Total Adipose Tissue Volume Research Articles

AI-derived body composition parameters as prognostic factors in patients with HCC undergoing TACE in a multicenter study

Background & AimsBody composition assessment (BCA) parameters have recently been identified as relevant prognostic factors for patients with hepatocellular carcinoma (HCC). Here we aimed to investigate the role of BCA parameters for prognosis prediction in patients with HCC undergoing transarterial chemoembolization (TACE). MethodsThis retrospective multicenter study included a total of 754 treatment-naïve patients with HCC who underwent TACE at six tertiary care centers between 2010–2020. Fully automated artificial intelligence-based quantitative 3D volumetry of abdominal cavity tissue composition was performed to assess skeletal muscle volume (SM), total adipose tissue (TAT), intra- and intermuscular adipose tissue (IMAT), visceral adipose tissue (VAT), and subcutaneous adipose tissue (SAT) on pre-intervention computed tomography scans. BCA parameters were normalized to the slice number of the abdominal cavity. We assessed the influence of BCA parameters on median overall survival (OS) and performed multivariate analysis including established estimates of survival. ResultsUnivariate survival analysis revealed that impaired median OS was predicted by low SM volume (p < 0.001), high TAT volume (p = 0.013), and high SAT volume (p = 0.006). In multivariate survival analysis, SM remained an independent prognostic factor (p = 0.039), while TAT and SAT volumes no longer showed predictive ability. ConclusionsSkeletal muscle volume is an independent prognostic factor for survival prediction. Thus, the integration of SM into novel scoring systems could potentially improve survival prediction and clinical decision-making. Fully automated approaches are needed to foster the implementation of this imaging biomarker into daily routine. Impact and implicationsBody composition assessment parameters, especially skeletal muscle mass, have been identified as relevant prognostic factors for many diseases and treatments. In this study skeletal muscle volume has been identified as an independent prognostic factor for patients with HCC undergoing TACE. Therefore, skeletal muscle mass as a metaparameter could play a role as an opportunistic biomarker in holistic patient assessment and be integrated into decision support systems. Workflow integration with AI evaluation is essential for automated body composition assessment quantification output enabling broad availability in multidisciplinary case discussions.

Preterm Formula, Fortified or Unfortified Human Milk for Very Preterm Infants, the PREMFOOD Study: A Parallel Randomised Feasibility Trial

Objective: Uncertainty exists regarding optimal supplemental diet for very preterm infants if the mother’s own milk (MM) is insufficient. We evaluated feasibility for a randomised controlled trial (RCT) powered to detect important differences in health outcomes. Methods: In this open, parallel, feasibility trial, we randomised infants 25+0–31+6 weeks of gestation by opt-out consent to one of three diets: unfortified human milk (UHM) (unfortified MM and/or unfortified pasteurised human donor milk (DM) supplement), fortified human milk (FHM) (fortified MM and/or fortified DM supplement), and unfortified MM and/or preterm formula (PTF) supplement from birth to 35+0 weeks post menstrual age. Feasibility outcomes included opt-outs, adherence rates, and slow growth safety criteria. We also obtained anthropometry, and magnetic resonance imaging body composition data at term and term plus 6 weeks (opt-in consent). Results: Of 35 infants randomised to UHM, 34 to FHM, and 34 to PTF groups, 21, 19, and 24 infants completed imaging at term, respectively. Study entry opt-out rate was 38%; 6% of parents subsequently withdrew from feeding intervention. Two infants met predefined slow weight gain thresholds. There were no significant between-group differences in term total adipose tissue volume (mean [SD]: UHM: 0.870 L [0.35 L]; FHM: 0.889 L [0.31 L]; PTF: 0.809 L [0.25 L], p = 0.66), nor in any other body composition measure or anthropometry at either timepoint. Conclusions: Randomisation to UHM, FHM, and PTF diets by opt-out consent was acceptable to parents and clinical teams, associated with safe growth profiles and no significant differences in body composition. Our data provide justification to proceed to a larger RCT.

Defining reference values for body composition indices by magnetic resonance imaging in UK Biobank.

Magnetic resonance imaging (MRI) is the gold standard for evaluating body composition. However, the reference ranges have not been established. Three lean tissue and seven adipose tissue parameters based on MRI data from the UK Biobank were used in this study. Participants with European ancestry and data on at least one parameter were screened. Age- and sex-specific percentile curves were generated using the lambda-mu-sigma method. Three levels of reference ranges were provided, which were equivalent to the mean±1 standard deviation (SD), 2 SDs and 2.5 SDs. The final analysis set for each parameter ranged from 4842 to 14148 participants (53.4%-56.6% women) with a median age of 61. For lean tissue parameters, compared with those at age 45, the median total lean tissue volume and total thigh fat-free muscle volume at age 70 were 2.83 and 1.73L, and 3.02 and 1.51L lower in men and women, respectively. The median weight-to-muscle ratios at age 45 were 0.51 and 0.83kg/L lower compared with those at age 70 in men and women, respectively. Adipose tissue parameters showed inconsistent differences. In men, the median muscle fat infiltration, visceral adipose tissue (VAT) volume, total abdominal adipose tissue index and abdominal fat ratio were 1.48%, 0.32L, 0.08L/m2 and 0.4 higher, and the median abdominal subcutaneous adipose tissue (ASAT) volume and total adipose tissue volume were 0.47 and 0.41L lower, respectively, at age 70 than at age 45. The median total trunk fat volume was approximately 9.53L at all ages. In women, the median muscle fat infiltration and VAT volume were 1.68% and 0.76L higher, respectively, at age 70 than at age 45. The median ASAT volume, total adipose tissue volume, total trunk fat volume, total abdominal adipose tissue index and abdominal fat ratio were 0.35L, 0.78L, 1.12L, 0.49L/m2 and 0.06 higher, respectively, at age 60 than at age 45. The medians of the former three parameters were 0.33L, 0.14L and 0.20L lower, at age 70 than at age 60. The medians of the latter two parameters were approximately 3.64L/m2 and 0.55 at ages between 60 and 70. We have established reference ranges for MRI-measured body composition parameters in a large community-dwelling population. These findings provide a more accurate assessment of abnormal adipose and muscle conditions.

Pathogenesis of development and influence of metabolically associated fatty liver disease by correlation analysis

Metabolically associated (nonalcoholic) fatty liver disease (MAFLD) has become the most common liver disease worldwidewhich can be effectively treated and prevented only at the stage of steatosis, which is why the pathogenesis of its occurrence and progression should be taken into account. The study aims at establishing the pathogenetic relationship between the occurrence and progression of MAFLD using correlation analysis. Materials and methods. To achieve the research objectives the total of 36 patients with hypertension, compensated hypothyroidism and overweight/obesity have been examined, median age 56.0 years, 92% women.The patients were divided into the main group (n = 23) with sonographically confirmed MAFLD and control (n = 13) without it, which were examined according to the standard protocols with additional determination of cortisol in blood, obesity characteristics (waist-to-hip ratio, total adipose tissue volume; mass of visceral adipose tissue; relative proportion of body fat), adaptive potential according to Baevsky RM (1987). The results were statistically processed for calculating the median (M), the significance was determined by Mann-Whitney U-test; the correlations were estimated using the Kendall rank correlation coefficient; the probability value was assumed to be p&lt;0.05. Results and discussion. The patients withMAFLD were significantly different in all anthropometric characteristics of obesity,characterized by a higher degree of hypertension, an increase in the right lobe of the liver above normal (158.0 [153.0; 170.0] vs. 145.0 [137.0; 150.0] mm) and portal vein dilation (10.0 [10.0; 10.8] vs. 7.5 [5.9; 10.0] mm, both p &lt;0.05). The liver echogenicity correlated with the obesity parameters, degree of hypertension, cardiovascular risk and aortic root diameter.In addition, the increased echogenicity was associated with a decrease in the total blood cholesterol (τ = -0.26; p = 0.032) and an increase in cortisol (τ = 0.63; p = 0.047).The increase in both liver sizes significantly correlated with the increase in the heart rate (τ = 0.28; p = 0.027), which occurred in parallel with the increase in blood cortisol (τ = 0.63; p = 0.047),activation of the sympathetic nervous system according to the Kerdo index (τ = 0.29; p = 0.021) and inflammation according to segmental blood neutrophils (τ = 0.29; p = 0.028) and seromucoid levels (τ = 0.67; p = 0.021). Conclusions: the changes which were described in metabolically associated fatty liver disease constitute the only vicious circle of pathogenesis, each link of which exacerbates the other and makes the pathological process irreversible.

Is visceral obesity associated with colorectal cancer? The first volumetric study using all CT slices.

We aimed to examine the possible relationship between abdominal adiposity parameters and the presence of colorectal cancer (CRC) and between these adiposity parameters and various histopathologic findings of the tumor. A total of 60 control subjects and 111 CRC patients, 63 with early-stage and 48 with advanced-stage disease, were enrolled. Medical data and abdominopelvic computed tomography (CT) examinations of each study group were retrospectively reviewed. Abdominal adiposity parameters, including visceral adipose tissue (VAT) volume, subcutaneous adipose tissue (SAT) volume, and total adipose tissue (TAT) volume, were calculated on all slices of the CT examinations with specialized software, and results for each study group were compared. Adiposity parameters were also compared with tumor histopathologic findings. We found lower VAT and higher SAT volumes in advanced-stage CRC patients, compared with the early-stage group. However, this relationship was not statistically significant (P = 0.721 for VAT and P = 0.432 for SAT volumes). We detected significantly lower VAT and SAT volumes in the early-stage CRC group compared with the control group (P = 0.014 for both). There was no significant relationship between TAT volumes and the study groups (P = 0.06). No statistically significant relationship was detected between adipose tissue parameters and histopathologic features of the CRC group (P > 0.05). We found statistically significant lower VAT and SAT volumes in patients with early-stage CRC compared with the control group. Volumetric adipose tissue measurements may be more accurate than area measurements and can easily be performed on abdominopelvic CT examination, which is the routine imaging modality for CRC patients.

Quantification of fetal organ volume and fat deposition following in utero exposure to maternal Western Diet using MRI.

PurposeTo examine the feasibility of using MRI to identify differences in liver size and fat deposition in fetal guinea pigs exposed to an in utero environment influenced by maternal consumption of a Western diet.Materials and methodsFemale guinea pigs fed either an energy-dense Western Diet (WD), comprised of increased saturated fats and simple sugars, or a Control Diet (CD) from weaning through pregnancy, underwent MR scanning near term (~ 60 days; term ~ 69 days). Maternal weights were collected at mating and at MR scanning. T1-weighted, T2-weighted, and IDEAL water-fat images were acquired at 3 Tesla. The images were used to segment maternal adipose tissue, fetal liver, fetal brain, fetal adipose tissue, and total fetal volumes and to measure maternal and fetal hepatic fat fractions.ResultsWeights of WD sows were lower prior to pregnancy (P = .04), however their weight gain over pregnancy did not differ from the CD group (P = .98). The WD sows had less total adipose tissue (TAT) at MR scanning (P = .04), while hepatic fat content was significantly elevated (P = .04). When controlling for litter size, WD fetuses had larger livers (P = .02), smaller brains (P = .01), and increased total adipose tissue volume (P = .01) when normalized by fetal volume. The WD fetuses also had increased hepatic fat fractions compared to CD fetal livers (P < .001).ConclusionMaternal Western Diet consumption prior to and during pregnancy induces differences in maternal liver fat content, fetal liver volume and liver fat storage, as well as changes in fetal adipose tissue deposition that can be measured in utero using MRI.

Body Composition following Necrotising Enterocolitis in Preterm Infants

Background: The optimal nutritional regimen for preterm infants, including those that develop necrotising enterocolitis (NEC), is unknown. Objective: The objective here was to evaluate body composition at term in infants following NEC, in comparison with healthy infants. The primary outcome measure was non-adipose tissue mass (non-ATM). Methods: We compared body composition assessed by magnetic resonance imaging at term in infants born <31 weeks of gestational age that participated in NEON, a trial comparing incremental versus immediate delivery of parenteral amino acids on non-ATM, and SMOF versus intralipid on intrahepatocellular lipid content. There were no differences in the primary outcomes. We compared infants that received surgery for NEC (NEC-surgical), infants with medically managed NEC (NEC-medical), and infants without NEC (reference). Results: A total of 133 infants were included (8 NEC-surgical; 15 NEC-medical; 110 reference). In comparison with the reference group, infants in the NEC-surgical and NEC-medical groups were significantly lighter [adjusted mean difference (95% CI) NEC-surgical: –630 g (–1,010, –210), p = 0.003; NEC-medical: –440 g (–760, –110), p = 0.009] and the total adipose tissue volume (ATV) was significantly lower [NEC-surgical: –360 cm³ (–516, –204), p < 0.001; NEC-medical: –127 cm³ (–251, –4); p = 0.043]. There were no significant differences in non-ATM [adjusted mean difference (95% CI) NEC-surgical: –46 g (–281, 189), p = 0.70; NEC-medical: –122 g (–308, 63), p = 0.20]. Conclusion: The lower weight at term in preterm infants following surgically and medically managed NEC, in comparison to preterm infants that did not develop the disease, was secondary to a reduction in ATV. This suggests that the nutritional regimen received was adequate to preserve non-ATM but not to support the normal third-trimester deposition of adipose tissue in preterm infants.

Dapagliflozin once daily plus exenatide once weekly in obese adults without diabetes: Sustained reductions in body weight, glycaemia and blood pressure over 1 year

AimsDapagliflozin and exenatide reduce body weight by differing mechanisms. Dual therapy with these agents reduces body weight, adipose tissue volume, glycaemia and systolic blood pressure (SBP) over 24 weeks. Here, we examined these effects over 1 year in obese adults without diabetes.Materials and methodsObese adults without diabetes (N = 50; aged 18‐70 years; body mass index, 30‐45 kg/m2) were initially randomized to double‐blind oral dapagliflozin 10 mg once daily plus subcutaneous long‐acting exenatide 2 mg once weekly or to placebo. They entered an open‐label extension from 24 to 52 weeks during which all participants received active treatment.ResultsOf the original 25 dapagliflozin + exenatide‐treated and 25 placebo‐treated participants, respectively, 21 (84%) and 17 (68%) entered the open‐label period and 16 (64%) and 17 (68%) completed 52 weeks of treatment. At baseline, mean body weight was 104.6 kg, and 73.5% of participants had prediabetes (impaired fasting glucose or impaired glucose tolerance). Reductions with dapagliflozin + exenatide at 24 weeks were sustained at 52 weeks, respectively, for body weight (−4.5 and −5.7 kg), total adipose tissue volume (−3.8 and −5.3 L), proportion with prediabetes (34.8% and 35.3%), and SBP (−9.8 and −12.0 mm Hg). Effects on body weight, SBP and glycaemia at 52 weeks with placebo → dapagliflozin + exenatide were similar to those observed with continuation of dapagliflozin + exenatide. Nausea and injection‐site reactions were more frequent with dapagliflozin + exenatide than with placebo and diminished over time. Safety and tolerability were similar to that in previous diabetes trials with these agents. No clear difference in adverse event‐related withdrawals between placebo and active treatment periods was observed.ConclusionsDapagliflozin + exenatide dual therapy produced sustained reductions in body weight, prediabetes and SBP over 52 weeks and was well tolerated in obese adults without diabetes.

Development of Early Adiposity in Infants of Mothers With Gestational Diabetes Mellitus.

Infants born to mothers with gestational diabetes mellitus (GDM) are at greater risk of later adverse metabolic health. We examined plausible candidate mediators, adipose tissue (AT) quantity and distribution and intrahepatocellular lipid (IHCL) content, comparing infants of mothers with GDM and without GDM (control group) over the first 3 postnatal months. We conducted a prospective longitudinal study using MRI and spectroscopy to quantify whole-body and regional AT volumes, and IHCL content, within 2 weeks and 8-12 weeks after birth. We adjusted for infant size and sex and maternal prepregnancy BMI. Values are reported as the mean difference (95% CI). We recruited 86 infants (GDM group 42 infants; control group 44 infants). Mothers with GDM had good pregnancy glycemic control. Infants were predominantly breast-fed up to the time of the second assessment (GDM group 71%; control group 74%). Total AT volumes were similar in the GDM group compared with the control group at a median age of 11 days (-28 cm(3) [95% CI -121, 65], P = 0.55), but were greater in the GDM group at a median age of 10 weeks (247 cm(3) [56, 439], P = 0.01). After adjustment for size, the GDM group had significantly greater total AT volume at 10 weeks than control group infants (16.0% [6.0, 27.1], P = 0.002). AT distribution and IHCL content were not significantly different at either time point. Adiposity in GDM infants is amplified in early infancy, despite good maternal glycemic control and predominant breast-feeding, suggesting a potential causal pathway to later adverse metabolic health. Reduction in postnatal adiposity may be a therapeutic target to reduce later health risks.

Visceral and Subcutaneous Fat Quality and Cardiometabolic Risk

The aim of this study was to evaluate whether computed tomography (CT) attenuation, as a measure of fat quality, is associated with cardiometabolic risk factors above and beyond fat quantity. Visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) are pathogenic fat depots associated with cardiometabolic risk. Adipose tissue attenuation in CT images is variable, similar to adipose tissue volume. However, whether the quality of abdominal fat attenuation is associated with cardiometabolic risk independent of the quantity is uncertain. Participants were drawn from the Framingham Heart Study CT substudy. The VAT and SAT volumes were acquired by semiquantitative assessment. Fat quality was measured by CT attenuation and recorded as mean Hounsfield unit (HU) within each fat depot. Sex-specific linear and logistic multivariable regression models were used to assess the association between standard deviation (SD) decrease in HU and each risk factor. Lower CT attenuation of VAT and SAT was correlated with higher body mass index levels in both sexes. Risk factors were generally more adverse with decreasing HU values. For example, in women, per 1 SD decrease in VAT HU, the odds ratio (OR) was increased for hypertension (OR: 1.80), impaired fasting glucose (OR: 2.10), metabolic syndrome (OR: 3.65), and insulin resistance (OR: 3.36; all p < 0.0001). In models that further adjusted for VAT volume, impaired fasting glucose, metabolic syndrome, and insulin resistance remained significant. Trends were similar but less pronounced for SAT and for men. There was evidence of an interaction between HU and fat volume among both women and men. Lower CT attenuation of VAT and SAT is associated with adverse cardiometabolic risk above and beyond total adipose tissue volume. Qualitative indices of abdominal fat depots may provide insight regarding cardiometabolic risk independent of fat quantity.

Bariatric surgery-mediated weight loss and its metabolic consequences for type-2 diabetes

The worldwide epidemic of obesity and its medical complications are being dealt with a combination of life style changes (e.g., healthier diet and exercise), medications and a variety of surgical interventions. The Roux-en Y gastric bypass (RYGB) and laparoscopic adjustable gastric banding (LAGB) are two of the most common weight loss surgeries for morbid obesity-associated metabolic syndrome and insulin resistance. A vast majority of patients that undergo RYGB and LAGB are known to experience marked weight loss and attenuation of diabetes. A number of recent studies have indicated that the rates of remission in glycemic control and insulin sensitivity are significantly greater in patients that have undergone RYGB. A plausible hypothesis to explain this observation is that the gastric bypass surgery as opposed to the gastric banding procedure impinges on glucose homeostasis by a weight loss-independent mechanism. In a recent paper, Bradley et al have experimentally explored this hypothesis. The authors compared several clinical and laboratory parameters of insulin sensitivity and β-cell function in cohorts of RYGB and LAGB patients before and after they lost approximately 20% of their body mass. After weight loss, both groups of patients underwent similar changes in their intra-abdominal and total adipose tissue volume, hepatic triglyceride and circulating leptin levels. The RYGB patients who lost 20% body mass, manifested higher postprandial output of glucose, insulin and glucagon-like peptide-1; these laboratory parameters remained unchanged in LABG patients. Irrespective of the observed differences in transient responses of RYGB and LAGB patients to mixed meal, the overall glycemic control as judged by glucose tolerance, multi-organ insulin sensitivity and β-cell function were nearly identical in the two groups. Both RYGB and LAGB patient cohorts also experienced similar changes in the expression of a number of pro- and anti-inflammatory markers. Based on these analyses, Bradley et al concluded that similar restoration of insulin sensitivity and b-cell function in non-diabetic obese patients that have undergone RYGB and LAGB were directly due to marked weight loss. These data have important implications for the risk/benefit analysis of weight loss therapy by bariatric procedures.

46 Change in Regional Adipose Tissue and Intrahepatocellular Lipid in Healthy Fully Breast-Fed Babies, Between Birth and Three Months

Background and aimsTotal adiposity doubles in early infancy1, however there exists little data describing the change in adipose tissue (AT) distribution and intrahepatocellular lipid (IHCL) over this period. In adults...

Optimal CT Number Range for Adipose Tissue When Determining Lean Body Mass in Whole-Body F-18 FDG PET/CT Studies.

The aim of this study was to define an optimal CT number range applicable to adipose tissue (AT) measurement in modern PET/CT systems. CT number (in Hounsfield units, HU) was measured in three different pure AT compartments in 53 patients. CT number range for AT was determined in three different ways, including pixel histogram analysis, to take the effect of partial volume averaging into account. The effect of changing the CT number range for AT on the total AT volume was investigated. The lower limits for CT number for pure subcutaneous AT, retroperitoneal AT, and visceral AT were -140, -140, and -130 HU, respectively. The corresponding upper limits were -70, -71, and -52 HU. The CT number range for AT using three methods when considering partial volume averaging was -144 to -141 HU to -30 to -33 HU, showing similar values between the three methods. The optimal CT number range for AT based on these data was -140 to -30 HU. Increases in total AT volume of 7.5% and 1.8% were found when the upper or lower limit was extended using 10 HU intervals, respectively, compared with the reference range of -140 to -30 HU. This study demonstrated that the optimal CT number range of AT that is applicable to modern PET/CT systems can be defined as -140 to -30 HU. The use of this CT number range of AT allowed lean body mass to be determined in whole-body F-18 FDG PET/CT studies.

Correlation of adipose tissue with liver histology in Asian Indian patients with nonalcoholic fatty liver disease (NAFLD)

Background. There is sparse literature on the association of adipose tissue with liver histology in patients with nonalcoholic fatty liver disease (NAFLD).Aim. To study the correlation of visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT) and total adipose tissue (TAT) with liver histology in Indian patients with NAFLD.Material and methods. A single slice CT scan at the level of L4-L5 vertebrae was done to assess the abdominal VAT and SAT volumes in 21 patients with histological diagnosis of NAFLD. Adult treatment panel III criteria with modified abnormal waist were used to define metabolic syndrome (MS). Histological grading was done according to the NAFLD activity score (NAS).Results. Twenty-one patients with NAFLD [13 males, median age: 35 years, median BMI: 25.97 kg/m2] were included prospectively. Even though overweight/obese patients had severe liver disease, there was no difference in the volume of VAT adjusted for BMI between 6 (28.5%) lean and 15 (71.5%) overweight/obese patients. Patients with NASH and borderline NASH were older, obese with higher VAT and SAT volumes than no-NASH group. SAT volume (SATV) correlated significantly with hepatic steatosis but none of the adipose tissue volumes had any correlation with other histological variables. Both SATV and TAT volume (TATV) correlated significantly with severity of liver disease as determined by NAS score whereas presence of MS or insulin resistance had no correlation with histological severity.Conclusion. Both subcutaneous and total adipose tissue volume are related to the disease severity as determined by NAFLD activity score in Indian patients with NAFLD.

Effects of Acupuncture Therapy on Abdominal Fat and Hepatic Fat Content in Obese Children: A Magnetic Resonance Imaging and Proton Magnetic Resonance Spectroscopy Study

The aim of this study was to use magnetic resonance imaging (MRI) together with proton magnetic resonance spectroscopy ((1)H-MRS) to study the influence of acupuncture therapy on abdominal fat and hepatic fat content in obese children. The design was a longitudinal, clinical intervention study of acupuncture therapy. SUBJECTS were 10 healthy, obese children (age: 11.4 ± 1.65 years, body-mass index [BMI]: 29.03 ± 4.81 kg/m(2)). Measurements included various anthropometric parameters, abdominal fat (assessed by MRI) and hepatic fat content (assessed by (1)H-MRS) at baseline and after 1 month of acupuncture therapy. One (1) month of acupuncture therapy significantly reduced the subjects' BMI by 3.5% (p = 0.005), abdominal visceral adipose tissue (VAT) volume by 16.04% (p < 0.0001), abdominal total adipose tissue volume by 10.45% (p = 0.001), and abdominal visceral to subcutaneous fat ratio by 10.59% (p = 0.007). Decreases in body weight (-2.13%), waist circumference (-1.44%), hip circumference (-0.33%), waist-to-hip ratio (WHR) (-0.99%), abdominal subcutaneous adipose tissue (SAT) volume (-5.63%), and intrahepatic triglyceride (IHTG) content (-9.03%) were also observed, although these were not significant (p > 0.05). There was a significant correlation between the level of abdominal fat (SAT, VAT) and anthropometric parameters (weight, BMI, waist circumferences, hip circumferences). There was no statistically significant correlation between IHTG and anthropometric parameters or abdominal fat content. The first direct experimental evidence is provided demonstrating that acupuncture therapy significantly reduces BMI and abdominal adipose tissue by reducing abdominal VAT content without significant changes in body weight, waist circumference, hip circumference, WHR, abdominal SAT, or IHTG content. Thus, the use of acupuncture therapy to selectively target a reduction in abdominal VAT content should become more important and more popular in the future.

382 Adipose Tissue Quantity and Distribution in Healthy Term Infants Using Magnetic Resonance Imaging

Until recently lean mass and adipose tissue mass in infants and adults have been estimated by indirect methods. The use of magnetic resonance imaging has allowed direct measurement of these two components. There are no published data on normal values of adipose tissue and lean body mass in healthy term infants at birth using this technique. We carried out whole body adipose tissue (AT) magnetic resonance imaging. Individual volumes of subcutaneous, intra-abdominal and other internal adipose tissue were quantified and these summated to derive total AT. We converted total AT volume to adipose tissue mass and subtracted this from the body weight to derive the lean body mass. We expressed lean mass as a ratio of adipose tissue mass. Total adipose tissue mass is expressed as a percentage of body weight (%ATM) and the individual compartments of adipose tissue as a percentage of total adipose tissue volume. The local research ethics committee approved the study and written parental consent was sought. Results are expressed as mean (sd). 20 healthy appropriately grown Caucasian infants were studied within a week of birth. Their gestational age at birth was 39.9 (1.4) weeks. The %ATM in this group was 17.7 (2.6). Of the total adipose tissue, 91.9 (1.2) % was in the subcutaneous compartment and 3.1 (0.5) % was deposited intra abdominally. The lean to adipose tissue mass ratio was 4.8 (0.9). No significant differences were noted between male and female babies in any of the results. Normative data on body composition in the term infant has relied on data obtained either by whole body chemical analysis carried or derived from indirect measures of lean mass and fat mass. We have presented data from normal healthy term infants of similar ethnic origin using a novel technique to study body composition.

Studies on human body composition during the first 4 months of life using magnetic resonance imaging and isotope dilution.

Assessing body composition during infancy requires data for the so-called reference infant. Currently available data for this purpose need to be updated and extended using methods based on principles different from those used previously to define the reference infant. Thus, magnetic resonance imaging was applied to full-term healthy boys (n = 25) and girls (n = 21), 4-131 d old, to estimate adipose tissue volume (ATV) and the amounts of s.c. and non-s.c. adipose tissue (AT). Total body water was estimated using isotope dilution. Total body fat (TBF), fat free weight (FFW) and the degree of hydration in FFW were calculated. Increases in weight, TBF, and FFW with age agreed with current reference data, although when compared with the reference, a slightly more rapid increase in % TBF was observed for boys. The degree of hydration in FFW was 78.9 +/- 4.5% (n = 45). Both sexes showed significant increases with age in s.c. ATV (14.7 and 13.0 mL/d for boys and girls, respectively) and in non-s.c. ATV (1.58 and 1.26 mL/d, respectively). Subcutaneous ATV was 90.5 +/- 1.8% (boys) and 91.1 +/- 1.9% (girls) of total ATV. In conclusion, a pronounced increase with age in the amount of AT was demonstrated involving a considerable gain in s.c. fat during early life. Except for % TBF in boys, changes in body composition with age agreed with current reference data.

Visceral fat loss evaluated by total body magnetic resonance imaging in obese women operated with laparascopic adjustable silicone gastric banding.

To investigate the changes of visceral fat, as compared with total and subcutaneous adipose tissue (AT) in obese patients operated with laparascopic adjustable silicone gastric banding (LAP-BAND). Six premenopausal morbid obese (body mass index range: 41.4-44.2 kg/m2) women, aged 38-42 y, operated with LAP-BAND, evaluated before, 8 weeks after, and 24 weeks after surgery. Fat distribution was analysed by total body multi-slices MRI. Total AT, gluteo-femoral subcutaneous AT, abdominal subcutaneous AT, and abdominal visceral AT volumes were measured. FM was calculated from MRI-determined total AT volume and AT density. A weight loss of 9.9+/-3.8 kg was observed in the first 8 weeks after LAP-BAND (0-8 weeks), and a further weight loss of 7.1+/-4.9 kg in the subsequent 16 weeks (8-24 weeks). Total AT showed a statistically significant reduction of 6.2+/-4.0 l in 0-8 weeks and a further significant reduction of 7.7+/-3.9 l in 8-24 weeks (P<0.01 from baseline). A similar trend was observed for both abdominal and gluteo-femoral subcutaneous AT. Visceral AT showed a statistically significant reduction of 1.0+/-0.9 l in the 0-8 weeks (P<0.05) and a further non-significant reduction of 0.6+/-0.7 l in 8-24 weeks (P<0.05 from baseline). In 0-8 weeks, the relative reduction of visceral AT was higher than the relative reduction of both total AT and gluteo-femoral subcutaneous AT. A highly significant correlation was observed between the reduction of total AT and the reduction of both abdominal and gluteo-femoral subcutaneous AT. By contrast, in 0-8 weeks, the reduction of total AT and the reduction of visceral AT were not correlated. In a subsequent analysis, both observations collected in the first 8 weeks after LAP-BAND and observations collected in the last 16 weeks are simultaneously considered, leading to a total of 12 time periods (two time periods for each individual patient). In order to identify factors associated with preferential visceral fat reduction, we calculated for each of the 12 time periods the difference between the percentage changes of visceral AT and the percentage changes of total AT. The relationship between this difference and several other variables were investigated by simple correlation analysis. The only variables found to be associated were the initial visceral AT volume, the absolute level of weight loss (kg) per week of observation, and the relative level of weight loss (%) per week of observation. In the phase of rapid weight loss following LAP-BAND, a preferential mobilization of visceral fat, as compared with total and subcutaneous AT, can occur. However, this preferential visceral fat reduction occurs only in those patients presenting higher levels of visceral fat deposition at baseline and higher levels of weight loss. International Journal of Obesity (2000)24, 60-69

Description and evaluation of a method based on magnetic resonance imaging to estimate adipose tissue volume and total body fat in infants.

Information about body fatness is important during nutritional assessment of infants, but current methods to estimate body composition in vivo are often not applicable in infants. Therefore, a new method based on magnetic resonance imaging (MRI) was developed. This method, which can assess the volume and distribution of adipose tissue (AT) as well as total body fat, was applied in 11 healthy full-term infants. Their total body water was also estimated using the isotope dilution technique. Adipose tissue volume (ATV) was calculated from AT area in 16 images of the body taken by an MRI scanner (1.5 tesla). AT area was assessed using a computer program in which AT criteria was defined by the observer. ATV of the infants was therefore evaluated once by three observers and twice by a fourth observer. The different observers estimated total, s.c., and non-s.c. ATV with a precision that varied between 1.9 and 7.2%, 2.0 and 4.8%, and 4.2 and 40.7%, respectively. Variations during AT area calculations accounted for a large part of the imprecision when assessing total and s.c. ATV. The linear relationship between percent total body water and total ATV in relation to body weight was significant in all evaluations. Although average total ATV varied when estimated by the four observers, there was, within each evaluation, a fairly constant order between infants with respect to their ATV. It is concluded that the MRI procedure represents a useful possibility to assess body fatness in infants.

Computed tomography—determined body composition in relation to cardiovascular risk factors in Indian and matched Swedish males

Relationships between cardiovascular risk factors, body composition, and tissue distributions were examined in 10 Indian and 10 Swedish males matched by age, height, and weight. The body was divided into 29 compartments by means of a multiscan computed tomography (CT) technique. Fasting glucose, insulin, and triglycerides (TG) were higher in Indians than in Swedes. During the oral glucose tolerance test (OGTT), the glucose area was similar in both groups, whereas the insulin area was 80% larger in Indians. Adipose tissue (AT) and skin volumes were larger and remaining lean tissues were smaller in Indians. Indians had proportionally less muscle and more skeleton in the legs, but no ethnic difference could be demonstrated with respect to AT distribution. The visceral AT to total AT volume ratio was positively related to insulin and TG, and with higher risk factors for Indians at any given ratio. TG and glucose were negatively related to the leg muscle to total muscle volume ratio, and this ratio was smaller in Indians. It is concluded that the metabolic disturbances of Indians are not necessarily dependent on a preponderance of visceral AT, and also that an upper-body muscle distribution—recognized as a new phenotypic companion to the metabolic syndrome—is statistically related to cardiovascular risk factors.