Visceral adipose tissue predicts severity and prognosis of acute pancreatitis in obese patients

Acute pancreatitis is a common systemic inflammatory disease, manifested by a spectrum of severity, ranging from mild in the majority of patients to severe acute pancreatitis. Patients with severe acute pancreatitis suffer from severe local and systemic complications and organ failure, leading to a poor prognosis. The early recognition of the severe condition is important to improve prognosis. Obesity has risen in tandem with an increase in the severity of acute pancreatitis in recent years. Studies have revealed that adipose tissue, particularly visceral adipose tissue is associated with the prognosis of acute pancreatitis. This review discussed the role of visceral adipose tissue in obese patients with acute pancreatitis and explored the possible mechanism involved.

Pre-operative visceral adipose tissue radiodensity is a potentially novel prognostic biomarker for early endoscopic post-operative recurrence in Crohn’s disease

BACKGROUND Evidence suggests inflammatory mesenteric fat is involved in post-operative recurrence(POR)of Crohn’s disease(CD).However,its prognostic value is INTRODUCTION Crohn’s disease(CD)is a debilitating chronic immune-mediated inflammatory disease(IMID)of the gastrointestinal tract that is increasing in incidence and prevalence globally[1].CD patients often undergo surgery for disease-related complic-ations and/or medically refractory disease.Unfortunately,surgery is not curative,and many patients develop post-operative recurrence(POR)of CD with a significant proportion eventually requiring additional surgeries.With advances in early detection and therapeutics,the contemporary 10-year risk of surgery has improved from 50%to 26%,but the risk of recurrent surgery has remained unchanged at 30%,suggesting a need to improve post-operative management strategies[2].Presently,there are two accepted strategies to mitigate POR,but each have potential limitations.Firstly,patients start early post-operative pharmacologic prophylaxis within 4-6 wk after surgery.This strategy can potentially overtreat a subset of patient who may not develop long-term disease recurrence off therapy.Consequently,these patients are at risk of medication-related adverse events and the direct and indirect costs associated with therapy with little or no benefit[3].The second strategy is performing early colonoscopy within 6-12 months after surgery and escalating therapy based on FOOTNOTES Author contributions:Gu P is the guarantor of the article and was involved in concept and design,data collection,statistical analysis,drafting of manuscript,and final approval of manuscript;Dube S and Choi SY were involved in statistical analysis,drafting of the manuscript,and final approval of manuscript;Gellada N,Win S,Lee YJ and Yang S were involved in the data collection,drafting of the manuscript,and final approval of manuscript;Haritunians T and Li D were involved in data analysis and interpretation,drafting of manuscript and final approval of manuscript;Melmed GY,Yarur AJ,Fleshner P,Kallman C and Devkota S were involved in study concept and design,data interpretation,drafting of manuscript and final approval of manuscript;Vasiliauskas EA,Bonthala N,Syal G,Ziring D and Targan SR were involved in data interpretation,drafting of manuscript and final approval of manuscript;Rabizadeh S was involved in study concept and design,drafting of manuscript and final approval of manuscript;McGovern DPB was involved in concept and design,statistical analysis,drafting of manuscript and final approval of manuscript.

Characteristics and mechanisms of subcutaneous and visceral adipose tissue aging

Aging is one of the most significant health challenges worldwide and is a primary cause of chronic diseases and physiological decline.Among the myriad changes that occur with aging,alterations in adipose tissue distribution and function have gained considerable attention because of their profound impact on metabolic health and overall well-being.Subcutaneous adipose tissue(SAT)and visceral adipose tissue(VAT)are the two major depots of white adipose tissue,each with distinct roles in metabolism and health.Understanding the characteristics and underlying mechanisms of SAT and VAT is crucial for elucidating the aging process and developing strategies to promote healthy aging.This review focuses on delineating and analyzing the characteristics and intrinsic mechanisms underlying the aging of subcutaneous and visceral adipose tissue during the aging process,which can contribute to a better understanding of the aging process and enhance healthy aging.

The Importance of Systemic Balance in Safeguarding Health: A Randomized Double-Blind Clinical Trial on VLDL, Triglycerides, Free T3, Leptin, Ghrelin, Cortisol and Visceral Adipose Tissue

The purpose of this clinical trial was to delineate some of the negative consequences of high BMI on health and explore the possibility of a solution. We analysed the blood test results of nine overweight adults with sedentary lifestyles, and an average BMI of 32.23. Results revealed a statistically significant reduction of visceral adipose tissue, very-low density lipoprotein (VLDL), and triglycerides. Testosterone, leptin, IGF-1 and Free T3 increased within the normal range, juxtaposed by cortisol and ghrelin that declined, but without dipping into abnormality. These findings have important implications during the COVID-19 pandemic, where optimal immunity is deemed necessary in limiting susceptibility to the virus. Recent research indicates that weight gain often escalates vulnerability to respiratory track disturbances, cardiovascular disease (CVD) and diabetes. Consequently, pre-existing conditions increase COVID-19 mortality rates. CVD and diabetes emerge out of hormonal imbalances that involve Free T3, leptin, ghrelin, testosterone, and cortisol. Physical training is decidedly the most acclaimed solution, yet, the least implemented one, due to procrastination, or demoralization after investing constant exhaustive effort with no immediately visible physical change. COVID-19 confinement exacerbates the tendency for inactivity, and promotes stress-eating behaviours. Moreover, strenuous exercise, necessary for visceral fat reduction, results in a negative cortisol/testosterone relationship that provokes caloric consumption and inflammation. Offering an alternative to exercise that effectively improves health, boosts metabolism, and controls appetite, may serve as a proactive, and preventive method that can safeguard health.

Critical visceral adipose tissue thresholds aassociated with type 2 diabetes mellitus in chinese population

To compare intervertebral location L2-L3 with L4-L5 as landmarks for measuring abdominal fat distribution and to determine critical levels of visceral adipose tissue （VAT） at those planes, exceeding which may lead to the development of type 2 diabetes. Methods： Abdominal fat distribution was measured using computed tomography（CT） in 29 diabetics （19 male, 10 female） and 30 non-diabetics （18 male, 12 female）. CT images obtained at two intervertebral locations L2-L3 and L4-L5 were used to measure the areas of total fat, VAT and subcutaneous adipose tissue （SCAT） using slice thickness of 5mm and an attenuation range from -190 to -30 Hounsfield units （HU）. Data were analyzed using logistic regression and Receiver-operating characteristic （ROC） analysis. Results： At L2-L3, diabetes and obesity were correctly classified at 91.53% and 83.05% respectively, while at L4-L5, the same were correctly classified at 84.75% and 88.14% respectively. VAT compared to SCAT, had significantly higher correctly classified percent values for predicting diabetes in both measurement sites. At L2-L3, VAT≥177.29 cm2 or VAT ≥51.52% of the total fat area had the highest correctly classified value for predicting diabetes in men, while VAT ≥ 132.27 cm2 or VAT≥45.7% of the total fat area had the highest correctly classified value for predicting diabetes in women. At LA-L5, VAT≥ 130.82 cm2 or VAT≥45.5,$% of the total fat area had the highest correctly classified value for predicting diabetes in men, while VAT≥ 118.56 cm2 or VAT≥32.24% of the total fat area had the highest correctly classified value for predicting diabetes in women. Conclusion： L2-L3 plane is a better landmark for measuring abdominal fat distribution for predicting diabetes, while abdominal fat distribution measured at L4-L5 has better association with obesity. Regardless of the measurement site, VAT compared to SCAT, has significantly stronger association with diabetes.

Transcriptional Features of Cattle Visceral and Subcutaneous Adipose Tissues: A Study of RNA-seq

Visceral and subcutaneous are the two major types of bovine adipose tissues, and they show metabolic and functional differences according to their distribution, exploring the transcriptional features of visceral and subcutaneous adipose tissues is necessary. In the present study, we conducted RNA-seq analysis to compare the transcriptome between visceral (great omental) and subcutaneous (backfat) adipose tissues from Chinese Simmental cattle and validate them by qRT-PCR. We found that 5864 genes were differentially expressed between two tissues, including 2979 up-regulated and 2885 down-regulated in visceral adipose tissue. Functional analysis revealed a variety of differentially expressed genes (DEGs) involved in lipid metabolism and immune response processes. This may provide valuable information to further our understanding of the complexity of gene regulation governing the physiology of different fat depots. This work highlighted potential genes regulating lipid metabolism and immune responses;it may contribute to a better understanding of the metabolic and functional differences between visceral and subcutaneous adipose tissues.

The Danger within:Covid-19 Affinity for ACE2 Receptors in Adipose Tissue and Testes.The Protective Effects of Estradiol,Fitness,and Weight Management

The imminent danger of the Covid-19 pandemic has accelerated research in pharmaceuticals that either target the viral Spike proteins fusion with ACE2 receptors,or the infectious RNA replication that often overwhelms immune defences.The scope of this review was to elucidate the main human vulnerabilities to Covid-19,including the accumulation of ACE2 receptors in testes,adipose tissue,thyroid,heart and kidneys that escalate viral affinity in males,the aged,and certain medical conditions,including diabetes,CVD,and pulmonary diseases.Pre-existing inflammation inherent in obesity may exacerbate the“cytokine storm,”a rampaging immune reaction during the course of Covid-19 that is deleterious to the host.We examined the molecular dynamics illustrating the action of new therapeutics necessary for Covid-19 patients;the estradiol advantage hypothesis;alternative therapies including hormone replacement procedures and mesenchymal stem cells;plus preventive and protective interventions.The current perspective also explored the primary components of dysregulated health predisposing individuals to Covid-19,including hormonal imbalance,increased lipids and lipoproteins,thyroid dysfunction,degraded fitness,and age-related testosterone decline accompanied by cortisol increase that provokes stress eating behaviours and weight accumulation.Obesity increases the probability of Covid-19 infection due to its abundance of ACE2 receptors;while physical activity may decrease Covid-19 vulnerability,by reducing fat and increasing muscle mass that manifests a relatively inhibited ACE2 expression.Several weight management solutions feature lasers and radiofrequency which diminish subcutaneous adiposity but do not enhance fitness.A data metanalysis of seven recently published clinical studies on 95 obese individuals,73 males and 22 females with an average BMI of 30.9,demonstrated visceral fat reduction combined with increased skeletal muscle mass.It also revealed a statistically significant decrease in BMI,lipids,lipoproteins,inflammation and toxicity as measured by CRP,Creatinine and Bilirubin respectively,juxtaposed by optimally healthier levels of Cortisol,Testosterone,Free T3,IGF-1,Insulin,and the appetite controlling hormones Leptin and Ghrelin.

Molecular mechanisms of the anti-obesity potential effect of Moringa oleifera in the experimental model

Objective: To elucidate the molecular mechanisms of the potent anti-obesity effect of Moringa oleifera Lam.(M. oleifera) ethanolic extract and to clarify the link between these mechanisms and the associated metabolic and vascular risks in the experimental model of visceral obesity.Methods: M. oleifera ethanolic extract was orally administered at 600 mg/kg body weight in obese female rats daily for 12 weeks. At the end of treatment, body weight was determined, and the atherogenic index, coronary artery index, glucose level, insulin resistance status, liver and kidney functions were assessed. Also, the m RNA of leptin, adiponectin and resistin in visceral adipose tissue was determined by quantitative real time-PCR.Results: The results showed that M. oleifera extract down-regulated m RNA expression of leptin and resistin, while it up-regulated adiponectin gene expression in obese rats relative to untreated obese control counterparts. This amelioration of genes expression was paralleled by a reduction in body weight and improvement of the atherogenic index and coronary artery index, as well as glucose level and insulin resistance value without adverse effects on liver or kidney functions, versus the untreated obese control ones.Conclusions: It is reasonable to assume that the anti-obesity, anti-atherogenic and antidiabetic properties of M. oleifera are mechanistically achieved via working directly on the adipokines of the visceral adipose tissue. Therefore, M. oleifera may be a good therapeutic candidate for the symptoms of metabolic syndrome.

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.

The role of visceral adipose tissue on improvement in insulin sensitivity following Roux-en-Y gastric bypass:a study in Chinese diabetic patients with mild and central obesity

Background:Most Chinese patients with type 2 diabetes mellitus(T2DM)have mild obesity and central obesity.Central obesity is combined with insulin resistance.The aim of this study was to assess the effect of abdominal adipose tissue on insulin-sensitivity improvement after Roux-en-Y gastric bypass(RYGB)in Chinese diabetic patients with mild and central obesity.Methods:Seventeen T2DM patients with a mean body mass index of 30.3 kg/m^(2) were scheduled for laparoscopic RYGB.A hyperinsulinemic-euglycemic clamp and dual-energy X-ray absorptiometry were performed prior to surgery and 3 months after RYGB.The primary end points were the correlations between insulin sensitivity and abdominal adipose tissue,including visceral adipose tissue(VAT)and subcutaneous adipose tissue(SAT),before and 3 months after RYGB.Results:Indices of peripheral insulin sensitivity,including glucose-disposal rate(M value)and glucose infusion rate,were significantly increased after RYGB.Body-fat mass,VAT and SAT were significantly reduced after RYGB.The pre-operative M value was significantly correlated with VAT mass(r=–0.57,P=0.02),but not correlated with SAT mass.M value changes after RYGB were highly correlated with changes in VAT mass(r=–0.59,P=0.01),percentage of VAT mass(r=–0.66,P<0.01),VAT area(r=–0.56,P=0.02)and percentage of VAT area(r=–0.57,P=0.02).Conclusions:A significant correlation was observed between increased peripheral insulin sensitivity and decreased VAT following RYGB in Chinese patients with mild and central obesity.VAT and SAT were significantly decreased with improved insulin sensitivity after RYGB.VAT mass may be considered as an indication for gastric bypass during patient selection.

Postoperative excessive gain in visceral adipose tissue as well as body mass index are associated with adverse outcomes of an ileal pouch

Background:There are no published studies on the impact of visceral adipose tissue(VAT)change on outcomes of restorative proctocolectomy and ileal pouch-anal anastomosis(IPAA).The aim of this historic cohort study was to evaluate the impact of excessive VAT gain on the outcomes of inflammatory bowel disease(IBD)patients with IPAA.Methods:We evaluated all eligible patients with at least two sequential CT scans after pouch construction from our prospectively maintained Pouchitis Registry between 2002 and 2014.The visceral fat area(VFA)was measured on CT images.The study group comprised patients with a significant VAT gain(>15%),and the control group was those without.The adverse outcomes of the pouch were defined as the new development of chronic pouch inflammation(chronic pouchitis,chronic cuffitis or Crohn’s disease of the pouch),anastomotic sinus and the combination of above(the composite adverse outcome)or pouch failure,after the inception CT.Results:Of 1564 patients in the Registry,59(3.8%)with at least 2 CT scans after pouch surgery were included.Twenty-nine patients(49.2%)were in the study group,and 30(50.8%)were in the control group.The median duration from the inception to the latest CT was 552(range:31–2598)days for the entire cohort.We compared the frequency of new chronic pouch inflammation(13.8%vs 3.3%,P=0.195),new pouch sinus(10.3%vs 0%,P=0.112),composite adverse pouch outcome(24.1%vs 3.3%,P=0.026)or pouch failure(10.3%vs 6.7%,P=0.671)between the two groups.Kaplan-Meier plot for time-to-pouch failure between the pouch patients with or without excessive body mass index(BMI)gain(>10%)showed statistical difference(P=0.011).Limited stepwise multivariate analysis showed that excessive VAT gain(odds ratio=12.608,95%confidence interval:1.190–133.538,P=0.035)was an independent risk factor for the adverse pouch comes.Conclusions:In this cohort of ileal pouch patients,excessive VAT gain as well as gain in BMI after pouch construction was found to be associated with poor long-term outcomes.

Preoperative Assessment of Abdominal Adipose Tissue to Predict Microvascular Invasion in Small Hepatocellular Carcinoma

Background and Aims:Microvascular invasion(MVI)affects recurrence after treatment of small hepatocellular carcinoma(sHCC)of≤3 cm in size.The present study aimed to investigate whether abdominal subcutaneous adipose tissue(SAT),visceral adipose tissue(VAT),and intermuscular adipose tissue(IMAT)are associated with MVI in patients with sHCC.Methods:A total of 124 patients with pathologicallyconfirmed sHCC diagnosed on surgical resection at the First Hospital Affiliated to Army Military University were recruited and divided into two groups according to MVI classification criteria(i.e.,MVI-positive or MVI-negative).The SAT,VAT,and IMAT areas at the lumbar 3 vertebral level were imaged with abdominal computed tomography and measured using ImageJ software.Their association with MVI in sHCC was analyzed.Results:Of the 124 patients with sHCC,67 were MVIpositive and 57 were MVInegative.Univariate analysis revealed a significant difference in the abdominal VAT and SAT between the MVI-positive and MVI-negative groups(p<0.05),with an area under the receiver operating characteristic curve of 0.76 and 0.65,respectively.Conclusions:The results of this study suggest that the areas of abdominal SAT and VAT are of significant clinical value because they can effectively predict the MVI status in patients with sHCC.

Sex-and age-specific associations between abdominal fat and non-alcoholic fatty liver disease:a prospective cohort study

Obesity is closely related to non-alcoholic fatty liver disease(NAFLD).Although sex differences in body fat distribution have been well demonstrated,little is known about the sex-specific associations between adipose tissue and the development of NAFLD.Using community-based cohort data,we evaluated the associations between magnetic resonance imaging quantified areas of abdominal adipose tissue,including visceral adipose tissue(VAT)and subcutaneous adipose tissue(SAT),and incident NAFLD in 2830 participants(1205 males and 1625 females)aged 55–70 years.During a 4.6-year median follow-up,the cumulative incidence rates of NAFLD increased with areas of VAT and SAT both in males and in females.Further analyses showed that the abovementioned positive associations were stronger in males than in females,especially in participants under 60 years old.In contrast,these sex differences disappeared in those over 60 years old.Furthermore,the risk of developing NAFLD increased non-linearly with increasing fat area in a sex-specific pattern.Additionally,sex-specific potential mediators,such as insulin resistance,lipid metabolism,inflammation,and adipokines,may exist in the associations between adipose tissue and NAFLD.This study showed that the associations between abdominal fat and the risk of NAFLD were stratified by sex and age,highlighting the potential need for sex-and age-specific management of NAFLD.

Nonalcoholic fatty liver disease in lean subjects:is it all metabolic-associated fatty liver disease?

The epidemiology of nonalcoholic fatty liver disease goes hand-in-hand with the obesity pandemic.The pathogenesis of fatty liver has shifted from an hepatocentric view to an adipocentric view,in which the overloaded adipose tissue spills out lipids that spread to ectopic tissues and organs such as the liver,elicits inflammation,and changes its adipokines profile promoting insulin resistance and the metabolic syndrome.Up to 40%of nonalcoholic fatty liver disease(NAFLD)patients are not obese and up to 20%are actually lean.Furthermore roughly 10%of lean subjects have NAFLD.In fact,adiposopathy can occur in patients with normal weight,and it is associated with expansion of metabolically active visceral fat and a qualitatively different adipose tissue that becomes overwhelmed after challenged by a mildly positive energy balance.This defines the concept of personal fat threshold that when exceeded results in metabolic dysfunction.Overweight/obese persons have higher probability of exceeding that threshold,explaining why adiposopathy/metabolic syndrome/NAFLD is more frequent in the obese.In this article,the epidemiology,pathogenesis,and management of patients with lean NAFLD are reviewed with an emphasis on reconciling the concepts of NAFLD in its relationship with adiposity and of NAFLD in lean individuals.