Subcutaneous Adiposity Research Articles

Visual Scoring of Ruminant Body Condition: Trapped in Inaccuracy

This perspective article raises a global concern on accuracy of body condition scoring (BCS) of ruminants based on visual observations of external fat depts. Recent evidence suggests that low body condition score in a visually and apparently thin animal does not accurately indicated that the animal is truly thin. Visually think looking ruminants may have considerable amount of visceral or abdominal adipose tissues that significantly contribute to hepatic import of fats and unhealthy substrates. Body condition score as a visual indicator of external and subcutaneous ruminant adiposity cannot be relied on accurately to be utilized in effective metabolic management of high-producing dairy and beef ruminants.

Association between visceral and subcutaneous adiposity and clinicopathological outcomes in non-metastatic clear cell renal cell carcinoma.

Visceral adiposity has been inconsistently associated with clinicopathologic features and outcomes of clear cell renal cell carcinoma (ccRCC); however, most studies were conducted in non-Western populations. We evaluated the associations between visceral and subcutaneous adiposity and clinicopathological characteristics of non-metastatic ccRCC patients in a Western population. The medical records of 220 surgically treated ccRCC patients with documented preoperative body mass index (BMI) and computed tomography (CT) scans were retrospectively reviewed. Nineteen patients with stage IV disease were excluded. Visceral (VFA) and subcutaneous fat area (SFA) were computed from pre-operative CT scans. Correlations between obesity measures were assessed with Pearson correlation. Associations between obesity measures and pathologic features were evaluated using logistic regression models adjusted for sex. Overall survival (OS) probabilities were estimated using Cox regression analysis. The log-rank test was used for group comparisons. The study cohort comprised 150 men and 51 women. Women had higher SFA (p = 0.01) but lower VFA (p < 0.001) than men. BMI was highly correlated with SFA (r = 0.804) and moderately correlated with VFA (r = 0.542). SFA and VFA were weakly correlated (r = 0.367). An increased BMI was associated with a better OS (p = 0.028). When adjusting for sex, neither SFA nor VFA was significantly associated with tumour grade, stage, or OS. Consistent with prior reports, our study suggests that increased BMI is associated with a better OS for patient with nonmetastatic ccRCC. Despite the high correlation between SFA and BMI, neither SFA nor VFA were significantly associated with tumour stage, grade, or OS in the current study; however, further studies in larger cohorts are required to validate this finding.

Methodologies to assess paediatric adiposity.

Childhood obesity is associated with increased risk of adult obesity, cardiovascular disease, diabetes and cancer. Appropriate techniques for assessment of childhood adiposity are required to identify children at risk. The aim of this review was to examine core clinical measurements and more technical tools to assess paediatric adiposity. The online databases PubMed, CINALH and EMBASE were searched and the abstracts identified were reviewed to determine appropriate studies. Their reference lists were also searched to identify further eligible studies. Publications were included if they described childhood measurement techniques or involved validation. There are many body composition assessment tools available, none of which are direct. Each technique has limitations and a combination of methods may be used. The main clinical techniques are weight, height, body mass index (BMI) and circumferences which provide sufficient information to enable classification of overweight or obesity when growth centile charts and ratios are employed. Further investigation depends on resources available and examiner skill. Skinfold thicknesses are cost-effective but require technical training and only measure subcutaneous fat. Dual energy X-ray absorptiometry (DEXA), air displacement plethysmography (ADP), magnetic resonance imaging (MRI) and computed tomography (CT) are more costly and intensive, requiring the child to remain still for longer periods. DEXA and ADP are capable of accurately measuring adiposity but are unable to distinguish between fat depots. MRI and CT can distinguish intra-abdominal from subcutaneous adiposity and are considered gold standards, but CT is unsuitable for adiposity measurement in children due to high levels of radiation exposure. Ultrasound is a promising technique capable of measuring intra-abdominal adiposity in children but requires further validation. The core clinical measurements of weight, height, BMI and circumferences are sufficient to enable diagnosis of paediatric overweight and obesity while more technical tools provide further insight.

Maternal tobacco smoke increased visceral adiposity and serum corticosterone levels in adult male rat offspring.

Maternal tobacco smoke (MTS) predisposes human and rat offspring to visceral obesity in early adulthood. Glucocorticoid excess also causes visceral obesity. We hypothesized that in utero MTS would increase visceral adiposity and alter the glucocorticoid pathway in young adult rats. We developed a novel model of in utero MTS exposure in pregnant rats by exposing them to cigarette smoke from E11.5 to term. Neonatal rats were cross-fostered to control dams and weaned to standard rat chow through young adulthood (postnatal day 60). We demonstrated increased visceral adiposity (193%)*, increased visceral adipose 11-β hydroxysteroid dehydrogenase 1 mRNA (204%)*, increased serum corticosterone (147%)*, and no change in glucocorticoid receptor protein in adult male MTS rat offspring. Female rats exposed to MTS in utero demonstrated no change in visceral or subcutaneous adiposity, decreased serum corticosterone (60%)*, and decreased adipose glucocorticoid receptor protein (66%)*. *P < 0.05. We conclude that in utero MTS exposure increased visceral adiposity and altered in the glucocorticoid pathway in a sex-specific manner. We speculate that in utero MTS exposure programs adipose dysfunction in adult male rat offspring via alteration in the glucocorticoid pathway.

Obesity, central adiposity and cardiometabolic risk factors in children and adolescents: a family-based study.

The objective of this study was to assess genetic and phenotypic correlations of obesity-related cardiometabolic risk factors in a family-based cohort. Anthropometric, body composition and biochemical measurements were collected on 999 members of 111 extended Midwestern US families of Northern European origin. Forward stepwise regression was used to identify which of Tanner stage, sex, Tanner stage by sex, body fat mass index, body fat percentage (dual-energy X-ray absorptiometry), visceral fat (VF)/subcutaneous fat (SubQF) (computed tomography scans for adults or magnetic resonance imaging for children), VF, SubQF, body mass index (BMI)% and waist to height ratio most influence homeostasis model assessment (HOMA), high-density lipoprotein cholesterol (HDL-c), plasma triglycerides (TG) and low-density lipoprotein cholesterol (LDL-c). In children and adolescents, subcutaneous adiposity was the most significant covariate for HOMA (P < 0.001) and TG (P = 0.001), and BMI percentile for HDL-c (P = 0.002) and LDL-c (P < 0.001). In adults, waist-height ratio (P < 0.001), VF/SubQF ratio (P = 0.001) and BMI (P = 0.02) were most significant for HOMA; VF (P < 0.001) and BMI (P = 0.02) for TG and VF for LDL-c (P = 0.001). Subcutaneous adiposity at the waist is a more significant predictor of metabolic syndrome traits in children and adolescents than it is in adults.

Epicardial and Perivascular Adipose Tissues and Their Influence on Cardiovascular Disease: Basic Mechanisms and Clinical Associations

It is well established that the cardiovascular (CV) risk of obesity is more strongly associated with visceral rather than subcutaneous adiposity.[1][1]–[3][2] Anthropometric variables that account for visceral adiposity, such as body mass index (BMI) and waist circumference (WC), have limited

Predictive equations for central obesity via anthropometrics, stereovision imaging and MRI in adults

ObjectiveAbdominal visceral adiposity is related to risks for insulin resistance and metabolic perturbations. Magnetic resonance imaging (MRI) and computed tomography are advanced instruments that quantify abdominal adiposity; yet field use is constrained by their bulkiness and costliness. The purpose of this study is to develop prediction equations for total abdominal, subcutaneous, and visceral adiposity via anthropometrics, stereovision body imaging (SBI), and MRI.Design and MethodsParticipants (67 men and 55 women) were measured for anthropometrics, and abdominal adiposity volumes evaluated by MRI umbilicus scans. Body circumferences and central obesity were obtained via SBI. Prediction models were developed via multiple linear regression analysis, utilizing body measurements and demographics as independent predictors, and abdominal adiposity as a dependent variable. Cross-validation was performed by the data-splitting method.ResultsThe final total abdominal adiposity prediction equation was –470.28+7.10waist circumference–91.01gender+5.74sagittal diameter (R²=89.9%); subcutaneous adiposity was –172.37+8.57waist circumference–62.65gender–450.16stereovision waist-to-hip ratio (R²=90.4%); and visceral adiposity was –96.76+11.48central obesity depth–5.09 central obesity width+204.74stereovision waist-to-hip ratio–18.59gender (R²=71.7%). R² significantly improved for predicting visceral fat when SBI variables were included, but not for total abdominal or subcutaneous adiposity.ConclusionsSBI is effective for predicting visceral adiposity and the prediction equations derived from SBI measurements can assess obesity.

Abstract 4253: Genome-wide blood leukocyte DNA methylation in relation to visceral, subcutaneous, and hepatic adiposity in postmenopausal women.

Abstract Obesity has a broad spectrum of health consequences and is responsible for 15-20% of cancer deaths. Yet, little is known about systemic epigenetic alterations that may mediate the detrimental metabolic effects of excess adiposity. We investigated differences in genome-wide blood leukocyte methylation associated with amounts of visceral, liver and abdominal subcutaneous fat in healthy women. Participants were drawn from a feasibility study conducted in Honolulu, Hawaii, where 60 women, aged 60-65 years and of Japanese or European descent, underwent dual energy X-ray absorptiometry assessing total and regional fat (kg) and abdominal magnetic resonance imaging at L4-L5 assessing visceral and subcutaneous fat areas (cm2) and percent liver fat. Forty six women with MRI data were analyzed for the study. Over 480K loci were determined by the Illumina HumanMethylation450K BeadChip. Data were normalized using GenomeStudio and transferred to Partek Genomics Suite for analysis. We performed analysis of covariance adjusted for age and ethnicity to determine loci that were differentially methylated (DM) by levels of visceral fat (VF), liver fat (LF) and abdominal subcutaneous fat (SF) (dichotomization at the median). DM genes were examined for their biological pathway. We found that 70 loci were DM for high vs. low levels of VF at p&amp;lt;5.0xE-03. 56 and 109 loci were DM for SF and LF, respectively. The top DM loci included hypo-CPLX1, FAM163A, ACLY and hyper-UCP3 for VF (p&amp;lt;6.0xE-05); hypo-BAI1, TNNT1, DAPK3, PRAME and hyper-CD81 for SF (p&amp;lt;5.0xE-05); and hyper-DIAPH2, RPA4, WT1, TBC1D3C and NRG1 for LF (p&amp;lt;3.0xE-05). Although none of these loci reached statistical significance after multiple test correction (Bonferroni p&amp;lt;1.0xE-07), their hyper- and hypo-methylation clearly segregated by high vs. low levels of VF, SF or LF in principal component analyses and heatmaps. We limited the pathway analysis to the CpGs in promoters because they are most likely to regulate gene expression. VF was associated with hypermethylation of cellular development and proliferation related genes (CDK6, FAM204A, GUSB, HLA-DMB, MAGED1, MATK, miR-10B, PPP1R13L, PPP1R14C, PPP2R2B, UCP3 and VAV3). SF was associated with hypomethylation of cellular growth and proliferation, tissue morphology and cell cycle related genes (DAPK3, EHMT2, MAFB, NHLRC1, PRAME, SMPD3 and TGOLN2). LF was associated with hypermethylation of genes related to neurological disease, organismal abnormalities, and cell-to-cell signaling (ADRB3, COMT, DNTTIP1, PLEC, RPA4 and SEPT6). There was little overlap among DM genes by different levels of the fat depots. Our findings provide further evidence that the various body fat depots are distinct metabolic entities and suggest that they are associated with specific DNA methylation profiles in blood leukocytes. Citation Format: Min-Ae Song, Unhee Lim, Thomas Ernst, Maarit Tiirikainen, Lynne R. Wilkens, Cheryl L. Albright, Rachel Novotny, Linda Chang, Laurence N. Kolonel, Loic Le Marchand. Genome-wide blood leukocyte DNA methylation in relation to visceral, subcutaneous, and hepatic adiposity in postmenopausal women. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 4253. doi:10.1158/1538-7445.AM2013-4253

Comparison of Visceral Adiposity and Obesity Parameters in Caucasian and Hispanic Adults

Abdominal adiposity can be classified generally as total, subcutaneous, and visceral. The distribution of these fat depots is important, as visceral adiposity is a better indicator of adverse health risks than subcutaneous adiposity. Yet the bulkiness and high costs associated with current detection devices limit their use in field settings. This study determined central obesity parameters via a three‐dimensional stereovision body imaging (SBI), an inexpensive, portable method of fat assessment. 121 Caucasian and Hispanic adults were measured for anthropometrics, abdominal adiposity volumes by magnetic resonance imaging; and body circumferences and central obesity by SBI. The Hispanic women had the highest amount of total abdominal and subcutaneous adiposity. Conversely, Caucasian men had the lowest depots of total abdominal and subcutaneous adiposity, but greater visceral adiposity. Central obesity depth (Caucasian r=0.83 and Hispanic r=0.78 women; Caucasian r=0.76 and Hispanic r=0.52 men) and the ratio of central obesity depth and width (Caucasian r=0.81 and Hispanic r=0.75 women; Caucasian r=0.88 and Hispanic r=0.65 men) were the most reliable parameters that exhibited a significantly positive association with visceral adiposity. These results suggest that SBI is an effective means to evaluate central adiposity in clinical settings in diverse populations. NIH 3R21DK081206–02S1.

Metabolic syndrome in the prevention of cardiovascular diseases and diabetes—still a matter of debate?

After metabolic syndrome was first introduced to identify persons at greater cardiovascular disease (CVD) risk, it has been associated with an increased risk of CVD and type 2 diabetes (T2D). Obesity has been considered as the fundamental factor in metabolic syndrome and it is thought to be mediated, at least in part by the role of the adipocyte in controlling circulating free fatty acids and the development of insulin resistance. However, the obese population is not perfectly overlapped with the population with metabolic syndrome. Is metabolic syndrome a better predictor than obesity to prevent CVD and T2D? Has metabolic syndrome been considered as a cluster of risk factors or an additional independent risk factor to assess CVD and T2D risk? The debate on the necessity of metabolic syndrome diagnosis seems not to be ended. Various definitions of metabolic syndrome were advocated by different organizations with emphasis on different components, and these definitions have different abilities to predict CVD and T2D among different populations because of fundamental philosophical differences. In the definitions of metabolic syndrome, only the cutoffs of each component were presented but rather continuous values or the degree of the severity of the syndrome with multiple cutoffs. Moreover, metabolic syndrome did not incorporate all the risk factors as known for CVD and T2D, such as physical activity. Future prospective studies with the measurement of sophisticated metabolic markers and of abdominal visceral and subcutaneous adiposity are needed to examine if the metabolic syndrome is a good CVD and T2D risk predictor over obesity and other risk factors. In practice, prevention action should be taken at the stage of obesity and providers need to pay attention to any components in the definition of metabolic syndrome even if the number of positive components has not achieved three or more.

Contribution of diet and physical activity to metabolic parameters among survivors of childhood leukemia

Determine the relationship between diet and metabolic abnormalities among adult survivors of childhood acute lymphoblastic leukemia (ALL). We surveyed 117 adult survivors of childhood ALL using the Harvard Food Frequency Questionnaire. Physical activity energy expenditure (PAEE) was measured with the SenseWear Pro2 Armband. Insulin resistance was estimated using the Homeostasis Model for Insulin Resistance (HOMA-IR). Visceral and subcutaneous adiposity were measured by abdominal CT. Adherence to a Mediterranean diet pattern was calculated using the index developed by Trichopoulou. Subjects were compared using multivariate analysis adjusted for age and gender. Greater adherence to a Mediterranean diet pattern was associated with lower visceral adiposity (p = 0.07), subcutaneous adiposity (p < 0.001), waist circumference (p = 0.005), and body mass index (p = 0.04). For each point higher on the Mediterranean Diet Score, the odds of having the metabolic syndrome fell by 31 % (OR 0.69; 95 % CI 0.50, 0.94; p = 0.019). Higher dairy intake was associated with higher HOMA-IR (p = 0.014), but other individual components of the Mediterranean diet, such as low intake of meat or high intake of fruits and vegetables, were not significant. PAEE was not independently associated with metabolic outcomes, although higher PAEE was associated with lower body mass index. Adherence to a Mediterranean diet pattern was associated with better metabolic and anthropometric parameters in this cross-sectional study of ALL survivors.

DNA methylation of the IGF2/H19 imprinting control region and adiposity distribution in young adults

BackgroundThe insulin-like growth factor 2 (IGF2) and H19 imprinted genes control growth and body composition. Adverse in-utero environments have been associated with obesity-related diseases and linked with altered DNA methylation at the IGF2/H19 locus. Postnatally, methylation at the IGF2/H19 imprinting control region (ICR) has been linked with cerebellum weight. We aimed to investigate whether decreased IGF2/H19 ICR methylation is associated with decreased birth and childhood anthropometry and increased contemporaneous adiposity.DNA methylation in peripheral blood (n = 315) at 17 years old was measured at 12 cytosine-phosphate-guanine sites (CpGs), analysed as Sequenom MassARRAY EpiTYPER units within the IGF2/H19 ICR. Birth size, childhood head circumference (HC) at six time-points and anthropometry at age 17 years were measured. DNA methylation was investigated for its association with anthropometry using linear regression.ResultsThe principal component of IGF2/H19 ICR DNA methylation (representing mean methylation across all CpG units) positively correlated with skin fold thickness (at four CpG units) (P-values between 0.04 to 0.001) and subcutaneous adiposity (P = 0.023) at age 17, but not with weight, height, BMI, waist circumference or visceral adiposity. IGF2/H19 methylation did not associate with birth weight, length or HC, but CpG unit 13 to 14 methylation was negatively associated with HC between 1 and 10 years. β-coefficients of four out of five remaining CpG units also estimated lower methylation with increasing childhood HC.ConclusionsAs greater IGF2/H19 methylation was associated with greater subcutaneous fat measures, but not overall, visceral or central adiposity, we hypothesize that obesogenic pressures in youth result in excess fat being preferentially stored in peripheral fat depots via the IGF2/H19 domain. Secondly, as IGF2/H19 methylation was not associated with birth size but negatively with early childhood HC, we hypothesize that the HC may be a more sensitive marker of early life programming of the IGF axis and of fetal physiology than birth size. To verify this, investigations of the dynamics of IGF2/H19 methylation and expression from birth to adolescence are required.

Corrigendum: Visceral and Subcutaneous Adiposity and Adiponectin in Middle-aged Japanese Men: The ERA JUMP Study

Corrigendum: Visceral and Subcutaneous Adiposity and Adiponectin in Middle-aged Japanese Men: The ERA JUMP Study

Abdominal radiation and diabetes: one more piece in the puzzle

In 1995, Cecile Teinturier and colleagues1 noted that a young adult who had been treated with abdominal radiation during early childhood developed diabetes 20 years later. This observation prompted them to review records of 121 nephroblastoma (Wilms’ tumour) survivors who had been similarly treated. They reported, in a letter to The Lancet,1 that 6·6% of the survivors had developed diabetes, all diagnosed in young adulthood, and although clinical and laboratory findings were not suggestive of type 1 diabetes mellitus, the patients did have inadequate insulin responses. Concurrently, Alessandro Cicognani and colleagues2 pondered whether the pancreas, being within the field of radiation in the treatment of Wilms’ tumour, would consequently manifest β-cell dysfunction. They compared the insulin response to an intravenous glucose tolerance test in 22 non-diabetic Wilms’ tumour survivors who been treated with abdominal radiation to 22 survivors without this exposure; on average, the 44 survivors were 8 years from completion of their cancer therapy.2 The authors found an inadequate first-phase of the insulin response in 31·8% (seven of 22) of the irradiated survivors compared with 4·5% in the non-irradiated group, with a preponderance of abnormalities occurring in men, and seemingly unrelated to bodyweight. These observations led us to investigate this issue using the Childhood Cancer Survivor Study (CCSS).3 We compared 8599 young adult survivors of childhood cancer with 2936 similarly aged siblings, and noted that patients who received abdominal radiation treatment for neuroblastoma were seven times more likely than their siblings to develop diabetes. Patients who received abdominal radiation treatment for either Wilms’ tumour or Hodgkin’s lymphoma were twice as likely to develop diabetes as their siblings.3 No increased risk of diabetes was seen in survivors of these cancers who were not treated with abdominal irradiation. We found this relation between diabetes and abdominal irradiation to be independent of body-mass index (BMI) and thus surmised that the increased risk was secondary to β-cell dysfunction and not obesity. In The Lancet Oncology, Florent de Vathaire and colleagues,4 report on a French–UK cohort of young adult survivors of a childhood solid tumour or lymphoma (excluding leukaemia), and substantially extend our understanding of this late effect of cancer therapy by showing a dose–response relation between radiation to the pancreas and risk of diabetes.4 Moreover, they noted that the risk correlated only with radiation to the tail of the pancreas, where the β-cells are concentrated, but not with radiation to the head or the body of the pancreas. Although laboratory testing was not included in the study, the relative risk of both insulin dependent and non-insulin dependent diabetes or type 2 diabetes was increased and similar after pancreatic radiation. As in the CCSS, this link between abdominal irradiation and diabetes was apparent irrespective of BMI, though it seemed marginally—but not significantly—stronger for those with increased BMI. This study has several strengths, including the large population of long-term survivors, confirmation of diabetes by the survivors’ physicians, and radiation dose estimates for different regions of the pancreas. The primary weaknesses of the study, similar to our experience in the CCSS, were a lack of prospective laboratory testing to more precisely characterise β-cell function and insulin resistance and the absence of correlative data of visceral and subcutaneous adiposity. The authors suggest, and we agree, that radiation can induce β-cell loss and impairment. Indeed, animal studies show that pancreatic radiation results in degranulation, vacuolisation, mitochondrial destruction, and impaired insulin secretion.5, 6 However, additional functional damage is probably necessary for diabetes to develop. Otherwise, we would expect diabetes to occur in childhood, rather than young adulthood, that the risk would not plateau at 20–29 Gy, and that there would be a preponderance of type 1 diabetes. Importantly, abdominal radiation damages more than just the pancreas. In particular, subcutaneous, but not visceral, adipose tissue is sensitive to radiation exposure.7 We hypothesise that with the loss of the normal abdominal subcutaneous depot, fat accumulation occurring with aging is preferentially stored in the deep viscera. Because visceral adiposity is strongly linked to insulin resistance, we speculate that this preferential increase in visceral adiposity might contribute to relative β-cell insufficiency with insulin resistance developing in adulthood. This hypothesis warrants further prospective study. The clinical implications of this study are important, since radiation remains an integral part of therapy for many children with Wilms’ tumour or neuroblastoma. Diabetes is a major risk factor for all-cause and cardiovascular mortality. Additionally, visceral adiposity and insulin resistance are important in tumorigenesis.8,9 Further study is therefore needed to clarify the mechanisms underlying diabetes after abdominal radiation. Understanding these mechanisms will, hopefully, result in the development of targeted interventions that will lead to a reduction in risk in this population.

Waist circumference in children and adolescents correlate with metabolic syndrome and fat deposits in young adults

To determine the relevance of waist circumference (WC) measurement and monitoring in children and adolescents as an early indicator of overweight, metabolic syndrome (MS) and cardiovascular problems in young adults in comparison with visceral and subcutaneous adiposity. A cohort study with 159 subjects (51.6% female) started in 1999 with an average age of 13.2 years. In 1999, 2006 and 2008 weight, height, and WC were evaluated. In 2006 blood samples for laboratory diagnosis of MS were added. In 2008 abdominal computed tomography (ACT) to quantify the fat deposits were also added. The WC measured in children and adolescents was strongly correlated with body mass index (BMI) measured simultaneously. A strong correlation was established between WC in 1999 with measures of WC and BMI as young adults. WC strongly correlated with fat deposits in ACT. The WC in 1999 expressed more subcutaneous fat (SAT), while the WC when young adults expressed strong correlation with both visceral fat (VAT) and SAT. The correlation of WC with fat deposits was stronger in females. WC and not BMI in 1999 was significantly higher in the group that evolved to MS. The WC in children and adolescents was useful in screening patients for MS. WC expressed the accumulation of abdominal fat; especially subcutaneous fat.

Adiposity Is Associated with Blunted Cardiovascular, Neuroendocrine and Cognitive Responses to Acute Mental Stress

Obesity and mental stress are potent risk factors for cardiovascular disease but their relationship with each other is unclear. Resilience to stress may differ according to adiposity. Early studies that addressed this are difficult to interpret due to conflicting findings and limited methods. Recent advances in assessment of cardiovascular stress responses and of fat distribution allow accurate assessment of associations between adiposity and stress responsiveness. We measured responses to the Montreal Imaging Stress Task in healthy men (N = 43) and women (N = 45) with a wide range of BMIs. Heart rate (HR) and blood pressure (BP) measures were used with novel magnetic resonance measures of stroke volume (SV), cardiac output (CO), total peripheral resistance (TPR) and arterial compliance to assess cardiovascular responses. Salivary cortisol and the number and speed of answers to mathematics problems in the task were used to assess neuroendocrine and cognitive responses, respectively. Visceral and subcutaneous fat was measured using T2 *-IDEAL. Greater BMI was associated with generalised blunting of cardiovascular (HR:β = −0.50 bpm.unit−1, P = 0.009; SV:β = −0.33 mL.unit−1, P = 0.01; CO:β = −61 mL.min−1.unit−1, P = 0.002; systolic BP:β = −0.41 mmHg.unit−1, P = 0.01; TPR:β = 0.11 WU.unit−1, P = 0.02), cognitive (correct answers: r = −0.28, P = 0.01; time to answer: r = 0.26, P = 0.02) and endocrine responses (cortisol: r = −0.25, P = 0.04) to stress. These associations were largely determined by visceral adiposity except for those related to cognitive performance, which were determined by both visceral and subcutaneous adiposity. Our findings suggest that adiposity is associated with centrally reduced stress responsiveness. Although this may mitigate some long-term health risks of stress responsiveness, reduced performance under stress may be a more immediate negative consequence.

Ethnic and sex differences in body fat and visceral and subcutaneous adiposity in children and adolescents

Body fat and the specific depot where adipose tissue (AT) is stored can contribute to cardiometabolic health risks in children and adolescents. Imaging procedures including magnetic resonance imaging and computed tomography allow for the exploration of individual and group differences in pediatric adiposity. This review examines the variation in pediatric total body fat (TBF), visceral AT (VAT) and subcutaneous AT (SAT) due to age, sex, maturational status and ethnicity. TBF, VAT and SAT typically increase as a child ages, though different trends emerge. Girls tend to accumulate more TBF and SAT during and after puberty, depositing fat preferentially in the gynoid and extremity regions. In contrast, pubertal and postpubertal boys tend to deposit more fat in the abdominal region, particularly in the VAT depot. Sexual maturation significantly influences TBF, VAT and SAT. Ethnic differences in TBF are mixed. VAT tends to be higher in white and Hispanic youth, whereas SAT is typically higher in African American youth. Asian youth typically have less gynoid fat but more VAT than whites. Obesity per se may attenuate sex and ethnic differences. Particular health risks are associated with high amounts of TBF, VAT and SAT, including insulin resistance, hepatic steatosis, metabolic syndrome and hypertension. These risks are affected by genetic, biological and lifestyle factors including physical activity, nutrition and stress. Synthesizing evidence is difficult as there is no consistent methodology or definition to estimate and define depot-specific adiposity, and many analyses compare SAT and VAT without controlling for TBF. Future research should include longitudinal examinations of adiposity changes over time in representative samples of youth to make generalizations to the entire pediatric population and examine variation in organ-specific body fat.

Effects of recombinant human growth hormone therapy in adults with Prader–Willi syndrome: a meta‐analysis

Prader-Willi syndrome (PWS) is associated with GH deficiency, deleterious changes in body composition and function. As the effects of recombinant human GH (rhGH) in PWS adults have not been well established, we sought to conduct a meta-analysis of pertinent studies. Meta-analysis of studies examining the effects of rhGH therapy in PWS adults. One hundred and thirty four PWS adults (75 men, 59 women). Literature searches, including publications (PubMed, EMBASE and the Cochrane Register), and abstracts presented at meetings through July 2011 describing studies of rhGH therapy in PWS adults; 8/1194 articles, describing unique cohorts, were included. Two authors independently extracted data and examined study quality. rhGH therapy for 12 months led to [weighted mean difference (95% CI)] decreased body fat [-2·91% (-3·90, -1·91)], visceral [-32·97 cm(2) (-55·67, -10·26)] and subcutaneous adiposity [-55·24 cm(2) (-89·05, -21·44)], and increased lean body mass (LBM) [2·41 Kg (1·32, 3·49)]. Similar changes in body fat [-2·89% (-4·69, -1·07)] and LBM [2·82 Kg (1·31, 4·33)] were found in longer studies. There were no changes in body mass index (BMI) or lipids. There was a small increase in fasting glucose [0·27 mmol/l (0·05, 0·49)] and trends towards higher fasting insulin [20·24 pmol/l (-0·55, 41·02)] and insulin resistance [HOMA: 0·60 (-0·04, 1·24)] after rhGH therapy for 12 months. In PWS adults, rhGH therapy led to decreased body adiposity and increased LBM without changes in BMI or lipids. There was a small increase in fasting glucose and trends towards higher insulin and insulin resistance.

Contribution of diet and physical activity to metabolic parameters among survivors of childhood leukemia.

9552 Background: Survivors of childhood acute lymphoblastic leukemia (ALL) are at increased risk for obesity, insulin resistance and increased visceral adiposity. A history of cranial radiation therapy (CRT) worsens this risk. In non-cancer populations, adherence to a Mediterranean Diet has been shown to improve metabolic parameters and risk of diabetes mellitus. Whether diet may contribute to insulin resistance and increased adiposity in ALL survivors is not known. Methods: We surveyed 117 adult survivors of childhood ALL using the Harvard Food Frequency Questionnaire. Physical activity energy expenditure (PAEE) was measured with the SenseWear Pro2 Armband. Fasting blood was obtained on all subjects and insulin resistance was estimated using the Homeostasis Model for Insulin Resistance (HOMA-IR). Visceral adiposity was measured by abdominal CT. Adherence to a Mediterranean Diet pattern was calculated using the index developed by Trichopoulou. Subjects were compared using univariate analysis. Results: Subjects were majority female (56%); 25% were minority or Hispanic white. A history of CRT was present in 15 (29%) men and 25 (38%) women. Among all subjects, greater adherence to a Mediterranean diet pattern was associated with improved HOMA-IR (p=0.14), visceral adiposity (p=0.03), subcutaneous adiposity (p=0.005), waist circumference (p=0.02), and body mass index (p=0.03) (all unadjusted analyses). The effect of adherence to a Mediterranean diet on insulin resistance was especially notable in men who did not receive CRT (p=0.06). Higher dairy intake was found to worsen HOMA-IR (p=0.014), but other individual components of the Mediterranean diet, such as low intake of meat and high intake of fruits and vegetables, were not significant. Inclusion of PAEE did not alter our findings, although higher PAEE was associated with lower body mass index. Conclusions: Adherence to a Mediterranean diet pattern, especially low consumption of dairy products, may improve insulin resistance in survivors of childhood ALL. Further study is warranted.

The relationship between visceral adiposity and cognitive performance in older adults

a direct association between visceral adiposity on abdominal computed tomography (CT) and cognitive performance has not been reported. to investigate the associations between total and regional adiposity measured with abdominal CT, and cognitive performance in elderly persons and to explore their modification by age. cross-sectional study. a health promotion centre of a tertiary university hospital. two-hundred and fifty individuals aged 60 years and above who underwent anthropometric measurements, abdominal CT and cognitive testing. adiposity measures included body mass index (BMI), waist circumference and visceral and subcutaneous adiposity by abdominal CT. Poor cognitive performance was defined as Mini-Mental State Examination score being at or below 1 SD of age, sex and education-normative values. in multivariate logistic regression analyses obesity [odds ratio (OR) 2.61, 95% confidence interval (CI)=1.21-6.01, P=0.015] and being in the top tertile of the visceral adiposity area (OR: 2.58, 95% CI=1.001-6.62, P=0.045) were associated with poor cognitive performance in subjects younger than 70 years, but not in those 70 years and older. high adiposity, particularly visceral adiposity, was associated with poor cognitive functioning in younger elderly persons.