Ratio Of Visceral Adipose Tissue Research Articles

Abstract 4136677: High Visceral-to-Subcutaneous Fat Ratio is Correlated with Increased Cardiovascular Events in Patients with Low Waist Circumference Suspected of Coronary Artery Disease

Introduction: Waist circumference (WC) has been recognized as an appropriate index of obesity and is closely associated with the amount of abdominal fat. Although abdominal fat distribution (AFD), which is represented by the ratio of visceral adipose tissue (VAT) to subcutaneous adipose tissue (SAT) area (V/S ratio), is possibly related to an increased risk of cardiovascular disease (CVD), few studies have explored the relationship between AFD and CVD outcomes. This study aimed to assess the influence of AFD based on the V/S ratio and physique categorized by WC on long-term clinical results in patients with suspected coronary artery disease (CAD). Methods: We evaluated 931 consecutive patients (mean age, 67 years; 42.4% women) with suspected CAD who underwent computed tomography (CT) angiography. The patients also underwent plain abdominal CT to assess and measure VAT and SAT areas; V/S ratio was calculated to assess AFD. The patients were divided into four groups based on the median V/S ratio (0.624) and reference values of WC for metabolic syndrome in Japan (85 cm for men, 90 cm for women). We assessed the relationship between the V/S ratio and long-term clinical outcomes in each WC group. The main outcome was major adverse cardiac events (MACEs, including cardiac death, any coronary revascularization, acute coronary syndrome, and emergency hospitalization due to cardiac cause). Results: Over a median follow-up of 1869 days, although the incidence of any cardiovascular event was not related to the V/S ratio among patients with high WC, a higher incidence of MACE and cardiac death was noted among patients with low WC in the high V/S ratio group than in the low V/S ratio group. Furthermore, Kaplan–Meier analysis revealed a significantly lower MACE-free survival rate among patients with low WC in the high V/S ratio group than in the low V/S ratio group, despite of no differences being noted among high WC patients in both the V/S ratio groups (Figure). Conclusion: Only in patients with low WC, a high V/S ratio was linked to increased risks of MACE. Thus, high V/S ratio may be an essential risk factor for CVD, specifically in patients with low WC. However, AFD did not influence CVD prognosis in patients with high WC.

Surrogate Biomarker to Identify Obesity and Predict Cardiovascular Disease Risk: A Systematic Review

The study investigates the relationship between obesity and cardiovascular disease (CVD) risk, comparing the use of body mass index (BMI) versus other biomarkers in predicting CVD risk among obese individuals. It conducts a systematic literature review following the PRISMA guidelines, searching databases for relevant articles published from 2017-2022. The review analyzes 12 eligible articles and finds that factors beyond just BMI, such as genetics, physical activity, metabolic disorders, previous heart disease history, nutrition, fat distribution, and changes in BMI, can significantly impact the prognosis of heart disease in obese individuals. Importantly, the study shows that measures of fat distribution, like waist-to-height ratio, waist circumference, log-transformed body shape index (LBSIZ), and the ratio of visceral adipose tissue (VAT) to subcutaneous adipose tissue (SAT), are superior to BMI in predicting CVD risk among those with obesity. The key takeaway is that while obesity is strongly linked to CVD risk, BMI alone often fails to predict that risk accurately. Fat distribution measures may be a more effective tool for identifying obesity status and predicting associated CVD risk compared to relying solely on BMI.

Pre-operative visceral adipose tissue radiodensity is a potentially novel prognostic biomarker for early endoscopic post-operative recurrence in Crohn's disease.

Evidence suggests inflammatory mesenteric fat is involved in post-operative recurrence (POR) of Crohn's disease (CD). However, its prognostic value is uncertain, in part, due to difficulties studying it non-invasively. To evaluate the prognostic value of pre-operative radiographic mesenteric parameters for early endoscopic POR (ePOR). We conducted a retrospective cohort study of CD subjects ≥ 12 years who underwent ileocecal or small bowel resection between 1/1/2007 to 12/31/2021 with computerized tomography abdomen/pelvis ≤ 6 months pre-operatively and underwent ileocolonoscopy ≤ 15 months post-operatively. Visceral adipose tissue (VAT) volume (cm3), ratio of VAT:subcutaneous adipose tissue (SAT) volume, VAT radiodensity, and ratio of VAT:SAT radiodensity were generated semiautomatically. Mesenteric lymphadenopathy (LAD, largest lymph node > 10 mm) and severe vasa recta (VR) engorgement (diameter of the VR supplying diseased bowel ≥ 2 × VR supplying healthy bowel) were derived manually. The primary outcome was early ePOR (Rutgeert's score ≥ i2 on first endoscopy ≤ 15 months post-operatively) and the secondary outcome was ePOR severity (Rutgeert's score i0-4). Regression analyses were performed adjusting for demographic and disease-related characteristics to calculate adjusted odds ratio (aOR) and 95% confidence interval (CI). Of the 139 subjects included, 45% of subjects developed early ePOR (n = 63). VAT radiodensity (aOR 0.59, 95%CI: 0.38-0.90) and VAT:SAT radiodensity (aOR 8.54, 95%CI: 1.48-49.28) were associated with early ePOR, whereas, VAT volume (aOR 1.23, 95%CI: 0.78-1.95), VAT:SAT volume (aOR 0.80, 95%CI: 0.53-1.20), severe VR engorgement (aOR 1.53, 95%CI: 0.64-3.66), and mesenteric LAD (aOR 1.59, 95%CI: 0.67-3.79) were not. Similar results were observed for severity of ePOR. VAT radiodensity is potentially a novel non-invasive prognostic imaging marker to help risk stratify CD patients for POR.

Abstract 15886: High Visceral to Subcutaneous Fat Ratio is Correlated With Increased Cardiovascular Events in Elderly Patients With Suspected Coronary Artery Disease

Introduction: Although abdominal fat distribution (AFD), presented as the ratio of visceral adipose tissue (VAT) to subcutaneous adipose tissue (SAT) area (V/S ratio), is possibly associated with an increased risk of cardiovascular disease (CVD), the relationship between V/S ratio and its long-term outcomes have rarely been studied. Methods: We assessed 942 consecutive patients with suspected coronary artery disease who underwent computed tomography (CT) angiography. The patients also underwent plain abdominal CT to measure VAT and SAT areas. The V/S ratio was calculated to assess the AFD. The patients were classified into four groups based on the median V/S ratio and median age (i.e., 0.625 and 69 years, respectively). We examined the association between the V/S ratio and its long-term outcomes in each age group. The primary outcome was major adverse cardiac events (MACEs), including all-cause death, any coronary revascularization, acute coronary syndrome, and emergent hospitalization due to CVD. Results: Over a median follow-up of 1507 days, the incidence of any cardiovascular event was not associated with the V/S ratio among younger patients; however, among older patients, the incidence of MACEs, all-cause death, and any coronary revascularization was higher in the high V/S ratio group than in the low V/S ratio group. According to the Kaplan-Meier analysis, only older patients had a significantly lower MACE-free survival rate in the high V/S ratio group than in the low V/S ratio group, and no differences were noted among the younger patients in both groups. After adjusting for traditional coronary risk factors, high V/S ratio was independently associated with incidence of MACEs in older patients (Figure). Conclusion: A high V/S ratio was associated with an increased risk of MACEs in older patients only. Therefore, a high V/S ratio may be an important risk factor for CVD, particularly in older patients. However, AFD did not affect CVD prognosis among younger patients.

Enhancing the Differentiation between Intestinal Behçet's Disease and Crohn's Disease through Quantitative Computed Tomography Analysis.

Behçet's disease (BD) behaves similarly to Crohn's disease (CD) when the bowel is involved. Computed tomography enterography (CTE) can accurately show intestinal involvement and obtain body composition data. The objective of this study was to evaluate whether CTE could improve the ability to distinguish between intestinal BD and CD. This study evaluated clinical, laboratory, endoscopic, and CTE features on first admission. Body composition analysis was based on the CTE arterial phase. The middle layers of the L1-L5 vertebral body were selected. The indicators assessed included: the area ratio of visceral adipose tissue (VAT)/subcutaneous adipose tissue (SAT) (VSR) in each layer, the total volume ratio of VAT/SAT, the quartile of VAT attenuation in each layer and the coefficient of variation (CV) of the VAT area for each patient was also calculated. Two models were developed based on the above indicators: one was a traditional model (age, gender, ulcer distribution) and the other was a comprehensive model (age, gender, ulcer distribution, proximal ileum involvement, asymmetrical thickening of bowel wall, intestinal stenosis, VSRL4, and CV). The areas under the receiver operating characteristic (ROC) curve of the traditional (sensitivity: 80.0%, specificity: 81.0%) and comprehensive (sensitivity: 95.0%, specificity: 87.2%) models were 0.862 and 0.941, respectively (p = 0.005).

Resistance training decreased abdominal adiposity in postmenopausal women.

To investigate if abdominal adipose tissue volumes and ratios change after a 15-week structured resistance training intervention in postmenopausal women with vasomotor symptoms (VMS). Sixty-five postmenopausal women with VMS and low physical activity were randomized to either three days/week supervised resistance training or unchanged physical activity for 15weeks. Women underwent clinical anthropometric measurements and magnetic resonance imaging (MRI) at baseline and after 15weeks. MRI was done using a Philips Ingenia 3.0T MR scanner (Philips, Best, The Netherlands). The per protocol principle was used in the analysis of data. The absolute change from baseline to week 15 in visceral adipose tissue (VAT) volume and the relative ratio (VAT ratio) between VAT and total abdominal adipose tissue (TAAT), i.e. the sum of abdominal subcutaneous adipose tissue (ASAT) and VAT. There were no significant differences between the groups in characteristics, anthropometry or MRI measures at baseline. Women who were compliant with the intervention (i.e. participated in at least two of the three scheduled training sessions per week) had significantly different reduction over time in ASAT (p=0.006), VAT (p=0.002), TAAT (p=0.003) and fat ratio (p<0.001) compared with women in the control group. Implementation of a 15-week resistance training regimen in midlife may help women to counteract the abdominal fat redistribution associated with the menopausal transition. gov registered ID: NCT01987778.

Visceral Adiposity Independently Predicts Time to Flare in Inflammatory Bowel Disease but Body Mass Index Does Not.

Obesity is associated with progression of inflammatory bowel disease (IBD). Visceral adiposity may be a more meaningful measure of obesity compared with traditional measures such as body mass index (BMI). This study compared visceral adiposity vs BMI as predictors of time to IBD flare among patients with Crohn's disease and ulcerative colitis. This was a retrospective cohort study. IBD patients were included if they had a colonoscopy and computed tomography (CT) scan within a 30-day window of an IBD flare. They were followed for 6 months or until their next flare. The primary exposure was the ratio of visceral adipose tissue to subcutaneous adipose tissue (VAT:SAT) obtained from CT imaging. BMI was calculated at the time of index CT scan. A total of 100 Crohn's disease and 100 ulcerative colitis patients were included. The median age was 43 (interquartile range, 31-58) years, 39% had disease duration of 10 years or more, and 14% had severe disease activity on endoscopic examination. Overall, 23% of the cohort flared with median time to flare 90 (interquartile range, 67-117) days. Higher VAT:SAT was associated with shorter time to IBD flare (hazard ratio of 4.8 for VAT:SAT ≥1.0 vs VAT:SAT ratio <1.0), whereas higher BMI was not associated with shorter time to flare (hazard ratio of 0.73 for BMI ≥25 kg/m2 vs BMI <25 kg/m2). The relationship between increased VAT:SAT and shorter time to flare appeared stronger for Crohn's than for ulcerative colitis. Visceral adiposity was associated with decreased time to IBD flare, but BMI was not. Future studies could test whether interventions that decrease visceral adiposity will improve IBD disease activity.

Differential Expression of FXR and Genes Involved in Inflammation and lipid Metabolism Indicate Adipose Tissue Dysfunction in Gestational Diabetes

Gestational diabetes mellitus (GDM) is the most frequent metabolic alteration in pregnancy. Several abnormalities in visceral adipose tissue (VAT) have been described as part of its pathophysiology including hypertrophy, inflammation and altered lipid metabolism. Farnesoid X receptor (FXR) is involved in adipocyte physiology and inflammation, so its expression may correlate with the expression of tumor necrosis factor-alpha (TNF-α), interleukin-10 (IL-10), lipoprotein lipase (LPL), and two fatty acid transporters (SLC27A2, and SLC27A4). To compare the FXR, LPL, SLC27A2, SLC27A4, TNF-α, and IL-10 mRNA expression in VAT between women with GDM and healthy pregnant (HP) women. Secondarily, to evaluate the potential correlation between these expression levels. Cross-sectional study of 50 GDM and 50 HP women. Conventional biochemical tests were performed and relative mRNA expression in VAT was measured by RT-qPCR. Gene expression levels of FXR and IL-10 were lower, whereas those of LPL, as well as the TNF-α/IL-10 ratio, were higher in women with GDM compared to HP. Pre-pregnancy BMI was the main significant independent variable for FXR levels in VAT from women with GDM. In all women, LPL expression levels correlated positively with those of SLC27A2. Only in women with GDM, IL-10 expression levels correlated negatively with those of SLC27A2, and SLC27A4. GDM is associated with decreased expression of FXR and IL-10 and increased expression of LPL, as well as a higher TNF/IL-10 ratio in VAT. These results suggest increased lipid storage and pro-inflammatory state indicating VAT dysfunction in this metabolic disorder.

S850 Obesity as Defined by Body Mass Index Is Not a Risk Factor for Post-Operative Recurrence in Crohn's Disease

Introduction: Obesity is a global epidemic and a condition which can lead to development of chronic illnesses such as diabetes, cardiovascular disease, and cancer, and has also been proposed as a risk factor for development and complications of inflammatory bowel diseases (IBD) such as Crohn’s disease (CD) and ulcerative colitis. In patients with CD, more than 70% require surgery due to stricturing and/or penetrating complications, and the risk for endoscopic recurrence within five years is as high as 60-90%. Obesity has not been studied extensively as a risk factor for postoperative recurrence (POR) of CD. We hypothesized that obesity as defined by BMI is a risk factor for POR. Methods: A retrospective study was performed at a university medical center following Institutional Review Board approval, and patients who had undergone CD-related surgery from January 2008 to July 2018 were included. Patients initiated on biologic therapy postoperatively were excluded. Data on patient demographics and covariates were collected, and the presence and timing of endoscopic, surgical, and/or radiographic recurrence were recorded. A Cox proportional hazard (PH) model was fitted to model the risk of POR of CD in obese patients, controlling for patient characteristics and risk factors. Results: A total of 82 patients were included in the analysis, one-fifth of whom were obese (n=18, 22%). Obesity as defined by a BMI ≥ 30 was not an independent risk factor for the development of POR in either the unadjusted or the adjusted model. Among the other examined variables, the risk of POR among males was 70% higher than in females (HR=1.70, 95% CI: 1.01, 2.86). Patients who smoked after surgery had a significantly higher risk of POR as compared to non-smokers (HR=1.74, 95% CI: 1.01, 3.01), while the presence of prior/current fistulizing disease reduced the recurrence of CD risk by more than 60% (HR=0.39, 95% CI: 0.20, 0.73). Cox PH models using BMI either as a continuous or categorical variable yielded similar results. (Table, Figure) Conclusion: Obesity as defined by BMI was not predictive of POR risk in our study, which may have been limited due to sample size and proportion of obese patients. The need to explore other measures of obesity in CD still exists, as identification of modifiable risk factors may help to prevent POR. Other measures of adiposity such as visceral fat area, visceral adipose tissue (VAT) and the ratio of VAT to total body fat mass have shown promise in predicting obesity-associated risks in the IBD population.Figure 1.: Six-year postoperative adjusted recurrence-free probabilities for each variable in the model. Table 1. - Hazard Ratios (HR) and Their 95% Confidence Intervals for Obesity, Demographic Characteristics and Covariates for Postoperative Recurrence Using Cox Proportional Hazard Modeling Characteristics Unadjusted HR (95% CI) Adjusted HR (95% CI) BMI Category Non-obese 1.00 1.00 Obese 1.28 (0.72, 2.27) 0.94 (0.49, 1.82) Gender Female 1.00 Male 1.70 (1.01, 2.86) Age at Surgery < 40 Years 1.00 ≥ 40 Years 1.35 (0.81, 2.25) Post-Surgery Smoking Non-smoker 1.00 Smoker 1.74 (1.01, 3.01) Fistulizing Disease No 1.00 Yes 0.39 (0.20, 0.73) Perianal Disease No 1.00 Yes 1.55 (0.84, 2.85) Prior Crohn's Disease Surgery No 1.00 Yes 1.14 (0.67, 1.92)

Associations of Abdominal Visceral Fat Content and Plasma Adiponectin Level With Intracranial Atherosclerotic Stenosis: A Cross-Sectional Study.

BackgroundAbdominal obesity and adipocytokines are closely related to atherosclerosis, and adiponectin level is considered one of the important clinical indicators. This study aimed to analyze the associations of abdominal visceral fat content and adiponectin level with intracranial atherosclerotic stenosis (ICAS).MethodsA total of 186 patients were enrolled in this study. Patients were distributed into ICAS and non-ICAS by the degree of artery stenosis. Plasma adiponectin levels and the ratio of visceral adipose tissue (VAT) to subcutaneous adipose tissue (SAT) were measured. The related factors of intracranial atherosclerotic stenosis were determined using multivariable logistic regression analysis.ResultsThe VAT/SAT ratio (OR, 26.08; 95% CI, 5.92–114.83; p < 0.001) and adiponectin (OR, 0.61; 95% CI, 0.44–0.84; p = 0.002) were found to be the independent predictors of ICAS in a multivariable logistic regression analysis. The prevalence of ICAS increased (T1: 27.4%; T2: 50.0%; T3: 75.8%) as the VAT/SAT ratio tertile increased (p < 0.001). The prevalence of ICAS decreased (T1: 72.6%; T2: 54.8%; T3: 25.8%) as the adiponectin tertile increased (p < 0.001). In ROC curves analysis, VAT/SAT ratio had a sensible accuracy for the prediction of ICAS. The optimal cut-off value of VAT/SAT ratio to predict ICAS in this study was 1.04 (AUC: 0.747; p < 0.001; sensitivity: 67.4%; specificity: 74.7%). The optimal adiponectin cutoff was 3.03 ug/ml (AUC: 0.716; p < 0.001; sensitivity:75.8%; specificity: 61.5%).ConclusionHigher VAT/SAT ratio and lower plasma adiponectin levels were closely related to the increased risk of intracranial atherosclerotic stenosis.

Estrogen supplementation deteriorates visceral adipose function in aged postmenopausal subjects via Gas5 targeting IGF2BP1.

Increased visceral fat is strongly associated with a series of metabolic complications. Postmenopausal women have an increased risk of visceral fat accumulation, metabolic disorders, and a high incidence of cardiovascular events. However, the effect of estrogen replacement therapy on visceral adipose tissue among postmenopausal women of different ages remains controversial, and the underlying mechanism remains unclear. Hence, it is important to understand when estrogen replacement therapy affects the function of visceral adipose tissue (VAT). Therefore, we collected VAT from pre- and post-menopausal females and we observed increased pro-inflammatory cytokines and insulin resistance-inducing factors, decreased insulin-sensitizing factors, and thermogenic factors in VAT of postmenopausal women. The analysis of adipocytes isolated from the VAT of females of different ages indicated that adiponectin and browning signature genes were significantly decreased with estrogen treatment in postmenopausal women, but were not altered in the young group. Estrogen supplementation in aged female mice (22m) significantly prevented visceral fat accumulation. However, it deteriorated VAT function by inducing pro-inflammatory cytokines and insulin resistance-inducing factors and decreasing insulin-sensitizing and thermogenic factors. Mechanistically, estrogen induced the expression of long non-coding RNA Gas5 via binding ERα in premenopausal women, which therefore suppressed IGF2BP1 to maintain VAT function. After menopause, with the reversal of ERα/ERβ ratio in VAT, estrogen supplementation mainly worked through ERβ, which led to low expression levels of Gas5 and eventually caused VAT dysfunction. Our study demonstrated the adverse effects of estrogen supplementation on VAT function in aged postmenopausal population and further elucidated the involved mechanism.

Can visceral adipose tissue and skeletal muscle predict recurrence of newly diagnosed Crohn’s disease in different treatments

Background and aimsIt is crucial to manage the recurrence of Crohn’s disease (CD). This study is aimed to explore whether visceral adipose tissue (VAT) and skeletal muscle (SM) are associated with the recurrence of CD upon different treatments.MethodsAll patients with a definite diagnosis of CD were retrospectively divided into three groups according to distinct treatment regimens: 5-amino salicylic acid group (Group A), steroids + azathioprine (Group B) and biologics (Group C). The pretreatment computerized tomography (CT) images and clinical data were collected. The VAT area, mesenteric fat index (MFI), the ratio of VAT area to fat mass (VAT area/FM) were assessed. The primary end point was the recurrence of CD within 1 year of follow-up.ResultsA total of 171 CD patients were enrolled, including 57 (33.33%) patients in Group A, 70 (40.94%) patients in Group B and 44 (25.73%) patients in Group C. Patients with 1-year recurrence had higher MFI (P = 0.011) and VAT area/FM (P = 0.000). ROC curve demonstrated that patients with the ratio of VAT area/FM and MFI higher than 0.578 and 1.394 tended to have recurrence with the AUC of 0.707 and 0.709. Similar results could be observed in Group A & B but not in Group C.ConclusionsHigh VAT area/FM and MFI are related to recurrence within 1 year for newly diagnosed CD patients treated by 5-amino salicylic or azathioprine + steroids rather than biologics. We could not observe any radiological data associated with the recurrence of CD patients under biological treatment.

Adverse Effects of Sarcopenic Obesity on Postoperative Complications after Major Hepatectomy in Patients with Hilar Cholangiocarcinoma.

Sarcopenic obesity (SO), which is defined as a high ratio of visceral adipose tissue to skeletal muscle, is a well-known risk factor for post-hepatectomy outcomes in patients with hepatocellular carcinoma. However, few studies have evaluated the effect of SO on postoperative outcomes in patients with hilar cholangiocarcinoma (CCC). This retrospective study aimed to evaluate the effect of preoperative SO on postoperative outcomes in patients with hilar CCC following major hepatectomy. Preoperative SO was assessed in 328 patients undergoing hepatectomy for hilar CCC at three institutions between 2006 and 2016. SO was calculated from cross-sectional visceral fat and muscle area displayed on preoperative CT imaging. Preoperative SO was present in 98 patients (29.9%). The major complication rate in patients with SO was higher than in those without SO (54.1% vs. 37.0%, p = 0.004). Additionally, postoperative hospital stays were prolonged in patients with SO (18.5 vs. 16.5 days, p = 0.038). After multivariable analysis, SO was identified as an independent risk factor for major complications after hepatectomy in hilar CCC patients (OR = 0.866, 95% CI: 1.148–3.034, p = 0.012). Careful postoperative management is needed after major hepatectomy in hilar CCC patients with SO.

Relationship of visceral obesity and coronary calcinosis in ischemic heart disease

To assess the relationship between the prevalence of visceral obesity (VO) and the severity of coronary calcification (CC) in patients with verified coronary artery disease (CAD). 125 patients with CAD were examined. Assessment of the morphometric characteristics of visceral adipose tissue (VAT) and CC was perform using multislice computed tomography (MSCT). The calcium index (CI) of the coronary arteries (CA) was determine by the Agatston method. Statistical analysis was perform using Statistica 10.0. VO was detect in 82 (65.6%) patients with CAD. In the presence of VO, higher CC values were observed in the projection of the envelope (p=0.00014), right coronary (p=0.00002) arteries, total CI (p=0.0003), and the prevalence of massive CC. Correlation analysis showed the relationship between the area of VAT and the CC of all the studied localizations. According to the ROC analysis, VO is a significant predictor of massive CC (area under the ROC curve AUC 0.72, 95% CI 0.560.89), in contrast to body mass index BMI (AUC 0.56, 95% CI 0.310.82). The index of the ratio of VAT to subcutaneous adipose tissue (VAT/SAT), but not BMI, had a direct correlation with CC. Morphology of VAT may be a significant diagnostic sign of massive CC in patients with CAD, as a factor affecting treatment and prognosis.

The Effect of Fat Distribution on the Inflammatory Response of Multiple Trauma Patients-A Retrospective Study.

Objectives In recent years; increasing evidence pointed out the clinical importance of adipose tissue (AT) distribution in various patient populations. In particular, visceral adipose tissue (VAT), when compared to subcutaneous adipose tissue (SAT), was found to play a pivotal role in the development of inflammatory reaction. The aim of the present study was to examine whether body fat distribution has an impact on the development of systemic inflammatory response syndrome (SIRS) in patients with polytrauma. Methods In our retrospective study; we filtered our institution records of the German Trauma Registry (Trauma Register DGU) from November 2018 to April 2021 and included 132 adult polytrauma patients with injury severity score (ISS) >16. Subsequently; we measured the visceral and subcutaneous adipose tissue area based on whole-body CT scan and calculated the ratio of VAT to SAT (VSr). Thereafter, the patient population was evenly divided into three groups; respectively VSr value less than 0.4 for the first group (low ratio), 0.4–0.84 for the second group (intermediate ratio), and greater than 0.84 for the third group (high ratio). Considering the other influencing factors; the groups were further divided into subgroups in the respective analysis according to gender (male/female), BMI (<25 or ≥25), and ISS (<26 or ≥26). Result VSr was an independent factor from body mass index (BMI) (r2 = 0.003; p = 0.553). VSr in male patients was significantly higher (p < 0.001). Patients with low VSr had higher ISS scores (p = 0.028). Polytrauma patients with higher VSr tended to have lower SIRS scores and significant differences of SIRS score were found on multiple days during the whole hospitalization period. In the low VAT/SAT group, male patients, and patients with BMI greater than 25, both exhibited higher SIRS scores during hospital stay (day 16: p = 0.01; day 22: p = 0.048 and p = 0.011; respectively). During hospitalization, patients with higher ISS score (≥26) in the low VSr group was found to have higher SIRS score (day 16; p = 0.007). Over the hospital stay; serum markers of CRP; CK; and leukocyte in patients with low VSr were higher than those in patients in the intermediate and high VSr groups; with significant difference discovered on multiple days (day 16: 0.014; day 22: p = 0.048). Conclusion Lower VSr is associated with increased inflammatory response and worse clinical outcome in patients with polytrauma. Furthermore; VSr is an independent factor providing additional information to BMI.

Avocado Consumption, Abdominal Adiposity, and Oral Glucose Tolerance Among Persons with Overweight and Obesity

BackgroundAlthough intake of Hass avocado has been cross-sectionally linked to lower abdominal obesity, knowledge of the effects of avocado consumption on abdominal adiposity and glycemic outcomes remains limited. ObjectiveThe effects of avocado consumption on abdominal adiposity, insulin resistance, oral-glucose-tolerance test (OGTT), and estimated β-cell function were evaluated. MethodsA total of 105 adults aged 25–45 y (61% female) with BMI ≥25 kg/m2 were randomly assigned to an intervention (N = 53) that received a daily meal with 1 fresh Hass avocado or a control (N = 52) that received an isocaloric meal with similar ingredients without avocado for 12 wk. DXA was used to assess the primary outcomes of abdominal adiposity [visceral adipose tissue (VAT), subcutaneous abdominal adipose tissue (SAAT), and the ratio of VAT to SAAT (VS Ratio)]. Fasted glucose and insulin were used to assess the primary outcomes of insulin resistance (HOMA-IR), and insulin sensitivity (Matsuda index) and β-cell function (Insulinogenic index) were estimated using an OGTT. Changes between groups were compared using an ANCOVA. Secondary analyses were conducted based on sex. ResultsThe control group exhibited a greater reduction in SAAT [–54.5 ± 155.8 g (control) compared with 17.4 ± 155.1 g (treatment), P = 0.017] and increase in VS Ratio [0.007 ± 0.047 (control) compared with –0.011 ± 0.044 (treatment), P = 0.024]. Among females, the treatment group exhibited a greater reduction in VAT [1.6 ± 89.8 g (control) compared with –32.9 ± 81.6 g (treatment), P = 0.021] and VS Ratio [0.01 ± 0.05 (control) compared with –0.01 ± 0.03 (treatment), P = 0.001]. Among males, there was no significant difference between groups in changes in abdominal adiposity or glycemic outcomes. ConclusionsDaily consumption of 1 fresh Hass avocado changed abdominal adiposity distribution among females but did not facilitate improvements in peripheral insulin sensitivity or β-cell function among adults with overweight and obesity.This study was registered at clinicaltrials.gov as NCT02740439.

VISCERAL FAT INDEX INFORMS RISK OF MEDICALLY REFRACTORY IBD AND NEED FOR SURGERY IN PATIENTS STARTING ANTI-TUMOR NECROSIS FACTOR (TNF) THERAPY

Increased visceral adipose tissue (VAT) is associated with systemic inflammation through amplified production of pro-inflammatory cytokines like TNF-α and interleukin-6. Higher visceral fat index (VFI), which is the ratio of VAT to subcutaneous adipose tissue (SAT) and reflects the degree of excess VAT in relation to SAT, is associated with complex IBD. However, its relevance to treatment response is unclear. We aim to evaluate the effect of VFI on treatment response and risk of surgery in IBD patients starting anti-TNF therapy.

VISCERAL FAT INDEX INFORMS RISK OF MEDICALLY REFRACTORY IBD AND NEED FOR SURGERY IN PATIENTS STARTING ANTI-TUMOR NECROSIS FACTOR (TNF) THERAPY

Abstract Background Increased visceral adipose tissue (VAT) is associated with systemic inflammation through amplified production of pro-inflammatory cytokines like TNF-α and interleukin-6. Higher visceral fat index (VFI), which is the ratio of VAT to subcutaneous adipose tissue (SAT) and reflects the degree of excess VAT in relation to SAT, is associated with complex IBD. However, its relevance to treatment response is unclear. We aim to evaluate the effect of VFI on treatment response and risk of surgery in IBD patients starting anti-TNF therapy. Methods IBD patients starting anti-TNF agents between 1/1/2009 to 7/31/2019 at two academic medical centers were included. Three dimensional VAT and SAT volumes were measured from CT scans with Aquarius (iNtuition, Foster City, CA). VFI was calculated with the ratio of VAT:SAT. Patients were categorized by predefined VFI cutoffs: &amp;lt;0.33, 0.33–0.66, &amp;gt;0.67. Primary outcomes included composite endpoint of corticosteroid-free response (CFR) at 6 and 12 months defined by meeting one of the following: a) clinical response based on Harvey Bradshaw Index for Crohn’s disease (CD) or Lichtiger score for ulcerative colitis (UC), b) endoscopic improvement based on ulcer healing for CD and Mayo score for UC compared to baseline, or c) 50% improvement or normalization of CRP or fecal calprotectin. Secondary outcomes included IBD-related surgery at 6 and 12 months. We performed a multivariable logistic regression on CFR and surgery, adjusting for age, gender, IBD diagnosis, disease duration, active tobacco use, and immunomodulator exposure, to calculate adjusted odds ratio (aOR) and 95% confidence interval (CI). Results We included 181 patients. Table 1 summarizes differences in baseline characteristics. There were no differences in disease severity or activity. There were no differences in CFR at 6 and 12 months (Figure 1a and b). With respect to surgery within 6 months, patients with VFI &amp;gt;0.67 were significantly more likely to undergo surgery (aOR: 41.92 [95%CI 5.09–345.59]), but no difference in patients with VFI 0.33–0.66 was observed when compared to patients with VFI &amp;lt;0.33 (aOR: 2.23 [95%CI 0.48–11.21]). Similarly at 12 months, patients with VFI &amp;gt;0.67 were more likely to undergo surgery (aOR: 15.55 [95%CI 2.85–80.56]) but no difference was observed in patients with VFI 0.33–0.66 compared to patients with VFI &amp;lt;0.33 (aOR: 1.38 [95%CI 0.36–5.29]). Conclusion In this retrospective, multicenter, cohort study, we found higher VFI is associated with increased odds of surgery in IBD patients starting anti-TNF therapy. If confirmed by future prospective studies, VFI may be employed as a biomarker to help identify IBD patients at risk for medically refractory disease and would benefit from an early surgical referral, especially considering the growing application of artificial intelligence in medical imaging.

Fat distribution in short‐stature children born small for gestational age

Children born small for gestational age (SGA) with catch-up growth are at high risk for developing obesity; however, the characteristics of body composition, especially fat distribution, before and after growth hormone (GH) treatment in SGA children without catch-up growth remains largely unknown. Anthropometric characteristics, body composition by dual-energy X-ray absorption, and fat distribution by computed tomography at the umbilical level were examined in 27 prepubertal short-stature children born SGA before and 1year after GH treatment. Before GH treatment, short-stature SGA children had lean phenotypes, and both visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) were significantly lower than the age- and sex-matched Japanese reference values. Growth hormone treatment significantly increased height standard deviation scores (SDS), without affecting body mass index SDS. Percentage fat mass decreased with GH treatment; however, fat mass was not altered. Both VAT and SAT were significantly lower than the reference values after GH treatment. The ratio of VAT over SAT significantly increased by GH treatment. Both VAT and SAT were within or below the age- and sex-matched Japanese reference values in short-stature children born SGA before and after GH treatment, indicating that GH treatment may not have unfavorable effects on adiposity in short-stature children born SGA, although it may alter fat distribution.

Abstract 13057: High Visceral-to-Subcutaneous Fat Ratio is Correlated With Increased Cardiovascular Events in Patients With Low Body Mass Index With Suspected Coronary Artery Disease

Introduction: Although abdominal fat distribution given by the ratio of visceral adipose tissue (VAT) to subcutaneous adipose tissue (SAT) area (V/S ratio) is possibly associated with an increased risk of cardiovascular disease (CVD), few studies have examined the effect of the V/S ratio and physique stratified by body mass index (BMI) on long-term clinical outcomes. Methods: We assessed 945 consecutive patients (mean age, 69 years; 42.5% females) with suspected coronary artery disease who underwent computed tomography (CT) angiography. The patients also underwent plain abdominal CT to measure VAT and SAT areas. The V/S ratio was calculated to assess abdominal fat distribution. The patients were classified into four groups based on the median V/S ratio and median BMI (0.627 and 23.61 kg/m 2 , respectively). We examined the association between the V/S ratio and long-term outcomes in each BMI group. The primary outcome was major adverse cardiac events (MACEs, including all-cause death, acute coronary syndrome, emergent hospitalization due to CVD, and any coronary revascularization). Results: Over a median follow-up of 792 days, although the incidence of any cardiovascular event was not associated with the V/S ratio among patients with high BMI, a higher incidence of MACE, all-cause death, and any coronary revascularization was noted among patients with low BMI in the high V/S ratio group than in the low V/S ratio group. In the Kaplan-Meier analysis, a statistically significantly lower MACE-free survival rate was noted among patients with low BMI in the high V/S ratio group than in the low V/S ratio group, despite no differences among high BMI patients in both the V/S ratio groups (Figure). Conclusion: Only in patients with low BMI, a high V/S ratio was associated with increased risks of MACE. A high V/S ratio may be an important risk factor for CVD, especially in patients with low BMI. In contrast, abdominal fat distribution did not affect CVD prognosis in patients with high BMI.