Visceral Fat Reduction Research Articles

Influence of Sex on the Changes in Regional Fat and Skeletal Muscle Mass in Response to Exercise Training in Adolescents with Obesity.

We retrospectively examined the sex differences in the changes in (1) total fat, total and regional subcutaneous adipose tissue (SAT), visceral fat, and intermuscular fat and (2) total and regional skeletal muscle distribution in response to aerobic exercise (AE) or resistance exercise (RE) in adolescents with obesity. Twenty-eight boys and 27 girls with obesity (BMI ≥95th percentile, 12-18 years) were randomly assigned to 3-month interventions (180 minutes per week) of AE or RE. Changes in total and regional fat and skeletal muscle distribution were assessed by a whole-body magnetic resonance imaging. After controlling for corresponding baseline values, age, and race, changes in body weight, BMI, BMI z-score, and waist circumference were similar between exercise groups (p > 0.05) and sexes (p > 0.05). There were no sex or exercise group differences in the reductions in total fat, total SAT, visceral fat, or intermuscular fat. With AE, boys had greater (p < 0.05) reductions in abdominal SAT as compared with girls. With RE, boys had greater (p < 0.05) increases in total, upper body, and abdominal skeletal muscle as compared with girls. Independent of exercise modality, the improvement in VO2max was greater (p < 0.05) in boys than in girls. Independent of sex, the increase in muscular strength index was higher (p < 0.05) in the RE vs. AE group. With the exception of abdominal SAT, there were no sex or exercise treatment differences in the reductions in total and regional fat. In response to RE, the increases in total and regional skeletal muscle were significantly greater in boys than in girls.

Crude glycerol in diets for Nile tilapia in the fattening stage

Abstract: The objective of this work was to evaluate the use of crude glycerol as an energy source to replace corn, in diets for Nile tilapia (Oreochromis niloticus) in the fattening stage. Two hundred Nile tilapia (190±4.5 g) were distributed in 20 tanks, in a completely randomized design. The treatments consisted of crude glycerol at 0, 60, 120, 180, and 240 g kg-1, to replace the dietary levels of corn, in order to maintain a constant digestible energy. Fish productive performance and the chemical composition of the fillet were evaluated. Histological analyses of the hepatopancreas, intestine, and visceral fat were also carried out. Crude glycerol had no effect on the performance parameters; however, it caused a quadratic reduction of visceral fat. There was an increase in the moisture and a decrease in the ether extract of the fillet. A linear effect on the blood glucose levels was verified in fish fed the diet without glycerol, and the peak occurred at 90 min. There were no differences for measurements of intestinal villi height and hepatocyte area. Crude glycerol can replace corn in diets for Nile tilapia in the fattening stage, without adversely affecting fish metabolism, productive performance, or survival.

Abstract 16911: Significant Reduction of Visceral Fat With Doctor-Supervised, Intense Weight Loss Program

While effective therapies are available to treat cardiovascular disease (CVD) in the United States, few strategies exist targeting visceral fat (VF) as a means to reduce risk of CVD and other metabolic diseases. Commercial weight loss programs target body weight but provide minimal effect on validated surrogates of CVD risk. VF is a validated direct marker of cardiovascular and metabolic disease risk in both the young and old. The 20Lighter Program (T20LP), a doctor-supervised program combining patent-pending meal plans, nutritional supplementation, and daily oversight is designed to reduce VF, lower risk of disease, and improve health. T20LP employs VF reduction as a clinical indicator of cardiovascular and metabolic disease risk instead of a simple weight loss endpoint. For the first time, we present data collected over the past 3 years from the T20LP including 2200 men and women completing T20LP by Dec 31, 2017. Baseline age (54±9.5), BMI (34.1±6.1), comorbidities, medical history, and prescription medications were typical of metabolic syndrome. From initial baseline to 20 days, 40 days, and 60 days, T20LP participants showed statistically significant and clinically meaningful reductions in % body weight (6.7±0.64, 10.9±0.10, 13.1±0.15) and % visceral fat (14.0±0.24, 20.1±0.31, 25.1±0.43) (Figure 1). Unlike conventional weight loss programs, our results show a significant reduction in VF thereby lowering risk of cardiovascular and metabolic disease. T20LP is a comprehensive lifestyle program capable of complementing pharmacological CVD and metabolic syndrome treatments. Our data suggest a doctor-supervised, structured setting can provide safe and clinically relevant VF reduction in overweight adults and teens at risk of CVD and metabolic disease.

Long-Term Testosterone Therapy in Type 2 Diabetes Is Associated with Decreasing Waist Circumference and Improving Erectile Function.

PurposeTo describe the 4-year metabolic follow-up results from the BLAST study.Materials and MethodsBaseline hemoglobin A1c (HbA1c), weight, and waist circumference (WC) data were recorded in 185 men recruited for the BLAST randomised controlled trial (RCT) and erectile function (EF) scores were also available in an additional 48 men screened for the RCT. Intra/inter-group associations between these parameters and testosterone replacement therapy (TRT) were assessed at 1) end of the RCT (30 weeks), 2) open-label phase (82 weeks), and 3) final assessment via non-parametric statistics.ResultsImprovement in HbA1c and weight at the end of the RCT and open-label phase in men on TRT was not maintained long-term. The convergence in HbA1c could have been due to incentivised care with HbA1c targets. Interestingly those on TRT at final assessment required fewer anti-diabetic agents. The weight increase in routine care may have been due to changes in diabetes medication or an increase in lean muscle mass. WC continued to decrease in men on TRT indicating possible reduction in visceral fat. Improvement in EF scores continued with long-term TRT, this was abolished when TRT was discontinued.ConclusionsThis study hints at benefits in glycaemic control, weight and WC, and long-term RCTs studying mechanisms of benefit and clinical outcomes are necessary. Our results also show that EF scores continued to improve with long-term TRT, even beyond the 6 months that we previously reported in the BLAST RCT.

High-Intensity Interval Training in the Real World: Outcomes from a 12-Month Intervention in Overweight Adults

Although high-intensity interval training (HIIT) and moderate-intensity continuous exercise have comparable health outcomes in the laboratory setting, effectiveness studies in real-world environments are lacking. The aim of this study was to determine the effectiveness of an unsupervised HIIT program in overweight/obese adults over 12 months. Two hundred and fifty overweight/obese adults could choose HIIT or current exercise guidelines of 30 min·d moderate-intensity exercise. HIIT participants received a single training session and were advised to independently perform HIIT three times per week using a variety of protocols. Mixed models, with a random effect for participant, compared differences in weight, body composition, blood pressure, aerobic fitness, physical activity, and blood indices at 12 months, adjusting for relevant baseline variables. Forty-two percent (n = 104) of eligible participants chose HIIT in preference to current guidelines. At 12 months, there were no differences between exercise groups in weight (adjusted difference HIIT vs conventional = -0.44 kg; 95% confidence interval [CI] = -2.5 to 1.6) or visceral fat (-103 cm; -256 to 49), although HIIT participants reported greater enjoyment of physical activity (P = 0.01). Evidence of adherence to ≥2 sessions per week of unsupervised HIIT (from HR monitoring) declined from 60.8% at baseline to 19.6% by 12 months. Participants remaining adherent to HIIT over 12 months (23%) were more likely to be male (67% vs 36%, P = 0.03), with greater reductions in weight (-2.7 kg; -5.2 to 0.2) and visceral fat (-292 cm; -483 to -101) than nonadherent participants. HIIT was well accepted by overweight adults, and opting for HIIT as an alternative to standard exercise recommendations led to no difference in health outcomes after 12 months. Although regular participation in unsupervised HIIT declined rapidly, those apparently adherent to regular HIIT demonstrated beneficial weight loss and visceral fat reduction. Australian New Zealand Clinical Trials Registry (ACTRN12615000010594), retrospectively registered.

Comparing Time Efficiency of Sprint vs. High-Intensity Interval Training in Reducing Abdominal Visceral Fat in Obese Young Women: A Randomized, Controlled Trial.

Introduction: High-intensity interval training (HIIT) is an emerging lifestyle intervention strategy for controlling obesity. HIIT consisted of brief all-out supramaximal sprint intervals was termed as sprint interval training (SIT). This study was designed to examine the time-efficient characteristics of SIT in reducing abdominal visceral fat.Methods: A randomized controlled trial was conducted to compare the specific adaptations of SIT (80 × 6 s all-out cycle sprints interspersed with 9 s passive recovery) with those resulting from a HIIT regimen with training volume relatively higher (repeated 4 min bouts of cycling at 90% O2max alternated with 3 min rest, until the work of 400KJ was achieved), and with those of nonexercising control counterparts (CON). Forty-six obese young women (body fat percentage ≥30) received either SIT (n = 16), HIIT (n = 16), or no training (n = 14), 3–4 sessions per week, for 12 weeks. The abdominal visceral fat area (AVFA) and abdominal subcutaneous fat area (ASFA) of the participants were measured through computed tomography scans pre-intervention and post-intervention. Total fat mass and the fat mass of the android, gynoid, and trunk regions were assessed through dual-energy X-ray absorptiometry.Results: Following the intervention, abdominal visceral and subcutaneous fat were reduced markedly (p < 0.05). The reduction in AVFA (−6.31, −9.7 cm2) was not different between SIT and HIIT (p > 0.05), while the reduction in ASFA (−17.4, −40.7 cm2) in SIT was less than that in HIIT (p < 0.05). Less reduction in the fat mass of the trunk (−1.2, −2.0 kg) region was also found in SIT, while the reductions in fat percentage (−1.9%, −2.0%), total fat mass (−2.0, −2.8 kg), and fat mass of the android (−0.2, −0.2 kg), and gynoid (−0.4, −0.3 kg) regions did not differ between the two regimes (p > 0.05). In contrast, the increase in O2max was significant greater following the SIT than HIIT (p < 0.01). No variable changed in CON.Conclusion: Such findings suggest that the lower training load and exercise time commitments of the SIT regime could optimize the time-efficiency advantage of the traditional HIIT, facilitating the abdominal visceral fat reduction in obese young women.

Weight loss and metabolic health effects from energy-restricted Mediterranean and Central-European diets in postmenopausal women: A randomized controlled trial

We conducted a randomized controlled trial to examine the effect of two energy-restricted diets on body weight (BW), visceral fat (VF) loss, and the risk factors for metabolic syndrome. A total of 144 centrally obese postmenopausal women were assigned to the moderate in fat Mediterranean diet (MED) or to the Central European diet (CED), which is moderate in carbohydrates and high in dietary fiber (DF), for 16 weeks. BW, waist circumference and VF were significantly reduced by 8.8%, 7.0%, and 24.6%, respectively, over the trial (P < 0.001), with no difference between groups. A similar trend was seen for total cholesterol, triglycerides, glucose, and blood pressure. Within each diet group, the more adherent participants lost significantly more BW than did their less adherent counterparts. VF was significantly reduced only in women who were more adherent to the CED, and the reduction in VF correlated with an increase in the proportion of DF. Short-term dietary treatment with the CED or the MED was associated with similar improvements in some anthropometric, lipid, and nonlipid parameters; however, adequate adherence to the prescribed diet is important in weight loss success and in achieving improvements in metabolic health.

Prenatal undernutrition attenuates fasting-induced reproductive dysfunction in pre-pubertal male rats

Prenatal undernutrition affects various physiological functions, such as metabolic and reproductive functions, after birth, and such changes are associated with the pathogeneses of certain diseases. It has been hypothesized that these changes are predictive adaptive responses that help individuals to endure similar conditions in the postnatal period. Thus, we evaluated the effects of prenatal undernutrition on the responses of the body weight (BW) regulation system and reproductive functions to fasting in the pre-pubertal period in male rats. Prenatally normally nourished and undernourished rats exhibited similar reductions in BW and visceral fat after 48 h fasting in the pre-pubertal period. Furthermore, these two groups displayed similar fasting-induced patterns of change in their hypothalamic levels of appetite regulatory factors; i.e., neuropeptide Y and pro-opiomelanocortin. These results indicate that prenatal undernutrition had no marked effects on BW regulation in male rats. On the other hand, serum luteinizing hormone and testosterone levels were decreased by 48 h fasting in the prenatally normally nourished rats, whereas the levels of these hormones did not change in the prenatally undernourished rats. However, the hypothalamic mRNA level of kisspeptin 1 (Kiss1), which is a positive regulator of gonadotropin-releasing hormone/gonadotropins, was reduced by fasting in both groups. These results indicate that prenatal undernutrition might attenuate fasting-induced reproductive dysfunction in the postnatal period; however, these changes might not be induced by alterations in the hypothalamic Kiss1 system. Further studies are needed to clarify the mechanisms involved in these changes in reproductive function.

Tonsil-derived mesenchymal stem cell-embedded in situ crosslinkable gelatin hydrogel therapy recovers postmenopausal osteoporosis through bone regeneration.

We investigated therapeutic potential of human tonsil-derived mesenchymal stem cells (TMSC) subcutaneously delivered to ovariectomized (OVX) mice for developing more safe and effective therapy for osteoporosis. TMSC were isolated from tonsil tissues of children undergoing tonsillectomy, and TMSC-embedded in situ crosslinkable gelatin-hydroxyphenyl propionic acid hydrogel (TMSC-GHH) or TMSC alone were delivered subcutaneously to the dorsa of OVX mice. After 3 months, three-dimensionally reconstructed micro-computed tomographic images revealed better recovery of the femoral heads in OVX mice treated with TMSC-GHH. Serum osteocalcin and alkaline phosphatase were also recovered, indicating bone formation only in TMSC-GHH-treated mice, and absence in hypercalcemia or other severe macroscopic deformities showed biocompatibility of TMSC-GHH. Additionally, visceral fat reduction effects by TMSC-GHH further supported their therapeutic potential. TMSC provided therapeutic benefits toward osteoporosis only when embedded in GHH, and showed potential as a supplement or alternative to current therapies.

Comparing the Effects of Ipragliflozin and Metformin on Visceral Fat Reduction in Patients with Type 2 Diabetes Inadequately Controlled with Sitagliptin–A Prospective, Multicenter, Blinded-Endpoint, Randomized Controlled Study in Japan (PRIME-V Study)

Objective: To determine the effects of SGLT2 inhibitor or metformin on reducing visceral fat in Asian patients with type 2 diabetes inadequately controlled with DPP-4 inhibitor, sitagliptin. Methods: A prospective, multicenter, blinded-endpoint, randomized controlled trial was conducted to evaluate the efficacy of treatment with either SGLT2 inhibitor (ipragliflozin) or metformin added on to sitagliptin for visceral fat reduction and glucose control in patients with type 2 diabetes. Patients who met the eligibility criteria were randomly selected (1:1) to receive ipragliflozin (Ipr; 50 mg daily) or metformin (Met; 1000 mg daily). The primary outcome is the change rate in visceral fat area, measured using computed tomography, after 24 weeks of therapy. Two radiologists, blinded to the information, analyzed the images. Results: A total of 51 patients were in enrolled in the Ipr group and 52 in the Met group. The reduction rate in visceral fat area was significantly greater in the Ipr group (-12.06% vs. -3.65%, group difference of -8.40%; 95% CI of -16.4 to -3.38, P&amp;lt;0.05) than in the Met group. Subcutaneous fat area, total fat area, body weight, BMI, and waist circumference also decreased significantly in the Ipr group. The Ipr group showed a significant decrease in fasting insulin (-20.73% vs. 0.85%, group difference -21.58%, 95% CI 2.80 to 34.20, P&amp;lt;0.05), while HbA1c decreased in the Met group compared with the Ipr group. The difference in the muscle volume and bone mineral density between the two groups was insignificant. Conclusion: Ipr significantly reduced the visceral fat area compared with Met as the secondary agent used in combination with DPP-4 inhibitors. As the fasting insulin level decreased, the reduction in visceral fat associated with Ipr administration may have contributed to the improvement of insulin resistance. Disclosure M. Koshizaka: None. K. Ishikawa: None. R. Ishibashi: None. Y. Maezawa: None. K. Sakamoto: None. D. Uchida: Speaker's Bureau; Self; Takeda Pharmaceuticals Japan, Tanabe Mitsubishi Pharmaceuticals Japan, Sanofi, MSD K.K., Novo Nordisk Inc. S. Nakamura: None. H. Yokoh: None. A. Kobayashi: None. S. Onishi: None. K. Kobayashi: None. J. Ogino: None. H. Tokuyama: None. F. Shimada: None. E. Ohara: None. T. Ishikawa: None. M. Shoji: None. K. Ide: None. S. Ide: None. Y. Baba: None. T. Horikoshi: None. R. Shimofusa: None. S. Takahashi: None. K. Nagashima: None. M. Takemoto: None. K. Yokote: Research Support; Self; Astellas Pharm Ltd, MSD K.K..

White- and Brown-Rice Supplementation Improves Insulin Tolerance, Brown Fat Activation, Energy Expenditure, and Changes the Gut Microflora in Diet-Induced Obesity

Increased consumption of white rice (WR) with parallel decreased use of brown rice (BR) have been associated with increased prevalence of type 2 diabetes (T2DM), suggesting WR may elevate the risk of T2DM. To test whether WR or BR have differential effects on glucose metabolism in diet-induced obesity, C57BL/6 mice were fed 6 different diets: control diet (CD, 10%), high fat diet (HFD, 46%) and CD and HFD with either WR or BR. Diets with WR or BR were controlled with comparable carbohydrate and protein contents. After 18 weeks, the median weights of HFD mice were greater (36%) than those on CD. Surprisingly, adding WR or BR to HFD decreased weight gains equally by 53% with parallel reduction of abdominal, visceral, subcutaneous, and total fat vs. HFD. Activity and food intake did not change among mice on HFD. However, HFD decreased heat, VO2, and VCO2 production vs. CD which were normalized by adding WR or BR, per indirect calorimetry with metabolic cages. Intraperitoneal glucose tolerance test on HFD were improved by either WR or BR, although mice on BR+HFD exhibited greater improvements than mice on WR+HFD (P&amp;lt;0.05). Adding WR or BR to HFD decreased HFD-induced elevations of plasma leptin and MCP-1 levels. HFD decreased brown fat tissue mass and markers, UCP-1 and PGC1α vs. CD mice which improved when WR or BR was added to HFD. Gut microbiota composition, assessed by 16S rRNA sequencing and metagenomic analysis, showed clear differences between HFD vs. CD or vs. the addition of BR or WR. The ratio of Firmicutes to Bacteroidetes was increased significantly in HFD vs. CD diet, which has been associated with obesity and metabolic syndrome, but decreased by the addition of WR (63%) or BR (81%). Thus, BR and, surprisingly, WR may activate BAT, increase energy expenditure to reduce body weight and improve insulin sensitivity while on HFD, possibly by altering gut microbiome, indicating that common substances may exist in BR and WR to lower the risks for T2DM. Disclosure H. Yokomizo: None. A. Ishikado: Employee; Self; Sunstar Inc.. Employee; Spouse/Partner; Sunstar Inc.. T. Shinjo: None. K. Park: None. Y. Maeda: None. I. Wu: None. D.M. Pober: None. S. Devkota: None. M. Matsumoto: Employee; Self; Sunstar Inc.. A. Kostic: None. G.L. King: Research Support; Self; Sanofi-Aventis.

Brain Insulin Sensitivity Predicts Adiposity—Nine-Year Results of the Tulip Study

Lifestyle intervention reduces body weight and prevents type 2 diabetes. One crucial modulator of food intake and whole body energy metabolism is insulin action in the brain. We now test whether brain insulin sensitivity is a long-term predictor of weight and body fat distribution during and after a lifestyle intervention program. Before, after 9 months, at the end of lifestyle intervention at 24 months, as well as after 8.7 ±1.6 years follow-up, participants of the Tuebingen Lifestyle Intervention Program underwent a 75g OGTT, and whole body MRI. Brain insulin sensitivity was measured at baseline by changes in neuronal signals (theta frequency band) with magnetoencephalography during a hyperinsulinemic-euglycemic clamp in a subgroup of 28 participants of whom long-term follow-up was available in 15 persons. Higher brain insulin sensitivity before lifestyle intervention was associated with a more pronounced reduction in total and visceral fat during the lifestyle intervention (all p&amp;lt;0.01). High brain insulin sensitivity was also associated with less regain of fat mass during the long-term follow-up. In contrast to visceral fat, changes in subcutaneous adipose tissue were independent of the brain insulin responsiveness. Our results extend previous findings on the role of brain insulin for the success of lifestyle intervention to a long-term perspective. Insulin action in the human brain appears to be not only important for weight loss, but seems to determine regain of body weight and especially total and visceral fat mass thereafter. Experimental findings demonstrated that insulin administration to the brain modulates peripheral energy fluxes in humans. In line, our results indicate fat depots specific effects of brain insulin with particular benefits in the visceral compartment. These findings support the role of brain insulin in the regulation of body fat distribution and body weight. Disclosure V. Schmid: None. O. Tschritter: None. J. Machann: None. R. Wagner: None. N. Stefan: Consultant; Self; Merck Sharp &amp; Dohme Corp.. Speaker's Bureau; Self; Novo Nordisk A/S. Research Support; Self; AstraZeneca. Speaker's Bureau; Self; AstraZeneca, OmniaMed Ltd.. H. Preissl: None. H. Haering: None. A. Fritsche: Advisory Panel; Self; Sanofi-Aventis Deutschland GmbH, Novo Nordisk A/S, Eli Lilly and Company, Boehringer Ingelheim GmbH. M. Heni: Research Support; Self; Boehringer Ingelheim GmbH. Speaker's Bureau; Self; Boehringer Ingelheim GmbH, Merck Sharp &amp; Dohme Corp., Novo Nordisk Inc..

Effects of Japanese diet in combination with exercise on visceral fat accumulation.

In our previous study, we showed that among Japanese diets from different time periods, the 1975 Japanese diet has the greatest health benefits and is the most effective to prevent obesity. In addition, exercise is also effective to reduce obesity. Therefore, we conducted a human clinical trial combining the 1975 Japanese diet and exercise and, as a result, found a reduction in body weight, visceral fat, and serum lipids. However, the mechanism of this phenomenon was not determined. Therefore, in this study, we examined this mechanism in mice using a diet that was similar to that used in the human trial. The modern and 1975 Japanese diets were cooked, lyophilized, powdered, and fed freely to 5 wk old male C57 BL/6 J mice for 8 wk. In addition, the mice exercised on a treadmill. Total white adipose tissue weight decreased significantly due to the interaction between the 1975 Japanese diet and exercise. A histologic examination revealed that the hypertrophy of adipocytes was suppressed. To clarify this mechanism, the mRNA levels for lipid metabolism-related genes in epididymal adipose tissue were measured, and the mRNA level of hormone sensitive lipase (Hsl), which is related to lipolysis, was found to be significantly increased after intake of the 1975 Japanese diet combined with exercise. In the gut microbiota analysis, the Bacteroidetes to Firmicutes ratio, which is decreased in obese people, was increased by the 1975 Japanese diet and exercise. At the genus level, there was an increase in butyrate-producing bacteria as a result of the 1975 Japanese diet intake and exercise. A combination of the 1975 Japanese diet and exercise increased lipolysis in white adipose tissue and increased butyrate-producing bacteria in gut microbiota, and thereby suppressed fat accumulation.

Comparing the Effects of Ipragliflozin versus Metformin Added to Sitagliptin on Visceral Fat Reduction in Asian Patients with Type 2 Diabetes: A Prospective, Multicenter, Blinded-Endpoint Randomized Controlled Study (PRIME-V Study)

Background: Visceral fat accumulation is associated with insulin resistance and various metabolic complications. We aimed to determine the effect of ipragliflozin (sodium-dependent glucose transporter-2 inhibitor) versus metformin with a dipeptidyl peptidase-4 (DPP-4) inhibitor (sitagliptin) in reducing visceral fat in Asian patients with insufficiently controlled type 2 diabetes. Methods: A prospective, multicenter, blinded-endpoint, randomized controlled study was conducted to evaluate the efficacy of treatment with either ipragliflozin or metformin combined with sitagliptin on visceral fat reduction and glycemic control among Japanese patients with type 2 diabetes, HbA1c 7-10%, and BMI ≥22 kg/m2. Patients who met the eligibility criteria were randomly assigned (1:1) to receive ipragliflozin 50 mg (n=51) or metformin 1000-1500 mg daily (n=52). The primary outcome was rate change in visceral fat area measured by computed tomography at 24 weeks of therapy. Two radiologists, blinded to patients' clinical information and randomized treatment assignment, analyzed the images. Secondary outcomes included effects on blood glucose, fasting insulin level, and lipids. The full analysis set was used for analysis. Findings: Mean percent reduction in visceral fat area was significantly greater in the ipragliflozin group than in the metformin group (-12·06% vs. -3·65%, group difference [95% CI] -8·40%; [-16·4 to -3·38], P=0·040). The ipragliflozin group also showed significant lowering of fasting insulin (-20·73% vs. 0·85%, group difference [95% CI] -21·58%, [2·80 to 34·20], P=0·018), while HbA1c decreased in the metformin group compared with ipragliflozin group. Interpretation: Ipragliflozin significantly reduced the visceral fat area compared with metformin, as the secondary agent used in combination with DPP-4 inhibitor. Since the fasting insulin level decreased, the reduction in visceral fat associated with ipragliflozin administration might have contributed to the improvement in insulin resistance. Trial Registration Number: Trial registration: UMIN 000015170. Funding Statement: To conduct this study, an agreement was signed between Chiba University and Astellas Pharma Inc. (Tokyo, Japan). Astellas Pharma Inc. funded this work. Declaration of Interests: KY received research grants from Astellas Pharma Inc. and MSD K.K. (Tokyo, Japan), and received a lecture fee from Astellas Pharma Inc. and Sumitomo Dainippon Pharma (Tokyo, Japan). No conflicts of interest are declared for other authors. Ethics Approval Statement: The study protocol was approved by the Institutional Review Boards (IRBs), Ethics Review Committees, or Ethics Committees of the following institutions: Chiba University Hospital (ID number: G26009), Asahi General Hospital (ID number: 2014091602), National Hospital Organization Chiba Medical Center, Seirei Sakura Citizen Hospital, Chiba Rosai Hospital (ID number: 26-21), Toho University Sakura Medical Center (ID number: 2014-077), Tokyo Women’s Medical University Yachiyo Medical Center (ID number: 150303), Chiba Aoba Municipal Hospital, Kimitsu Chuo Hospital, Funabashi Central Hospital (ID number: H27-1), and Chiba Kaihin Municipal Hospital. In other facilities, approval was provided at Chiba University Hospital (which had the centralized IRB).

Metabolic effects, safety, and acceptability of very low-calorie ketogenic dietetic scheme on candidates for bariatric surgery

BackgroundPrevious studies have demonstrated significant advantages from a preoperative dietetic regimen for candidates to bariatric procedure. ObjectivesEvaluation of safety, efficacy, and acceptability of a very low-calorie ketogenic diet in patients before bariatric surgery. SettingUniversity Hospital. MethodsA standardized 30-day sequential preoperative diet regimen has been analyzed, optimizing metabolic response with gradual carbohydrate reintroduction. Patients were given a dedicated KetoStationkit, for use during the first 10 days of the scheme, followed by a hypocaloric scheme for 20 days. The study group underwent routine laboratory tests and anthropometric measurements (percent weight loss, body mass index, waist circumference) at enrollment (T0), after 10 days (T1), and after 30 days (T2). Ketone body levels were measured in the plasma and urine. ResultsBetween January 2015 and September 2015, 119 patients were included in the study. Mean body mass index was 41.5 ± 7.6 kg/m2. Weight, body mass index, and waist circumference at T0 and T1, T0 and T2, and T1 and T2 decreased significantly (P<.05). A bioelectrical impedance assay determined a significant reduction in visceral fat at T1 and T2. We observed a significant (P<.05) improvement in several clinical parameters, including glycemic and lipid profile parameters. We also observed a mean 30% reduction in liver volume. The majority of patients declared satisfied or very satisfied. The adverse effects were mild, of short duration, and not clinically relevant. ConclusionOur results confirm the acceptability, safety, and significant advantage of a very low-calorie ketogenic diet for reducing weight and liver volume of patients in preparation for bariatric surgery.

Antiangiogenic Herbal Composition Ob-X Reduces Abdominal Visceral Fat in Humans: A Randomized, Double-Blind, Placebo-Controlled Study.

Adipose tissue growth is angiogenesis-dependent, and angiogenesis inhibitors can regulate adipose tissue mass by cutting off the blood supply. We examined whether antiangiogenic herbal composition Ob-X can reduce fast-growing abdominal fat, especially visceral fat in humans by inhibiting angiogenesis. Eighty abdominally obese subjects (body mass index: 25-29.9 kg/m2, waist circumference: exceeding 90 cm for males and 85 cm for females) participated in a 12-week randomized, double-blind, placebo-controlled human study to evaluate the efficacy and safety of Ob-X. 690 mg of Ob-X was administered orally twice a day. The Ob-X group showed a noticeable reduction in visceral fat of 20.5% after the 12-week treatment as compared to baseline measured by computed tomography. The change in visceral fat in the Ob-X group was statistically significant as compared to the placebo group (p = 0.0495) and 1.9 times higher than in the placebo group. Therefore, angiogenesis inhibitor Ob-X has the potential to improve obesity-related metabolic syndrome by reducing dangerous visceral fat.

Vitamin D is associated with metabotropic but not neurotrophic effects of exercise in ovariectomized rats

PurposeHere, we studied the beneficial effects of aerobic exercise on metabolic syndrome components, cognitive performance, brain derived neurotrophic factor (BDNF) and irisin in ovariectomized rats with different serum vitamin D (Vit D) status.MethodsEighty female wistar rats were divided into 2 groups of sham operated (sham, n = 8), and ovariectomized (OVX, n = 72). Then OVX were divided into 9 groups of receiving combination of exercise protocol with low dose of Vit D (OVX + EXE + LD), high dose of Vit D (OVX + EXE + HD), Vit D deficiency (OVX + EXE − D), and (OVX + EXE + Veh). Also non exercised groups of OVX receiving high dose of Vit D (OVX + HD), low dose of Vit D (OVX + LD), Vit D deficiency (OVX − D), and Veh (OVX + Veh) were included. After 2 months of related interventions, spatial memory was assessed using Morris water maze (MWM), and then metabolic syndrome components were measured.ResultsHigh dose of Vit D supplementation showed significant reduction in weight (p = 0.001), lipid profiles (p = 0.001), visceral fat (p = 0.001) and waist circumference (p = 0.001) regardless of exercising or not, with no change in cognitiive function. Serum BDNF level was significantly higher in Vit D deficient group (p = 0.001), and was decreased in the OVX + HD. In contrary, irisin did not show any significant relationship with serum concentration of Vit D, while it was significantly elevated in the exercised groups compared with non-exercised counterparts.ConclusionVit D insufficiency deteriorates metabolic syndrome components, and elevates serum BDNF as a compensatory metabotropic factor, and further supplementation significantly attenuates these components parallel with reduction in BDNF. In addition, aerobic exercise successfully induces various metabolic benefits, provided optimum serum level of Vit D.

Visceral fat reduction with tesamorelin is associated with improved liver enzymes in HIV.

Tesamorelin reduces visceral adipose tissue (VAT) in HIV. We investigated whether reductions in VAT with tesamorelin are associated with changes in alanine aminotransferase (ALT) and aspartate aminotransferase (AST). We utilized data from two multicenter Phase III trials of tesamorelin among 806 HIV-infected patients with abdominal obesity. These studies showed that the majority of patients treated with tesamorelin are 'responders', defined a priori by the Food and Drug Administration as achieving at least 8% reduction in VAT. In the current analysis, we sought to examine the impact of VAT reduction on ALT and AST among patients participating in the Phase III trials with baseline elevated ALT or AST. Within this group, we compared changes in ALT and AST in VAT responders vs. nonresponders after 26 weeks of treatment, and then assessed the effects of drug discontinuation on these endpoints over a subsequent 26-week period. At baseline, VAT was positively associated with ALT (P = 0.01). In study participants assigned to tesamorelin with baseline ALT or AST more than 30 U/l, VAT responders experienced greater reductions in ALT (-8.9 ± 22.6 vs. 1.4 ± 34.7 U/l, P = 0.004) and AST (-3.8 ± 12.9 vs. 0.4 ± 22.4 U/l, P = 0.04) compared with nonresponders over 26 weeks. This improvement among VAT responders persisted over 52 weeks even in those switched to placebo despite a partial reaccumulation of VAT. A clinically significant VAT reduction with tesamorelin was associated with improved liver enzymes among HIV-infected patients with abdominal obesity and elevated baseline transaminases.

Loss of skeletal muscle mass and its predictors in type 2 diabetes patients under a multifaceted treatment approach.

Weight loss, which is an effective method for reducing visceral fat, may cause a concomitant loss of skeletal muscle mass. The aim of this study was to elucidate the changes in visceral fat and skeletal muscle mass in response to diabetes treatment including weight control. For 6months we observed the changes in the body compositions of 72 Japanese patients with type 2 diabetes who underwent multifaceted treatment including educational hospitalization. Visceral fat area (VFA) and appendicular skeletal muscle mass (ASM) were measured using a bioelectrical impedance method and dual-energy X-ray absorptiometry, respectively. During the follow-up period, VFA reduced significantly whereas the average ASM did not change. Changes in ASM were strongly positively associated with changes in body weight (r=0.50). Additionally, in an analysis of covariance, an above-median BMI (27kg/m2) and above-median VFA (110cm2) at baseline were found to be independent predictors of ASM reduction prevention. Of the 55 patients who lost weight, those who had a baseline VFA of ≥110cm2 had significantly greater reductions in VFA than those with a baseline VFA of <110cm2 (p<0.01). ASM reduced significantly in patients with a VFA of <110cm2 (p<0.01), but not in those with a VFA of ≥110cm2 (p=0.98). Baseline accumulation of visceral fat may predict a preferential reduction of visceral fat rather than skeletal muscle during weight control programs in type 2 diabetes patients.

Cancers of the Esophagus and Stomach: Potential Mechanisms Behind the Beneficial Influence of Physical Activity.

To compare findings from several recent meta-analyses showing a reduced risk of gastric and esophageal cancers in physically active individuals, to assess the magnitude of this benefit, and to seek information on potential underlying mechanisms. A comprehensive search of Ovid/Medline from 1996 to February 2016, using the terms physical activity or exercise or training and esophageal or gastric cancer, and supplementing the articles identified by material from references lists and personal files. Moderate-to-vigorous physical activity is associated with a 20% to 30% reduction in the risk of gastroesophageal adenocarcinomas, with a significant dose/response relationship. Benefit is greater in women than in men, and greater for noncardia than for cardia or esophageal tumors. Mechanisms could include a reduction of visceral fat (with a lesser production of cancer promoting hormones and reduced gastroesophageal reflux) and/or a lesser likelihood of smoking and excessive alcohol consumption. Physical activity does not protect against Helicobacter pylori infections or gastric ulceration, but mechanisms related to the impact of exercise on immune function, antioxidant mechanisms, and gastroesophageal reflux remain to be explored. Regular, moderate-to-vigorous physical activity is associated with a clinically significant reduction in the risk of gastroesophageal adenocarcinomas, but mechanisms are as yet unclear, and a causal relationship remains to be proven.