of the fat accumulated during pregnancy (1.92% vs – 0.44%, P < 0.001) when assessed over six months after their delivery. Conclusion: The findings could represent more exaggerated physiological responses to the pregnant state in the primiparous woman as compared to multiparous women. [ABSTRACT FROM AUTHOR]

The effects of conjugated linoleic acid (CLA) on body weight and body composition in man are controversial. The aim of this study was to investigate the effects of milk supplementation with CLA on body composition and on the biochemical parameters of the metabolic syndrome. This was a randomised, double-blind, placebo-controlled trial. Subjects were randomised to a daily intake of 500??ml milk supplemented with 3??g CLA (using a mixture of the bioactive isomers cis-9, trans-11 and trans-10, cis-12, marketed as Tonalin??, Naturlinea; Central Lechera Asturiana) or placebo for 12 weeks. Sixty healthy men and women (aged 35???65 years) with signs of the metabolic syndrome participated (BMI 25???35??kg/m2). Dual-energy X-ray absorptiometry was used to measure body composition (week 0 baseline and week 12). Total fat mass in the CLA-milk subgroup with a BMI???????30??kg/m2 decreased significantly while no changes were detected in the placebo group (~2??%, P??=??0??01). Trunk fat mass showed a trend towards reduction (~3??%, P??=??0??05). CLA supplementation had no significant effect on the parameters of the metabolic syndrome, nor was it associated with changes in haematological parameters or renal function. The supplementation of milk with 3??g CLA over 12 weeks results in a significant reduction of fat mass in overweight but not in obese subjects. CLA supplementation was not associated with any adverse effects or biological changes. [ABSTRACT FROM PUBLISHER]

Both thyroid hormones and leptin affect sympathetic nervous system activity, basal metabolic rate, body fat mass, food intake, and thermogenesis, and each one also affects the actions of the other. We examined the alterations in serum leptin concentrations and leptin mRNA expression in hypothyroid rats and investigated the relation between serum leptin and leptin mRNA levels with the total adipose tissue mass and total body weight. Twenty male Wistar rats were divided into 2 groups, euthyroid and hypothyroid. Their body compositions were examined by Dual Energy X-ray Absorptiometry at the beginning and end of the study. Serum leptin concentrations and levels of leptin mRNA in the retroperitoneal white adipose tissue were measured at the end of the study. Serum leptin concentrations did not show any difference between the two groups (1.9 ± 0.2 ng/ml in the hypo and euthyroid group, P > 0.05), but the fat mass of the hypothyroid rats were lower than the euthyroid rats (21.1 ± 2.5 g in the euthyroid group and 14.2 ± 1.9 g in the hypothyroid group, P > 0.05 between groups at the end of the study) although the difference between the groups was statistically not significant. Leptin mRNA level was significantly higher in the hypothyroid group than in the euthyroid group (21.6 ± 1.6 vs. 15.1 ± 1.2 ng respectively, P = 0.002) although the dissected retroperitoneal fat weight was significantly lower in the hypothyroid group versus the euthyroid group (1.0 ± 0.2 vs. 1.8 ± 0.2 g respectively, P = 0.013). In conclusion, the change of leptin mRNA expression in white adipocytes was thought to be the direct result of hypothyroidism or a compensatory response to metabolic changes caused by hypothyroidism. [ABSTRACT FROM AUTHOR]

Introduction: The association between body fat composition as measured by dual energy x-ray absorptiometry (DEXA) scanning and pediatric sleep related breathing disorder (SRBD) is not well established. We investigated the relationship between body mass index (BMI) and DEXA parameters and their association with SRBD in obese children., Patients and Methods: Overnight polysomnography was performed on obese/overweight children (10-17 years) with habitual snoring. Total body fat mass (g), trunk fat mass (g), total body % fat, and trunk % fat were determined by DEXA., Results: Forty-one subjects were studied. Logarithm (Log) total arousal index correlated with BMI (p < 0.01, r = 0.473), total body fat mass (p < 0.05, r = 0.331), and trunk fat mass (p < 0.05, r = 0.319). Log desaturation index correlated with BMI (p < 0.05, r = 0.313), total body fat mass (p < 0.05, r = 0.375), and trunk fat mass (p < 0.05, r = 0.391), whereas obstructive apnea hypopnea index (OAHI) did not. In males 10-12 years, there was a significant correlation between Log total arousal index and obesity parameters, but not for males aged 13-17 years. BMI correlated with DEXA parameters in all subjects: total body fat mass (p < 0.001, r = 0.850); total body % fat (p < 0.01, r = 0.425); trunk fat mass (p < 0.001, r = 0.792) and trunk % fat (p < 0.05, r = 0.318) and in 10-12 year old males. This relationship was not significant in males aged 13-17 years., Conclusions: Total body fat mass and trunk fat mass as well as BMI correlated with total arousal index and desaturation index. BMI correlated with DEXA parameters in 10-12 year old males but not in 13-17 year old males. The value of using DEXA scanning to study the relationship between obesity and SRBD may depend on age and pubertal stage., (© 2015 American Academy of Sleep Medicine.)