Can visceral fat parameters based on computed tomography be used to predict occult peritoneal metastasis in gastric cancer?

BACKGROUND The preoperative prediction of peritoneal metastasis(PM)in gastric cancer would prevent unnecessary surgery and promptly indicate an appropriate treatment plan.AIM To explore the predictive value of visceral fat(VF)parameters obtained from preoperative computed tomography(CT)images for occult PM and to develop an individualized model for predicting occult PM in patients with gastric carcinoma(GC).METHODS A total of 128 confirmed GC cases(84 male and 44 female patients)that underwent CT scans were analyzed and categorized into PM-positive(n=43)and PM-negative(n=85)groups.The clinical characteristics and VF parameters of two regions of interest(ROIs)were collected.Univariate and stratified analyses based on VF volume were performed to screen for predictive characteristics for occult PM.Prediction models with and without VF parameters were established by multivariable logistic regression analysis.RESULTS The mean attenuations of VF_(ROI 1)and VF_(ROI 2)varied significantly between the PM-positive and PMnegative groups(P=0.044 and 0.001,respectively).The areas under the receiver operating characteristic curves(AUCs)of VF_(ROI 1)and VF_(ROI 2)were 0.599 and 0.657,respectively.The mean attenuation of VF_(ROI 2)was included in the final prediction combined model,but not an independent risk factor of PM(P=0.068).No significant difference was observed between the models with and without mean attenuation of VF(AUC:0.749 vs 0.730,P=0.339).CONCLUSION The mean attenuation of VF is a potential auxiliary parameter for predicting occult PM in patients with GC.

Age-dependent Changes in Skeletal Muscle Mass and Visceral Fat Area in a Chinese Population

Objective:The present study was conducted to demonstrate the age-dependent changes in skeletal muscle mass and visceral fat area in a population of Chinese adults aged 30-92 years old.Methods:A total of 6669 healthy Chinese men and 4494 healthy Chinese women aged 30-92 years old were assessed for their skeletal muscle mass and visceral fat area.Results:The results showed age-dependent decreases in the total skeletal muscle mass indexes in both men and women aged 40-92 years old as well as age-dependent increases in the visceral fat area in men aged 30-92 years old and in women aged 30-80 years old.Multivariate regression models showed that the total skeletal muscle mass index was positively associated with the body mass index and negatively associated with the age and visceral fat area in both sexes.Conclusion:The loss of skeletal muscle mass becomes obvious at approximately 50 years of age,and the visceral fat area commences to increase at approximately 40 years of age in this Chinese population.

Effect of Ovariectomy on Serum Adiponectin Levels and Visceral Fat in Rats

This study was aimed to examine the effect of ovariectomy on visceral fat, serum adi- ponectin levels and lipid profile. Forty-five female Sprague DawIey rats were divided into three groups （n=15 each）： ovariectomized group （OVX）, ovariectomized plus estrogen-treated group （OVX＋E2）, and sham-operated group （SHAM）. Body weight, abdominal adipose tissues, serum adiponectin and lipid profile were measured and compared among the groups after three-month feeding post-surgery. Signifi- cant increases in body weight and visceral fat were found in ovariectomized rats when compared with sham-operated ones and significant increases were also observed in serum adiponectin, triglyceride and very low density lipoprotein cholesterol levels in ovariectomized rats. Body weight, visceral fat and se- rum adiponectin levels were profoundly reduced in OVX＋E2 group as compared with OVX group. It was concluded that ovarian hormone deficiency induced by ovariectomy leads to significant increases in body weight and visceral fat, along with increased serum adiponectin, triglyceride and very low density lipoprotein cholesterol levels in rats. Attenuation in these changes can be achieved by estrogen supple- mentation.

Estimation of visceral fat is useful for the diagnosis of significant fibrosis in patients with non-alcoholic fatty liver disease

BACKGROUND Obesity is a risk factor for non-alcoholic fatty liver disease(NAFLD),although obese patients with NAFLD do not always develop significant fibrosis.The distribution of body fat could predict the risk of NAFLD progression.AIM To investigate the role of bioelectrical impedance-estimated visceral fat(VF)in assessing NAFLD severity.METHODS In this cross-sectional study,patients with biopsy-proven NAFLD were prospectively included.All patients underwent anthropometric evaluation,blood tests and bioelectrical impedance analysis.RESULTS Between 2017 and 2020,119 patients were included[66.4%male,56 years(SD 10.7),62.2%obese,61.3%with metabolic syndrome].Sixty of them(50.4%)showed significant fibrosis(≥F2)in liver biopsy.Age,VF and metabolic syndrome were associated with significant fibrosis(61 years vs 52 years,16.4 vs 13.1,73.3%vs 49.2%,respectively;P<0.001 for all).In the multivariate analysis,VF and age were independently associated with significant fibrosis(VF,OR:1.11,95%CI:1.02-1.22,P=0.02;age,OR:1.08,95%CI:1.03-1.12,P<0.01).A model including these variables showed and area under the receiver operating characteristic curve(AUROC)of 0.75,which was not inferior to transient elastography or NAFLD fibrosis score AUROCs.We developed a nomogram including age and VF for assessing significant fibrosis in routine practice.CONCLUSION VF is a surrogate marker of liver fibrosis in patients with NAFLD.Bioelectrical impedance analysis is an inexpensive and simple method that can be combined with age to guide patient referral when other resources may be unavailable.

The Accumulation of Visceral Fat and Preventive Measures among the Elderly

Visceral fat is a specifi c fat that is produced in the body,transformed into cholesterol,and circulated in the blood to other parts of the body.The circulated cholesterol usually in the form of low-density lipoproteins forms plaque on the walls of the arteries,thereby constricting and blocking them and preventing the free fl ow of nutrients to various vital organs in the body.Visceral fat is deleterious to the health of elderly people because it is mostly found in the region of the abdomen that houses vital organs such as the pancreas,liver,and digestive tract,and it further affects the normal functioning of hormones in the body.Globally,15 million people die of a noncommunicable disease(NCD)annually between the age of 30 years and the age of 69 years,and there is an increase in NCD morbidity among people older than 70 years.Accumulated visceral fat in elderly people could have deleterious health consequences,as it is a predisposing factor for many other NCDs and chronic health conditions.Sedentary lifestyle,unhealthy eating,stress,and inactivity are the major causes of excessive visceral fat.However,measures to prevent the accumulation of visceral fat are straightforward,and impressive results are achieved with regular physical exercise,healthy diet choices,and proper stress management.

Analysis of the Correlation Between Visceral Fat Area and Insulin Resistance in Patients with Type 2 Diabetes and Abdominal Obesity

Objective: To analyze the correlation between visceral fat area and insulin resistance index (HOMA-IR) in patients with type 2 diabetes mellitus (T2DM) and abdominal obesity and to provide a reference for screening and related research of such patients. Methods: Two hundred patients with T2DM admitted to Guandu People’s Hospital of Kunming were included. The study was carried out from October 2022 to December 2023. The patients were divided into three groups according to different abdominal visceral fat areas (VFA): Group A (n = 65) was less than 75cm2, Group B (n = 75) was 75-100 cm2, and Group C (n = 60) was greater than 100 cm2. The subjects in the three groups were all tested for glycated hemoglobin (HbA1c), fasting insulin (FINS), and fasting blood glucose (FPG). Height and weight were measured to calculate body mass index (BMI). The HOMA-IR and TYG (fasting triglyceride and glycemic index) were also calculated. Changes in the BMI, VFA, HOMA-IR, and TYG levels were observed in the three groups. Results: The VFA, BMI, HbA1c, FPG, FINS, HOMA-IR, and TYG of the patients all increased, with a more significant increase in the BMI, FINS, HOMA-IR, and TYG levels (P < 0.01). Multiple linear stepwise regression analyses used visceral fat area (VFA) as the dependent variable. The results showed that VFA was closely related to BMI, FINS, HOMA-IR, and TYG. Conclusion: Early reduction of VFA to reduce insulin resistance may be a better treatment and effective method for T2DM, providing powerful measures and new strategies for effective blood sugar control and early prevention in the treatment of metabolic diseases.

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

Background and Aims:Intra-abdominal visceral fat accumulation and patatin-like phospholipase domain containing 3(PNPLA3)rs738409 G/C gene polymorphism confer a greater susceptibility to nonalcoholic fatty liver disease(NAFLD).We examined whether the relationship between visceral fat accumulation and liver disease severity may be influenced by PNPLA3 rs738409 polymorphism.Methods:The variant of PNPLA3 rs738409 was genotyped within 523 Han individuals with biopsy-confirmed NAFLD.Visceral fat area(VFA)was measured by bioelectrical impedance.Significant liver fibrosis(SF),defined as stage F≥2 on histology,was the outcome measure of interest.Results:The distribution of PNPLA3 genotypes was CC:27.5%,CG:48.2%,and GG:24.3%.Higher VFA was associated with greater risk of having SF(adjusted-odds ratio[OR]:1.03;95%confidence interval[CI]:1.02–1.04,p<0.05),independent of potential confounders.Among subjects with the same VFA level,the risk of SF was greater among carriers of the rs738409 G genotype than among those who did not.Stratified analysis showed that PNPLA3 rs738409 significantly influenced the association between VFA and SF.VFA remained significantly associated with SF only among the rs738409 G-allele carriers(adjusted-OR:1.05;95%CI:1.03–1.08 for the GG group;and adjusted-OR:1.03;95%CI:1.01–1.04 for the GC group).There was a significant interaction between VFA and PNPLA3 rs738409 genotype(Pinteraction=0.004).Conclusions:PNPLA3 rs738409 G allele has a moderate effect on the association between VFA and risk of SF in adult individuals with biopsy-proven NAFLD.Existence of the PNPLA3 rs738409 G allele and VFA interact to increase risk of SF。

Evaluation of Visceral and Subcutaneous Fat by Ultrasound and Its Relationship with Clinical and Metabolic Parameters of Insulin Resistance and Subclinical Atherosclerosis

Objective: this study set out to investigate the association between abdominal obesity ultrasound measurements, waist circumference and body mass index (BMI), metabolic syndrome (MS) components and subclinical atherosclerosis. Methods: sixty patients were recruited and divided equally into two groups, according to the presence of MS. All subjects had an ultrasound examination for measurement of visceral and subcutaneous fat thickness and carotid IMT. Results: the values of visceral fat thickness, preperitoneal circumference and carotid IMT were higher in patients with MS than in control subjects. Visceral fat thickness showed significant correlations with many cardiovascular risk factors (waist circumference, BMI, fasting plasma glucose, HDL and LDL cholesterol). All abdominal obesity measurements were correlated with BMI. Carotid IMT showed correlations with age, visceral fat and preperitoneal circumference. Visceral fat was independently associated with systolic and diastolic blood pressures and fasting plasma glucose. Systolic and diastolic blood pressures and BMI were independent determinants of carotid IMT. Conclusion: visceral fat thickness showed the best correlation with MS components, suggesting that it could be a useful parameter in cardiovascular risk assessment. Age, systolic and diastolic blood pressures and BMI were independent determinants of subclinical atherosclerosis. MS was associated with a higher carotid IMT.

Body composition and metabolic syndrome in patients with type 1 diabetes

BACKGROUND In recent years,the prevalence of obesity and metabolic syndrome in type 1 diabetes(T1DM)patients has gradually increased.Insulin resistance in T1DM deserves attention.It is necessary to clarify the relationship between body composition,metabolic syndrome and insulin resistance in T1DM to guide clinical treatment and intervention.AIM To assess body composition(BC)in T1DM patients and evaluate the relationship between BC,metabolic syndrome(MS),and insulin resistance in these indi-viduals.METHODS A total of 101 subjects with T1DM,aged 10 years or older,and with a disease duration of over 1 year were included.Bioelectrical impedance analysis using the Tsinghua-Tongfang BC Analyzer BCA-1B was employed to measure various BC parameters.Clinical and laboratory data were collected,and insulin resistance was calculated using the estimated glucose disposal rate(eGDR).RESULTS MS was diagnosed in 16/101 patients(15.84%),overweight in 16/101 patients(15.84%),obesity in 4/101(3.96%),hypertension in 34/101(33.66%%)and dyslip-idemia in 16/101 patients(15.84%).Visceral fat index(VFI)and trunk fat mass were significantly and negatively correlated with eGDR(both P<0.001).Female patients exhibited higher body fat percentage and visceral fat ratio compared to male patients.Binary logistic regression analysis revealed that significant factors for MS included eGDR[P=0.017,odds ratio(OR)=0.109],VFI(P=0.030,OR=3.529),and a family history of diabetes(P=0.004,OR=0.228).Significant factors for hypertension included eGDR(P<0.001,OR=0.488)and skeletal muscle mass(P=0.003,OR=1.111).Significant factors for dyslipidemia included trunk fat mass(P=0.033,OR=1.202)and eGDR(P=0.037,OR=0.708).CONCLUSION Visceral fat was found to be a superior predictor of MS compared to conventional measures such as body mass index and waist-to-hip ratio in Chinese individuals with T1DM.BC analysis,specifically identifying visceral fat(trunk fat),may play an important role in identifying the increased risk of MS in non-obese patients with T1DM.

Prediction of Abdominal Visceral Obesity From Body Mass Index,Waist Circumference and Waist-hip Ratio in Chinese Adults:Receiver Operating Characteristic Curves Analysis

Objective To evaluate the sensitivity and specificity of body mass index (BMI), waist circumference (WC) and waist-to-hip ratio (WHR) measurements in diagnosing abdominal visceral obesity. Methods BMI, WC, and WHR were assessed in 690 Chinese adults (305 men and 385 women) and compared with magnetic resonance imaging (MRI) measurements of abdominal visceral adipose tissue (VA). Receiver operating characteristic (ROC) curves were generated and used to determine the threshold point for each anthropometric parameter. Results 1) MRI showed that 61.7% of overweight/obese individuals (BMI≥25 kg/m2) and 14.2% of normal weight (BMI<25 kg/m2) individuals had abdominal visceral obesity (VA≥100 cm2). 2) VA was positively correlated with each anthropometric variable, of which WC showed the highest correlation (r=0.73-0.77, P<0.001). 3) The best cut-off points for assessing abdominal visceral obesity were as followed: BMI of 26 kg/m2, WC of 90 cm, and WHR of 0.93, with WC being the most sensitive and specific factor. 4) Among subjects with BMI≥28 kg/m2 or WC≥95 cm, 95% of men and 90% of women appeared to have abdominal visceral obesity. Conclusion Measurements of BMI, WC, and WHR can be used in the prediction of abdominal visceral obesity, of which WC was the one with better accuracy.

Shifting perspectives-interplay between non-alcoholic fatty liver disease and insulin resistance in lean individuals

Non-alcoholic fatty liver disease(NAFLD)has become a significant public health burden affecting not only obese individuals but also people with normal weight.As opposed to previous beliefs,this particular subset of patients has an increased risk of all-cause mortality and worse outcomes than their obese counterparts.The development of NAFLD in lean subjects seems to be interconnected with metabolic phenotype,precisely visceral fat tissue,sarcopenia,and insulin resistance.Here,we summarize available data focusing on the co-dependent relationship between metabolic phenotype,insulin resistance,and development of NAFLD in lean individuals,suggesting more appropriate tools for measuring body fat distribution for the screening of patients at risk.

Pancreatic enzymes and abdominal adipose tissue distribution in new-onset prediabetes/diabetes after acute pancreatitis

BACKGROUND New-onset prediabetes/diabetes after acute pancreatitis(NODAP)is the most common sequela of pancreatitis,and it differs from type 2 prediabetes/diabetes mellitus(T2DM).AIM To study the associations between circulating levels of pancreatic amylase,pancreatic lipase,chymotrypsin and fat phenotypes in NODAP,T2DM,and health.METHODS Individuals with NODAP(n=30),T2DM(n=30),and sex-matched healthy individuals(n=30)were included.Five fat phenotypes(intra-pancreatic fat,liver fat,skeletal muscle fat,visceral fat,and subcutaneous fat)were determined using the same magnetic resonance imaging protocol and scanner magnet strength for all participants.One-way analysis of covariance,linear regression analysis,and relative importance analysis were conducted.RESULTS Intra-pancreatic fat deposition(IPFD)was higher in NODAP(9.4%±1.8%)and T2DM(9.8%±1.1%)compared with healthy controls(7.8%±1.9%)after adjusting for covariates(P=0.003).Similar findings were observed in regards to visceral fat volume(P=0.005),but not subcutaneous fat volume,liver fat,or skeletal muscle fat.Both IPFD(β=-2.201,P=0.023)and visceral fat volume(β=-0.004,P=0.028)were significantly associated with circulating levels of pancreatic amylase in NODAP,but not in T2DM or healthy individuals.Of the five fat phenotypes,IPFD explained the highest amount of variance in pancreatic amylase concentration(R2=15.3%out of 41.2%).None of the phenotypes contributed meaningfully to the variance in pancreatic lipase or chymotrypsin.CONCLUSION Both NODAP and T2DM are characterized by increased IPFD and visceral fat volume.However,only NODAP is characterized by significant inverse associations between the two fat phenotypes and pancreatic amylase.

SARS-CoV-2-the Unforeseen Peril of David Winning Against Goliath:the Immune Giant Collapsing Under Its Own Rampaging Cytokine Storm

We examined SARS-CoV-2(Covid-19)available treatments and prophylactic methods that included interventions associated with inhibiting the“type II transmembrane serine protease”(TMPRSS2)to limit the fusion between the Covid-19 Spike proteins and ACE2 receptors,or newly developed therapeutics like Remdesivir that interferes with the viral RNA replication.We explored the dilemma of ACE2 receptors that have a protective function against high blood pressure associated disorders,yet,they serve as the viral points of entry,elevating the probability of infection.Human tissues’analysis reveals a higher ACE2 expression in adipose tissue,placing obesity-related conditions in the eye of the pandemic storm.It primarily exposes males due to the surge of ACE2 receptors in the testes along with other tissues.Males manifest a relatively higher positive ACE2 correlations with certain immune cells in the lungs,thyroid,adrenals,liver and colon,while females evidence higher ACE2 correlations with immune cells in the heart.The remaining tissues’ACE2/immunity expressions are equivalent in both sexes,indicating that despite its preference for males,the threat of Covid-19 can easily target females.Recent reports indicate that Covid-19 is empowered by hindering the critical process of viral recognition during the adaptive immune response leading to the“cytokine storm”,the aggravated immune response that indiscriminately perseveres,rampaging the host’s vital organs.Sedentary lifestyle,age-related hormonal imbalance,and adiposity induced inflammation predispose the body to the immune collapse following Covid-19 invasion,spotlighting the detrimental aftermath of metabolic dysfunction,and excess food consumption provoked by elevated cortisol and dysregulated appetite hormones.ACE 2 expression is suppressed in the skeletal muscle,rendering fitness and weight management an effective Covid-19 preventive intervention,along with social distancing,hygiene,and facial coverings.Physical activity,or exercise alternative methods have recently demonstrated statistically significant reductions of the inflammatory marker C-Reactive Protein(CRP),triglycerides,visceral fat,cortisol and the orexigenic hormone ghrelin,juxtaposed by optimal increases of IGF-1,skeletal muscle mass,Free T3,HDL,and the anorexic hormone leptin.

Visceral adipose volume is correlated with surgical tissue fibrosis in Crohn’s disease of the small bowel

Background This study explored the diagnostic performance of visceral adiposity to predict the degree of intestinal inflammation and fibrosis.Methods The patients with Crohn’s disease(CD)who underwent surgical small bowel resection at the First Affiliated Hospital of Sun Yat-sen University(Guangzhou,China)between January 2007 and December 2017 were enrolled.We evaluated the intestinal imaging features of computed tomography enterography(CTE),including mesenteric inflammatory fat stranding,the target sign,mesenteric hypervascularity,bowel wall thickening,lymphadenopathy,stricture diameter,and maximal upstream diameter.We used A.K.software(Artificial Intelligence Kit,version 1.1)to calculate the visceral fat(VF)and subcutaneous fat(SF)volumes at the third lumbar vertebra level.Pathological tissue information was recorded.Diagnostic models were established based on the multivariate regression analysis results,and their effectiveness was evaluated by area under the curve(AUC)and decision curve analyses.Results Overall,48 patients with CD were included in this study.The abdominal VF/SF volume ratio(odds ratio,1.20;95%confidence interval,1.05–1.38;P=0.009)and the stenosis diameter/upstream intestinal dilatation diameter(ND)ratio(odds ratio,0.90;95%confidence interval,0.82–0.99;P=0.034)were independent risk factors for the severe fibrosis of the small intestine.The AUC values of the VF/SF ratio,the ND ratio,and their combination were 0.760,0.673,and 0.804,respectively.The combination of the VS/SF volume ratio and ND ratio achieved the highest net benefit on the decision curve.Conclusion The VF volume on CTE can reflect intestinal fibrosis.The combination of the VF/SF volume ratio and ND ratio of CD patients assessed using CTE can help predict severe fibrosis stenosis of the small intestine.