High Visceral Fat Area Research Articles

Learning curve and surgical factors influencing the surgical outcomes during the initial experience with laparoscopic pancreaticoduodenectomy.

Laparoscopic pancreaticoduodenectomy (LPD) requires sufficient laparoscopic training for optimal outcomes. Our aim is to determine the learning curve and investigate the factors influencing surgical outcomes during the learning curve. We analyzed surgical results of 150 consecutive cases of LPD performed by three hepatopancreatobiliary surgeons during their 50 first cases. Learning curves were constructed by cumulative sum (CUSUM) analysis. Preoperative factors influencing resection time and blood loss were investigated in the introductory and stable periods. RESULTS : The learning curve could be divided into three phases: initial (1-20 cases), plateau (21-30), and stable (31-50). Resection time with lymph node dissection was significantly longer during the introductory period (initial and plateau periods) (P < 0.01) but not the stable phase (P = 0.51). Multivariate analysis revealed that patients with pancreatitis had longer resection times and massive blood loss in both the introductory and stable periods (stable phase). High visceral fat area was also significantly related to massive blood loss in the introductory period (P = 0.04). Hepatopancreatobiliary surgeons need more than 30 cases until LPD becomes stable. Lymph node dissection and patients with high visceral fat area and concomitant pancreatitis should be avoided during the introductory period of the learning curve.

Mixing strategies of high solids anaerobic co-digestion using food waste with sewage sludge for enhanced biogas production

Mixing strategies of high solids anaerobic digesters using food waste (FW), codigested with sewage treatment plant sludge (STP) was evaluated for green and clean biogas production. Improper anaerobic digestion (AD) mixing leads to poor biogas yield at high organic loading rate (OLR). The present study evaluated the novel method of biogas recirculation using new ‘O’ shaped diffuser design for the AD mixing and compared the performance with the conventional mode of impeller driven mixing and unmixed mode for the optimum FW to STP ratio of 3:1 at high OLR The biogas recirculation frequency of 15 min/h produced maximum biogas (0.28–0.86 L/gVSr). An enhanced biogas yield was observed at intermittant biogas recirculation intensity of 2000 mL/min (0.25–0.92 L/gVSr). This was attributed to the synergistic effect of CO2 acidification and high VFA production at OLR of 6 gVS/Ld. Consequently, led to benefit of reduced digester pH (from 8.3 to 6.6), NH3 control (2380 mg/L), in-situ CH4 enrichment (88%) and sheath protected microbial morphology than the other mixing intensities. It is constructed that an optimum intermittent biogas recirculation could be used as an alternative mixing method for the large scale AD, for enhanced biogas yield, reduced impeller power consumption, and improved energy efficiency.

Demand-oriented energy supply by the anaerobic digestion of organic waste

The share of renewable energy is steadily increasing globally. Nevertheless, power generation from renewable energy sources, such as solar and wind energy, is highly dependent on suitable weather conditions and therefore highly fluctuating. Thus, alternatives to compensate fluctuations in the energy production are necessary. Biogas plants have the potential to balance energy generation fluctuations and work independently from unstable weather. Experiments on laboratory scale showed that the storage of food waste had only a marginal impact on its energy content. A rapid acidification due to a lactic acid fermentation leads to a pH decrease and concomitant organic acids increase, preserving the stored organic waste. The pH dropped from initially 4.8 to 4 within the first 2 days of storage. It declined until day 10 to 3.6 and stayed at this level until the end of the experiment. Due to a low pH and a high VFA concentration, only minor amounts of gas were produced during storage. No formation of explosive gas mixtures was detected during the storage. Therefore, no safety precautions are necessary to avoid danger from explosion. The results obtained in laboratory were confirmed by experiments on real scale. Thus, pre-condition of organic waste for a flexible feeding and demand-oriented energy supply is feasible to balance energy generation fluctuations.

The impact of reducing dietary crude protein and increasing total dietary fiber on hindgut fermentation, the methanogen community and gas emission in growing pigs

Sixty-four cross bred 6 week-old intact male pigs (initial BW = 13.8 ± 2.3 kg) were randomly distributed to 4 separated modules using a three-phase feeding program in which two dietary crude protein (CP) and total dietary fiber (TDF) levels were tested in a 2 × 2 factorial arrangement under a commercial-like production system. The room air was sampled and analyzed for NH3 and CH4 while the slurry pit air was sampled and analyzed for CH4 content during the early growing (phase I, 13.8–38.6 kg of body-weight), growing (phase II, 38.6–72.8 kg of body-weight) and finishing periods (phase III, 72.8–108.7 kg of body-weight); at the end of the finishing phase, 16 random pigs were sacrificed and cecum and colon contents were sampled to determine fermentation and microbial parameters. The pH and ammonium content increased with digesta transit being lower in cecum (6.0 and 69.7 mg/L) than in colon (6.3 and 156.3 mg/L) whereas the opposite trend was seen for total VFA and acetate (175.2 mM and 62.6 mol/100 mol vs. 141.1 mM and 57.2 mol/100 mol, respectively; P < 0.05). Low protein (LP) and high fiber (HF) diets showed a higher NH3 concentration in the colon but not in cecum samples. Dietary fiber also altered intestinal VFA concentration where animals fed Low fiber (LF) diet showed high VFA’s concentrations and such effect was more pronounced in colon samples. Total NH3 (1.8, 4.8 and 8.5 g/day) and methane (2.5, 3.5 and 7.5 g/day for Phase I, II and III, respectively) emissions increased consistently with age (P < 0.05), dietary CP level increased NH3 volatilization (6.3 vs. 3.8 g/d for high protein (HP) and LP diets respectively; P < 0.01) and fiber tended to increase methane emission (5.0 vs. 4.0 for HF and LF diets, respectively P < 0.1). The methane production measured at slurry pit contributed significantly to total CH4 emission (3.26, 9.02 and 16.91% in the phases I, II and III respectively). Dietary CP increased total bacteria (TB; 9.7 vs. 9.5; P < 0.03) and total methanogenic archaea (TMA; 7.2 vs. 6.4; P < 0.01) abundances in the intestinal as well as the slurry (6.8 vs. 6.3 Log n° copy/ g fresh matter (FM); P < 0.01) samples whereas TDF did not alter microbial titers. Differences in CH4 emission did not reflect the TMA concentration in hindgut contents.

Atherogenic Index of Plasma is Associated with Body Fat Level in Type 2 Diabetes Mellitus Patients.

To investigate the characteristics of body fat distribution and the relationship between body fat index and Atherogenic Index of Plasma (AIP) in Type 2 Diabetes Mellitus (T2DM) patients. A total of 316 participants were divided into a T2DM group and a non-diabetes group (controls). According to the Visceral Fat Area (VFA), all participants were further divided into VFA ≥100 cm2 and VFA <100 cm2 groups. To compare the differences of blood lipid, blood glucose, body fat index and AIP between the 2 groups, single factor correlation analysis was used to determine the correlation between the indexes and AIP, and multiple linear regression was used to analyse the correlation between the related factors and AIP. The body fat index (including body fat content, Percentage of Body Fat (PBF), Waist to Hip Fat Ratio (WHR) and VFA), Triglyceride (TG), Fasting Insulin (FINS), Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) and AIP in T2DM group were significantly higher than in the control group, while High Density Lipoprotein Cholesterol (HDL-C) level was significantly higher in the control group. In the VFA≥100 cm2 group, TG, Low Density Lipoprotein Cholesterol (LDL-C), FINS, HOMAIR and AIP were all higher than that in the VFA <100 cm2 group. There was a positive correlation between AIP and VFA, body fat content, percentage of body fat, and WHR, respectively. There was also a negative correlation between AIP and HDL-C, which was not related to age, sex, Fasting Glucose (FPG), glycosylated haemoglobin (HbA1c), Total Cholesterol (TC), LDL-C and course of disease. Compared with the VFA <100 cm2 group, the VFA ≥100 cm2 group had higher blood Uric Acid (UA) levels and UA was positively correlated with VFA. After correcting the effect of UA on AIP, VFA was still an independent related factor of AIP, and VFA increased the risk of atherosclerosis by increased UA. T2DM patients have the abnormal distribution of body fat and a high VFA, which was associated with AIP.

Visceral fat area measured with computed tomography does not predict postoperative course in Crohn´s disease patients.

The role of visceral fat measured by computer tomography is yet not well defined in patients with Crohn's disease. Therefore, the present study was designed to assess the impact of visceral fat area on postoperative short-term outcome and surgical characteristics. We analyzed 95 patients, who underwent intestinal resection for symptomatic Crohn's disease at an academic tertiary referral center between 2003 and 2008. Visceral fat area was measured on preoperative computed tomography scans. Postoperative morbidity was graded according to the Clavien-Dindo classification. Visceral fat area was correlated with baseline characteristics, disease phenotype and 30-day morbidity. Body mass index and age were significantly associated with a higher visceral fat area (p = 0.001). Overall 19 (20.0%) postoperative complications were observed, of whom 7 (7.4%) patients required surgical re-intervention. No significant difference was found with regard to visceral fat area between patients with an uneventful and eventful postoperative course (no complications: median visceral fat area 52.0 cm2 SD 59.7, complications: 41.3 cm2 SD 42.8; p = 0.465). In contrast to current literature, we cannot support the role of visceral fat area for predicting postoperative course in Crohn's disease. In addition, no correlation of the visceral fat area and disease behavior was detected.

Analysis of the Correlation Between Central Obesity and Abdominal Aortic Diseases

Atherosclerosis and abdominal aortic aneurysms (AAAs) have several similar risk factors but different pathogenesis. Inflammation of the arteries is common to both. Central obesity can act as an endocrine organ through the secretion of inflammatory cytokines, and the perivascular fat has a local effect that could contribute to diseases of the abdominal aorta. Although the relation between central obesity and atherosclerosis occlusive arterial disease has been demonstrated, the correlation with AAA has conflicting results. The aim of this study was to analyze the correlation between central obesity and the presence of abdominal aortic diseases using computed tomography. Six hundred thirty-nine consecutive patients classified into 3 groups (AAA, aortic atherosclerotic occlusive disease (AAOD), and without aortic disease [control group]) who underwent computed tomography had the aorta diameter, the visceral fat area (VFA), and the subcutaneous fat area (SFA) measured at the level of third and fourth lumbar vertebrae. VFA showed no difference between the groups. SFA was lower in atherosclerotic group (AAOD) than control (P<0.01 in general and P<0.04 in male). In AAA group, we found in men that the first tertile of aorta diameter had higher VFA than third tertile (P=0.02). There was no difference in VFA between patients in AAA, AAOD, and without aortic disease groups. In men with aneurysm, there was an inverse relationship between VFA and aortic diameter. In AAOD, visceral to subcutaneous ratio is higher due to lower SFA.

The Impact of Abdominal Fat Levels on All-Cause Mortality Risk in Patients Undergoing Hemodialysis.

Although an increased body mass index is associated with lower mortality in patients undergoing hemodialysis (HD), known as the “obesity paradox,” the relationship of abdominal fat levels with all-cause mortality has rarely been studied. We investigated the impact of computed-tomography-measured abdominal fat levels (visceral fat area (VFA) and subcutaneous fat area (SFA)) on all-cause mortality in this population. A total of 201 patients undergoing HD were enrolled and cross-classified by VFA and SFA levels according to each cutoff point, VFA of 78.7 cm2 and SFA of 93.2 cm2, based on the receiver operator characteristic (ROC) curve as following; group 1 (G1): lower VFA and lower SFA, G2: higher VFA and lower SFA, G3: lower VFA and higher SFA, G4: higher VFA and higher SFA. During a median follow-up of 4.3 years, 67 patients died. Kaplan–Meier analysis revealed 10-year survival rates of 29.0%, 50.0%, 62.6%, and 72.4% in G1, G2, G3, and G4 (p < 0.0001), respectively. The adjusted hazard ratio was 0.30 (95% confidence interval [CI] 0.05–1.09, p = 0.070) for G2 vs. G1, 0.37 (95% CI 0.18–0.76, p = 0.0065) for G3 vs. G1, and 0.21 (95% CI 0.07–0.62, p = 0.0035) for G4 vs. G1, respectively. In conclusion, combined SFA and VFA levels were negatively associated with risks for all-cause mortality in patients undergoing HD. These results are a manifestation of the “obesity paradox.”

Performance analysis of immobilized and co-immobilized enriched-mixed culture for hydrogen production

This paper presents an experimental investigation on using mixed culture for immobilization and co-immobilization for hydrogen production. The shape and diameter of the beads were investigated. Hydrogen was produced from 10 g.L1 glucose in anaerobic batch using immobilized mixed culture with extrusion dripping method. The alginate concentrations as immobilization material were 1%, 2%, and 3%. The mixed culture had three different biodigester sources consisting of cow dung, tofu waste, and fruit waste. The pretreatment of each mixed culture was acidification and enrichment. Then the mixed culture were mixed with immobilization material and inserted into a syringe, then dropped into 0.1M CaCl2. Activated carbon was added to alginate (co-immobilization) with ratio 1:1. The results showed that bead using 1% and 2% alginate concentrations were a pear-shaped. The highest concentration of hydrogen (mol H2/mol glucose) was 0.029 for immobilized beads with 2% alginate concentration and the lowest hydrogen (molH2/mol glucose) was 0.009 for immobilized beads with 3% alginate concentration. Acetic acid was the most dominant. The highest VFA (mg.L1) was 695.85 for immobilized beads with 3% alginate concentration (acetic acid 271.49; propionic acid 163.33; isobutyrate acid 123.45; butyric acid 137.57). Most hydrogen was produced from 2% alginate concentration and spherical-shape.

Effect of weight loss on circulating fatty acid profiles in overweight subjects with high visceral fat area: a 12-week randomized controlled trial

BackgroundSignificant associations between visceral fat and alterations in plasma fatty acids have been identified in overweight individuals. However, there are scant data regarding the relationships of the visceral fat area (VFA) with the plasma fatty acid profiles and desaturase activities following weight loss. We investigated the effect of weight loss with mild calorie restriction on the circulating fatty acid profiles and desaturase activities in nondiabetic overweight subjects with high VFA.MethodsEighty overweight subjects with high VFA (L4 VFA ≥100 cm2) were randomized into the 12-week mild-calorie-restriction (300 kcal/day) or control groups.ResultsComparison of the percent of body weight changes between groups revealed that the weight-loss group had greater reductions in body weight. The VFA decreased by 17.7 cm2 from baseline in the weight-loss group (P < 0.001). At follow-up, the weight-loss group showed greater reductions in serum triglycerides, insulin, and HOMA-IR than the control group. Significantly greater reductions in total saturated fatty acids, palmitic acid, stearic acid, total monounsaturated fatty acids, palmitoleic acid, oleic acid, eicosadienoic acid, and dihomo-γ-linolenic acid levels were detected in the weight-loss group compared with the control group after adjusting for baseline values. Following weight loss, C16 Δ9-desaturase activity was significantly decreased and Δ5-desaturase activity was significantly increased, and the changes were greater in the weight-loss group than in the control group.ConclusionsThe results suggest that mild weight loss improves abdominal obesity, overall fatty acid profiles, and desaturase activities; therefore, mild calorie restriction has potential health benefits related to obesity-related diseases in overweight subjects with high VFA.Trial registrationNCT02992639. Retrospectively registered 11 December 2016.

Visceral obesity is a significant risk factor for incisional hernia after laparoscopic colorectal surgery: A single-center review.

Although laparoscopic surgery uses relatively small incisions, incisional hernia after surgery is not uncommon. However, the incidence of incisional hernia and its risk factors are not well known. The purpose of our study was to investigate risk factors for incisional hernia after laparoscopic colorectal cancer surgery. The study group consisted of 212 patients who underwent laparoscopic colorectal cancer surgery at Hiroshima Prefectural Hospital between November 2008 and October 2013. Diagnosis of incisional hernia was performed by postoperative CT. The visceral fat area (VFA) and subcutaneous fat area at the level of the umbilicus were calculated using an image analysis system. For statistical analysis, Fisher's exact test or Student's t-test were used for univariate analysis, and logistic regression analysis was used for multivariate analysis. The cut-off value for risk factors was calculated from the receiver-operator curve. Incisional hernia was observed in 18 patients (8.5%). On univariate analysis, female sex (P = 0.04), older age (P = 0.02), subcutaneous fat area (P < 0.01), VFA (P = 0.02), and BMI >25 kg/m2 (P < 0.01) were significant risk factors for incisional hernia. The predictive cut-off values were as follows: age, 72 years; subcutaneous fat area, 110 cm2 ; VFA, 110 cm2 ; and albumin concentration, 3.9 g/dL. On multivariate analysis, a VFA >110 cm2 (P < 0.01) and female sex (P = 0.01) were retained as independent risk factors for incisional hernia. After laparoscopic colorectal cancer surgery, a higher VFA and female sex are independent risk factors for incisional hernia.

Clinical impact of obesity-related factors in perioperative management of esophageal cancer.

39 Background: Obese patients with esophageal cancer have been increasing worldwide. However, the impact of obesity on esophagectomy still remains controversial. In this study, we clarified the relations between obesity and postoperative outcomes after esophagectomy in patients with esophageal cancer. Methods: A total of 215 patients who underwent esophagectomy for esophageal cancer between 2008 and 2014 were retrospectively assessed. We qualified the body mass index (BMI), visceral fat area (VFA) and subcutaneous fat area (SFA) using CYNAPSE VINCENT™. Clincopathological factors, postoperative morbidity, and survival after esophagectomy were assessed with these obesity-related factors. Results: The mean BMI, VFA, and SFA were 22.0 kg/m², 83.0cm², and 87.3cm². BMI, VFA and SFA were significantly correlated each other (P &lt; 0.001). The prevalence of diabetes mellitus and hypertension were significantly more in high SFA than normal SFA (20% vs 10%, 30% vs 14%). When the patients were divided to two groups according to BMI (&lt; 25 or ≥25kg/m²), VFA ( &lt; 100 or ≥100cm²) and SFA ( &lt; 100 or ≥100cm²), operative time was significantly longer in high SFA (P = 0.03) than normal SFA, and tended to be longer in high BMI, but blood loss were similar in each groups. Maximum level of postoperative CRP was significantly higher in high BMI (P &lt; 0.001), in high VFA (P &lt; 0.001), and in high SFA (P &lt; 0.001). Length of systemic inflammatory response syndrome was significantly longer in high BMI than normal BMI (1.9 days vs 1.4 days P = 0.04), and length of ventilator support was significantly longer in high SFA than normal SFA (3.0 days vs 2.2 days P = 0.006). The incidence of anastomotic leakage and surgical site infection were significantly higher in high SFA than normal SFA (27% vs 10%, 37% vs 19%). There were no significant difference in overall survival, however, patients in high VFA tended to be longer survival than those in normal VFA (P = 0.078). Conclusions: Anastomotic leakage and surgical site infection occurred more frequently in high SFA. It might be useful to examine SFA preoperatively in obese patients with esophageal cancer for prevention of postoperative complications. Patients in high VFA tended to be longer survival than those in normal VFA.

High perirenal fat thickness predicts a poor progression-free survival in patients with localized clear cell renal cell carcinoma

ObjectivesThe aim of the study was to assess the association between the progression-free survival (PFS) and perirenal fat thickness (PFT) in a population of histopathologically confirmed, localized clear cell renal cell carcinoma (ccRCC) patients. MethodsWe retrospectively enrolled 174 patients with localized ccRCC at our center between December 2009 and December 2015. The preoperative visceral fat area (VFA), PFT, and subcutaneous fat area (SFA) were evaluated. Kaplan-Meier curves were used to assess the differences in PFS between the high and the low PFT groups within sexes. Potential independent prognostic factors of PFS were identified by univariable and multivariable Cox analyses. ResultsDuring the follow-up period (median, 38 months), 27 patients (21 with high PFT and 6 with low PFT) experienced tumor progression. Kaplan-Meier curves revealed that high PFT was associated with a worse PFS than low PFT (P = 0.005). In the univariable Cox analyses, high VFA, high PFT, T stage, and the presence of sarcomatoid differentiation were significantly associated with a poor PFS. Moreover, both high PFT and VFA retained significance in the multivariable analysis. ConclusionWe first report the evidence that high PFT presents as an independent risk factor of tumor progression in localized ccRCC. We suggest that this noninvasive and readily available preoperative parameter may help in the risk stratification of ccRCC patients before surgery.

Low Visceral Fat Content Is a Negative Predictive Marker for Bevacizumab in Metastatic Colorectal Cancer.

This study aimed to clarify the predictive impact of visceral fat on response to bevacizumab in patients with metastatic colorectal cancer (mCRC). Pretreatment computed tomography was used to measure visceral fat area (VFA) and patients with mCRC receiving first-line chemotherapy with/without bevacizumab were divided by median VFA value into two groups: high VFA and low VFA. In the bevacizumab-treated group, patients with low VFA had significantly shorter overall survival (OS) than patients with high VFA in univariate (median=21.1 vs. 38.9 months; hazard ratio=1.70, 95% confidence interval=1.06-2.70, p=0.03) and multivariate analysis (hazard ratio=1.85, 95% confidence interval=1.15-3.03, p=0.01). No significant differences were seen in OS between groups treated with chemotherapy alone. The VFA had a marginally significant modifying effect on the relationship between bevacizumab and OS (p for interaction=0.07). Our findings provide the first evidence that a low VFA might be a negative predictive marker for response to bevacizumab in patients with mCRC.

No Muscle Depletion with High Visceral Fat as a Novel Beneficial Biomarker of Sorafenib for Hepatocellular Carcinoma

Background: Sorafenib is a standard therapy for patients with advanced hepatocellular carcinoma (HCC). However, no predictive biomarkers of sorafenib efficacy have been discovered. Herein, we investigated the impact of body composition, such as skeletal muscle and visceral fat, on the prognosis of advanced HCC patients treated with sorafenib. Methods: We enrolled 100 patients with advanced HCC treated with sorafenib. Prior to receiving sorafenib therapy, skeletal muscle index (SMI) and visceral fat area (VFA) were measured using computed tomography at the third lumbar vertebra and umbilical level, respectively. Muscle depletion was defined as an SMI value < 42 cm²/m² in men and < 38 cm²/m² in women. High VFA (H-VFA) was defined as a value ≥100 cm². In addition to SMI and VFA, we also analyzed various clinical parameters as potential prognostic factors. Results: Multivariate analysis showed that having a tumor number < 7 (hazard ratio [HR] = 0.409, p < 0.001), absence of extrahepatic spread (EHS) (HR = 0.562, p < 0.001), absence of muscle depletion (HR = 0.498, p = 0.006), and H-VFA (HR = 0.556, p = 0.031) were significant factors for long-term survival. Therefore, we evaluated the prognosis of those with no muscle depletion with H-VFA. The no muscle depletion with H-VFA group showed significantly longer survival than the other group (median survival time 15.6 vs. 11.0 months, p = 0.003). Multivariate analysis showed that having a tumor number < 7 (HR = 0.454, p = 0.001), absence of EHS (HR = 0.511, p = 0.008), and no muscle depletion with H-VFA (HR = 0.454, p = 0.002) were significant predictors of survival. Conclusions: We identified no muscle depletion with H-VFA as a novel biomarker for advanced HCC patients treated with sorafenib.

Impact of visceral fat on surgical complications and long-term survival of patients with gastric cancer after radical gastrectomy.

The aim of this study was to examine the impact of visceral fat on surgical complications and long-term survival for patients undergoing radical gastrectomy. From 2009 to 2013, 859 patients who underwent curative resection for gastric cancer were enrolled from a prospectively maintained database. Visceral fat area (VFA) was assessed by preoperative CT scans. Patients were divided into two groups by VFA. Perioperative variables and postoperative outcomes were compared between the high VFA group and low VFA group. Univariable and multivariable analysis were performed to investigate independent risk factors of postoperative complications and survival. Some 859 patients were included in the study, 308 of whom were classified as high VFA. High VFA was correlated with advance age (P = 0.020), higher albumin levels (P = 0.001), hemoglobin levels (P < 0.05), ASA grade (P = 0.043) and Charlson Comorbidity Index (P = 0.004). Relative to patients with low VFA, those with high VFA had longer surgical durations (P = 0.004), higher rate of postoperative complications (P = 0.004), and longer hospital stays (P = 0.004). High VFA was identified as the only determinant for surgical complications by logistic regression analysis (OR, 2.236, 95% CI, 1.537-3.254; P < 0.001). Cox proportional hazards regression revealed no correlation between VFA and overall survival (OS) or disease-free survival (DFS). Increased VFA independently predicts surgical complications in patients after gastrectomy. However, VFA is not a prognostic biomarker of OS or DFS in patients with gastric cancer.

The relationship between visceral obesity and hepatic steatosis measured by controlled attenuation parameter.

BackgroundNonalcoholic fatty liver disease (NAFLD) is closely related with obesity. However, obese subjects, generally represented by high BMI, do not always develop NAFLD. A number of possible causes of NAFLD have been studied, but the exact mechanism has not yet been elucidated.MethodsA total of 304 consecutive subjects who underwent general health examinations including abdominal ultrasonography, transient elastography and abdominal fat computed tomography were prospectively enrolled. Significant steatosis was diagnosed by ultrasonography and controlled attenuation parameter (CAP) assessed by transient elastography.ResultsVisceral fat area (VFA) was significantly related to hepatic steatosis assessed by CAP, whereas body mass index (BMI) was related to CAP only in univariate analysis. In multiple logistic regression analysis, VFA (odds ratio [OR], 1.010; 95% confidence interval [CI], 1.001–1.019; P = 0.028) and triglycerides (TG) (OR, 1.006; 95% CI, 1.001–1.011; P = 0.022) were independent risk factors for significant hepatic steatosis. The risk of significant hepatic steatosis was higher in patients with higher VFA: the OR was 4.838 (P<0.001; 95% CI, 2.912–8.039) for 100<VFA≤200 cm2 and 7.474 (P<0.001; 95% CI, 2.462–22.693) for VFA >200 cm2, compared to patients with a VFA ≤100 cm2.ConclusionsOur data demonstrated that VFA and TG is significantly related to hepatic steatosis assessed by CAP not BMI. This finding suggests that surveillance for subjects with NAFLD should incorporate an indicator of visceral obesity, and not simply rely on BMI.

Abdominal Visceral Fat Area and Chronic Pouchitis after Ileal Pouch-Anal Anastomosis

Chronic pouchitis (CP) after ileal pouch-anal anastomosis is a significant clinical problem. Adipose tissues produce antiinflammatory cytokines and chemokines. We evaluated the association between abdominal visceral fat area (VFA) and CP. Patients with a preoperative CT evaluation were included. The diagnosis of CP was confirmed in all cases by endoscopy with afferent ileal limb intubation. Patients were allocated into groups of high VFA and low VFA. The study cohort of 52 patients had a median body mass index of 22 (range, 14-32). Indications for surgery were medically refractory disease in 46 (88%) patients and cancer/dysplasia in six (12%) patients. Median VFA was 27.1 (range, 1-144). Six (12%) patients developed CP. Low VFA patients were significantly younger (29 vs 45 years; P < 0.0001), had lower body mass index (20.4 vs 24.7; P < 0.0001), had surgery more commonly for medically refractory disease than for cancer or dysplasia (100 vs 77%; P = 0.02), and had a higher incidence of CP than high VFA patients (23 vs 0%; P = 0.02). Multiple linear regression analysis demonstrated that only low VFA was associated with CP (P = 0.009). An association is present between VFA and CP after ileal pouch-anal anastomosis, implicating adipocytes in the pathogenesis of inflammatory bowel disease.

Association of Epicardial, Visceral, and Subcutaneous Fat With Cardiometabolic Diseases.

Excess of visceral fat is a central factor in the pathogenesis of metabolic syndrome (MetS) and atherosclerosis. However, little is known about how much epicardial fat affects cardiometabolic disorders in comparison with visceral or subcutaneous fat.Methods and Results:Participants suspected as having angina pectoris underwent cardiac computed tomography (CT) imaging. Of them, 374 subjects were analyzed the association of clinical characteristics and CT-based fat distribution measured as epicardial fat volume (EFV), visceral fat area (VFA), and subcutaneous fat area (SFA). EFV was highly associated with VFA (R=0.58). Serum adiponectin was significantly decreased in high VFA subjects (VFA ≥100 cm2) and was also reduced in the high EFV group (EFV ≥80 cm3). Among the low VFA groups, the numbers of subjects with diabetes and coronary atherosclerosis were increased in high EFV group. Among the low EFV groups, the numbers of subjects with diabetes, hyperuricemia, and coronary atherosclerosis were increased among the high VFA subjects. In an age-, sex-, and body mass index (BMI)-adjusted model, EFV was associated with dyslipidemia and MetS, and VFA was significantly associated with hypertension, dyslipidemia, MetS, and coronary atherosclerosis, while SFA was not related with coronary risks and atherosclerosis. Epicardial fat accumulation may be a risk for coronary atherosclerosis in subjects without visceral fat accumulation. Visceral fat is the strongest risk for cardiometabolic diseases among the 3 types of fat depot.

Valorisation of the liquid fraction from hydrothermal carbonisation of sewage sludge by anaerobic digestion

AbstractBACKGROUNDThe mesophilic anaerobic digestion of the liquid fraction from hydrothermal carbonisation (208°C, 1 h) of dehydrated sewage sludge has been studied. Two initial inoculum concentrations (IC) (10 and 25 g COD L‐1) and four inoculum to substrate ratios (ISR) (2, 1, 0.5 and 0.4 on a COD basis) have been selected to analyse their influence on the evolution of the anaerobic digestion process.RESULTSThe substrate is characterised by a high COD (95.5 g L‐1) and TKN (8.7 g N L‐1) values. High inoculum concentration (25 g COD L‐1) and/or low ISR (≤ 0.5) inhibited methanogenesis due to the high ammonia nitrogen (1.4 g TAN L‐1) and VFA (&gt;4 g COD L‐1) released. For the inhibited samples final COD removals lower than 15% and IA/TA ratios higher than 0.3 were found. The greatest methane yield (177±5 mL CH4 STP g‐1 CODadded) was achieved at 25 g COD L‐1 of IC and at an ISR of 2.CONCLUSIONDuring anaerobic digestion of the liquid fraction from the hydrothermal carbonisation of sewage sludge, the IC and ISR must be adequately selected for proper operation of the process and successful valorisation. According to the results, working at an ISR ≥ 1 is recommended. © 2017 Society of Chemical Industry