Search

Objetivo: Determinar la prevalencia del volumen de grasa visceral estimado por ecuación predictiva en un grupo de adultos de Bogotá, Colombia, además de evaluar la relación de la grasa visceral con factores de riesgo asociados a enfermedad cardiovascular. Materiales y métodos: Estudio transversal en 413 hombres voluntarios del sector educativo y automotriz de Bogotá, Colombia. El volumen de grasa visceral fue estimado por ecuación predictiva y los resultados fueron divididos por terciles de volumen de grasa visceral. Se midió: índice de masa corporal, circunferencia de la cintura, razón cintura-estatura, índice de adiposidad corporal, tensión arterial sistólica, diastólica y media, colesterol total, triglicéridos, c-HDL, c-LDL y glucosa. Se calcularon los cocientes CT/c-HDL, c-LDL/c-HDL, TG/c-HDL e índice lipídico-metabólico. Resultados: La edad media de los evaluados fue 30,6 ± 11,8 (IC95% 29,4-31,7 anos) ˜ y la prevalencia de obesidad visceral fue de 34,6%. Los sujetos con menor valor de volumen de grasa visceral (tercil 1) presentaron mejores niveles de CT (terciles 1 a 3, 156,4, 168,6 y 202,0; p < 0,001 lineal), menor cociente TG/c-HDL (2,0, 2,8 y 5,2; p < 0,001 lineal), menor razón CT/cHDL (3,3, 3,8 y 4,7; p < 0,001 lineal), y un índice lipídico-metabólico más saludable (0,73, 0,44 y -0,68; p < 0,001 lineal). Los sujetos con mayor volumen de grasa visceral (tercil 2 y 3), presentaron correlación positiva y significativa con el peso corporal (r = 0,261), CC (r = 0,484), IAC (r = 0,188), RCE (r = 0,551), CT (r = 0,531), TG (r = 0,422), c-LDL (r = 0,389), c-LDL/c-HDL (r = 0,216), CT/c-HDL (r = 0,374) y TG/c-HDL (r = 0,393), p < 0,001. Conclusión: Se verificó una elevada prevalencia de obesidad visceral, y correlaciones positivas con factores de riesgo asociados a enfermedad cardiovascular. © 2016 Sociedad Colombiana de Cardiología y Cirugía Cardiovascular Objective To determine prevalence of visceral fat volume estimated by means of a predictive equation in an adult group in Bogota, Colombia, as well as to assess the relationship between visceral fact and risk factors associated to cardiovascular disease. Material and methods Cross-sectional study of 413 volunteer men working in the education and automotive sectors in Bogota, Colombia. Visceral fat volume was estimated with a predictive equation and results were divided into tertiles of visceral fat volume. The following values were measured: body mass index, waist circumference, wast-to-height ratio, body adiposity index, systolic, diastolic and average blood pressure, total cholesterol, triglycerides, HDL-c, LDL-c and glucose. Following ratios were calculated: TC/HDL-c, LDL-c/HDL-c, TG/HDL-c and lipid and metabolic index. Results Participants’ average age was 30.6 ± 11.8 (CI 95%; 29.4-31.7 years) and prevalence of visceral obesity was of 34.6%. Individuals with a lower volume of visceral fat (tertile 1) showed better TC levels (tertiles 1 o 3, 156.4, 168.6 y 202.0; p < 0.001 linear), lower TG/HDL-c ratio (2.0, 2.8 y 5.2; p < 0.001 linear), lower TC/HDL-c ratio (3.3, 3.8 y 4.7; p < 0.001 linear) and a healthier lipid and metabolic index (0.73, 0.44 y -0.68;p < 0.001 linear). Participants with a higher volume of visceral fat (tertiles 2 and 3) showed a positive and significant correlation with body mass (r = 0.261), WC (r = 0.484), BAI (r = 0.188), WHR (r = 0.551), TC (r = 0.531), TG (r = 0.422), LDL-c (r = 0.389), LDL-c/HDL-c (r = 0.216), TC/HDL-c (r = 0.374) and TG/HDL-c (r = 0.393), p < 0.001. Conclusion A high prevalence of visceral obesity and a positive correlation with risk factors associated to cardiovascular disease were verified. © 2016 Sociedad Colombiana de Cardiología y Cirugía Cardiovascular

Background. Adiponectin is an adipocytes-derived hormone which has been shown to possess insulin-sensitizing, antiatherogenic, and anti-inflammatory properties. In acromegaly, the data on adiponectin is contradictory. The relationship between adiponectin levels and cardiac parameters has not been studied. Objectives. The aim of this study was to find out how adiponectin levels were affected in acromegalic patients and the relationship between adiponectin levels and cardiac parameters. Material and Methods. We included 30 subjects (15 male, 15 female), diagnosed with acromegaly and 30 healthy (10 male, 20 female) subjects. Serum glucose, insulin, GH, IGF-1 and adiponectin levels were obtained and the insulin resistance of the subjects was calculated. Echocardiographic studies of the subjects were performed. Results. We determined that adiponectin levels were significantly higher in the acromegalic group than the control group. In the acromegalic group, there was no statistically significant relation between serum adiponectin and growth hormone (GH), or insulin-like growth factor-1 (IGF-1) levels (p = 0.3, p = 0.1). We demonstrated that cardiac function and structure are affected by acromegaly. IVST, PWT, LVMI, E/A ratio, DT, ET, IVRT, VPR, and LVESV values were increased and the results were statistically significant. In the acromegalic group, adiponectin levels were positively related with left ventricle mass index (LVMI) but this correlation was found to be statistically weak (p = 0.03). In our study, there was a positive correlation between VAI and LVM. We also could not find any correlation between VAI and adiponectin levels. Conclusions. Although insulin resistance and high insulin levels occur in active acromegaly patients, adiponectin levels were higher in our study as a consequence of GH lowering therapies. Our study showed that adiponectin levels may be an indicator of the cardiac involvement acromegaly. However, the usage of serum adiponectin levels in acromegalic patients as an indicator of cardiac involvement should be supported with other, wide, multi-centered studies. © Copyright by Wroclaw Medical University.

Introduction: Adipose tissue in mesenteric fat plays a key role in systemic and luminal inflammation through production of Tumor Necrosis Factor-α (TNF-α) and inhibition of adiponectin, an anti-inflammatory cytokine, in patients with Crohn's disease (CD). However, little is known about the role of visceral adipose tissue (VAT) and its interaction with genetic predisposition on CD progression. We therefore sought to examine the association between VAT and its interaction with genetic susceptibility on risk of CD complications. Methods: We conducted a cross-sectional study of CD patients enrolled in Prospective Registry in Inflammatory Bowel Disease Study at Massachusetts General Hospital (PRISM). Information on diagnosis of CD and its complications were collected and confirmed through review of medical records. VAT volume was measured from CT scans prior to development of disease complications, using Aquarius 3D (TeraRecon Inc., version 4.4.12). A genetic risk score was calculated using previously reported single nucleotide polymorphisms (SNPs) associated genome-wide with CD susceptibility. We used logistic regression models to estimate the multivariable-adjusted odds ratio (MV-adjusted OR) and 95% confidence interval (CI) while adjusting for age at diagnosis, duration of disease, body mass index (BMI), and smoking. We evaluated for effect modification by genetic predisposition using multiplicative interaction terms. Results: Among 470 CD patients with available data on VAT, 73 required surgery, 57 with penetrating disease, 60 with stricturing disease, and 143 with perianal disease. The risk of surgery appeared to increase with higher VAT volume (Ptrend = 0.007). Specifically, compared to individuals in the lowest quartile of VAT volume (≤ 904 cm3), the MV-adjusted OR of surgery among individuals in the highest quartile (> 3809 cm3) was 5.75 (95% CI, 1.61-20.56). We did not observe an association between VAT volume and risk of penetrating, structuring, or perianal disease (All Ptrend > 0.40). We also explored the possibility that the effect of VAT on CD complications may be modified by genetic predisposition as assessed by genetic risk score and observed no effect modification (All Pinteraction > 0.25). Conclusions: In this cohort of patients with CD, we show that VAT volume measured prior to development of disease complications may be associated with a significantly increase in risk of surgery. Taken together with previous findings that BMI is not associated with risk of CD complications, our data suggest that visceral adiposity as measured by VAT and not total obesity, may negatively impact long-term progression of CD. (Figure Presented).

Background: Several studies reported inverse associations between birth weight and central adiposity in adults. However, few studies investigated the contributions of different abdominal fat compartments.Objective: We examined associations between birth weight and adult visceral and subcutaneous abdominal fat in the population-based Fenland study.Design: A total of 1092 adults (437 men and 655 women) aged 3055 y had available data on reported birth weight, standard anthropometric measures, and visceral and subcutaneous abdominal fat estimated by ultrasound. In a subgroup (n = 766), dual-energy X-ray absorptiometry assessment of total abdominal fat was performed. Linear regression models were used to analyze relations between birth weight and the various fat variables adjusted for sex, age, education, smoking, and body mass index (BMI).Results: After adjustment for adult BMI, there was an inverse association between birth weight and total abdominal fat [B (partial regression coefficient expressed as SD/1-kg change in birth weight) = -0.09, P = 0.002] and visceral fat (B = -0.07, P = 0.01) but not between birth weight and subcutaneous abdominal fat (B = -0.01, P = 0.3). Tests for interaction showed that adult BMI modified the association between birth weight and visceral fat (P for interaction = 0.01). In stratified analysis, the association between birth weight and visceral fat was apparent only in individuals with the highest BMI tertile (B = -0.08, P = 0.04).Conclusions: The inverse association between birth weight and adult abdominal fat appeared to be specific to visceral fat. However, associations with birth weight were apparent only after adjustment for adult BMI. Therefore, we suggest that rapid postnatal weight gain, rather than birth weight alone, leads to increased visceral fat. Am J Clin Nutr 2010; 92: 347-52.

Funding: The authors acknowledge Clinica Médica e Diagnóstico Dr Joaquim Chaves (Alge´s, Portugal) for the technical assistance regarding the serum lipids determination. The present study was supported by FCT POCTI/CVT/2002/44 750 and PTDC/CVT/2006/66 114 grants. S. V. M., P. A. L. and S. P. A. are the recipients of FCT individual fellowships SFRH/BD/2005/2256, SFRH/BPD/2005/23 931 and SFRH/ BD/2007/37 793, respectively. S. V. M., P. A. L. and C. M. A. performed the animal experiment, tissue sampling, laboratory work and prepared the manuscript. P. O. R. was responsible for Luminex xMAP analysis. S. P. A. and R. J. B. B. were responsible for fatty acid analysis. R. M. A. P. performed the biochemistry serum profile. S. V. M. and R. J. B. B. performed the statistical analysis. M. F. C. and J. A. M. P. were responsible for interpretation of the results, preparation of the manuscript and design of the study. Conjugated linoleic acid (CLA) has been reported as having body fat lowering properties and the ability to modulate the inflammatory system in several models. In the present study, the effects of CLA added to saturated fat diets, from vegetable and animal origins, on the serum adipokine profile of obese Zucker rats were assessed. In addition, the fatty acid composition of epididymal and retroperitoneal adipose tissues was determined and a principal component analysis (PCA) was used to assess possible relationships between fatty acids and serum metabolites. Atherogenic diets (2% cholesterol) were formulated with palm oil and ovine fat and supplemented or not with 1% of a mixture (1:1) of cis-9, trans-11 and trans-10, cis-12-CLA isomers. CLA-fed animals exhibited lower daily feed intake, final body and liver weights, and hepatic lipids content. Total and LDL-cholesterol levels were increased in CLA-supplemented groups. CLA also promoted higher adiponectin and lower plasminogen activator inhibitor-1 (PAI-1) serum concentrations. In contrast to palm oil diets, ovine fat increased insulin resistance and serum levels of leptin, TNF-α and IL-1β. Epididymal and retroperitoneal adipose tissues had similar deposition of individual fatty acids. The PCA analysis showed that the trans-10, cis-12-CLA isomer was highly associated with adiponectin and PAI-1 levels. Summing up, CLA added to vegetable saturated enriched diets, relative to those from animal origin, seems to improve the serum profile of adipokines and inflammatory markers in obese Zucker rats due to a more favourable fatty acid composition. © 2009 The Authors. publishersversion published

There is growing evidence that not only the total amount of fat, but also the distribution of body fat determines risks for metabolic and cardiovascular disease. Developmental studies on factors influencing body fat distribution have been hampered by a lack of appropriate techniques for measuring intraabdominal fat in early life. Sonography, which is an established method for assessing abdominal fat distribution in adults, has not yet been evaluated in infants. To adapt the sonographic measurement of abdominal fat distribution to infants and study its reliability. The Generation R study, a population-based prospective cohort study. We included 212 one- and 227 two-year old Dutch infants in the present analysis. Sixty-two infants underwent replicate measurements to assess reproducibility. We developed a standardized protocol to measure the thickness of (1) subcutaneous and (2) preperitoneal fat in the upper abdomen of infants. To this end we defined infancy specific measurement areas to quantify fat thickness. Reproducibility of fat measurements was good to excellent with intraclass correlation coefficients of 0.93-0.97 for intra-observer agreement and of 0.89-0.95 for inter-observer agreement. We observed a pronounced increase in preperitoneal fat thickness in the second year of life while subcutaneous fat thickness increased only slightly, resulting in an altered body fat distribution. Gender did not significantly influence fat distribution in the first two years of life. Our age specific protocol for the sonographic measurement of central subcutaneous and preperitoneal fat is a reproducible method that can be instrumental for investigating fat distribution in early life.

OBJECTIVE: To determine the visualization rate of the normal appendix on low- and standard-dose unenhanced computed tomography (CT) and to evaluate the variables that may influence the identification of the appendix. METHODS: The study population was derived from the previous study, approved by the internal review board, investigating the effectiveness of low-dose CT (LDCT) in diagnosis of urolithiasis. Sixty-eight patients presenting with acute flank pain underwent 2 unenhanced dual-slice CT examinations. Standard-dose CT (SDCT) scans were obtained using 2 × 5-mm collimation, 120 kVp, and 170 effective mAs and followed by LDCT using 30 or 50 effective mAs. Two independent board-certified radiologists retrospectively recorded the visualization, outer diameter, and the wall thickness of normal appendices. The diameters, circumference, and cross-sectional area of the abdomen were measured. RESULTS: The prevalence of appendectomy was 8.8% (6 of 68 patients). The means of the 2 reviewers' sensitivity, specificity, positive and negative predictive values, and accuracy for visualization of normal appendix at SDCT versus LDCT respectively were 78% versus 73%, 100% versus 92%, 100% versus 99%, 31% versus 24%, and 80% versus 74% (P = 0.39-0.75). The interobserver agreement was good at both SDCT (κ = 0.61) and LDCT (κ = 0.74). Overall 40% to 58% of appendices at LDCT and 33% to 47% at SDCT was larger than 6 mm. There was no significant correlation in the appendix visualization neither with abdominal dimensions nor with visceral or pericecal fat at both dose sets. The calculated mean effective radiation dose at LDCT was 70% to 82% less than SDCT. CONCLUSIONS: Low- and standard-dose nonenhanced helical CT can visualize a normal appendix with high accuracy and good interobserver agreement. The diameter of normal appendix overlaps with that of appendicitis at CT. A diameter of 10.0 mm should be considered as the upper limit of normal in the absence of any other CT signs of appendicitis. © 2007 Lippincott Williams & Wilkins, Inc.

Objective: We investigated whether the presence of concomitant coronary heart disease (CHD) in patients with peripheral arterial disease (PAD) can be explained by intra-abdominal fat accumulation and compared different measures of adiposity as predictors of CHD in patients with PAD.Research Methods and Procedures: Data were collected from patients enrolled in the Second Manifestations of ARTerial disease (SMART) study, an ongoing prospective cohort study of patients with manifest vascular disease or vascular risk factors at the University Medical Centre Utrecht. The current analysis includes 315 patients, mean age 59 +/- 10 years, who had PAD with (n = 79) or without (n = 236) CHD. Parameters of adiposity were measured, and intra-abdominal fat and subcutaneous fat were measured ultrasonographically. Metabolic syndrome was defined according to Adult Treatment Panel III.Results: The prevalence of metabolic syndrome was higher among patients with CHD (63%) than among patients without CHD (48%). All parameters of adiposity indicated more fat in patients with CHD, except for subcutaneous fat. Waist circumference was associated with 64% higher prevalence of CHD (confidence interval, 20% to 123%) per 1 standard deviation increase in waist circumference after adjustment for age and sex. The odds ratio for waist circumference remained virtually the same after additional adjustment for the components of the metabolic syndrome and smoking.Discussion: An increased waist circumference, a crude measure of intra-abdominal fat, is associated with an increased risk of concomitant CHD in patients with PAD.

Context:Regional fat distribution rather than overall obesity has been recognized as important to understanding the link between obesity and cardiovascular disease.Objective:We examined the associations of abdominal visceral adipose tissue (VAT) and abdominal subcutaneous adipose tissue (SAT) with cardiovascular risk factors in a Caucasian population of men and women with normal glucose tolerance, prediabetes, or screen-detected diabetes.Design, Setting, and Participants:The study was based on cross-sectional analysis of data from 1412 adults age 45–80 years. VAT and SAT were assessed by ultrasound. The associations of VAT and SAT with blood pressure and lipids were examined by linear regression analysis adjusted for age, sex, smoking, alcohol, physical activity, glucose tolerance status (GTS), medication use, and body mass index. Effect modification by GTS and sex was examined, and stratified analyses performed.Results:Independent of SAT and overall obesity, VAT was associated with higher triglyceride and lower high-density lipoprotein (HDL) cholesterol levels in both men and women and additionally associated with higher total cholesterol in men. SAT was independently associated with higher total cholesterol and low-density lipoprotein cholesterol levels in both sexes, and SAT was additionally associated with higher triglyceride and lower HDL cholesterol levels in women and with higher blood pressure in participants with diabetes.Conclusion:Both abdominal VAT and SAT are independent of overall obesity associated with cardiovascular risk in a population of men and women at low to high risk of diabetes or with screen-detected diabetes.

Testosterone (T) levels are decreased in obese men, but the underlying causes are incompletely understood. Our objective was to explore the relation between low (free) T levels and male obesity, by evaluating metabolic parameters, subcutaneous adipose tissue (SAT) aromatase expression, and parameters of the hypothalamic-pituitary-gonadal axis. We recruited 57 morbidly obese men [33 had type 2 diabetes (DM2)] and 25 normal-weight men undergoing abdominal surgery. Fourteen obese men also attended a follow-up, 2 years after gastric bypass surgery (GBS). Circulating T levels were quantified by LC-MS/MS, whereas free T levels were measured using serum equilibrium dialysis and sex hormone-binding globulin, luteinizing hormone, and follicle-stimulating hormone by immunoassay. SAT biopsies were used to determine adipocyte cell size and aromatase expression by real-time PCR. Total and free T levels were decreased in obese males versus controls, with a further decrease in obese men with DM2 versus obese men without DM2. There were no differences in aromatase expression among the study groups, and sex steroids did not correlate with aromatase expression. Pearson analysis revealed an inverse association between (free) T and SAT cell size, triglycerides, and HOMA-IR. Multivariate analysis confirmed the inverse association between (free) T and SAT cell size (β = -0.321, P = 0.037 and β = -0.441, P = 0.011, respectively), independent of age, triglycerides, HOMA-IR, obesity, or diabetes. T levels were normalized 2 years after GBS. These data suggest that SAT cell size rather than SAT aromatase expression or parameters of the hypothalamic-pituitary-gonadal axis is related to low T in male obesity, which points to adipose cell size-related metabolic changes as a major trigger in decreased T levels.

Phospholipid transfer protein (PLTP) activity is elevated in obese and diabetic subjects. No prospective studies have examined the effect of weight loss on PLTP activity and assessed whether the resultant changes in activity are related to changes in body weight, insulin resistance, or both. PLTP activity was measured at baseline in 46 subjects (body mass index = 19-64 kg/m2) and after diet-induced weight loss in 19 of the obese subjects. Total body fat mass (FM) by dual-energy X-ray absorptiometry, intraabdominal fat (IAF), and abdominal subcutaneous fat (SQF) by CT scan, insulin sensitivity (SI) by frequently sampled intravenous glucose tolerance test, leptin, and lipids were determined. At baseline, PLTP activity correlated with FM (r = 0.36, P = 0.02) and SQF (r = 0.31, P = 0.045), but not with IAF (r = 0.16, P = 0.32) or SI (r = 0.10, P = 0.52). With diet-induced weight loss (16 +/- 7.3 kg), PLTP activity significantly decreased 9.1% (P = 0.002). The change in PLTP activity correlated with the change in SQF (r = 0.55, P = 0.014) (33.6% decrease), but not with IAF (r = 0.09, P = 0.73) or SI (r = 0.18, P = 0.44), and was highly correlated with the change in nonesterified fatty acid (NEFA) (r = 0.71, P < 0.001). In conclusion, elevated PLTP activity in obese subjects is likely a result of increased body fat, reflected by SQF, and is influenced by NEFAs but is not directly related to insulin resistance.

Background: We recently developed an ultrasound technique to estimate intraabdominal fat (IAF). This method is more accurate than measurement of waist and hip circumferences and is simpler and less expensive than computed tomography or magnetic resonance imaging.Objective: We compared the associations of ultrasound and waist-circumference (WC) measurements of IAF with other components of the metabolic syndrome.Design: IAF was determined in 600 consecutive participants in the Secondary Manifestations of Arterial Disease (SMART) study. The mean (+/-SD) age was 56.1 +/- 12.6 y, 30.0% of participants were women, and the mean body mass index (BMI; in kg/m(2)) was 26.6 +/- 4.1.Results: IAF increased with age (ultrasound: r=0.28; WC: r=0.25; P Conclusions: These results confirm the findings of computed tomography and magnetic resonance imaging investigations. When IAF is measured by ultrasound, the associations are more pronounced than when WC measurements are used and are independent of BMI. This suggests that IAF can be more reliably assessed by ultrasound measurements than by WC measurements.

OBJECTIVE: We studied the validity and reproducibility of a new abdominal ultrasound protocol for the assessment of intraabdominal adipose tissue. MEASUREMENTS: Intra-abdominal adipose tissue was assessed by CT MRI, anthropometry and ultrasonography on a single day. By ultrasonography the distance between peritoneum and lumbar spine was measured using a strict protocol, including the location of the measurements, pressure on the transducer and respiration. All measurements were repeated after 3 months. RESULTS: The study population consisted of 19 overweight patients with a body mass index (BMI) of 32.9 kg/m(2) (s.d. 3.7), intra-abdominal adipose tissue on CT 140.1 cm(2) (s.d. 55.9), and a mean ultrasound distance of 9.8 cm (s.d. 2.5). There was a strong association between the CT and ultrasonographic measures: Pearson correlation coefficient was 0.81 (P

OBJECTIVE: We studied the validity and reproducibility of a new abdominal ultrasound protocol for the assessment of intraabdominal adipose tissue. MEASUREMENTS: Intra-abdominal adipose tissue was assessed by CT MRI, anthropometry and ultrasonography on a single day. By ultrasonography the distance between peritoneum and lumbar spine was measured using a strict protocol, including the location of the measurements, pressure on the transducer and respiration. All measurements were repeated after 3 months. RESULTS: The study population consisted of 19 overweight patients with a body mass index (BMI) of 32.9 kg/m(2) (s.d. 3.7), intra-abdominal adipose tissue on CT 140.1 cm(2) (s.d. 55.9), and a mean ultrasound distance of 9.8 cm (s.d. 2.5). There was a strong association between the CT and ultrasonographic measures: Pearson correlation coefficient was 0.81 (P

Objetivos: Determinar si parámetros bioquímicos, utilizados en el adulto como indicadores del depósito de grasa intraabdominal (alanina aminotransferasa [ALT]), colinesterasa [ChE], gamma glutamiltransferasa [/GT], aspartato aminotransferasa [AST]), están o no elevados en obesos prepú-beres, así como valorar su posible correlación con valores basales de insulina e índices antropométricos. Pacientes y método: Estudio de casos y controles en niños de ambos sexos (46 obesos y 49 no obesos) de 6 a 9 años. A todos los niños se les determinó el índice de masa corporal (IMC), índice cintura/cadera e índice cintura/muslo. Se cuantificó: glucosa e insulina basal, índice insulina/glucosa, ALT, AST, gGT y ChE. La comparación de medias se realizó por la t de Student. La correlación entre variables se evaluó por el coeficiente de correlación de Pearson. Resultados: Los grupos fueron homogéneos, no presentaron diferencias significativas en la edad ni en el sexo. La concentración de glucosa fue similar en ambos grupos, en tanto que la de insulina, ALT, ChE, gGT e índice ALT/AST fueron significativamente superiores en el grupo de obesos. La concentración de ALT y de ChE se correlacionaron positivamente con la insulina, el índice insulina/glucosa, así como con el IMC e índice cintura/cadera. Conclusiones: Parámetros bioquímicos como la ALT y la ChE pueden ser de utilidad en el niño obeso como medida indirecta del depósito de grasa. El aumento de estos parámetros depende, a esta edad, tanto de la concentración de insulina como del grado de obesidad y distribución de la grasa. : Objective: To determine whether biochemical parameters, used in adult to indicate intraabdominal fat deposits [alanine aminotransferase (ALT), cholinesterase (ChE), gamma-glutamyltransferase (?-GT), and aspartate aminotransferase (AST)] are increased in obese pre-pubertal children and to evaluate their possible correlation with basal insulin levels and anthropometric measures. Patients and method: Study of obese pediatric patients and controls of both sexes (46 obese and 49 not obese) aged between 6 and 9 years. Body mass index (BMI), waist/hip and waist/thigh ratio were determined in all children. Glucose and basal insulin concentrations, the insulin/glucose index, ALT, AST, #yGT and ChE were quantified in all children. Student's t-test was used to perform the mean comparison and Pearson's correlation coefficient was used to evaluate the correlation between variables. Results: The groups were homogeneous, presenting no significant differences in age or sex. Glucose concentrations were similar in both groups, while those of insulin, ALT, ChE, #yGT and the ALT/AST index were significantly higher in the group of obese children. Concentrations of ALT and ChE were positively correlated with insulin and the insulin/glucose index, BMI, and waist/hip ratio. Conclusions: Biochemical parameters such as ALT and ChE may be useful as indirect measure of fat deposits in obese children. In this age group, an increase in these parameters depends on insulin concentration as well as on the degree of obesity and fat distribution.

Introduction: Adipose tissue in mesenteric fat plays a key role in systemic and luminal inflammation through production of Tumor Necrosis Factor-α (TNF-α) and inhibition of adiponectin, an anti-inflammatory cytokine, in patients with Crohn's disease (CD). However, little is known about the role of visceral adipose tissue (VAT) and its interaction with genetic predisposition on CD progression. We therefore sought to examine the association between VAT and its interaction with genetic susceptibility on risk of CD complications. Methods: We conducted a cross-sectional study of CD patients enrolled in Prospective Registry in Inflammatory Bowel Disease Study at Massachusetts General Hospital (PRISM). Information on diagnosis of CD and its complications were collected and confirmed through review of medical records. VAT volume was measured from CT scans prior to development of disease complications, using Aquarius 3D (TeraRecon Inc., version 4.4.12). A genetic risk score was calculated using previously reported single nucleotide polymorphisms (SNPs) associated genome-wide with CD susceptibility. We used logistic regression models to estimate the multivariable-adjusted odds ratio (MV-adjusted OR) and 95% confidence interval (CI) while adjusting for age at diagnosis, duration of disease, body mass index (BMI), and smoking. We evaluated for effect modification by genetic predisposition using multiplicative interaction terms. Results: Among 470 CD patients with available data on VAT, 73 required surgery, 57 with penetrating disease, 60 with stricturing disease, and 143 with perianal disease. The risk of surgery appeared to increase with higher VAT volume (Ptrend = 0.007). Specifically, compared to individuals in the lowest quartile of VAT volume (≤ 904 cm3), the MV-adjusted OR of surgery among individuals in the highest quartile (> 3809 cm3) was 5.75 (95% CI, 1.61-20.56). We did not observe an association between VAT volume and risk of penetrating, structuring, or perianal disease (All Ptrend > 0.40). We also explored the possibility that the effect of VAT on CD complications may be modified by genetic predisposition as assessed by genetic risk score and observed no effect modification (All Pinteraction > 0.25). Conclusions: In this cohort of patients with CD, we show that VAT volume measured prior to development of disease complications may be associated with a significantly increase in risk of surgery. Taken together with previous findings that BMI is not associated with risk of CD complications, our data suggest that visceral adiposity as measured by VAT and not total obesity, may negatively impact long-term progression of CD. (Figure Presented).

OBJECTIVE To test the hypothesis that hepatic steatosis is associated with risk factors for type 2 diabetes in overweight and obese youth, mediated by cardiorespiratory fitness. RESEARCH DESIGN AND METHODS This was a cross-sectional study comparing insulin sensitivity between 30 overweight and obese adolescents with hepatic steatosis, 68 overweight and obese adolescents without hepatic steatosis, and 11 healthy weight adolescents without hepatic steatosis. Cardiorespiratory fitness was determined by a graded maximal exercise test on a cycle ergometer. Secondary outcomes included presence of metabolic syndrome and glucose response to a 75-g oral glucose challenge. RESULTS The presence of hepatic steatosis was associated with 55% lower insulin sensitivity (P = 0.02) and a twofold greater prevalence of metabolic syndrome (P = 0.001). Differences in insulin sensitivity (3.5 vs. 4.5 mU ⋅ kg−1 ⋅ min−1, P = 0.03), prevalence of metabolic syndrome (48 vs. 20%, P = 0.03), and glucose area under the curve (816 vs. 710, P = 0.04) remained between groups after matching for age, sex, and visceral fat. The association between hepatic steatosis and insulin sensitivity (β = −0.24, t = −2.29, P < 0.025), metabolic syndrome (β = −0.54, t = −5.8, P < 0.001), and glucose area under the curve (β = 0.33, t = 3.3, P < 0.001) was independent of visceral and whole-body adiposity. Cardiorespiratory fitness was not associated with hepatic steatosis, insulin sensitivity, or presence of metabolic syndrome. CONCLUSIONS Hepatic steatosis is associated with type 2 diabetes risk factors independent of cardiorespiratory fitness, whole-body adiposity, and visceral fat mass.

Accurate quantification of visceral adipose tissue (VAT) is needed to understand ethnic variations and their implications for metabolic disease risk. The use of reference methods such as computed tomography (CT) and magnetic resonance imaging (MRI) is limited in large epidemiological studies. Surrogate measures such as anthropometry and dual-energy X-ray absorptiometry (DXA) do not differentiate between VAT and subcutaneous abdominal adipose tissue (SCAT). Ultrasound provides a validated estimate of VAT and SCAT in white populations. This study aimed to validate the use of ultrasound-based assessment of VAT in black South African adolescents. One hundred healthy adolescents (boys = 48, girls = 52) aged 18-19 years participating in the birth to twenty cohort study had VAT and SCAT measured by single slice MRI at L4. These MRI "criterion measures" were related to ultrasound VAT and SCAT thickness, anthropometry (BMI, waist and hip circumferences), and DXA android region fat. Ultrasound VAT thickness showed the strongest correlations with MRI VAT (Spearman's correlation coefficients: r = 0.72 and r = 0.64; in boys and girls, respectively), and substantially improved the estimation of MRI VAT compared to anthropometry and DXA alone; in regression models the addition of ultrasound VAT thickness to models containing BMI, waist, and DXA android fat improved the explained variance in VAT from 39% to 60% in boys, and from 31% to 52% in girls. In conclusion, ultrasound substantially increased the precision of estimating VAT beyond anthropometry and DXA alone. Black South African adolescents have relatively little VAT compared to elderly whites, and we therefore provide new ultrasound-based prediction equations for VAT specific to this group.

Accurate measures of visceral and abdominal subcutaneous fat are essential for investigating the pathophysiology of obesity. Classical anthropometric measures such as waist and hip circumference cannot distinguish between these two fat depots. Direct imaging methods such as computed tomography and magnetic resonance imaging (MRI) are restricted in large-scale studies due to practical and ethical issues. We aimed to establish whether ultrasound is a valid alternative method to MRI for the quantitative assessment of abdominal fat depots in older individuals. The study population comprised 74 white individuals (41 men and 33 women, aged 67-76 years) participating in the Hertfordshire Birth Cohort Physical Activity trial. Anthropometry included height, weight, waist and hip circumferences. Abdominal fat was measured by ultrasound in two compartments: visceral fat defined as the depth from the peritoneum to the lumbar spine; and subcutaneous fat defined as the depth from the skin to the abdominal muscles and compared to reference measures by MRI (10-mm single-slice image). Ultrasound measures were positively correlated with MRI measures of visceral and subcutaneous fat (visceral: r = 0.82 and r = 0.80 in men and women, respectively; subcutaneous: r = 0.63 and 0.68 in men and women, respectively). In multiple regression models, the addition of ultrasound measures significantly improved the prediction of visceral fat and subcutaneous fat in both men and women over and above the contribution of standard anthropometric variables. In conclusion, ultrasound is a valid method to estimate visceral fat in epidemiological studies of older men and women when MRI and computed tomography are not feasible.

OBJECTIVES: To evaluate the clinical significance of body fat distribution in childhood obesity, we investigated the associations of subcutaneous and intraabdominal (preperitoneal and visceral) fat, estimated by ultrasonography, with metabolic risk factors. SUBJECTS: Fifty-one obese (age 11.5+/- 2.6 years) and 33 non-obese (age 12.2+/- 2.7 years) children. STUDY DESIGN: Case control study. METHODS: Ultrasonographic measurements of fat thickness [maximum and minimum preperitoneal fat thicknesses (Pmax, Pmin), maximum and minimum subcutaneous fat thicknesses (Smax, Smin), visceral fat thickness (V), triceps (Tr) and subscapular (Ss) skin fold thicknesses] were documented. Blood pressures, lipid profiles, fasting insulin levels, glucose/insulin ratio and HOMA IR (homeostasis model assessment for insulin resistance) were evaluated in both groups and these parameters were correlated with body fat distribution. RESULTS: In the obese group, fasting insulin level was correlated to Smin, Smax, and Pmin. HOMA, accordingly, was also correlated to Smin, Smax, and Pmin. Fasting insulin level and HOMA showed no correlation with either Pmax or visceral fat thickness. ANALYSIS: Abdominal subcutaneous fat thickness measurements were the best predictors of hyperinsulinemia (R2: 0.32). CONCLUSION: We did not observe a significant correlation between blood pressure, lipid parameters and body fat distribution in obese group. Abdominal subcutaneous fat thickness might be a better predictor of the risk for hyperinsulinemia in childhood obesity.

Objective: Identification of specific origin of lipid accumulation in the liver of patients with non-alcoholic fatty liver disease (NAFLD) is the most important step in preventing this condition. Because liver steatosis, in the obese patients without any systemic disease, can be graded easily by ultrasonography (US), we aimed to demonstrate the degree of liver steatosis and abdominal fat distribution by US, furthermore evaluate biochemical, anthropometrical measurements, and define the possible relationship between these parameters in obese women with different grades of liver steatosis. Methods: In this controlled clinical study, according to US evaluation of liver steatosis, the patients were divided into four groups: control (no steatosis), mild, moderate and severe steatosis groups. Demographic, biochemical and anthropometric measurements were done. Insulin resistance was determined by using homeostasis model assessment (HOMA-IR). Liver steatosis and abdominal fat distributions were evaluated by US. Results: The subcutaneous and preperitoneal fat layer measurements did not show any significant difference between the groups. The visceral fat layer thickness was significantly higher in severe liver steatosis group compared to the control and steatosis groups. The highest serum fasting insulin, uric acid levels and HOMA-IR index were observed in the severe liver steatosis group. Visceral fat thickness was positively correlated with serum UA levels and HOMA-IR Conclusions: This study suggests that visceral adipose tissue, HOMA-IR and serum uric acid levels are the main determinants of NAFLD in obese patients. © I. Holzapfel Publishers 2007.