Changes In Visceral Adipose Tissue Research Articles

Effect of Galohgor Cookies and Powder Drinks on Visceral Adipose Tissue and Lipid Profile in Patients with Type 2 Diabetes Mellitus

This study aimed to assess the intervention effect of cookies and galohgor powder drinks on visceral adipose tissue (VAT) and lipid profile in patients with type 2 diabetes mellitus. The study design was quasi experimental. Subjects of this study were 26 adults with type 2 diabetes mellitus in Bogor District, West Java. Subjects were divided into two intervention groups; cookies and galohgor powder drinks (GCPD) group and cookies and powder drinks without galohgor (CPD) group. Both interventions were given for 38 days period. Analysis of Covariance (ANCOVA) was applied to assess the effect of interventions. The average changes in VAT controlled by covariates in GCPD group was significantly higher than in CPD group (-33.3% vs +6.7%; p 0.05). The average changes of triglycerides level in GCPD and with CPD group were -30.9% and +1.6% (p>0.05). The average changes in HDL level for GCPD group and CPD group were -9.0% and -12.0% (p>0.05). The average changes in LDL level for GCPD group and CPD group were -3.9% and -1.6% (p>0.05). Hence, it can be concluded that the administration of cookies and galohgor powder drinks significantly reduced the Visceral Adipose Tissue (VAT) in patients with type 2 diabetes mellitus.

How to best assess abdominal obesity.

Abdominal obesity, especially the increase of visceral adipose tissue (VAT), is closely associated with increased mortality related to cardiovascular disease, diabetes, and fatty liver disease. This review provides an overview of the recent advances for abdominal obesity measurement. Compared to simple waist circumference, emerging three-dimensional (3D) body-scanning techniques also measure abdominal volume and shape. Abdominal dimension measures have been implemented in bioelectrical impedance analysis to improve accuracy when estimating VAT. Geometrical models have been applied in ultrasound to convert depth measurement into VAT area. Only computed tomography (CT) and MRI can provide direct measures of VAT. Recent advances in imaging allow for evaluating functional aspects of abdominal fat such as brown adipose tissue and fatty acid composition. Waist circumference is a simple, inexpensive method to measure abdominal obesity. CT and MRI are reference methods for measuring VAT. Further studies are needed to establish the accuracy for dual-energy X-ray absorptiometry in estimating longitudinal changes of VAT. Further studies are needed to establish whether bioelectrical impedance analysis, ultrasound, or 3D body scanning is consistently superior to waist circumference in estimating VAT in different populations.

Rosiglitazone Increases Visceral and Subcutaneous Fat in Youth with Type 2 Diabetes (T2D) in the TODAY Study

Objective: In TODAY, metformin + rosiglitazone (M+R) was better in maintaining glycemic control than metformin alone (M) or metformin + lifestyle (M+L), but longitudinal differences in whole body adiposity were small and unrelated to treatment group. As excess visceral adipose tissue (VAT) and nonalcoholic fatty liver disease (NAFLD) are common in T2D, we hypothesized that changes in VAT, subcutaneous adipose tissue (SAT), and liver enzymes, as a marker of NAFLD, would be related to treatment effect. Methods: TODAY enrolled 699 youth 11-17 y/o with T2D <2 year. In 626 subjects, VAT and SAT (by DXA) and AST and ALT were measured at baseline (BL) and 24 mo. Changes from BL to 24 mo were analyzed in baseline-adjusted repeated measures models. Results: At BL, mean age was 13.9 year, 66.4% were female, 41.1% hispanic, 31.1% non-hispanic black, 20.3% non-hispanic white (NHW). Mean BMI was 33.7 kg/m2 and BMI z-score +2.2. 3.3% had ALT ≥1.5 upper limit of normal (ULN), suggestive of NAFLD, and 0.3% had AST ≥1.5 ULN. At 24 mo, BMI, BMI z-score, VAT, and SAT all increased. VAT increased most in M+R and least in M+L (14.2% vs. 3.1%, p<0.001). SAT increased more in M+R (15.7%) than M+L (6.9%, p<0.0001) or M (8.7%, p<0.001). At 24 mo, between-group differences in VAT:SAT ratio and AST were not significant, but ALT increased more in M+L than M+R (23.1% vs. 2.7%, p=0.015). Sex did not moderate treatment effects on VAT and SAT. Greater increases in VAT occurred in NHW in M+R than M (p<0.001) or M+L (p<0.001). VAT and SAT increases correlated with higher HbA1c (p<0.001), and lower insulin sensitivity (p<0.033), and c-peptide oral disposition index (p<0.038), but did not differ by treatment group. Conclusion: Unlike in adults, in youth in TODAY, VAT rise was greater in M+R than M+L. VAT and SAT changes were not related to treatment group differences in glycemic control. Increased VAT and SAT correlated with lower insulin sensitivity and secretion. In T2D youth, R may blunt the rise in ALT, but does not lower the VAT:SAT ratio. Disclosure R. Dhaliwal: None. J.A. Shepherd: None. L. El Ghormli: None. K.C. Copeland: Other Relationship; Self; Novo Nordisk Inc. M. Geffner: Other Relationship; Self; Daiichi Sankyo Company, Limited. J. Higgins: None. L.L. Levitsky: Consultant; Self; Eli Lilly and Company. K.J. Nadeau: None. R.S. Weinstock: Research Support; Self; Medtronic MiniMed, Inc., Mylan, Kowa Pharmaceuticals America, Inc., Diasome Pharmaceuticals, Inc., Calibra Medical, Dexcom, Inc., Ultradian Diagnostics LLC., JAEB Center For Health Research, JDRF, National Institute of Diabetes and Digestive and Kidney Diseases. N.H. White: None.

Abstract P259: Improvements in Diet Quality Are Associated With Reduced Abdominal Adiposetissue: A Prospective Study

Objectives: Visceral adipose tissue (VAT) and abdominal subcutaneous adipose tissue (SAT) are associated with cardiometabolic diseases. The relationship between diet quality and abdominal fat accumulation, however, has not been well studied. We aimed to examine the long-term association of change in diet quality and change in abdominal adipose tissue. Methods: In 1,677 participants who attended two consecutive Framingham Heart Study examinations, we measured the volume of VAT and SAT using multi-detector computed tomography at two time-points (median interval of 6 years). The ratio of VAT/SAT was calculated to reflect the relative abundance of these two fat stores, i.e., abdominal fat distribution. We created two scores to represent overall diet quality, the Mediterranean-style diet score (MDS) and the Alternative Healthy Eating Index (AHEI) score, using food frequency questionnaires at baseline and follow-up exams. We analyzed the association between change in the dietary scores and change in VAT, SAT, and VAT/SAT ratio with adjustment for baseline covariates including sex, age, dietary score, VAT, SAT, or VAT/SAT ratio, BMI, energy intake, smoking status, physical activity score, and change in energy intake, smoking status, and physical activity. Results: For each standard deviation increase in ΔMDS (diet quality improved), VAT volume reduced by 53±19 cm 3 (P=0.005) and SAT volume declined by 52±20 cm 3 (P=0.01). Similarly, for each standard deviation increase in ΔAHEI (diet quality improved), VAT volume declined by 45±18 cm 3 (P=0.01) and SAT volume fell by 57±19 cm 3 (P=0.003). In addition, an increased MDS was associated with a decline in VAT/SAT ratio (P=0.04), but there was no association between ΔAHEI and change in VAT/SAT ratio (P=0.06). We also observed that improved intake of nuts (P=0.04), whole grains (P=0.02), and meat (P=0.005) for MDS and fruits (P=0.02) and meat (P=0.03) for AHEI were associated with a decline in VAT/SAT ratio. Conclusions: The present study demonstrates that longitudinal improvements in diet quality were associated with reduced abdominal fat accumulation, both VAT and SAT. In addition, improved dietary intake of fruits, nuts, whole grains, and meat may affect abdominal fat distribution, i.e., more likely to reduce fat accumulation in VAT relative to SAT.

Effect of longitudinal changes of body fat on the incidence and regression of nonalcoholic fatty liver disease

AimsTo investigate the longitudinal association between changes in body fat amount and the incidence and regression of nonalcoholic fatty liver disease (NAFLD). MethodsWe performed a cohort study of 2017 subjects without liver disease or significant alcohol consumption from 2007 to 2008 and participated in a voluntary follow-up between 2011 and 2013. Of the 2017 subjects, we enrolled 956 (47.4%) subjects who had available abdominal fat data in both 2007–2008 and 2011–2013. NAFLD was diagnosed on the basis of ultrasonographic findings. Adipose tissue area was evaluated by computed tomography. ResultsWe observed 145 incident cases of NAFLD (22.6% of 642), and 79 subjects experienced a regression of NAFLD (25.2% of 314) during a median of 4.64 years. An increasing change in visceral adipose tissue (VAT) area was associated with a higher incidence of NAFLD (highest tertile vs. lowest tertile of VAT hazard ratio [HR] 2.45, 95% confidence interval [CI] 1.56–3.85, P for trend <0.001) in the multivariable analysis. An increasing change in VAT area was inversely associated with the regression of NAFLD (highest tertile vs. lowest tertile of VAT HR 0.40, 95% CI 0.20–0.80, P for trend = 0.008). ConclusionsAn increasing change in VAT area was longitudinally associated with a higher risk of incident NAFLD and inversely associated with the regression of NAFLD.

Anthropometric Changes in Patients with Pancreatic Cancer Undergoing Preoperative Therapy and Pancreatoduodenectomy

BackgroundThe changes in body composition that occur in response to therapy for localized pancreatic ductal adenocarcinoma (PDAC) and during the early survivorship period, as well as their clinical significance, are poorly understood. MethodsOne hundred twenty-seven consecutive patients with PDAC who received preoperative therapy followed by pancreatoduodenectomy (PD) at a single institution between 2009 and 2012 were longitudinally evaluated. Changes in skeletal muscle (SKM), visceral adipose tissue (VAT), and subcutaneous adipose tissue (SAT) were measured on serial computed tomography images obtained upon presentation, prior to pancreatectomy, and approximately 3 and 12 months after surgery. ResultsPrior to therapy, patients’ mean baseline BMI was 26.5±4.7 kg/m2 and 63.0% met radiographic criteria for sarcopenia. During a mean 5.4±2.3 months of preoperative therapy, minimal changes in SKM (− 0.5 ± 7.8%, p > 0.05), VAT (− 1.8 ± 62.6%, p < 0.001), and SAT (− 4.8 ± 27.7%, p < 0.001) were observed. In contrast, clinically significant changes were observed on postoperative CT compared to baseline anthropometry: SKM − 4.1 ± 10.7%, VAT − 38.7 ± 30.2%, and SAT − 24.1 ± 22.6% (all p < 0.001) and these changes persisted at one year following PD. While anthropometric changes during preoperative therapy were not independently associated with survival, SKM gain between the postoperative period and one-year follow-up was associated with improved overall survival (OR 0.50, 95% CI 0.29–0.87). ConclusionsIn contrast to the minor changes that occur during preoperative therapy for PDAC, significant losses in key anthropometric parameters tend to occur over the first year following PD. Ongoing SKM loss in the postoperative period may represent an early marker for worse outcomes.

Negative legacy of obesity.

Obesity promotes excessive inflammation, which is associated with senescence-like changes in visceral adipose tissue (VAT) and the development of type 2 diabetes (T2DM) and cardiovascular diseases. We have reported that a unique population of CD44hi CD62Llo CD4+ T cells that constitutively express PD-1 and CD153 exhibit cellular senescence and cause VAT inflammation by producing large amounts of osteopontin. Weight loss improves glycemic control and reduces cardiovascular disease risk factors, but its long-term effects on cardiovascular events and longevity in obese individuals with T2DM are somewhat disappointing and not well understood. High-fat diet (HFD)-fed obese mice were subjected to weight reduction through a switch to a control diet. They lost body weight and visceral fat mass, reaching the same levels as lean mice fed a control diet. However, the VAT of weight reduction mice exhibited denser infiltration of macrophages, which formed more crown-like structures compared to the VAT of obese mice kept on the HFD. Mechanistically, CD153+ PD-1+ CD4+ T cells are long-lived and not easily eliminated, even after weight reduction. Their continued presence maintains a self-sustaining chronic inflammatory loop via production of large amounts of osteopontin. Thus, we concluded that T-cell senescence is essentially a negative legacy effect of obesity.

Longitudinal changes in visceral and subcutaneous adipose tissue and metabolic syndrome: Results from the Multicultural Community Health Assessment Trial (M-CHAT)

AimFew studies have examined whether longitudinal changes in visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT), independent of each other, are associated with the risk of developing metabolic syndrome (MetS). The objective of this study was to examine the longitudinal effects of VAT and SAT on MetS and metabolic risk factors in a multi-ethnic sample of Canadians followed for 5-years. Materials and methodsIn total, 598 adults of the Multicultural Community Health Assessment Trial (M-CHAT) were included in this study. Assessments of body composition using computed tomography (CT) and metabolic risk factors were conducted at baseline, 3-, and 5-years. Mixed-effects logistic regression was used to model the longitudinal effects of VAT and SAT on MetS and metabolic risk factors. ResultsThere were significant between-person (cross-sectional) effects such that for every 10cm2 higher VAT, the odds of MetS, high-risk fasting glucose levels and high-risk HDL-C levels significantly increased by 16% (95% CI: 9–24%), 11% (3–20%), and 7% (0–14%) respectively. Significant within-person (longitudinal) effects were also found such that for every 10cm2 increase in VAT the odds of MetS and high-risk triglyceride levels significantly increased by 23% (9–39%) and 30% (14–48%), respectively. Cross-sectional or longitudinal changes in SAT were not associated with MetS or metabolic risk factors. ConclusionsThis study found a direct relationship between longitudinal change in VAT and MetS risk independent of changes in SAT. Clinical practice should focus on the reduction of VAT to improve cardiovascular health outcomes.

Obesity, Visceral Adipose Tissue, and Cognitive Function in Childhood

To evaluate the effects of a 9-month physical activity intervention on changes in adiposity and cognitive control based on pretrial weight status (ie, healthy weight vs obese) in children. Participants included obese (n = 77) and matched healthy-weight (n = 77) preadolescents (8-9 years) who participated in a 9-month physical activity randomized controlled trial. Cognitive function was assessed with an inhibitory control task (modified flanker task). After the 9-month physical activity intervention, participants exhibited a reduction in adiposity. In contrast, children in the waitlist-control condition, particularly children identified as obese pretrial, gained visceral adipose tissue (P= .008). Changes in visceral adipose tissue were related to changes in cognitive performance, such that the degree of reduction in visceral adipose tissue directly related to greater gains in inhibitory control, particularly among obese intervention participants (CI -0.14, -0.04; P= .001). Participation in a daily physical activity program not only reduces adiposity but also improves children's cognitive function as demonstrated by an inhibitory control task. Furthermore, these findings reveal that the benefits of physical activity to improvements in cognitive function are particularly evident among children who are obese. ClinicalTrials.gov: NCT01334359 and NCT01619826.

Cardiometabolic risk factors in type 2 diabetes with high fat and low muscle mass: At baseline and in response to exercise.

To examine the interplay between high fat and low muscle mass on cardiometabolic risk factors at baseline and in response to exercise in type 2 diabetes. Using baseline percent body fat and skeletal muscle mass index, 248 participants were divided into high fat versus low fat and low muscle versus high muscle. Linear mixed models were used to examine the main effects of fat mass and muscle mass and their interaction on baseline cardiometabolic risk factors and changes in risk factors in response to 6-month exercise training. At baseline, there was a fat mass by muscle mass interaction effect on hemoglobin A1c (HbA1c ; P = 0.009), suggesting that low muscle was associated with elevated HbA1c in those with high fat but not low fat. Significant interactions between baseline fat mass and muscle mass on the exercise-induced changes in visceral adipose tissue, insulin resistance, and triglyceride concentration indicated that low muscle attenuated the exercise responses in participants with high fat at baseline (all P < 0.05). High fat and low muscle may be synergistically associated with higher HbA1c in type 2 diabetes. In participants with high fat mass, low muscle mass may attenuate exercise-induced improvements in some cardiometabolic risk factors.

Clinical usefulness of abdominal bioimpedance (ViScan) in the determination of visceral fat and its application in the diagnosis and management of obesity and its comorbidities

Visceral adipose tissue (VAT) has been shown to be profoundly responsible of most of the obesity-associated metabolic derangements. The measurement of VAT usually implies the use of imaging techniques such as magnetic resonance imaging or computed tomography (CT). Our aim was to evaluate the accuracy of the determination of VAT by means of abdominal bioimpedance (BIA) with the ViScan device in comparison with CT and its clinical usefulness in the management of obesity. We studied a sample of 140 subjects (73 males/67 females) with BMI ranging from 17.7 to 50.4kg/m2 to evaluate the accuracy of the ViScan in comparison to CT to determine VAT. To further analyze ViScan's clinical usefulness we studied a separate cohort (n=2849) analyzing cardiometabolic risk factors. Furthermore, we studied the ability of the ViScan to detect changes in VAT after weight gain (n=107) or weight loss (n=335). The study was performed from October 2009 through June 2015. ViScan determines VAT with a good accuracy in individuals with a CT-VAT up to 200cm2, and then with lower precision with increasing body mass, exhibiting a moderate-high correlation with CT-VAT (r=0.75, P<0.001). Importantly, VAT determination with the ViScan exhibits better correlations with several cardiometabolic risk factors such as glucose, triglycerides, HDL-cholesterol and markers of fatty liver than anthropometric measurements such as BMI or waist circumference. ViScan is able to detect VAT variations after body weight changes. Since the possibility of measuring VAT by imaging techniques is not always available, abdominal BIA represents a good alternative to estimate VAT, allowing the identification of patients with increased VAT-related cardiometabolic risk and a better management of obese patients. ClinicalTrials.gov NCT01055626 and NCT01572090.

Effects of Calorie Restriction in Obese Older Adults: The CROSSROADS Randomized Controlled Trial.

We lack a comprehensive assessment of the risks and benefits of calorie restriction in older adults at high risk for cardiometabolic disease. Calorie restriction may reduce visceral adipose tissue (VAT) but also have negative effects on lean mass and quality of life. We conducted a 52-week, randomized controlled trial involving 164 older adults with obesity taking at least one medication for hyperlipidemia, hypertension, or diabetes. Interventions included an exercise intervention alone (Exercise), or with diet modification and body weight maintenance (Maintenance), or with diet modification and energy restriction (Weight Loss). The primary outcome was change in VAT at 12 months. Secondary outcomes included cardiometabolic risk factors, functional status, and quality of life. A total of 148 participants had measured weight at 12 months. Despite loss of -1.6% ± 0.3% body fat and 4.1% ± 0.7% initial body weight, Weight Loss did not have statistically greater loss of VAT (-192.6 ± 185.2 cm3) or lean mass (-0.4 ± 0.3 kg) compared with Exercise (VAT = -21.9 ± 173.7 cm3; lean mass = 0.3 ± 0.3 kg). Quality of life improved in all groups with no differences between groups. No significant changes in physical function were observed. Weight Loss had significantly greater improvements in blood glucose (-8.3 ± 3.6 mg/dL, p < .05) and HDL-cholesterol (5.3 ± 1.9, p < .01) compared with Exercise. There were no group differences in the frequency of adverse events. While moderate calorie restriction did not significantly decrease VAT in older adults at high risk for cardiometabolic disease, it did reduce total body fat and cardiometabolic risk factors without significantly more adverse events and lean mass loss.

Testosterone Deficiency Induces Changes of the Transcriptomes of Visceral Adipose Tissue in Miniature Pigs Fed a High-Fat and High-Cholesterol Diet.

Testosterone deficiency causes fat deposition, particularly in visceral fat, and its replacement might reverse fat accumulation, however, the underlying mechanisms of such processes under diet-induced adiposity are largely unknown. To gain insights into the genome-wide role of androgen on visceral adipose tissue (VAT), RNA-Seq was used to investigate testosterone deficiency induced changes of VAT in miniature pigs fed a high-fat and high-cholesterol (HFC) diet among intact male pigs (IM), castrated male pigs (CM), and castrated male pigs with testosterone replacement (CMT) treatments. The results showed that testosterone deficiency significantly increased VAT deposition and serum leptin concentrations. Moreover, a total of 1732 differentially expressed genes (DEGs) were identified between any two groups. Compared with gene expression profiles in IM and CMT pigs, upregulated genes in CM pigs, i.e., LOC100520753 (CD68), LCN2, EMR1, S100A9, NCF1 (p47phox), and LEP, were mainly involved in inflammatory response, oxidation-reduction process, and lipid metabolic process, while downregulated genes in CM pigs, i.e., ABHD5, SPP1, and GAS6, were focused on cell differentiation and cell adhesion. Taken together, our study demonstrates that testosterone deficiency alters the expression of numerous genes involved in key biological processes of VAT accumulation under HFC diet and provides a novel genome-wide view on the role of androgen on VAT deposition under HFC diet, thus improving our understanding of the molecular mechanisms involved in VAT changes induced by testosterone deficiency.

Changes in abdominal fat following antiretroviral therapy initiation in HIV-infected individuals correlate with waist circumference and self-reported changes.

We examined whether waist circumference (WC) and self-reported abdominal size changes can estimate visceral adipose tissue (VAT) changes for those initiating antiretroviral therapy (ART). Prospectively collected data from ACTG A5257 and its metabolic substudy, A5260s, were used for this analysis. ART-naive HIV-infected participants were randomized to one of three contemporary ART regimens. Changes in abdominal CT-measured VAT and total adipose tissue (TAT) and DXA-measured trunk fat were tested for association with WC changes (by Pearson correlation) and categories of self-reported abdominal size changes (by ANOVA) between entry and week 96. Linear models compared WC and self-reported changes. The study population (n=328) was predominantly male (90%) and White non-Hispanic (44%) with a baseline median age of 36 years and body mass index of 25 kg/m2. At week 96, median WC change was +2.8 cm. Of those reporting at week 96, 53% indicated 'no change/lost', 39% 'gained some/somewhat larger' and 8% 'gained a lot/much larger' as their self-reported changes. Trunk fat, VAT and TAT changes differed across self-reported groups (ANOVA P<0.0001 for all), and the group ordering was as expected. WC changes were strongly correlated with CT and DXA changes (trunk fat: ρ=0.72, p<0.0001; VAT: ρ=0.52, p<0.0001; TAT: ρ=0.62, p<0.0001). While WC changes explained a greater proportion of VAT, TAT and trunk fat variation, self-reported changes remained a significant predictor after controlling for WC (p<0.05). WC and self-reported abdominal changes each correlated directly with imaging-derived abdominal fat measures, and can be used as reliable, affordable tools for central adiposity assessment.

Effect of resistance training on liver fat and visceral adiposity in adults with obesity: A randomized controlled trial.

Regular aerobic exercise reduces visceral adipose tissue (VAT) and liver fat, however, not all individuals are able to adopt and adhere to such programs. Progressive resistance training (PRT) may be an alternative therapy, but there is limited available evidence. We examined the efficacy of PRT as per current exercise guidelines, compared with sham exercise placebo on liver fat and VAT. Twenty-nine inactive and overweight/obese (body mass index ≥25kg/m2 ) adults (age 29-59) were randomized to receive 8weeks of PRT (n = 15, 10 exercises per session, 8-12 repetitions, 2-3 sets per exercise at 80-85% of one-repetition maximum, 3days per week) or a sham exercise placebo control (CON) (n = 14). Change in liver fat, VAT, and abdominal s.c. adipose tissue (SAT) were assessed by magnetic resonance spectroscopy and imaging). There were no significant group by time interactions for change in liver fat in PRT versus CON groups (-0.07 ± 0.31% vs. 0.55 ± 0.77%, respectively, P = 0.19), VAT (-175 ± 85 cm3 vs. 10 ± 64 cm3 , respectively, P = 0.11), or abdominal SAT (-436 ± 245 cm3 vs. 127.29 ± 182 cm3 , respectively, P = 0.10) despite a significant increase in muscle volume (55 ± 78 cm3 vs. -0.04 ± 8 cm3 , respectively, P = 0.03). Traditional PRT is not effective for reducing liver fat in overweight/obese adults compared with placebo control. Although PRT has known metabolic benefits, an adequate volume of aerobic exercise should be promoted if liver fat is the therapeutic target.

The Effect of Diet or Exercise on Visceral Adipose Tissue in Overweight Youth.

Excess visceral adipose tissue (VAT) in children with obesity is associated with the development of cardiovascular and metabolic disease. This meta-analysis investigated if lifestyle interventions can reduce VAT in overweight and obese youth. Pubmed, Cochrane, and PEDro were searched for clinical trials that objectively assessed VAT and included study arms with supervised diet, exercise, or a combination of both. If there was a no-therapy control group, the data of the control group and the intervention groups were used to meta-analyze the data. In all other cases, the preintervention and the postintervention data were used to meta-analyze. Effect sizes were calculated as standardized mean differences or changes of VAT and expressed as Hedges' g. The overall weighted mean effect size on VAT of all included interventions was -0.69 (95% confidence interval [CI] = -0.90 to -0.48) (P < 0.001). Subgroup analysis showed that the overall weighted mean effect size of diet-only interventions on VAT was 0.23 (95% CI = -0.22 to 0.68) (P = 0.311). Interventions that combined diet and exercise showed a pooled effect size on VAT of -0.55 (95% CI = -0.75 to -0.39) (P < 0.001). The pooled effect size of exercise-only interventions on VAT was -0.85 (95% CI = -1.20 to -0.57) (P < 0.001). Supervised exercise-only or combined diet and exercise interventions can reduce VAT in overweight and obese children and adolescents. The strongest effect was found in exercise-only groups. However, high-quality randomized controlled trials describing the effect of supervised dietary interventions on VAT in children are lacking.

Effects of visceral adipose tissue reduction on CVD risk factors independent of weight loss: The Look AHEAD study

ABSTRACTObjectives: To determine if the reduction of visceral adipose tissue (VAT) volume by lifestyle intervention improved risk factors for cardiovascular disease (CVD) independent of weight loss amount. Design: Ancillary study of randomized-controlled trial. Setting: Data analysis using multivariable regression models. Participants: Participants of the Look AHEAD (Action for HEAlth in Diabetes) Fatty Liver Ancillary Study. Main outcome measures: Correlations between changes in VAT and in CVD risk factors, while adjusting for weight loss and treatment (intensive lifestyle intervention [ILI] vs. diabetes support and education [DSE]). Results: Of 100 participants analyzed, 52% were women, and 36% were black, with a mean age of 61.1 years. In the DSE group, mean weight and VAT changed by 0.1 % (p=0.90) and 4.3% (p=0.39), respectively. In the ILI group, mean weight and VAT decreased by 8.0% (p<0.001) and 7.7% (p=0.01), respectively. Across both groups, mean weight decreased by 3.6% (p<0.001), and mean VAT decreased by 1.2% (p=0.22); the decrease in VAT was correlated with the increase in HDL-cholesterol (HDL-C; R=−0.37; p=0.03). There were no correlations between changes in VAT and blood pressure, triglycerides, LDL-C, glucose, or HbA1c. After adjusting for age, race, gender, baseline metabolic values, fitness, and treatment group, changes in HDL-C were not associated with changes in VAT, while weight changes were independently associated with decrease in glucose, HbA1c, and increase in HDL-C. Conclusions: VAT reduction was not correlated with improvements of CVD risk factors in a sample of overweight and obese adults with type 2 diabetes after adjusting for weight loss.

Association between exercise-induced change in body composition and change in cardiometabolic risk factors in postmenopausal South Asian women.

The South Asian population suffers from a high prevalence of type 2 diabetes and cardiovascular disease (CVD). A unique obesity phenotype of elevated visceral adipose tissue (VAT) is associated with CVD risk among South Asians. Exercise-induced reduction in VAT and body fat is an effective mechanism to improve cardiometabolic risk factors but this has not been shown in South Asians. Whether exercise-induced changes in measurements such as waist circumference (WC) are independently related to changes in cardiometabolic risk factors in South Asians is unknown. Multi-slice computed tomography scanning was used to assess VAT, cardiometabolic risk factors through a fasting blood sample, and body fat using dual-energy X-ray absorptiometry. Forty- nine postmenopausal South Asian women who participated in two 12-week aerobic exercise programs were included. Bivariate correlations were used to assess associations between change in cardiometabolic risk factors and change in body composition. Regression analyses were conducted with change in glucose, insulin, and homeostatic model assessment of insulin resistance (HOMA-IR) as dependent variables and change in body composition as independent variables of interest. There were significant associations between changes in fasting insulin, glucose, and HOMA-IR with change in VAT. The association between change in VAT and these cardiometabolic risk factors was independent of change in other body composition variables of interest. South Asian women should be encouraged to engage in aerobic activity to reduce their risk of type 2 diabetes and CVD, and physicians should be aware of improvements in glucose regulation with exercise training not observed through reductions in WC.

Effects of an Almond‐Enriched Energy Restricted Diet on Body Composition, Visceral Adipose Tissue and Blood Pressure in Obese Adults

BACKGROUNDAlmonds are a good source of protein and monounsaturated fats and their effects on differential rates of visceral and subcutaneous body fat loss, in conjunction with energy restriction, have not been widely examined. Increasing the proportion of protein in an energy‐restricted diet enhances satiety, energy expenditure and greater relative fat mass loss. In addition, monounsaturated fats are oxidized preferentially and a diet higher in the unsaturated: saturated fat ratio may reduce subcutaneous adipose tissue (SAT) but more importantly, visceral adipose tissue (VAT) during weight loss. The promotion of VAT loss is important clinically as this may translate into a reduction in the risk for metabolic diseases. In addition, emerging evidence indicates food‐derived peptides such as arginine reduce the risk of cardiovascular disease. Almonds contain a high level of arginine, a peptide that helps to reduce blood pressure (BP).METHODSObese adults (n=28, age: 35.7±11.4 yr, body mass index: 33.1±2.7 kg/m2) were randomly assigned to a 12 week energy restricted (500 kcal deficit) almond‐enriched diet (AED) (n=14) or an energy restricted nut‐free diet (NFD) (n=14). Participants in the AED group were asked to consume dry‐roasted, lightly salted almonds comprising of 15% energy in the individualized energy‐restricted diet. Participants in the NFD group were asked to avoid all nuts during the intervention period. The primary outcomes for this analysis were changes in weight, body composition, VAT and BP pre‐ and post‐study. Body composition was assessed using DEXA. VAT was predicted using multivariate anthropometric models. Resting BP was assessed using automated instruments.RESULTSBody weight, trunk fat percent, total fat percent, VAT and systolic BP decreased after 12 weeks on energy restriction (p&lt;0.05). Diastolic BP remained unchanged with weight loss. Both groups lost similar amounts of body weight over time. The AED group lost more trunk fat percent and total fat percent over time compared to the NFD group (p&lt;0.05). The AED group also had a greater trend for VAT loss over time compared to the NFD group. Both groups had similar reductions in systolic BP with weight loss.CONCLUSIONConsumption of almonds during a weight loss regimen resulted in greater improvements in trunk and total body composition compared to the nut‐free weight loss regimen. The overall improvements in body composition with almond consumption coupled with greater trend for VAT loss may help to reduce metabolic disease risk. In addition, consumption of lightly salted almonds had similar blood pressure reducing effects as the nut‐free intervention.Support or Funding InformationAlmond Board of California

Neuropeptide Y gene-by-psychosocial stress interaction effect is associated with obesity in a Korean population

BackgroundChronic psychosocial stress is a crucial risk factor in the development of many diseases including obesity. Neuropeptide Y (NPY), distributed throughout the peripheral and central nervous system, is believed to pay a role in the pathophysiologic relationship between stress and obesity. Although several animal studies have investigated the impact on obesity of interactions between NPY single nucleotide polymorphisms (SNPs) and stress, the same remains to be analyzed in humans. MethodsTo identify NPY gene-by-stress interaction effects on human obesity, we analyzed the interaction between four NPY SNPs and stress with obesity-related traits, including visceral adipose tissue (VAT). A total of 1468 adult subjects were included for this analysis. ResultsIn a SNP-only model without interaction with stress, no significant SNPs were found (pSNP>0.05). However, NPY SNPs-by-stress interaction effects were significantly linked to body mass index (BMI), waist circumference, and VAT (pint<0.05), even though a significant interaction effect for rs16135 on BMI was not identified. These significant interaction effects were also detected in interaction results for the binary traits of obesity. Among the obesity traits, mean changes of VAT by increased stress levels in homozygous risk allele carriers were the greatest (range of mean increases for four SNPs (min-max)=12.57cm2−29.86cm2). ConclusionsThis study suggests that common polymorphisms for NPY were associated with human obesity by interacting with psychosocial stress, emphasizing the need for stress management in obesity prevention.