Sex Differences of Visceral Fat Area and Visceral-to-Subcutaneous Fat Ratio for the Risk of Incident Type 2 Diabetes Mellitus

Influence of body composition, muscle strength, and physical performance on the postoperative complications and survival after radical gastrectomy for gastric cancer: A comprehensive analysis from a large-scale prospective study

PurposeVisceral obesity has been recognized as a predictor of metabolic risk factors. However, few studies have evaluated the metabolic risks in subjects with normal waist circumference (WC). We aimed to examine if the visceral-to-subcutaneous fat ratio (VSR) has diagnostic value to identify multiple metabolic risk factors in subjects with normal WC, compared with visceral fat area (VFA) and subcutaneous fat area (SFA).MethodsThis is a cross-sectional study in which we have compared mean VFA, SFA, and VSR according to each metabolic risk factor. We performed a receiver operating characteristic (ROC) curve analysis for VFA, SFA, and VSR to assess their accuracy in picking out two or more non-adipose factors for metabolic syndrome.ResultsFor each metabolic risk factor, mean VSRs were significantly different between groups (risk-absent group vs risk-present group) in men and women, except for men with low high-density lipoprotein. However, mean VFAs and SFAs showed no significant differences between groups. VSR showed superior diagnostic values in predicting at least two non-adipose metabolic risk factors in men and similar diagnostic value in women. Areas under ROC curves for VSR and VFA were 0.705 and 0.649 in men (P=0.028) and 0.798 and 0.785 in women (P=0.321).ConclusionFor men with a normal WC, VSR appeared to effectively predict the presence of multiple metabolic risk factors. Thus, VSR may serve as an indicator for identifying men who have a normal WC and multiple metabolic risk factors.

Visceral obesity as a risk factor of incisional hernia after single-port laparoscopic gynecologic surgery

ObjectiveThis study aimed to assess the relationship between abdominal fat distribution (AFD) and urinary albumin/creatinine ratio (UACR) in Chinese adults.Methods823 patients with type 2 diabetes mellitus(T2DM) were selected. Abdominal visceral fat area (VFA) and subcutaneous fat area (SFA) were measured using bioelectrical impedance analysis (BIA). Patients were divided into four groups: low VFA /low SFA, low VFA /high SFA, high VFA /low SFA, and high VFA /high SFA based on the median values (low: < median, high: ≥median).ResultsIn the multifactor analysis after adjusting for relevant factors, VFA, waist-to-height ratio (WHtR), waist-hip ratio (WHR), and waist circumference (WC) showed significant positive correlations with UACR, while SFA and BMI did not. AFD combinations were independent predictors of UACR. The risk of UACR30-300 mg/g was highest in the high VFA/low SFA group (OR = 3.12), and for UACR > 300 mg/g, it was highest in the high VFA/high SFA group (OR = 24.69). The areas under the receiver operating characteristic (ROC) curvefor VFA prediction of UACR ≥ 30 mg/g was 0.69, significantly greater than that for WHtR, WHR, and WC. Optimal cut-off values were 98.8 cm² for VFA. When analyzed by gender, the optimal cut-off values for VFA were 98.8 cm² for males and 102.3 cm² for females.ConclusionCentral obesity indicators (VFA, WHtR, WHR, WC) were associated with UACR. VFA was the strongest predictor for UACR ≥ 30 mg/g.

BackgroundVisceral fat accumulation has been regarded as a poor prognostic factor for coronary artery disease. Moderate overweight and mild obesity are associated with a lower mortality in patients with several infectious diseases on intensive care units, and this phenomenon is referred to as the obesity paradox. Pyelonephritis is one of the common infectious diseases, and although computed tomography (CT) imaging is frequently used in its localization, its prognostic value is limited. In this study, we analyze the relationship between the visceral and subcutaneous fat areas in CT scans and prognosis of patients with pyelonephritis.Fig. 1ROC curves using subcutaneous and visceral fat area to discriminating surviving pyelonephritis patients from deceased pyelonephritis patientsThe black line shows the curve using subcutaneous fat area and the gray line shows the curve using visceral fat area.MethodsWe included hospitalized patients with pyelonephritis who underwent computed tomography of the abdomen. Clinical data were obtained from the medical records. Subcutaneous and visceral fat aeras were analyzed at the umbilical level using the abdominal analysis (2D) function of the 3D image analysis system volume analyzer.Results505 patients were included in the study. There were 497 survivors and 8 non-survivors, with both subcutaneous and visceral fat areas being lower in the non-survivors than in the survivors (subcutaneous fat area 49.3 ± 73.9 cm2 vs 123.7 ± 85.3 cm2, p=0.012; visceral fat area 42.2 ± 29.2 cm2 vs 98.4 ± 69.1 cm2, p< 0.01, respectively. ROC analysis using subcutaneous and visceral fat areas to discriminate survival and death showed that the areas under the curve of subcutaneous and visceral fat areas were 0.794 (p=0.002) and 0.770 (p< 0.001), respectively (Fig.1).ConclusionPatients with poor prognosis of pyelonephritis tended to have lower subcutaneous and visceral fat area at onset than patients with improved prognosis. The results suggest that both subcutaneous and visceral fat area using CT may have prognostic value for pyelonephritis.DisclosuresAll Authors: No reported disclosures

BackgroundThe aim of the study were to analyze the lumbar volumetric bone mineral density (BMD), fat distribution and changes of skeletal muscle with quantitative computed tomography (QCT) in postmenopausal women with type 2 diabetes mellitus (T2DM), and to evaluate the relationship between body composition and BMD.MethodsOne hundred seventy-seven postmenopausal women with T2DM and 136 postmenopausal women without diabetes were included in the study and were divided into two groups according to age, 50–65 years age group and over 65 years of age group. The lumbar BMD (L1-L3), visceral fat mass (VFM), visceral fat area (VFA), subcutaneous fat mass (SFM), subcutaneous fat area (SFA), psoas major mass (PMM) and psoas major area (PMA) of each group were compared. Univariable and multivariable linear regression analysis were used to analyze the contribution of each variable to BMD in postmenopausal women with T2DM.ResultsIn women aged 50–65, the patients in the T2DM group had higher body mass index (BMI), VFM, VFA, and SFM (p < 0.05), compared with non-T2DM group. Over 65 years old, the BMI, BMD, VFM, VFA, and SFM was found to be much higher in participants with T2DM than in non-T2DM group (p < 0.05). Compared with women aged in 50–65 years old, those over 65 years old had higher VFA and VFM and lower BMD (p < 0.05), whether in the T2DM group or the non-T2DM group. Age, VFA and VFM were negatively correlated with BMD (r = -0.590, p ≤ 0.001; r = -0.179, p = 0.017; r = -0.155, p = 0.040, respectively). After adjusting for age, VFM and VFA were no longer correlated with BMD. No correlations between fat distribution or psoas major muscle and BMD in postmenopausal women with T2DM were observed.ConclusionsT2DM can affect abdominal fat deposition in postmenopausal women. Postmenopausal elderly women with diabetes have higher BMD than normal elderly women. There was no correlation between fat distribution or psoas major and BMD in postmenopausal women with diabetes mellitus.

IntroductionGallstones are a prevalent gastrointestinal disorder influenced by metabolic factors and obesity. Visceral adiposity is metabolically active and proinflammatory, yet the role of the relative distribution of visceral and subcutaneous fat, quantified as the visceral-to-subcutaneous fat ratio (VSR), in gallstone formation remains unclear. This study aimed to investigate the association between VSR, measured by computed tomography (CT), and the prevalence of gallstones in Korean men.MethodsThis retrospective cross-sectional study included 4,914 Korean men who underwent both abdominopelvic CT and ultrasonography as part of routine health examinations. Visceral and subcutaneous fat areas were quantified at the L3 vertebral level using CT images, and participants were categorized into quartiles based on the VSR. Logistic regression analyses were conducted to evaluate the association between VSR and the prevalence of gallstones, adjusting for age, body mass index (BMI), lifestyle factors, comorbidities, and biochemical markers.ResultsThe mean age and BMI were 52.3 ± 9.3 years and 24.6 ± 2.9 kg/m2, respectively. Gallstone prevalence increased progressively across VSR quartiles, from 4.0% in the lowest quartile to 7.6% in the highest (p < 0.001). In fully adjusted models, men in the highest VSR quartile had 1.6-fold higher odds of having gallstones compared to the lowest quartile (OR 1.596, 95% CI 1.074–2.373, p = 0.021).ConclusionA higher VSR, reflecting a predominance of visceral over subcutaneous fat, was independently associated with an increased risk of gallstones in Korean men. These findings highlight the importance of abdominal fat distribution, beyond overall obesity, in gallstone pathogenesis. The VSR may serve as a valuable imaging biomarker for identifying men at elevated risk of developing gallstones.

PurposeTo determine the association of machine learning-derived CT body composition and 90-day mortality after transjugular intrahepatic portosystemic shunt (TIPS) and to assess its predictive performance as a complement to Model for End-Stage Liver Disease (MELD) score for mortality risk prediction.Materials and MethodsThis retrospective multi-center cohort study included patients who underwent TIPS from 1995 to 2018 and had a contrast-enhanced CT abdomen within 9 months prior to TIPS and at least 90 days of post-procedural clinical follow-up. A machine learning algorithm extracted CT body composition metrics at L3 vertebral level including skeletal muscle area (SMA), skeletal muscle index (SMI), skeletal muscle density (SMD), subcutaneous fat area (SFA), subcutaneous fat index (SFI), visceral fat area (VFA), visceral fat index (VFI), and visceral-to-subcutaneous fat ratio (VSR). Independent t-tests, logistic regression models, and ROC curve analysis were utilized to assess the association of those metrics in predicting 90-day mortality.ResultsA total of 122 patients (58 ± 11.8, 68% male) were included. Patients who died within 90 days of TIPS had significantly higher MELD (18.9 vs. 11.9, p < 0.001) and lower SMA (123 vs. 144.5, p = 0.002), SMI (43.7 vs. 50.5, p = 0.03), SFA (122.4 vs. 190.8, p = 0.009), SFI (44.2 vs. 66.7, p = 0.04), VFA (105.5 vs. 171.2, p = 0.003), and VFI (35.7 vs. 57.5, p = 0.02) compared to those who survived past 90 days. There were no significant associations between 90-day mortality and BMI (26 vs. 27.1, p = 0.63), SMD (30.1 vs. 31.7, p = 0.44), or VSR (0.97 vs. 1.03, p = 0.66). Multivariable logistic regression showed that SMA (OR = 0.97, p < 0.01), SMI (OR = 0.94, p = 0.03), SFA (OR = 0.99, p = 0.01), and VFA (OR = 0.99, p = 0.02) remained significant predictors of 90-day mortality when adjusted for MELD score. ROC curve analysis demonstrated that including SMA, SFA, and VFA improves the predictive power of MELD score in predicting 90-day mortality after TIPS (AUC, 0.84; 95% CI: 0.77, 0.91; p = 0.02).ConclusionCT body composition is positively predictive of 90-day mortality after TIPS and improves the predictive performance of MELD score.Level of Evidence: Level 3, Retrospective multi-center cohort study.Graphical

Visceral adiposity and inflammatory bowel disease.

Data on longitudinal changes of computed tomography (CT)-determined visceral fat area (VFA), skeletal muscle area (SMA) and skeletal muscle radiodensity (SMD) after adrenalectomy are limited in patients with hypercortisolism. To examine the association of severity of cortisol excess and improvement of CT-based muscle and fat parameters after adrenalectomy. Retrospective observational cohort study. One hundred thirty-four patients with overt Cushing's syndrome (CS; n=39), mild autonomous cortisol excess (MACE; n=57), or nonfunctioning adrenal tumour (NFAT; n=38) at a tertiary endocrinology institution between 2006 and 2017 were included. Changes in CT-determined VFA, visceral-to-subcutaneous fat ratio (VSR), SMA, skeletal muscle index (SMI), and SMD measured at the third lumbar vertebra (L3). At baseline, CS patients had higher VFA, lower SMA, SMI and SMD values, compared to NFAT or MACE patients. Compared to NFAT, significant decreases in VFA and increases in SMA, SMI and SMD was observed in CS 1year after adrenalectomy. In MACE, adjusted mean changes of SMD but not VFA, SMA or SMI differ significantly compared to NFAT (+8.9% vs -3.4%, P=0.032). In a multivariate linear regression model, the increase by 1μg/dL of post-dexamethasone serum cortisol at baseline was independently associated with greater reduction of VFA (-3.95%), VSR (-3.07%), and increase in SMD (+0.92%, P<0.05 for all) after adrenalectomy. The severity of cortisol excess was associated with greater improvement of L3 VFA, VSR and SMD 1year after adrenalectomy. These CT-based markers may allow more objective assessment of treatment benefit at earlier stage.

Purpose. A better identification of patients who are more likely to benefit from vascular endothelial growth factor-targeted therapy is warranted in metastatic renal cell carcinoma (mRCC). As adipose tissue releases angiogenic factors, we determined whether parameters such as visceral fat area (VFA) were associated with outcome in these patients. Experimental Design. In 113 patients with mRCC who received antiangiogenic agents (bevacizumab, sunitinib, or sorafenib) (n = 64) or cytokines (n = 49) as first-line treatment, we used computed tomography to measure VFA and subcutaneous fat area (SFA). We evaluated associations linking body mass index (BMI), SFA, and VFA to time to progression (TTP) and overall survival (OS). Results. High SFA and VFA values were significantly associated with shorter TTP and OS. By multivariate analysis, high VFA was independently associated with shorter TTP and OS. These results were internally validated using bootstrap analysis. By contrast, VFA was not associated with survival in the cytokine group. In the whole population, interaction between VFA and treatment group was significant for TTP and OS, thereby confirming the results. Conclusion. Our study provides the first evidence that high VFA could be a predictive biomarker from shorter survival in patients given first-line antiangiogenic agents for mRCC.

AimThe study aimed to investigate the association between the nocturnal sleep duration and five obesity indicators, namely, visceral fat area (VFA), subcutaneous fat area (SFA), bodyweight, body mass index (BMI) and waist circumference (WC), among people with type 2 diabetes mellitus (T2DM) in Ningbo, China.MethodsA cross-sectional study was conducted using the National Metabolic Management Centre (MMC) - Ningbo First Hospital data from 1st March 2018 to 28th February 2021. Adults with T2DM were included in the study. Simple and multiple (adjusted for sociodemographic and lifestyle factors and health conditions) linear regression analyses were performed to identify the associations.ResultsIn terms of VFA, SFA, bodyweight, BMI and WC, the eligibility criteria were satisfied by 2771, 2771, 2863, 2863 and 2862 patients, respectively. In the unadjusted model, the shorter nocturnal sleep duration was associated with higher VFA, SFA, bodyweight, BMI and WC. In other words, an hour increase in the nocturnal sleep duration was associated with a decrease of 2.07 cm2 in VFA (regression coefficient = −2.07; 95% CI = −3.25 to −0.88), 2.67 cm2 in SFA (−2.67; −4.55 to −0.78); 0.82 kg in bodyweight (−0.82; −1.2 to −0.43), 0.2 kg/m2 in BMI (−0.2; −0.31 to −0.09) and 0.46 cm in WC (−0.46; −0.76 to −0.16). In the adjusted models, the shorter nocturnal sleep duration was still found to be associated with higher VFA, SFA, bodyweight, BMI and WC (except SFA and WC in models where we further adjusted for health conditions).ConclusionThe nocturnal sleep duration among people with T2DM in Ningbo, China is negatively associated with visceral and general obesity indicators (VFA, bodyweight and BMI). Thus, there is a need for appropriate interventions to address the issue of sleep deprivation.

BackgroundAdipose tissue releases angiogenic factors that may promote tumour growth.ObjectiveTo determine whether body mass index (BMI), subcutaneous fat area (SFA) and visceral fat area (VFA) are associated with outcomes in...

Background Obesity has previously been correlated with poorer survival in both early and metastatic breast cancer. Adipose tissues release proangiogenic factors such as Insulin-like Growth Factor and Vascular Endothelial Growth Factor that may ultimately promote tumor growth. CTscan can be used to measure the visceral fat area (VFA) and the subcutaneous fat area (SFA) on the same section. High VFA has been shown to independently predict poorer outcome in patients given first-line bevacizumab-based treatment for metastatic colorectal cancer and metastatic renal cell carcinoma. The prospective multicenter COMET trial included metastatic HER2 negative breast cancer patients receiving bevacizumab and paclitaxel as fist-line chemotherapy. This study was designed to identify and validate reliable factors to predict benefit of bevacizumab and allow for a more personalized use of this antiangiogenic agent. Our aim was to evaluate the prognostic value of BMI (Body Mass Index), VFA and SFA in the COMET cohort and their impact on the quality of life. Patients and Methods Out of the 510 patients included in the COMET trial from 9/2012 to 3/2016, 480 received bevacizumab and paclitaxel as first-line treatment and 360 had available CTscan data. VFA and SFA were measured retrospectively on the CTscans performed before chemotherapy initiation, at the level of the umbilicus with the patient in the supine position. ImageJ software was used to measure pixels with densities in the -190 HU to -30 HU range in order to delineate the subcutaneous and visceral compartments and to compute the cross-sectional area of each in cm2. These measurements were performed by a radiologist blinded to patients’ characteristics and outcomes. For VFA and SFA, we used a threshold at the median value. VFA and SFA levels were tested for their association with progression-free survival (PFS) and overall survival (OS). The impact on quality of life was based on the Global Health Status, the Physical functioning, the Emotional functioning, Fatigue and Pain scores. Results The mean age at inclusion was 57 years (range: 28-83). At initial diagnosis, the main histological type was invasive ductal carcinoma (n = 247, 80.7%). Most patients had received prior neoadjuvant/adjuvant chemotherapy (n = 245, 68.1%) and a large majority (95.4%) had less than 3 metastatic sites. One hundred and forty patients (46.7%) had histological grade II and 41% had grade III tumors. The majority of the patients had positive hormone receptor tumor (n = 238, 79.3 %) and 62 (20.7%) had triple-negative tumor subtype. The median BMI was 24.7 (range : 17-46). After a median follow-up of 60.6 months (95%CI, 60-61.3), median PFS was 9.5 months (95CI, 8.6-10.3). There was no significant correlation between BMI (p = 0.69), VFA (p = 0.24) or SFA (p = 0.58) and PFS in the univariate analysis. The median OS was 29.6 months (95CI, 25.9-32.4). BMI, VFA and SFA were not correlated with OS. Out of the 360 patients, 328 had available data regarding the quality of life. There was no impact of the VFA or the SFA on the different quality of life scores. Conclusions In our prospective cohort of 360 patients with metastatic breast cancer receiving bevacizumab and paclitaxel as first-line treatment, high VFA or high SFA were not associated with a poorer survival. VFA and SFA had no impact on quality of life. Citation Format: Séverine Guiu, Boris Guiu, Marion Chevrier, Oumar Billa, Christelle Levy, Olivier Trédan, Isabelle Desmoulins, Marc Debled, Jean-Marc Ferrero, Christelle Jouannaud, Anthony Gonçalves, Maria Rios, Marie-Ange Mouret-Reynier, Frédérique Berger, Fatima-Zohra TOUMI, Jérôme Lemonnier, Jean-Yves Pierga, Sandrine Dabakuyo, Sophie Gourgou. Visceral fat area as a predictive factor in metastatic HER2 negative breast cancer patients treated by first line chemotherapy with weekly paclitaxel and bevacizumab [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P1-03-04.

Introduction: Abdominal obesity increases the risk of gastroesophageal reflux disease (GERD). This study aimed to determine the association between GERD and abdominal fat area quantified by computed tomography (CT). Methods: We analyzed the effect of abdominal fat area on gastroesophageal reflux symptoms and erosive esophagitis using logistic regression models in 5,338 participants who underwent abdominal fat measurement CT and screening esophagogastroduodenoscopy. Results: Participants with reflux symptoms and erosive esophagitis were diagnosed in 1,168 (21.9%) and 671 (12.5%), respectively. Multivariate analysis showed that subcutaneous and visceral fat areas were significantly associated with reflux symptoms and erosive esophagitis. The adjusted odds ratio (OR) in the fourth quartile of visceral fat area compared with that in the lowest quartile was 1.98 (95% confidence interval (CI) 1.63–2.39) for reflux symptoms and 2.33 (95% CI 1.80–3.01) for erosive esophagitis. Visceral fat area had a stronger effect in the younger age-group. In the group <50 years, the adjusted OR in fourth quartile of visceral fat area was 2.70 (95% CI 1.86–3.94) for reflux symptoms and 3.59 (95% CI 2.22–5.80) for erosive esophagitis. High visceral-to-subcutaneous fat ratio (VSR) increased the risk of reflux symptoms and erosive esophagitis in participants with body mass index <25 kg/m² and normal waist circumference. Conclusion: Subcutaneous and visceral fat areas were associated with an increased risk of reflux symptoms and erosive esophagitis. High VSR increased the risk of reflux symptoms and erosive esophagitis in participants with normal body weight and waist circumference.