Changes In Visceral Adipose Tissue Research Articles

P-113 YI Body Fat and Skeletal Muscle Composition Differs in Crohnʼs Disease Patients Depending on Radiological Response to Medical Therapy

Prior studies have demonstrated changes in body fat composition after initiation of infliximab therapy. Radiological transmural response to medical therapies has recently been shown to be associated with better long-term outcomes in small bowel Crohn's disease (CD). We sought to explore changes in body fat and skeletal muscle composition as surrogate biomarkers of radiological response after treatment initiation. We conducted a pilot study on patients with small bowel CD who underwent a computed tomography enterography (CTE) prior to initiation of therapy with follow-up CTE after median 447 days (IQR, 369–629 days). Small bowel lesions were scored for length, enhancement, mural thickness, dilated vasa recta, perienteric inflammation, penetrating or stricturing disease. Patients were complete responders if all lesions improved, non-responders if existing lesion(s) worsened or new lesion detected, and partial responders for other scenarios. The total cross-sectional area of subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT), intramuscular adipose free tissue (IMAFT) and intermuscular adipose tissue (IMAT) were measured at the mid-vertebral level over contiguous axial CT images from the first lumbar (L1) to the third sacral (S3) vertebrae and subsequently summated to give a volumetric analysis. A representative axial image at each level was identified by a single radiologist (MM), with images subsequently undergoing semiautomated analysis using in-house developed image processing algorithms (NT, MATLAB 13.0; Math Works, Natick, MA). To calculate SAT and VAT area (cm2), the outer and inner boundaries of the abdominal wall and paraspinal muscles were demarcated. Adipose cross-sectional area was calculated by applying a CT threshold attenuation value between −190 and −30 Hounsfield Units (HU). Lean skeletal muscle (IMAFT) was measured using threshold attenuation values between −29 to +150 HU. Right lower quadrant (RLQ) VAT was selected encompassing the right half VAT between L4 to S3 levels. Both VAT and RLQ VAT were standardized for height by dividing by height-squared. Body adipose composition at baseline and change at 1st follow up CTE (“delta”) of complete/partial responders and non-responders were compared using Wilcoxon rank-sum test. A total of 20 CD patients were included: 10 complete responders (50%), 4 partial responders (20%), and 6 non-responders (30%). At baseline CTE, standardized VAT (264.8 [IQR, 171.8–407.2] versus 203.6 [75.1–356.9]), standardized RLQ VAT (56.6 [25.2–78.2] versus 39.2 [15.9–75.2]) and IMAFT (1070.6 [851.9–1491.9] versus 1055.7 [927.1–1423.1]) were similar between radiological responders and non-responders, respectively. After treatment initiation, the standardized delta VAT was similar between the 2 groups while the standardized delta RLQ VAT (5.4 [−6.3 to 19.2] versus −2.4 [−14.7 to 0.1], P = 0.08) showed a trend towards significance. Delta IMAFT (54.1 [1.7–109.1] versus—72.3 [−114.8 to 17.2], P = 0.009) was significantly different between radiological responders and nonresponders. The change in RLQ VAT and IMAFT after initiation of medical therapy potentially differs among radiological responders versus non-responders. These findings suggest a role for analysis of body fat and skeletal composition as a surrogate biomarker for radiological response.

Sugar-Sweetened Beverage Consumption Is Associated With Change of Visceral Adipose Tissue Over 6 Years of Follow-Up.

Sugar-sweetened beverage (SSB) intake has been linked to abnormal abdominal adipose tissue. We examined the prospective association of habitual SSB intake and change in visceral adipose tissue (VAT) and subcutaneous adipose tissue. The quantity (volume, cm(3)) and quality (attenuation, Hounsfield Unit) of abdominal adipose tissue were measured using computed tomography in 1003 participants (mean age 45.3 years, 45.0% women) at examination 1 and 2 in the Framingham's Third Generation cohort. The 2 exams were ≈ 6 years apart. At baseline, SSB and diet soda intake were assessed using a valid food frequency questionnaire. Participants were categorized into 4 groups: none to <1 serving/mo (nonconsumers), 1 serving/mo to <1 serving/week, 1 serving/week to 1 serving/d, and ≥ 1 serving/d (daily consumers) of either SSB or diet soda. After adjustment for multiple confounders including change in body weight, higher SSB intake was associated with greater change in VAT volume (P trend<0.001). VAT volume increased by 658 cm(3) (95% confidence interval [CI], 602 to 713), 649 cm(3) (95% CI, 582 to 716), 707 cm(3) (95% CI, 657 to 757), and 852 cm(3) (95% CI, 760 to 943) from nonconsumers to daily consumers. Higher SSB intake was also associated with greater decline of VAT attenuation (P trend=0.007); however, the association became nonsignificant after additional adjustment for VAT volume change. In contrast, diet soda consumption was not associated with change in abdominal adipose tissue. Regular SSB intake was associated with adverse change in both VAT quality and quantity, whereas we observed no such association for diet soda.

Prognostic Impact of Changes in Adipose Tissue Areas after Colectomy in Colorectal Cancer Patients

There have been few studies assessing the changes in the body components of patients after colectomy in colorectal cancer (CRC). The purpose of this study was to verify the trends in the adipose tissue areas of CRC patients before and after surgery and to determine their clinical relevance. Computed tomography (CT)-assessed subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT) areas were recorded before and after curative resection in stage I to III CRC patients. Changes in the adipose tissue were assessed by calculating the difference in the adipose tissue area between preoperative CT and the most recent postoperative CT, which is disease-free state. Regarding obesity before surgery, there were no prognostic effect of body mass index (BMI), VAT and SAT, and 47.3% of patients had increases in VAT after colectomy. By multivariate analysis, adjusting sex, age, stage, differentiation, VAT change was the only obesity related factor to predict the prognosis, that patients who had increase in VAT after colectomy had better overall survival (HR, 0.557; 95% CI, 0.317-0.880) and disease-free survival (HR, 0.602; 95% CI, 0.391-0.927). BMI and SAT change had no significant association. In subgroup analysis of stage III CRC patients, VAT change had significance for prognosis only in patients who had adjuvant chemotherapy but not in those who did not receive postoperative chemotherapy. Increase in visceral adipose tissue after surgery is a favorable predictor of prognosis for CRC patients.

Ipragliflozin effectively reduced visceral fat in Japanese patients with type 2 diabetes under adequate diet therapy.

To investigate if ipragliflozin, a novel sodium-glucose co-transporter 2 inhibitor, alters body composition and to identify variables associated with reductions in visceral adipose tissue in Japanese patients with type 2 diabetes mellitus. This prospective observational study enrolled Japanese participants with type 2 diabetes mellitus. Subjects were administered ipragliflozin (50 mg/day) once daily for 16 weeks. Body composition, visceral adipose tissue volume and plasma variables were measured at 0, 8, and 16-weeks. The subjects' lifestyle habits including diet and exercise were evaluated at baseline and 16 weeks. The primary endpoint was defined as the decrease of visceral adipose tissue mass. Twenty-four of 26 enrolled participants completed the study. The visceral adipose tissue decreased significantly (110 ± 33 to 101 ± 36 cm(2), p = 0.005) as well as other parameters for metabolic insufficiency including hemoglobin A1c. Seventy-one % of the total body weight reduction (-2.49 kg) was estimated by a decrease in fat mass (-1.77 kg), and the remaining reduction (22%) by water volume (-0.55 kg). A minor but significant reduction in the skeletal muscle index was also observed. Correlation analyses were performed to identify variables associated with changes in visceral adipose tissue and the only significant variable identified was diet therapy (Spearman's r = -0.416, p = 0.043). Ipragliflozin significantly decreased visceral adipose tissue, and improved parametres for metabolic dysfunction. Adequate diet therapy would be necessary to induce and enhance the therapeutic merit.

Adipose tissue attenuation as a marker of adipose tissue quality: Associations with six-year changes in body weight.

Weight gain is associated with fat volume increases, but associations with fat quality are less well characterized The associations of weight change with visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) volume and attenuation were investigated. Computed tomography abdominal scans were acquired on a Framingham Heart Study subset (N=836; 40.2% women; mean age 45.7years), a mean of 6.1years apart. Fat attenuation estimated fat quality. Mean weight change was +2.0 (SD 6.8; IQR -0.7, 5.0)kg in women and +2.7 (SD 6.0; IQR -0.5, 5.4)kg in men. Per 2.5kg weight increase in women, VAT volume increased 126cm(3) (95% CI, 112-140, p<0.0001), SAT volume increased 258cm(3) (95% CI, 239-278, p<0.0001), and fat attenuation decreased (i.e., fat quality worsened) in VAT and SAT (p<0.0001). Increasing VAT volume was associated with decreasing fat attenuation even after accounting for weight change. Relative to weight-stable women (n=129), women who lost >2.5kg (n=58) had smaller SAT attenuation decreases (p<0.0001). Similar patterns were seen in men. Weight gain was associated with decreases in fat attenuation independent of VAT and SAT volume changes. These findings highlighted the associations of weight gain and worsening fat attenuation, suggesting fat attenuation may be dynamic.

Increased Visceral Adipose Tissue Is an Independent Predictor for Future Development of Atherogenic Dyslipidemia.

Atherogenic dyslipidemia is frequently observed in persons with a greater amount of visceral adipose tissue (VAT). However, it is still uncertain whether VAT is independently associated with the future development of atherogenic dyslipidemia. The aim of this study was to determine whether baseline and changes in VAT and subcutaneous adipose tissue (SAT) are associated with future development of atherogenic dyslipidemia independent of baseline lipid levels and standard anthropometric indices. Community-based prospective cohort study with 5 years of follow-up. A total of 452 Japanese Americans (240 men, 212 women), aged 34-75 years were assessed at baseline and after 5 years of follow-up. Abdominal fat areas were measured by computed tomography. Atherogenic dyslipidemia was defined as one or more abnormalities in high-density lipoprotein (HDL) cholesterol, triglycerides, or non-HDL cholesterol levels. Baseline VAT and change in VAT over 5 years were independently associated with log-transformed HDL cholesterol, log-transformed triglyceride, and non-HDL cholesterol after 5 years (standardized β = -0.126, 0.277, and 0.066 for baseline VAT, respectively, and -0.095, 0.223, and 0.090 for change in VAT, respectively). However, baseline and change in SAT were not associated with any future atherogenic lipid level. In multivariate logistic regression analysis, incremental change in VAT (odds ratio [95% confidence interval], 1.73 [1.20-2.48]; P = .003), triglycerides (4.01 [1.72-9.33]; P = .001), HDL cholesterol (0.32 [0.18-0.58]; P < .001), and non-HDL cholesterol (7.58 [4.43-12.95]; P < .001) were significantly associated with the future development of atherogenic dyslipidemia independent of age, sex, diastolic blood pressure, homeostasis model assessment insulin resistance, body mass index (BMI), change in BMI, SAT, and baseline atherogenic lipid levels. Baseline and change in VAT were independent predictors for future development of atherogenic dyslipidemia. However, BMI, waist circumference, and SAT were not associated with future development of atherogenic dyslipidemia.

What is the best reference site for a single MRI slice to assess whole-body skeletal muscle and adipose tissue volumes in healthy adults?

Whole-body magnetic resonance imaging (MRI) is the gold standard for the assessment of skeletal muscle (SM) and adipose tissue volumes. It is unclear whether single-slice estimates can replace whole-body data. We evaluated the accuracy of the best single lumbar and midthigh MRI slice to assess whole-body SM, visceral adipose tissue (VAT), and subcutaneous adipose tissue (SAT). Whole-body MRI was performed in 142 healthy adults aged 19-65 y [mean ± SD age: 37.0 ± 11.8 y; BMI (in kg/m(2)): 25.3 ± 5.9]. Single slices were taken at lumbar vertebrae L1-L5 plus intervertebral discs and the thigh (midthigh, 10 cm distally from the midthigh, and 10 cm proximally from the midthigh). The value of single-slice areas was also tested in a longitudinal study on 48 healthy volunteers during weight loss (8.2 ± 5.2 kg). Cross-sectionally, all SM and adipose tissue single-slice areas correlated with total tissue volumes (P < 0.01). Because of the close associations between L3 areas and corresponding tissue volumes (r = 0.832-0.986, P < 0.01), this location was identified as the reference to estimate SM and adipose tissue in both sexes. SM, SAT, and VAT areas at L3 explained most of the variance of total tissue volumes (69-97%, with SEs of estimation of 1.96 and 2.03 L for SM, 0.23 and 0.61 L for VAT, and 4.44 and 2.47 L for SAT for men and women, respectively. There was no major effect on the explained variance compared with that for optimal slices. For SM, the optimal slice area was shown at midthigh. With weight-loss changes in total SM, VAT, and SAT, volumes were significantly different from those at baseline (SM changes: -2.8 ± 2.9 L; VAT changes: -0.7 ± 1.0 L; SAT changes: -5.1 ± 6.0 L). The area at L3 reflected changes in total VAT and SAT. To assess changes in total SM volumes, areas at midthigh showed the best evidence. In both sexes, a single MRI scan at the level of L3 is the best compromise site to assess total tissue volumes of SM, VAT, and SAT. By contrast, L3 does not predict changes in tissue components. This trial was registered at clinicaltrials.gov as NCT01737034.

A double-blind, placebo-controlled randomized trial to evaluate the efficacy of docosahexaenoic acid supplementation on hepatic fat and associated cardiovascular risk factors in overweight children with nonalcoholic fatty liver disease

Background and AimsVery little information is available on whether docosahexaenoic acid (DHA) supplementation has a beneficial effect on liver fat and cardiovascular disease (CVD) risk factors in children with nonalcoholic fatty liver disease (NAFLD). In a double-blind, placebo-controlled randomized trial we investigated whether 6-month treatment with DHA improves hepatic fat and other fat depots, and their associated CVD risk factors in children with biopsy-proven NAFLD. Methods and ResultsOf 58 randomized children, 51 (25 DHA, 26 placebo) completed the study. The main outcome was the change in hepatic fat fraction as estimated by magnetic resonance imaging. Secondary outcomes were changes in visceral adipose tissue (VAT), epicardial adipose tissue (EAT), and left ventricular (LV) function, as well as alanine aminotransferase (ALT), triglycerides, body mass index-standard deviation score (BMI-SDS), and insulin sensitivity. At 6 months, the liver fat was reduced by 53.4% (95% CI, 33.4–73.4) in the DHA group, as compared with 22.6% (6.2–39.0) in the placebo group (P = 0.040 for the comparison between the two groups). Likewise, in the DHA group VAT and EAT were reduced by 7.8% (0–18.3) and 14.2% (0–28.2%), as compared with 2.2% (0–8.1) and 1.7% (0–6.8%) in the placebo group, respectively (P = 0.01 for both comparisons). There were no significant between-group changes for LV function as well as BMI-SDS and ALT, while fasting insulin and triglycerides significantly decreased in the DHA-treated children (P = 0.028 and P = 0.041, respectively). ConclusionsDHA supplementation decreases liver and visceral fat, and ameliorates metabolic abnormalities in children with NAFLD.

Perivascular adipose tissue, inflammation and insulin resistance: link to vascular dysfunction and cardiovascular disease

Obesity is a leading risk factor for the development of type 2 diabetes mellitus (DM2) and cardiovascular disease (CVD), however the underlying mechanisms still remain to be fully uncovered. It is now well accepted that dysfunctional adipose tissue in conditions of obesity is a critical source of inflammation that impacts the cardiovascular system and contributes to CVD. Although traditionally visceral adipose tissue has been linked to increased CVD risk, there is mounting interest in the role that fat accumulation around the vasculature plays in the pathogenesis of vascular dysfunction. Perivascular adipose tissue (PVAT) is in intimate contact with large, medium and small diameter arterial beds in several tissues, and has been shown to control vascular function as well as remodeling. PVAT does not merely mirror visceral adipose tissue changes seen in obesity, but has unique features that impact vascular biology. In lean individuals PVAT exerts vasodilatory and anti-inflammatory functions, however obesity results in PVAT inflammation, characterized by imbalance between pro- and anti-inflammatory cells as wells as adipokines. PVAT inflammation promotes insulin resistance in the vasculature, thus resulting in impaired insulin-mediated vasodilatory responses and vascular remodeling. In this review we address current knowledge about the mechanisms that link PVAT inflammation to insulin resistance and vascular dysfunction. Indeed, PVAT emerges as a novel type of adipose tissue that participates in the pathogenesis of CVD, independently to a large extent to visceral adipose tissue.

The effect of recombinant human growth hormone with or without rosiglitazone on hepatic fat content in HIV-1-infected individuals: a randomized clinical trial.

Hepatic fat is related to insulin resistance (IR) and visceral adipose tissue (VAT) in HIV+ and uninfected individuals. Growth hormone (GH) reduces VAT but increases IR. We evaluated the effects of recombinant human GH (rhGH) and rosiglitazone (Rosi) on hepatic fat in a substudy of a randomized controlled trial. HIV+ subjects with abdominal obesity and IR (QUICKI≤0.33) were randomized to rhGH 3 mg daily, Rosi 4 mg twice daily, the combination or double placebo. Hepatic fat was measured by magnetic resonance spectroscopy, visceral fat by MRI and IR by frequently sampled intravenous glucose tolerance tests at baseline and week 12. 31 subjects were studied at both time points. Significant correlations between hepatic fat and VAT (r=0.41; P=0.02) and QUICKI (r=0.39; P<0.05) were seen at baseline. IR rose with rhGH but not Rosi. When rhGH treatment groups were combined, hepatic fat expressed as percentage change decreased significantly (P<0.05) but did not change in Rosi (P=0.71). There were no correlations between changes in hepatic fat and VAT (P=0.4) or QUICKI (P=0.6). In a substudy of 21 subjects, a trend was noticed between changes in hepatic fat and serum insulin-like growth factor-1 (IGF-1; P=0.09). Hepatic fat correlates significantly with both VAT and IR, but changes in hepatic fat do not correlate with changes in VAT and glucose metabolism. Hepatic fat content is reduced by rhGH but Rosi has no effect. These results suggest an independent effect of GH or IGF-1 on hepatic fat. The study was registered at Clinicaltrials.gov (NCT00130286).

Liraglutide reduces lipogenetic signals in visceral adipose of db/db mice with AMPK activation and Akt suppression.

Liraglutide, a glucagon-like peptide-1 analog, has been proved to reduce body weight and visceral adipose tissue (VAT) in human studies. In this study, we aimed at examining lipogenetic signal changes in VAT after weight-loss with liraglutide in db/db mice. The mice were divided into two groups: liraglutide-treated group (n=14, 8-week-old, fasting glucose. >10 mmol/L, liraglutide 300 μg/kg twice a day for 4 weeks) and control group (n=14, saline). We found body weight gain and food intake were reduced after liraglutide treatment (P<0.05). Compared to the control group, the VAT weights were significantly lower in the treated group (2.32±0.37 g versus 3.20±0.30 g, P<0.01) than that in control group. In VAT, compared with control group, the lipogenetic transcription factors PPARγ and C/EBPα expressions were both reduced with pAMPK and pACC increased 3.5-fold and 2.31-fold respectively, while pAkt and pP38MAPK were reduced 0.38-fold and 0.62-fold respectively (P<0.01). In conclusion, VAT was reduced after weight loss with AMPK activation and Akt suppression with liraglutide treatment, which was associated with reduction of lipogenetic process in VAT.

Covariation of change in bioavailable testosterone and adiposity in midlife women

ObjectiveTo determine whether menopause-related changes in reproductive hormones are associated with change in adiposity and whether these relationships are independent of important covariates.Design and MethodsAnnual assessments of adiposity measures [CT-assessed visceral adipose tissue (VAT), subcutaneous abdominal adipose tissue (SAT), and DXA-assessed total body fat (TBF)] over 4 years from an ancillary study at the Chicago site of the Study of Women's Health Across the Nation (SWAN) were paired with reproductive hormones collected by SWAN. Included were 243 women (44% African American, 56% Caucasian), who were eligible participants in a population-based cohort with a 72% participation rate.ResultsVAT increased by 3.8% annually, and SAT increased by 1.8% per year. Change in bioavailable testosterone was significantly positively associated with changes both inVAT and in SAT but was not related to change in total body fat. The associations were independent of age, race, physical activity, smoking, baseline TBF, baseline bioavailable testosterone, and change in TBF. Change in estradiol were unrelated to changes in any adiposity measure.ConclusionBioavailable testosterone may play an important role in menopause-related redistribution of visceral and subcutaneous fat in the central abdominal region.

Effect of tesamorelin on visceral fat and liver fat in HIV-infected patients with abdominal fat accumulation: a randomized clinical trial.

Among patients infected with human immunodeficiency virus (HIV), visceral adiposity is associated with metabolic dysregulation and ectopic fat accumulation. Tesamorelin, a growth hormone-releasing hormone analog, specifically targets visceral fat reduction but its effects on liver fat are unknown. To investigate the effect of tesamorelin on visceral and liver fat. Double-blind, randomized, placebo-controlled trial conducted among 50 antiretroviral-treated HIV-infected men and women with abdominal fat accumulation at Massachusetts General Hospital in Boston. The first patient was enrolled on January 10, 2011; for the final patient, the 6-month study visit was completed on September 6, 2013. Participants were randomized to receive tesamorelin, 2 mg (n=28), or placebo (n=22), subcutaneously daily for 6 months. Primary end points were changes in visceral adipose tissue and liver fat. Secondary end points included glucose levels and other metabolic end points. Forty-eight patients received treatment with study drug. Tesamorelin significantly reduced visceral adipose tissue (mean change, -34 cm2 [95% CI, -53 to -15 cm2] with tesamorelin vs 8 cm2 [95% CI, -14 to 30 cm2] with placebo; treatment effect, -42 cm2 [95% CI, -71 to -14 cm2]; P = .005) and liver fat (median change in lipid to water percentage, -2.0% [interquartile range {IQR}, -6.4% to 0.1%] with tesamorelin vs 0.9% [IQR, -0.6% to 3.7%] with placebo; P = .003) over 6 months, for a net treatment effect of -2.9% in lipid to water percentage. Fasting glucose increased in the tesamorelin group at 2 weeks (mean change, 9 mg/dL [95% CI, 5-13 mg/dL] vs 2 mg/dL [95% CI, -3 to 8 mg/dL] in the placebo group; treatment effect, 7 mg/dL [95% CI, 1-14 mg/dL]; P = .03), but changes at 6 months in fasting glucose (mean change, 4 mg/dL [95% CI, -2 to 10 mg/dL] with tesamorelin vs 2 mg/dL [95% CI, -4 to 7 mg/dL] with placebo; treatment effect, 2 mg/dL [95% CI, -6 to 10 mg/dL]; P = .72 overall across time points) and 2-hour glucose (mean change, -1 mg/dL [95% CI, -18 to 15 mg/dL] vs -8 mg/dL [95% CI, -24 to 8 mg/dL], respectively; treatment effect, 7 mg/dL [95% CI, -16 to 29 mg/dL]; P = .53 overall across time points) were not significant. In this preliminary study of HIV-infected patients with abdominal fat accumulation, tesamorelin administered for 6 months was associated with reductions in visceral fat and additionally with modest reductions in liver fat. Further studies are needed to determine the clinical importance and long-term consequences of these findings. clinicaltrials.gov Identifier: NCT01263717.

623 Visceral Adipose Tissue Changes After Surgery in Colorectal Cancer Patients May Have Prognostic Implications

623 Visceral Adipose Tissue Changes After Surgery in Colorectal Cancer Patients May Have Prognostic Implications

Type 2 diabetic conditions in Otsuka Long-Evans Tokushima Fatty rats are ameliorated by 5-aminolevulinic acid

A precursor of protoporphyrin IX, 5-aminolevulinic acid (5-ALA) is used as a prodrug for photodiagnosis and photodynamic therapy. Recently, it has been shown that 5-ALA reduces glucose levels during fasting and after glucose loading in prediabetic subjects. We hypothesized that 5-ALA ameliorates diabetic conditions through mitochondrial changes in visceral adipose tissue. In order to explore the metabolic effects on the type 2 diabetic state, we administered ALA hydrochloride in combination with sodium ferrous citrate to Otsuka Long-Evans Tokushima Fatty (OLETF) rats at intragastric doses of 20 and 300 mg kg−1 d−1 for 6 weeks. The administration of 300 mg kg−1 d−1 of 5-ALA improved glucose intolerance, hypertriglyceridemia, and hyperleptinemia in OLETF rats more effectively than the administration of an equivalent dose of metformin, in accordance with reductions in food intake and body weight. Furthermore, the weight of the retroperitoneal fat tended to decrease and cellular mitochondrial content of the fat was markedly reduced by the 5-ALA administration, showing a positive correlation. These results suggest that 5-ALA ameliorates diabetic abnormalities in OLETF rats by reducing the visceral fat mass and mitochondrial content of adipocytes in a site-specific manner.

The natural history of HIV-associated lipodystrophy in the changing scenario of HIV infection.

In long-term HIV-infected patients, peripheral lipoatrophy (LA) and central lipohypertrophy (LH) appear to be related to the same insults (virus and antiretroviral drugs), but are likely to be associated with different fat depot physiologies. The objective of this study was to describe the natural history of lipodystrophy assessed using dual energy X-ray absorptiometry (DEXA) and computed tomography (CT) in a large HIV out-patients metabolic clinic. An observational retrospective study was carried out including HIV-infected patients recruited at the Metabolic Clinic of Modena, Modena, Italy, who were assessed for lipodystrophy and had at least two anthropometric evaluations using DEXA for leg fat per cent mass and abdominal CT for visceral adipose tissue (VAT). Factors associated with leg fat per cent and VAT changes were analysed using multivariable generalized estimating equation (GEE) regression models. A total of 6789 DEXAs and 7566 CT scans were evaluated in the observation period. A total of 1840 patients were included; the mean age was 45.2 ± 7.2 (standard deviation) years, 621 (34%) were women, and the median HIV infection duration was 176 (interquartile range 121-232) years. According to the GEE multivariable regression analysis, leg fat per cent evaluated with DEXA appeared to increase over calendar years (ß = 0.92; P < 0.001); moreover, a progressive increase in VAT was observed in the cohort (ß = 5.69; P < 0.001). No association with antiretroviral drugs was found. In our study, neither LA nor LH appeared to be associated with antiretroviral drug exposure. We observed a progressive increase in LH in HIV-infected patients over calendar years. This anthropometric change, together with loss of appendicular lean mass, could describe a physiological aging process in HIV-infected patients.

Effects of two popular weight loss programs on changes in body composition and visceral adipose tissue in women (LB296)

The purpose of this study was to determine if different types of exercise and diet interventions promote greater changes in visceral adipose tissue (VAT). 54 sedentary women (34±8 yrs, BMI 35±6) were randomized to participate in the Curves (C) or Weight Watchers (W) weight loss programs for 16‐wks. Participants in the C program followed a 1,200 kcal/d diet for 1‐wk and 1,500 kcal/d diet for 3 wks (30:45 CHO:PRO). Subjects then ingested 2,000 kcals/d for 2‐wks (45:30 CHO:PRO) and repeated this diet while participating in the Curves with Zumba program 3‐d‐wk. Remaining subjects followed the W point‐based diet program, received weekly counseling, and were encouraged to exercise. DEXA body composition with VAT was determined at 0 &amp;amp; 16 wks. MANOVA revealed a significant time (p&lt;0.001) and group x time (p=0.035) effect. Both groups lost a similar amount of weight (W ‐6.3±4, C ‐4.8±4 kg, p=0.17), fat mass (W ‐3.1±6, C ‐5.9±6 kg, p=0.13), and VAT mass (W ‐98±468, C ‐240±445 g, p=0.26). Subjects in the C group experienced greater gains in FFM (W ‐3.3±5.9. C +1.2±4.1 kg, p=0.002) and tended to lose more body fat (W ‐1.1±8, C ‐4.5±5.5 %, p=0.07). Changes in VAT mass significantly correlated with changes in weight (r=0.38), fat mass (r=0.73), FFM (r=‐0.62), and body fat (r=0.64). Results indicate that different types of diets can differentially affect changes in body composition and VAT.Grant Funding Source: Curves International, Inc. (Waco, TX)

Comparative effectiveness of popular diet programs on changes in body composition and visceral adipose tissue in women (LB297)

The purpose of this study was to determine if different types of exercise and diet interventions promote greater changes in visceral adipose tissue (VAT). 127 sedentary women (46±12 yr, 45.5±5% body fat, 35.1±5 kg/m2) were randomized to participate in a control group (C) or the Curves Complete® program with online support (CC), Weight Watchers® Points Plus (WW), Jenny Craig® (JC), or Nutrisystem® Advance Select™ (NS) weight loss programs for 12‐wks. DEXA body composition with VAT determination was obtained at 0 &amp;amp; 12 wks. MANOVA revealed significant (p=&lt;0.001) time and group x time (p=&lt;0.001) effects. Participants in the CC group experienced greater loss in fat mass (C ‐0.0±2.1; CC ‐4.6±3.7; WW ‐2.2±2.7; JC ‐3.5±3.3; NS ‐2.1±2.7 kg, p&lt;0.001), less loss in FFM (C 0.2±2.3; CC ‐0.3±2.7; WW ‐1.7±2.4; JC ‐1.8±2.3; NS ‐1.8±2.4 kg, p=0.01), and greater reductions in percent body fat (C ‐0.0±1.7; CC ‐3.1±2.5; WW ‐0.7±2.6; JC ‐1.4±2.5; NS ‐0.5±1.7 %, p&lt;&lt;0.001). VAT mass, volume and area decreased over time (p=0.004) with no significant differences among groups. Changes in VAT mass significantly correlated with changes in fat mas (r=0.20) and body fat (r=0.22). Results indicate that different types of diets can differentially affect changes in body composition but promote proportional changes in VAT.Grant Funding Source: Supported by Curves International (Waco, TX)

Abstract P090: Change in Visceral Adipose Tissue and Change in Cardiometabolic Risk in a Minority Cohort: The IRAS Family Study

Visceral adipose tissue (VAT), the more metabolically harmful fat depot, has been associated with a higher prevalence of diabetes, insulin resistance, and impaired glucose homeostasis. Higher levels of VAT are associated cross-sectionally with cardiovascular (CV) risk factors, specifically hypertension and unfavorable lipid profiles. Research on the effects of change in VAT on CV risk factors is extremely limited and no studies have explored these questions in minority cohorts. The Insulin Resistance Atherosclerosis Family (IRAS Family) Study offered the opportunity to explore whether changes in VAT were associated with changes in CV risk, independent of changes in BMI, in a minority cohort. Abdominal computed tomography (CT) scans were obtained at two time points spanning a five year interval among African-American (N=295) and Hispanic-American participants (N=719), aged 18-65 years. The CV risk factors included 5-year change in insulin resistance (HOMA), high density lipoprotein (HDL) cholesterol and systolic blood pressure (SBP). To account for family structure, we used mixed models stratified by gender to estimate change in CV risk factors as a function of change in VAT, adjusted for change in BMI, age category, race, physical activity level, smoking status, statin use (for HDL) and antihypertensive use (for SBP). The cohort was 62% female, with an overall mean age of 40 years at baseline. The mean (SD) changes in BMI and VAT over 5-years were 1.1 (2.6) kg/m 2 and 4.2 (31.0) cm 2 , respectively; the mean (SD) changes in HOMA, HDL, and SBP over 5 years were 1.3 units (2.8), 4.8 (9.3) mg/dL and 2.4 (12.7) mm Hg, respectively. On average, a one standard deviation increase in VAT (31 cm 2 ) was significantly associated with a 0.58 unit increase in HOMA in men (p&lt;0.0001) and 0.42 unit increase in women (p=0.0048) in the adjusted model. A 31 cm 2 increase in VAT was significantly associated with a 1.8 mg/dL decrease in HDL in women (p=0.0007), but not in men (0.07 mg/dL increase, p=0.87). VAT change was not significantly associated with change in SBP in men or women. In this study of change in CT measured abdominal fat area in a large minority cohort, modest increases in VAT were significantly related to changes in HOMA and HDL, independent of changes in BMI. Further research is needed to determine whether preventing VAT accumulation may lead to improvements in glucose homeostasis and lipid profile.

Modification of Abdominal Fat Distribution After Aromatase Inhibitor Therapy in Breast Cancer Patients Visualized Using 3-D Computed Tomography Volumetry

Introduction/BackgroundThe purpose of this study was to describe modification of subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT) distributions in breast cancer patients after aromatase inhibitor (AI) therapy using computed tomography (CT) volumetric measurement of abdominal body fat distribution. Patients and MethodsSixty-four consecutive patients who were receiving adjuvant AI therapy were included in this study. Patients were evaluated using CT before and after at least 6 months of AI therapy with imaging follow-up of 4.3 ± 2.2 years. Abdominal fat distribution was automatically calculated using a workstation that obtained total abdominal adipose tissue (TAAT) area (mm3). SAT was manually segmented and VAT was determined as TAAT − SAT. Percentages were calculated for change of TAAT, VAT, and SAT. VAT/SAT ratio was calculated. ResultsPercentage of TAAT after AI therapy was increased by a mean of 9.1% from baseline (16,280.3 ± 6953.3 mm3) to (17,763.6 ± 6850.8 mm3). Two groups of patients were observed; those with an increase in TAAT and those with a decrease. Modification of VAT/SAT ratio was observed (from 1.38 to 1.69) in all subjects, reflecting a relative increased volume of VAT (mean, 18%) and slight mean reduction of SAT (mean 1.9%). ConclusionIn our study, therapy with AI in breast cancer patients was accompanied with a change in fat distribution to relatively greater VAT/SAT ratio in patients, regardless of whether they gained or lost weight after therapy. Because this pattern of fat distribution is associated with metabolic disorders, attention must be paid to these clinical manifestations in patients during their follow-up management.