Subcutaneous Adipose Tissue Cross-sectional Area Research Articles

Body composition and Crohn's disease behavior: Is adiposity the main game changer?

ObjectiveWe investigated the association between body composition upon diagnosis and complicated phenotypes and time until surgery in patients with Crohn's disease (CD). MethodsWe conducted a retrospective cohort study including patients with CD who had a computed tomography enterography or a magnetic resonance enterography performed ≤6 mo of diagnosis. Skeletal muscle and visceral and subcutaneous adipose tissue cross-sectional areas were determined with computed tomography or magnetic resonance images at the third lumbar vertebral level, processed with the sliceOmatic (TomoVison, Magog, QC, Canada) and ABACS plugin. ResultsWe included 63 patients: 33 (52%) men, median age 35 y. Disease location (L) and behavior (B) according to the Montreal classification were L1 (ileal disease) = 28 (44%), L2 (colonic disease) = 13 (21%), L3(ileocolonic disease) = 18 (28%), L1 + L4 (ileal and isolated upper disease) = 1 (2%), L3 + L4 (ileocolonic and isolated upper disease) = 3 (5%), B1 (non-stricturing) = 39 (62%), B2 (stricturing) = 11 (17%), and B3 (penetrating)= 13 (21%); 20 (32%) patients had perianal disease. Visceral obesity was present in 12 (19%) patients and was associated with higher age of CD onset (median 60 versus 34 y; P = 0.002) and complicated disease behavior (B2 and B3) (66.7% versus 31.7%; P = 0.021). After adjusting for age and perianal disease, total adipose tissue was associated with a 4% increase in the odds of complicated behavior per 10 cm2 of total adipose tissue (odds ratio [OR] = 1.004; 95% confidence interval [CI], 1.00–1.008; P = 0.043). Median follow-up time was 3.35 y, during which 15 (24%) of patients underwent abdominal surgery. Visceral obesity was associated with 5.10-times higher risk of abdominal surgery (95% CI, 1.52–17.09; P = 0.008); after adjusting for disease behavior, visceral obesity maintained a near-significant association with a 2.90-times higher risk of surgery (95% CI, 0.83–10.08; P = 0.09). ConclusionTotal fat was associated with complicated disease phenotype and visceral obesity, with higher risk of abdominal surgery and shorter time until surgery.

P139 Body composition and Crohn’s disease behavior: Is adiposity the main game changer?

Abstract Background Introduction: Visceral fat has been associated with unfavorable outcomes in Crohn’s disease (CD) patients. We investigated the association between body composition upon diagnosis and complicated phenotypes and time until surgery in patients with CD. Methods retrospective cohort study including patients with CD who had a computed tomography enterography (CT) or an entero magnetic resonance (MR) performed within 6 months of diagnosis. Skeletal muscle, visceral and subcutaneous adipose tissue cross-sectional areas were determined with CT or MR images at L3 vertebrae level, after being processed with Slice-o-Matic (Tomovison) and ABCS module (applicable only to CT scan images). Logistic regression was used to assess predictors of disease behaviourand time until abdominal urgery was modeled with proportional hazards Cox models. Results We included 63 patients: 33(52%) men with median age of 35 years. Disease location and behaviour according to Montreal classification was as follows: L1=28(44%), L2=13(21%), L3=18(28%), L1+L4=1(2%), L3+L4=3(5%); B1=39(62%), B2=11(17%), B3=13(21%); 20(32%) patients had perianal disease. At diagnosis, 17(27%) patients were treated with corticosteroids. Anti-TNF agents were started in 8(13%) patients, azathioprine in 23(36%), combination therapy in 15(24%); 17(27%) patients did not start any medical therapy. Visceral obesity was present in 12(19%) patients at diagnosis. Visceral obesity was associated with higher age of CD onset (median 60 vs 34 years, p=0.002) and complicated disease behaviour(B2/B3) at diagnosis (66.7% vs 31.7%, p=0.021), with an approximately 4 times higher risk of complicated behaviour(OR=4.37, 95%IC=1.19–18.44, p=0.03).After adjusting for age and perianal disease, total adipose tissue (visceral and subcutaneous fat) remained statistically significant and was associated with a 4% increase in the odds of complicated behaviourat diagnosis per 10 cm2of total adipose tissue (OR 1.004,95%CI 1.00–1.008, p=0.043). Median follow-up time was 3.35 years, during which 15 (24%) of patients underwent abdominal surgery. Visceral obesity was associated with a 5.10 times higher risk of abdominal surgery during follow-up (95%CI 1.52–17.09, p=0.008); after adjusting to disease behaviour, visceral obesity maintained a near significant association with a 2.90 times higher risk of surgery (95%CI 0.83–10.08, p=0.09). Conclusion In our cohort of patients with newly diagnosed CD, total fat upon diagnosis seems to be associated with B2 and B3 disease phenotypes. Furthermore, visceral obesity was associated with a 5.10 times higher risk of abdominal surgery during follow-up and with a shorter time until surgery.

Influence of body composition and muscle strength on outcomes after multimodal oesophageal cancer treatment.

BackgroundInfluence of sarcopenia in combination with other body composition parameters and muscle strength on outcomes after oesophageal surgery for oesophageal cancer remains unclear. The objectives were (i) to describe the incidence of sarcopenia in relation to adipose tissue quantity and distribution and muscle strength; (ii) to evaluate if neoadjuvant chemoradiation (nCRTx) influences body composition and muscle strength; and (iii) to evaluate the influence of body composition and muscle strength on post‐operative morbidity and long‐term survival.MethodsThis retrospective study included patients with oesophageal cancer who received nCRTx followed by surgery between January 2011 and 2016. Skeletal muscle, visceral, and subcutaneous adipose tissue cross‐sectional areas were calculated based on computed tomography scans, and muscle strength was measured using hand grip tests, 30 seconds chair stand tests, and maximal inspiratory and expiratory pressure tests prior to nCRTx and after nCRTx.ResultsA total of 322 patients were included in this study. Sarcopenia was present in 55.6% of the patients prior to nCRTx and in 58.2% after nCRTx (P = 0.082). Patients with sarcopenia had a significantly lower muscle strength and higher fat percentage. The muscle strength and incidence of sarcopenia increased while the mean body mass index and fat percentage decreased during nCRTx. A body mass index above 25 kg/m2 was associated with anastomotic leakage (P = 0.032). Other body composition parameters were not associated with post‐operative morbidity. A lower handgrip strength prior to nCRTx was associated with pulmonary and cardiac complications (P = 0.023 and P = 0.009, respectively). In multivariable analysis, a lower number of stands during the 30 seconds chair stand test prior to nCRTx (hazard ratio 0.93, 95% confidence interval 0.87–0.99, P = 0.017) and visceral adipose tissue of >128 cm2 after nCRTx (hazard ratio 1.81, 95% confidence interval 1.30–2.53, P = 0.001) were associated with worse overall survival.ConclusionsSarcopenia occurs frequently in patients with oesophageal cancer and is associated with less muscle strength and a higher fat percentage. Body composition changes during nCRTx did not influence survival. Impaired muscle strength and a high amount of visceral adipose tissue are associated with worse survival. Therefore, patients with poor fitness might benefit from preoperative nutritional and muscle strengthening guidance, aiming to increase muscle strength and decrease visceral adipose tissue. However, this should be confirmed in a large prospective study.

Dietary manipulation and testosterone replacement therapy may explain changes in body composition after spinal cord injury: A retrospective case report.

BACKGROUNDReduced level of physical activity, high-fat diet and skeletal muscle atrophy are key factors that are likely to contribute to deleterious changes in body composition and metabolic following spinal cord injury (SCI). Reduced caloric intake with lowering percentage macronutrients of fat and increasing protein intake may likely to improve body composition parameters and decrease ectopic adiposity after SCI.AIMTo highlight the effects of dietary manipulation and testosterone replacement therapy (TRT) on body composition after SCIMETHODSA 31-year-old male with T5 SCI was administered transdermal TRT daily for 16 wk. Caloric intake and percentage macronutrients were analyzed using dietary recalls. Magnetic resonance imaging and dual-energy x-ray absorptiometry were used to measure changes in body composition.RESULTSCaloric intake and fat percentage were reduced by 445 kcal/d and 6.5%, respectively. Total body weight decreased by 8%, body fat decreased by 29%, and lean mass increased by 7%. Thigh subcutaneous adipose tissue cross-sectional area was reduced by 31%.CONCLUSIONManipulation of caloric intake, fat percentage, and protein percentage may have influenced body composition after SCI.

Anthropometric Prediction of Visceral Adipose Tissue in Persons With Motor Complete Spinal Cord Injury

BackgroundSpinal cord injury (SCI) results in increased accumulation of visceral adipose tissue (VAT). Anthropometrics may provide an alternative to estimate VAT cross-section area (CSA) compared to magnetic resonance imaging (MRI). ObjectiveTo validate the use of anthropometrics, including abdominal circumference and skinfold thickness (SFT) measurements against MRI to predict subcutaneous adipose tissue (SAT) and VAT cross-sectional areas in persons with SCI. DesignCross-sectional. SettingClinical research center ParticipantTwenty-two men with motor complete SCI MethodsAnthropometric measurements and MRI were taken during a single visit. Abdominal circumference and SFT were used to derive prediction equations for subcutaneous adipose tissue (SATAnthro-CSA) and VAT (VATAnthro-CSA). Three-axial MRI at the level of umbilicus was used to establish the prediction equations. VATAnthro-CSA was compared against body mass index (BMI), waist circumference, and SFT. Bland-Altman plots were used to determine limits of agreement between prediction equations and MRI. Main Outcome MeasurementsSAT and VAT cross-sectional areas. ResultsSATAnthro-CSA explained 76% of the variance in SAT cross-sectional area (r2 = 0.76, standard error of the estimate [SEE] = 49.5 cm2, P <.001). VATAnthro-CSA explained 72% of VAT cross-sectional area (r2 = 0.72, SEE = 45.8 cm2, P <.001). Compared to VATAnthro-CSA, BMI, waist circumference, and SFT explained only 37%, 63%, and 31%, respectively, in the variance of VAT MRI. ConclusionAbdominal circumference and SFT demonstrated an alternative way to predict VAT CSA. VATAnthro-CSA estimated VATMRI more accurately than BMI, waist circumference, and SFT in individuals with chronic SCI. Level of EvidenceI

Gender Dimorphism in Central Adiposity May Explain Metabolic Dysfunction After Spinal Cord Injury

BackgroundIncrease in visceral adipose tissue (VAT) is an independent risk for mortality and other health-related comorbidities. ObjectiveTo examine the gender differences in VAT and subcutaneous adipose tissue (SAT) cross-sectional areas (CSA) between men and women with chronic spinal cord injury (SCI). The differences in the distribution of central adiposity were used to determine the association of VAT and SAT to metabolic dysfunction after SCI. DesignCross-sectional design. SettingHospital-based study. ParticipantsSixteen individuals (8 men and 8 women) with motor complete SCI were matched based on age, time since injury, and level of injury. MethodsAnthropometrics, dual x-ray absorptiometry (DXA), and magnetic resonance imaging were captured to measure lean mass, fat mass (FM), percentage FM, VAT, and SAT CSAs. Basal metabolic rate was measured, and intravenous glucose tolerance test and lipid panel were performed. Main Outcome MeasurementsVAT, SAT, and metabolic profile. ResultsSAT CSA was 1.6 -1.75 times greater in the upper and lower trunks in women compared to men with SCI (P < .05). VAT CSA was 1.8-2.6 times greater in the upper and lower trunks in men compared to women with SCI (P < .05). VAT adjusted to body weight was greater in men compared to women with SCI. High-density lipoprotein cholesterol (HDL-C) was positively related to SAT and negatively related to VAT. Glucose effectiveness was negatively related to lower trunk SAT (r = −0.60, P = .02). HDL-C ratio and triglycerides were positively related to upper VAT, lower VAT, and VAT:SAT ratio. ConclusionMagnetic resonance imaging demonstrated that there is a gender dimorphism in central adiposity in persons with chronic SCI. This gender dimorphism in central adipose tissue distribution may explain the higher prevalence of metabolic dysfunction in men with SCI, especially, the decrease in the HDL-C profile. Level of EvidenceIV

Abdominal adipose tissue in MGUS and multiple myeloma.

To determine abdominal adipose tissue parameters on PET/CT in patients with monoclonal gammopathy of undetermined significance (MGUS) and multiple myeloma (MM) that may serve as predictors of progression of MGUS to MM. We hypothesized that patients with MM had higher abdominal adiposity and higher fat metabolic activity compared to patients with MGUS. Our retrospective study was IRB approved and HIPAA compliant. The study group comprised 40 patients (mean age 64 ± 13years) with MGUS and 32 patients (mean age 62 ± 10years) with recently diagnosed MM (mean time since diagnosis of MM 3.0 ± 3.9months) who had not undergone MM treatment. All patients underwent whole body FDG-PET/CT. Total abdominal adipose tissue (TAT), abdominal subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT) cross sectional areas (CSA) (cm(2)) and metabolic activity (SUV) were assessed. Groups were compared using ANOVA. ROC curve analysis was performed to determine cutoff values for abdominal adipose tissue parameters to detect MM. Patients with recently diagnosed MM had higher TAT and SAT CSA (p ≤ 0.03) and higher fat metabolic activity (p < 0.01). VAT metabolic activity showed the highest sensitivity and specificity for identifying patients with MM (area under the curve 0.95 with cutoff value of >0.34, sensitivity 90.6%, specificity 92.5%, p < 0.0001). Patients who were recently diagnosed with MM had higher abdominal fat CSA and higher fat metabolic activity compared to patients with MGUS. These parameters may serve as novel biomarkers of progression of MGUS to MM.

A Preliminary Report on the Effects of the Level of Spinal Cord Injury on the Association Between Central Adiposity and Metabolic Profile

To determine the effects of the level of injury on visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), and the VAT:SAT ratio in individuals with tetraplegia (T-spinal cord injury [SCI]) and paraplegia (P-SCI) and the relationships among central adiposity and glucose and lipid profile. Cross-sectional and correlation. Clinical hospital and academic settings. Thirteen individuals with motor complete SCI were divided into T-SCI (n = 6, C5-C7, American Spinal Injury Association Impairment Scale [AIS] A and B) and P-SCI (n = 7, T4-T11, AIS A and B) groups. Both groups underwent overnight fasting to measure serum lipid profile, plasma glucose, and insulin responses to an oral glucose tolerance test, which was followed by magnetic resonance imaging to quantify VAT and SAT cross-sectional areas (CSA) and volume across multi-axial slices. The CSA and volumes of VAT and SAT were not different between T-SCI and P-SCI. VAT CSA was related to the fasting glucose in both groups, with nonsignificant association with glucose area under the curve. The CSA and volume of SAT were strongly associated with lipid profile outcomes in the T-SCI (r = 0.86-0.99, P < .02) but not in the P-SCI. The preliminary work suggests that the level of injury does not appear to influence the distribution of VAT and SAT. VAT and SAT distribution could not explain the difference noted in glucose and insulin profiles between the T-SCI and P-SCI groups. Finally, SAT is a strong predictor of lipid profile in individuals with T-SCI.

Racial differences in abdominal depot–specific adiposity in white and African American adults

There is increasing interest in understanding racial differences in adiposity in specific body depots as a way to explain differential health risks associated with obesity. Our aim was to examine the differences in abdominal visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) between white and African American adults. The sample included 1967 adults aged 18-84 y, including 790 white women, 435 African American women, 606 white men, and 136 African American men. Total body fat was measured by using dual-energy X-ray absorptiometry, whereas abdominal VAT and SAT cross-sectional areas (L4-L5 level) were measured by using computed tomography. Sex-specific differences in SAT and VAT between racial groups were analyzed by the use of general linear models, which controlled for age and total body fat. Additional models tested for racial differences in VAT and SAT and controlled for age, total body fat, smoking, and menopausal status. Statistical significance was accepted at P < 0.05. Abdominal VAT was significantly higher in white than in African American men and women, even after adjustment for covariates. White women had significantly lower SAT than did African American women, both before and after adjustment for covariates. White men had significantly higher SAT than did African American men, but after adjustment for covariates, their SAT was lower than that of African American men. Abdominal visceral adiposity is significantly greater in white men and women. After adjustment for covariates, white men and women had significantly lower SAT than did African American men and women. The results of this study highlight the heterogeneity of human body fat distribution across racial groups.This trial was registered at clinicaltrials.gov as NCT00959270.

Adipose Tissue Infiltration of Skeletal Muscle in Children with Cerebral Palsy

To determine whether children with quadriplegic cerebral palsy (QCP) have a greater adipose tissue (AT) infiltration of skeletal muscle than typically developing children (12/group and 5-14 years). Cross-sectional area (CSA) of AT and muscle in the midthigh were assessed with magnetic resonance imaging. Physical activity was assessed with an activity monitor. Children with QCP had 2.3-fold higher intermuscular AT CSA and 51% lower muscle CSA in the midthigh than control subjects. Midthigh intermuscular, subfascial, and subcutaneous AT CSA adjusted for midthigh muscle CSA were higher in children with QCP (all P < .05). Moreover, the proportion of intermuscular AT CSA and subfascial AT CSA relative to subcutaneous AT CSA in the midthigh were 2.5-fold and 1.8-fold higher in children with QCP than control subjects (all P < .05). Children with QCP also had 70% fewer physical activity counts, which was inversely related to intermuscular AT CSA (r = -0.76) and subfascial AT CSA (r = -0.63) adjusted for muscle CSA in the midthigh of children with QCP (both P < 0.05), but not in control subjects. Children with QCP have a greater AT infiltration of skeletal muscle than typically developing children, which is related to their low level of physical activity.

Effects of an Ad Libitum, High Carbohydrate Diet and Aerobic Exercise Training on Insulin Action and Muscle Metabolism in Older Men and Women

Previous studies have demonstrated that aerobic exercise training and weight loss have independent effects on insulin-stimulated glucose disposal (ISGD). We hypothesized that ad libitum consumption of a high-carbohydrate diet would result in weight loss and improved ISGD, and that aerobic exercise training would facilitate greater improvements in ISGD compared with diet alone. Older participants (13 women, 9 men; age = 66 +/- 1 year) with impaired glucose tolerance were randomly assigned to an ad libitum diet alone (18% fat, 19% protein, 63% carbohydrate) or this diet plus aerobic exercise training (4 d/wk, 45 min/d, 80% VO(2peak)) for 12 weeks. ISGD, abdominal fat distribution, muscle glycogen, and glycogen synthase activity were assessed pre- and postintervention. Consumption of the diet resulted in significant weight loss and an improvement in ISGD. Consumption of the diet plus exercise training also resulted in weight loss and increased ISGD, but results were not significantly different from those in the diet-alone group. Mean abdominal visceral and subcutaneous adipose tissue cross-sectional areas were smaller postintervention compared to baseline with no difference between groups. Exercise training and consumption of the diet increased muscle glycogen content (344.7 +/- 21.3 to 616.7 +/- 34.4 micromol.g(-1)) and decreased glycogen synthase activity (0.21 +/- 0.02 to 0.13 +/- 0.01) compared to the diet alone. These results demonstrate that consumption of an ad libitum, high-carbohydrate diet alone or in combination with aerobic exercise training results in weight loss and improved insulin sensitivity. Furthermore, exercise combined with this diet appears to limit additional increases in insulin sensitivity due to muscle glycogen supercompensation with a concomitant adaptive response of glycogen synthase.

RACE SIMILARITIES IN THE MULTIVARIATE ASSOCIATIONS BETWEEN EXERCISE-INDUCED CHANGES IN BLOOD LIPIDS AND BODY FATNESS

Racial differences in blood lipids and lipid parameters have been documented. The role of aerobic exercise training and depot-specific fat loss on consequent changes in blood lipids is not well understood. PURPOSE To explore the role of reductions in visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), and total fat mass (FM) in blood lipid changes following aerobic exercise training. METHODS The sample included 643 participants (440 White and 203 Black) from the HERITAGE Family Study. Total FM was determined by densitometry, whereas VAT and SAT cross-sectional areas were determined by computed tomography scans at the L4-L5 level. Blood lipids measurements included total cholesterol (TC), HDL-C, LDL-C, triglycerides (TG), and the TC/HDL ratio and were obtained before and after a 20-week supervised aerobic exercise program. Canonical correlation was used to quantify the multivariate association between changes in body fatness and changes in blood lipids. RESULTS The first canonical correlation was 0.46 in Black men, 0.35 in White men, 0.46 in Black women, and 0.30 in White women (all p < 0.05). The pattern of loadings indicated similar relationships between changes in fatness and changes in blood lipids among the four sex and race groups. Fat loss, characterized by loss of FM, VAT and SAT was associated with a lipid response characterized by an increase in HDL-C, and decreases in LDL-C, TG, TC, and TC/HDL. CONCLUSION The association between fat loss and changes in blood lipids consequent to aerobic exercise training appears to be similar among Black and White men and women.