Fat Area Research Articles

Predictive factors involving the remission and recurrence of hypertension post-laparoscopic sleeve gastrectomy in Japanese patients with severe obesity.

Metabolic surgery, including laparoscopic sleeve gastrectomy (LSG), may improve hypertension (HTN) complicated by severe obesity; however, insufficient deliberation exists regarding the therapeutic effect of post-metabolic surgery on HTN. This study aimed to analyze the factors correlated with HTN remission and recurrence post-LSG in patients who have severe obesity, and to create a classification system to predict HTN remission and recurrence. Of the 102 patients who underwent LSG at Iwate Medical University Hospital between 2008 and 2020, 62 were enrolled in this study. Factors correlated with HTN remission and recurrence post-LSG were retrospectively analyzed. The HTN remission rate 12-months post-LSG was 40.3%. The remission cohort had a lower number of preoperative antihypertensive drugs (ADs) than that of the non-remission cohort (one and two tablets, respectively; p< 0.001). Additionally, the remission cohort had a statistically significantly smaller visceral fat area (VFA) than that of the non-remission cohort, at all time points. Logistic regression analysis revealed that the number of preoperative ADs and VFA were independent predictors of remission. The HTN recurrence rate 36-months post-LSG was 36.0%. In the recurrence cohort, the number of preoperative ADs and VFA were higher and larger than that in the non-recurrence cohort, respectively. Stratification, based on the number of preoperative ADs and VFA, revealed that the HTN remission and recurrence rates in the sub-cohort with a small number of preoperative ADs and small VFA (100% and 16.7%, respectively) were better than those in the sub-cohort with a large number of preoperative ADs and large VFA (5.3% and 100%, respectively). In Japanese patients with severe obesity, the number of preoperative ADs and VFA were correlated with HTN remission and recurrence post-LSG. Stratification, by combining the number of preoperative ADs and VFA, may be useful in predicting HTN remission and recurrence.

Association between sex-specific criteria for visceral obesity and surgical site infection after gastrectomy

BackgroundHigh visceral fat area (VFA), estimated by computed tomography (CT), is reportedly associated with surgical site infection (SSI) in patients undergoing gastrectomy for gastric cancer (GC). Given that fat distributions vary markedly according to gender, sex-specific definitions of visceral obesity should be applied. We investigated the optimal sex-specific thresholds for VFA at the L3 level for assessing the risk of SSI after gastrectomy. MethodsWe studied 828 patients (564 males and 264 females) who underwent curative gastrectomy. Intra-abdominal or incisional infectious complications with Clavien Dindo scores ≥ 2 were defined as SSIs. Receiver operating characteristics (ROC) analyses were used to determine the optimal sex-specific VFA cut-offs for extracting obese patients prone to develop SSI. We performed logistic regression analyses and the corrected Akaike’s Information Criterion (AICc) was calculated to compare the capability for evaluating the possibility of SSI of our sex-specific VFA-based criteria versus the conventional VFA-based or BMI-based criterion. ResultsSSI developed in 59 males and 16 females. Optimal VFA thresholds were 119.3 cm2 for males and 57.2 cm2 for females. Multivariate analyses revealed visceral obesity, as defined by the sex-specific criteria, to be an independent risk factor for SSI (odds ratio: 2.74; 95% confidence interval: 1.62−4.66; p < 0.01). The logistic regression model with our sex-specific criteria yielded better AICc (456.4) than those with the conventional (461.8) or BMI-based (467.0) criterion for obesity. ConclusionSex-specific criteria can enhance the capability of VFA for assessing the risk of SSI after gastrectomy, as compared with the non-sex-specific criterion.

Development of a sex-specific visceral fat area estimation using discrete multi-wavelength near-infrared spectroscopy measurements in Korean individuals.

A high level of visceral fat area (VFA) is associated with obesity and cardiometabolic risk factors. VFA measured by computer tomography (CT) scan is accurate but has limitations for everyday use. Meanwhile, near-infrared (NIR) light penetrates the superficial layers of the human body so that fat content can be measured just as CT imaging measures fat accumulation. This study evaluated whether discrete multi-wavelength NIR spectroscopy (DMW-NIRS) can be used to measure abdominal fat as a satisfactory alternative to a CT scan. 290 subjects were enrolled in this study, and each subject underwent DMW-NIRS NIR measurement and CT scan. A sex-specific DMW-NIRS-based VFA estimation formula was developed by multiple linear regression, including lipid density, age, and body mass index (BMI). The model of DMW-NIRS estimated VFA gave the least Akaike Information Criterions (AIC), Root Mean Squared Errors (RMSE), and the greatest Coefficient of determination (R2) to predict VFA (1199, 29.5, 0.544 in female, and 1714, 41.3, 0.504 in male, respectively). Also, the DMW-NIRS estimated that VFA was highly performed to determine visceral obesity, which is comparable with other obesity surrogates. This study suggested that lipid density can be used as a valid, noninvasive method to determine visceral obesity.

Long-Term Physiological Adaptations Induced by Short-Interval High-Intensity Exercises: An RCT Comparing Active and Passive Recovery.

Background: High-intensity interval training (HIIT) is one of the most debated methods involving several parameters that could be modulated, but the long-term adaptations it induces are still unclear. This investigation aimed to evaluate the efficacy of running and whole-body exercises with high-intensity (>80% heart rate) short intervals (30 s) in body composition and physical performance and compare the effects between groups with active (AR) or passive recovery (PR), both in males and females. Methods: Eighteen trained young adults (55.56% ♀) were randomly allocated to the PR (n = 9, 23.09 ± 2.56 years, 163.69 ± 9.88 cm, 68.96 ± 14.62 kg) or AR (n = 9, 22.05 ± 1.54 years, 170.61 ± 11.5 cm, 68.78 ± 12.45 kg) group. Both groups performed eight weeks of HIIT, with an equal progression, training, and volume load (TL: F = 1.55, p = 0.214; VL: F = 0.81, p = 0.505). Body fat (BF), fat-free mass (FFM), upper and lower limb fat (UFI, LFI) and muscle areas (UMA, LMA), handgrip strength (HGS), power (countermovement jump, CMJ), agility (5-0-5), and maximal oxygen consumption (V˙O2p) were tested before and after treatments. Results: The proposed HIIT reduced BF by 9.57% and increased FFM by 2.09%. Females reported better adaptations in LMA (8.34 times higher than males), while both sexes' upper limb mass distribution was better affected by PR (♀: UFI g = 1.851, 95% CI: 0.51, 3.14; ♂: UFI g = 2.456, 95% CI: 0.336, 4.487). Concerning conditioning, the protocol increased V˙O2p by 6.47%. Females showed better adaptations in CMJ (RR = 1.8), while males showed better adaptations in agility (RR = 3.76). The interaction effects were significant for PR females (right = +6.28%; left = +9.28%) and for AR males (right = +19.21%; left = +19.04%) in HGS. Conclusions: Short-interval HIIT with different exercise recovery types may be a practical solution in training where several physiological improvements are needed. Coaches and trainers can take advantage of the versatile nature of HIIT, relying on desired movement patterns and long-term responses in both male and female individuals.

The effect of lumbar multifidus muscle degeneration on upper lumbar disc herniation.

This study aimed to investigate the effect of lumbar multifidus muscle (MF) degeneration on upper lumbar disc herniation (ULDH). This study used 3.0T magnetic resonance imaging (MRI) T2 axial weighted images to retrospectively analyze 93 ULDH patients and 111 healthy participants. Sixty-five pairs of participants were included in this study using propensity score matching (PSM). Cross-sectional area, fat infiltration area, anteroposterior diameter (APD), lateral diameter (LD), cross-sectional area of the bilateral multifidus muscles at the corresponding level, intervertebral disc area at the corresponding section, and visual analog scale (VAS) score for low back pain (LBP). For inter-group comparisons, we used the t-test, analysis of variance (ANOVA), Mann-Whitney U test, Kruskal-Wallis test, chi-square test, or Fisher's exact test, according to the type of data. We used Pearson correlation analysis to study the correlation between the VAS score and related indicators, and established a predictive model for upper lumbar disc herniation using the receive operative characteristic (ROC) curve analysis method. Finally, univariate and multivariate logistic regression analyses were performed to establish a predictive model for the risk of high lumbar disc herniation. We compared the fat areas at the lumbar vertebral levels L1/2, L2/3, and L3/4, as well as the left lateral diameter (LD) (MF), L1/2 left lumbar multifidus muscle index (LMFI), and L1/2 total fat infiltration cross-section area (TFCSA), and found significant differences between the case and control groups (P < 0.001). Furthermore, we observed a significant positive correlation (P < 0.05) between the VAS scores and multiple muscle indicators. Additionally, we developed ROC prediction models to assess the risk of lumbar intervertebral disc protrusion at the L1/2, L2/3, and L3/4 levels, with the results identifying L1/2 TFCSA, L2/3 TFCSA, and L3/4 relative psoas major muscle cross-section area (rPMCSA) as the most predictive indicators. Finally, univariate and multivariate logistic regression analyses showed that the L1/2 rPMCSA, L2/3 TFCSA were significantly associated with the risk of lumbar intervertebral disc protrusion in both models. Degeneration of the MF is significantly correlated with the occurrence of ULDH, and the larger the area of fat infiltration in the MF, the more obvious the lower back pain in ULDH patients. In addition, TFCSA can serve as an indicator of the occurrence of ULDH.

Stair climbing outperforms gait speed in predicting postoperative outcomes in patients undergoing radical gastrectomy for gastric cancer: A prospective study

BackgroundStair climbing test (SCT) and gait speed test (GST) are two physical performance measures, both of which are associated with postoperative outcomes. However, few studies have compared these two tests for the prognostic value. MethodsA prospective study was conducted in patients undergoing radical gastrectomy for gastric cancer. Handgrip strength (HGS) test, 7-steps SCT and 6-m GST were performed before surgery. Body compositions were analyzed using abdominal computed tomography (CT). Sarcopenia was diagnosed by low HGS plus either low muscle mass or quality. ResultsA total of 548 patients were included in this study. Time of GST and SCT were both significantly correlated with HGS, skeletal muscle index and skeletal muscle density, but not with subcutaneous or visceral fat area. Low SCT performance (SCT time ≥12.65s) was associated with higher incidence of postoperative complications and longer postoperative length of stay, whereas low GST performance (GST time ≥5.45s) did not. Low performance in SCT and GST were both associated with worse overall survival (OS) and disease-free survival (DFS) after surgery. Low SCT performance was an independent predictor for postoperative complications, OS, and DFS, whereas low GST performance was not significant in multivariate analyses adjusting for the same covariates. The combination of sarcopenia with low SCT performance showed higher accuracy in predicting postoperative complications and mortality compared with sarcopenia combined with low GST performance. ConclusionSCT outperformed GST in predicting outcomes after radical gastrectomy for gastric cancer, either as a singular indicator or in combination with sarcopenia assessments.

BCAA was more closely associated with visceral fat area than subcutaneous fat area in patients of type 2 diabetes mellitus: a cross-sectional study

BackgroundBranched-chain amino acid (BCAA) has been reported to be associated with obesity, the association of BCAA with visceral fat area (VFA) and subcutaneous fat area (SFA) remained unclear in patients with type 2 diabetes.MethodsThis cross-sectional study was conducted in 284 patients with type 2 diabetes mellitus. Enzyme-linked immunospecific assay was used to measure levels of serum BCAA and branched-chain keto acid (BCKA). VFA and SFA were measured with bio-impedance analysis method. The association between BCAA and VFA was calculated using Pearson correlation and multivariable linear regression analysis.ResultsThere were significant differences in the means of body mass index, waist circumstance, SFA and VFA among the three groups divided by total BCAA tertiles (all p < 0.05). Compared to patients with lower levels of serum BCAA (the lower tertile group), the means of VFA and SFA were significantly larger in the middle and upper tertile groups (all p < 0.05). However, the differences in above obesity parameters were nonsignificant according to various BCKA tertiles. Pearson correlation analysis also demonstrated that BCAA levels were positive associated with each obesity parameter (p < 0.05). Nevertheless, multivariable linear regression analysis showed that levels of serum BCAA were correlated with VFA, BMI and WC (all p < 0.05) rather than SFA after adjusted for other confounders.Conclusionslevels of serum BCAA were more closely correlated with VFA than SFA, prospective studies should be warranted to further explore the mechanism mediating BCAA and visceral fat accumulation in Human beings.Clinical trial numberNot applicable.

Use of real-time ultrasound measurements of fat thickness and longissimus thoracis muscle characteristics for predicting body fat depots in crossbred hair ewes

This study aimed to predict body fat depots using ultrasound measurements (USM) of fat thickness and longissimus thoracis muscle characteristics in crossbred hair ewes. A total of 24 animals with a mean body weight (BW) of 37 ± 4 kg and a body condition score of 2.39 ± 0.49 were used. USM was recorded 24 h before slaughter and included: subcutaneous fat thickness (SFT), area (LTMA), amplitude (LTA), and depth (LTD) of the l. thoracis muscle and kidney fat thickness (µKFT). After slaughter, the internal fat (IF) was separated, classified, and weighed as mesenteric (MF), omental (OF), or pelvic fat (PF). The left half was then separated into subcutaneous and intermuscular fat (CF), and the muscle and bone tissues were weighed separately and adjusted to take account of the whole animal. Total body fat (TBF) was determined to be the IF plus the CF weights. LTA and LTMA correlated poorly to moderately with fat depots (0.37 ≤ r ≤ 0.74, P < 0.05). Other than CF, µKFT showed poor to moderate correlation with the other depots of body fat (0.44 ≤ r ≤ 0.75, P < 0.05). The regression model used to predict MF had r2 of 0.87 (RSD=0.14 kg) and included BW and LTMA (P<0,05). OF and PF were predicted with r2 of 0.55 and 0.44, respectively, including µKFT (RSD = 0.20 and 0.17 kg). IF was predicted by empty BW, LTMA, and µKFT with r2 as 0.81 (RSD=0.30 kg). For TBF, EBW and LTMA explained 72 % of its variation (RSD= 0.59 kg). USM of fat thickness and l. thoracis muscle characteristics can improve the accuracy of predicting body energy reserves in crossbred hair ewes.

Intensified outpatient nutrition management improves body weight and skeletal muscle loss after esophageal cancer surgery: a single-center, retrospective, single-arm clinical study

BackgroundThe progression of malnutrition and sarcopenia after esophagectomy for esophageal cancer negatively influences long-term prognosis. To improve nutritional status after esophagectomy, we introduced an intensified nutrition management (iNM) protocol, in which nutritional counselling by dietitians was provided more frequently. The aim of this study was to evaluate the efficacy of iNM compared with the conventional NM (cNM).MethodsWe included 126 patients who underwent esophagectomy before and after NM revision, and compared nutritional status and changes in body composition after esophagectomy between the cNM and iNM groups. Nutritional parameters were assessed, and we also calculated skeletal muscle index (SMI), skeletal muscle density (SMD), and visceral fat area (VFA) using computed tomography volumetry.ResultsThere were no significant differences in baseline characteristics or surgical outcomes between the groups. Compared with the cNM group, nutritional counselling was provided more frequently (P < 0.001) in the iNM group, and compliance rate increased from 56.3 to 91.9% (P < 0.001). Body weight loss at 4 and 6 months and SMI reduction at 6 months were significantly improved in the iNM group compared with the cNM group (P < 0.001, P = 0.032, and P = 0.023, respectively). There were no significant differences in the changes in SMD, VFA, serum albumin level, and prealbumin level between the two groups.ConclusionsOutpatient iNM significantly mitigated the reduction in body weight and SMI 3–6 months after esophagectomy.

Low skeletal muscle density assessed by abdominal computerized tomography predicts outcome in children with chronic kidney disease

ObjectiveSkeletal muscle loss and abnormal fat distribution are predictors of poor clinical outcomes in adults with chronic kidney disease (CKD). However, the relationship between body composition (muscle mass and adipose tissue) and prognosis in children with CKD has not been well elucidated. MethodsThe retrospective single-center study enrolled children with CKD and healthy group who underwent an abdominal Computerized tomography (CT) examination and compared the body composition of the third lumbar spine (L3) between the two groups. We defined the primary outcome as hemodialysis, peritoneal dialysis, kidney transplantation, or death. Logistic regression analysis was applied to assess the connection between low skeletal muscle density (SMD) and clinical and demographic variables. Multivariate Cox regression analysis was used to evaluate the risk factors for progression to the primary outcome. Kaplan-Meier survival analysis was performed to compare the effect of different body composition on event-free survival rate. Results32 patients with CKD [eGFR: 14.89(8.86, 29.88) (mL/min/1.73m2)] and 66 heathy subjects [eGFR: 135.72(121.70, 161.29) (mL/min/1.73m2)] were recruited in our study. From the assessment of body composition assessed by CT, skeletal muscle area, SMD and skeletal muscle index (SMI) in CKD group was lower than those in healthy group (P<0.05). On the other hand, visceral fat area and visceral fat index in CKD group were significantly higher than those in healthy group (P<0.05). In logistic regression analysis, triglyceride (OR: 8.635, 95%CI: 1.153-64.687) was independently associated with low SMD. After adjusting clinical data and body composition, high serum albumin (HR: 0.873, 95%CI: 0.798-0.955) and high SMD (HR: 0.895, 95%CI: 0.822-0.974) were protective factors for delaying renal failure. Based on the Kaplan-Meier analysis, only the group with low SMD had lower event-free survival in comparison to the reference group (P<0.05). ConclusionsThese findings suggest that there is significant skeletal muscle loss and decrease in SMD in CKD children. Notably, low SMD is indicative of poor prognosis in CKD children.

Sex differences of visceral fat with cardiac structure and function in type 2 diabetes: A cross-sectional study.

The aim of this study is to analyze the associations among fat distribution, left ventricular (LV) structure, and function in T2DM patients and further assess the sex differences among them. Two thousand and one hundred seven T2DM patients were enrolled to this study. Patients' height, weight, BMI, visceral fat area (VFA), baPWV, parameters of cardiac structure and function, and clinical biochemical indicators were measured and collected. There were significant differences between male and female T2DM patients in age, duration of diabetes, complication ratio of hypertension and dyslipidemia, smoking history, visceral fat, baPWV, and ventricular structure and function (p < 0.05). Compared with the Q1 group, female patients in the highest quartile (Q4) of VFA had a decreased LVEF and significantly increased baPWV (p < 0.05), whereas no such changes were found in males. The correlation analysis showed that LVEF in male patients was negatively correlated with hypertension history, using of CCBs, GLP-1RA, lipid-lowering medications, BMI, WC, WHR, FPG, FC-P, HbA1c, GA, HOMA-IR, Cr, and baPWV, while the LVEF in female patients was negatively correlated with VFA, VSR, VFA/BMI, VFA/H2, VFA/weight in females (p < 0.05). LVMI was positively associated with diabetes duration, age, hypertension history, WC, WHR, VFA, SFA, VFA/BMI, VFA/H2, VFA/weight, and baPWV in both males and females. Multivariable-adjusted linear regression analysis showed that VFA was independently associated with LVEF (β = - 0.096, p = 0.010), LVMI (β = 0.083, p = 0.038), and baPWV (β = 0.120, p = 0.003) in females. Values of VFA were independently associated with LVEF, LVMI, and baPWV in women, but not in men, in patients with T2DM.

Impacto clínico de la adiposidad visceral en la mortalidad a largo plazo de pacientes sometidos a revascularización coronaria

Introduction and objectives: Although visceral adiposity increases cardiovascular risk in the general population, the obesity paradox has been reported in critically ill patients. However, evidence for its prognostic role in patients undergoing coronary artery bypass grafting (CABG) is limited. This study evaluated the prognostic implications of visceral adiposity in patients who underwent CABG using computed tomography-based measurement of visceral fat.Methods: A total of 2810 patients who underwent CABG from 2007 to 2017 were analyzed. The study population was classified into 3 groups according to visceral fat area index (VFAI) tertiles. VFAI was calculated as visceral fat area (cm2)/height2 (m2) at the L3 level. The primary outcome was all-cause mortality during follow-up.Results: Patients in the low VFAI group (lowest tertile) were younger and had a lower body mass index and less subcutaneous fat than those in the high VFAI group (highest tertile). During a median 8.7-year follow-up, VFAI was significantly associated with the risk of mortality in restricted cubic spline curve analysis (HR, 0.94 per 10 increases; 95%CI, 0.91-0.97; P < .001). Patients in the low VFAI group had a higher incidence of long-term mortality than those in the intermediate and high VFAI groups (T1 36.1%, T2 27.2%, and T3 29.1%; T1 vs T2; adjusted HR, 1.36; 95%CI, 1.15-1.61; P < .001; T1 vs T3; adjusted HR, 1.37; 95%CI, 1.16-1.62; P < .001). Similar results were obtained after inverse probability treatment-weighting analysis.Conclusions: Low visceral adiposity was associated with an increased risk of long-term mortality in patients who underwent CABG.

Beyond MELD Score: Association of Machine Learning-derived CT Body Composition with 90-Day Mortality Post Transjugular Intrahepatic Portosystemic Shunt Placement.

To 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. This retrospective multi-center cohort study included patients who underwent TIPS from 1995 to 2018 and had a contrast-enhanced CT abdomen within 9months 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. A 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). CT body composition is positively predictive of 90-day mortality after TIPS and improves the predictive performance of MELD score. Level 3, Retrospective multi-center cohort study.

Assessment of cardiopulmonary exercise capacity in suspected heart failure with preserved ejection fraction: impact of coronary flow velocity reserve and body fat

Abstract Background and objectives Heart failure with preserved ejection fraction (HFpEF) has various pathophysiology including coronary microvascular dysfunction (CMD), obesity, and frailty. In the present study, we aimed to assess the cardiopulmonary exercise capacity according to coronary microvascular function and body composition in patients with suspected HFpEF. Methods Patients with chest symptoms with non-obstructive coronary artery disease (&amp;lt;50% stenosis) and preserved left ventricle (LV) ejection fraction (≥50%) were enrolled. LV end-diastolic pressure was measured during coronary angiography. All patients underwent body composition analysis, adenosine stress echocardiography with the evaluation of coronary blood flow, and cardiopulmonary exercise test assessing maximal oxygen consumption (VO2max). Coronary flow velocity reserve (CFvR) was defined as the ratio of peak to baseline mean diastolic velocity of coronary blood flow. Association between VO2max and CFvR as well as body composition was assessed. Results Of the 106 patients (mean age 63.5), 54 (50.9%) were women, 52.4% had hypertension, and 28.6% had diabetes. Baseline LV end-diastolic pressure was 15.3 ± 5.5 mmHg. Median Heart Failure Association-PEFF score was 3, while medial e’ velocity was 6.7 ± 2.0 cm/s and E/e’ was 9.6 (7.6 – 12.0). Mean diastolic velocity of coronary blood flow was 0.17 [interquartile range (IQR) 0.13 – 0.23] m/sec at baseline, while it increased to 0.46 [IQR 0.38 – 0.57] m/sec at peak, resulting in CFvR of 2.75 [IQR 2.10 – 3.67]. Eighteen (17.1%) patients had CMD (CFvR &amp;lt;2.0). VO2max was 23.1 ± 5.4 mL/kg/min with lower value in women (21.7 ± 4.8 vs. 24.5 ± 5.6 mL/kg/min, p = 0.007). CFvR was directly related to VO2max (r = 0.350, p &amp;lt;0.001). In body composition, skeletal muscle mass index, percent body fat, and visceral fat area were associated with VO2max. In multivariable analysis, age, visceral fat area or percent body fat, and CFvR were linearly correlated with VO2max, and estimated VO2max was well correlated with measured VO2max. Conclusions Cardiopulmonary exercise capacity represented by VO2max was correlated with CFvR and body composition including skeletal muscle mass index, percent body fat, and visceral fat area in patients with suspected HFpEF. VO2max could be estimated by CFvR and fat component in the body.

Beneficial Effects of a Freeze-Dried Kale Bar on Type 2 Diabetes Patients: A Randomized, Double-Blinded, Placebo-Controlled Clinical Trial.

Type 2 diabetes (T2D) is one of the most common global diseases, with an ever-growing need for prevention and treatment solutions. Kale (Brassica oleracea L. var. acephala) offers a good source of fiber, minerals, bioavailable calcium, unsaturated fatty acids, prebiotic carbohydrates, vitamins, health-promoting secondary plant metabolites, as well as higher amounts of proteins and essential amino acids compared to other vegetables. The objective of this study was to investigate whether daily intake of freeze-dried kale powder can provide health benefits for T2D patients vs. placebo. This study was designed as a 12-week, blinded, randomized, controlled trial. Thirty T2D patients were randomly assigned to either a placebo bar (control) or a kale bar (intervention). Participants in the intervention group were instructed to consume three bars/day, each containing 26.25 g of freeze-dried kale (corresponding to approx. 341 g fresh kale/day). At baseline and 12 weeks, all participants underwent an oral glucose tolerance test (OGTT), 24 h blood pressure measurements, DEXA scans, and fasted blood samples were taken. A significant reduction in HbA1c, insulin resistance, body weight, and calorie intake was observed in the intervention group compared to control. Positive trends were detected in fasted blood glucose and LDL-cholesterol for those in the kale intervention group. No significant differences were found in total body fat mass and area under the curve glucose 240 min OGTT. Given the positive effects of high daily kale intake observed in this study, further research with a larger sample size is needed to better understand the health benefits of kale bars. This could potentially lead to new dietary recommendations for patients with T2D.

Association of visceral fat area with early-stage locomotive syndrome across various age groups: a cross-sectional study

The association between visceral fat area (VFA) and locomotive syndrome (LS) has been extensively studied in the older population; however, the association between VFA and early-stage LS (stage 1 [LS1]) remains unclear. In this cross-sectional study, we investigated this association across different age groups. The study involved 1,236 (524 male and 712 female) participants (aged 20–85 years). Multiple regression analysis adjusted for sex, body mass index, skeletal muscle mass index, T-score, exercise habits, smoking status, and alcohol consumption revealed a significant association between LS1 and VFA across all VFA quartiles. The adjusted odds ratio OR for quartiles 2, 3, and 4 was 1.84, 2.68, and 4.12, respectively. The association between LS1 and VFA across the age groups—high VFA (> 73 cm2) and non-older (< 65 years) (OR, 1.87; 95% CI, 1.28–2.72; p = 0.001), low VFA (≤ 73 cm2) and older (≥ 65 years) (OR, 3.16; 95% CI, 1.94–5.14; p < 0.001), and high VFA and older groups (OR, 6.43; 95% CI, 3.98–10.4; p < 0.001)—was significantly stronger than that in the low VFA and non-older group. In summary, our findings suggest that managing VFA through diet and exercise is crucial for preventing LS1 across all age groups.

Visceral Obesity and a High Glasgow Prognostic Score Are Key Prognostic Factors for Metastatic Colorectal Cancer Treated with First Line Chemotherapy.

The prognostic significance of a high visceral fat area (VFA) in metastatic colorectal cancer (mCRC) remains unclear. We evaluated the prognostic impact of high-VFA on the long-term outcomes of patients with mCRC who underwent chemotherapy. Ninety patients with metastatic CRC who underwent chemotherapy were included. VFA measurement was performed by pre-treatment computed tomography using image analysis system. Overall survival (OS) and progression-free survival (PFS) rates were analyzed using the Cox proportional hazards model and Kaplan-Meier curves with the log-rank test. High-VFA was identified in 39 patients. The OS (2-year OS rates: 51.6% vs 33.3%, p=0.0023) and PFS rates (2-year PFS rates: 18.0% vs 2.7%, p=0.012) were significantly lower in the high-VFA group than in the low-VFA group. In multivariate analysis, the independent significant predictors of OS were carbohydrate antigen 19-9 (CA19-9) ≥37.0 U/mL (HR: 1.99, 95%CI [1.20-3.31], p=0.007), Glasgow prognostic score (GPS) of 1 or 2 (HR: 2.65, 95%CI [1.53-4.58], p<0.001), and high-VFA (HR: 3.09, 95%CI [1.81-5.25], p<0.001). Similarly, the independent significant predictors of PFS were CA19-9 ≥37.0 U/mL (HR: 2.02, 95%CI [1.21-3.38], p=0.007), GPS of 1 or 2 (HR: 1.87, 95%CI [1.17-2.99], p=0.008), and high-VFA (HR: 2.65, 95% CI [1.61-4.35], p<0.001). We demonstrated that pre-treatment high-VFA and high-GPS were significantly associated with worse OS and PFS rates in patients with mCRC who underwent chemotherapy.

Characterizing body composition modifying effects of a glucagon-like peptide 1 receptor-based agonist: A meta-analysis.

Diabetes is an independent risk factor for muscle mass loss, with possible mechanisms including impaired insulin signalling and chronic inflammation. The use of a glucagon-like peptide 1 (GLP-1) receptor-based agonist could lead to weight reduction, which might result from the loss of both fat and skeletal muscle. However, the body composition-modifying effects of GLP-1 receptor-based agonists have not been systematically characterized. PubMed, EMBASE, the Cochrane Center Register of Controlled Trials for Studies and Clinicaltrial.gov were searched from inception to October 2023. Randomized controlled trials of GLP-1 receptor agonist or glucose-dependent insulinotropic polypeptide/GLP-1 receptor dual agonist, which reported the changes of body composition, were included. The results were computed as weighted mean differences (WMDs) and 95% confidence intervals (CIs) in a random-effects model. In all, 19 randomized controlled trials were included. When compared with controls, substantial reductions in fat body mass were observed in patients using GLP-1 receptor-based agonist treatment (WMD = -2.25 kg, 95% CI -3.40 to -1.10 kg), with decrease in areas of both subcutaneous fat (WMD = -38.35 cm2, 95% CI, -54.75 to -21.95 cm2) and visceral fat (WMD = -14.61 cm2, 95% CI, -23.77 to -5.44 cm2). Moreover, greater reductions in lean body mass were also observed in GLP-1 receptor-based agonist users compared with non-users (WMD = -1.02 kg, 95% CI, -1.46 to -0.57 kg), while the changes in lean mass percentage were comparable between GLP-1 receptor-based agonist users and non-users. Compared with the controls, GLP-1 receptor-based agonist users experienced greater reductions in fat body mass, with body shaping effects in terms of both subcutaneous fat mass and visceral fat mass. Although greater reductions in lean body mass were also observed in GLP-1 receptor-based agonist users, the changes in lean mass percentage were comparable between the users and non-users.

Role of CT-based body composition parameters in the course of COVID-19.

A significant correlation is observed between the course of coronavirus disease 2019 (COVID-19) and body composition parameters including visceral fat quantification, muscle mass, and hepatic attenuation. The aim of the study was to investigate the correlation between the extent of lung involvement and various computed tomography (CT) parameters, as well as laboratory findings in COVID-19 patients. A retrospective analysis was conducted on 72 adult patients with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 infection who underwent two consecutive thorax CT scans at least 2 weeks apart. The patients were divided into two groups, as progressive and nonprogressive, based on the presence of two consecutive CT scans. Skeletal muscle area (SMA), subcutaneous fat area (SFA), visceral fat area (VFA), total fat area (TFA), liver-to-spleen (L/S) density ratio, and laboratory findings were compared between the groups. The correlation between the extent of lung involvement and CT parameters, as well as the laboratory findings were assessed. A total of 72 patients were included in the study, with 34 (47.2%) females and 38 (52.8%) males. Hemoglobin levels were significantly lower in the progressive group compared to the nonprogressive group. C-reactive protein (CRP) values were higher in the progressive group at follow-up. The nonprogressive group exhibited decreases in the SFA, VFA, and TFA, while liver density increased. The progressive group showed a decrease in the twelfth thoracic vertebra (T12) paravertebral muscle area and muscle index. In the comparison of the laboratory and radiological data in the course of COVID-19, white blood cell (WBC) and neutrophil counts increased, SMA T12, and the skeletal muscle index (SMI) decreased in the lung progressive group. Hemoglobin and CRP levels at admission may indicate disease progression. Future studies are warranted to increase the reliability with larger series.

Association between different patterns of obesity and the short-term outcomes of gastric cancer surgery.

Previous studies have shown that general and central obesity are each linked to adverse outcomes in gastrointestinal cancers. However, their combined effect on gastrointestinal cancers surgery outcomes were less understood. This study aims to integrate both general and central obesity to examine the outcomes of gastric cancer surgery in different obesity patterns. We retrospectively analyzed 248 patients who underwent gastric cancer surgery between 2021 and 2023 in a single institute. The Inbody720 body composition analyzer measured body composition. We evaluated the relationship between obesity patterns - combining BMI with central obesity measures (waist circumference, waist-to-hip ratio, visceral fat area) - and postoperative complications and 30-day readmission. Central-only obesity were more likely to induce fistula (P = 0.025), while non-obesity was more likely to develop postoperative abdominal effusion (P = 0.049) and bleeding (P = 0.042). Central-only obesity was significantly associated with severe postoperative complications after adjustment for hypertension, diabetes, abdominal surgery history, preoperative albumin levels, age, sex, and surgical types. This remains significant even after adjusting for muscle mass. However, we did not find the same results for significant complications. Regarding 30-day readmission, there are no differences between different patterns of obesity. Central-only obesity is an independent risk factor for severe postoperative complications in gastric cancer, while a high BMI appears to be associated with a lower risk compared to non-obese patients, but not significant postoperative complications. The likelihood of readmission within 30 days post-surgery may not be related to the patient's pattern of obesity.