Visceral Obesity Research Articles

FRUCTOSE EXACERBATES ANTHRACYCLINE AND HER–2 BLOCKING AGENT MEDIATED CARDIOTOXICITY THROUGH NLRP3 AND MYD88 MEDIATED PATHWAYS: NEW ROLES OF SWEETENERS IN CARDIO–ONCOLOGY

Abstract Background Combinatorial therapy based on anthracyclines and HER–2 blocking agents increases the risk of cardiomyopathy in women with breast cancer. Fructose is a monosaccharide associated with high risk of diabetes, non–alcoholic fatty liver disease, atherosclerosis and visceral obesity. A high fructose diet is a potential cardiometabolic risk factor and may increase cardiac risk in women with breast cancer treated with cardiotoxic drugs. Purpose In this study, we highlighted the role of sweeteners fructose in the worsening of cardiotoxicity induced by combinatorial therapy anthracycline–HER2–blocking agents. Methods Human cardiomyocytes were pre–exposed with doxorubicin combined to trastuzumab (at 300 and 1000 nM) for 48 and 72h alone or combined to fructose at 0.25, 1 and 2.5 mM. After the incubation period, we performed the following tests: determination of cell viability, through mitochondrial dehydrogenase activity, study of lipid peroxidation (quantifying cellular Malondialdehyde and 4–hydroxynonenal), intracellular Ca2+ homeostasis. Moreover, pro–inflammatory studied were also performed (activation of NLRP3 inflammasome; expression of peroxisome proliferator–activated receptor–α; transcriptional activation of p65/NF–κB and secretion of cytokines involved in cardiotoxicity (Interleukins 1β, 8, 6, CXCL–12). Results High fructose increases significantly cell mortality of cardiomyocytes exposed to doxorubicin and trastuzumab thorugh the activation of NLRP–3 and Myd–88 expression. Intracellular Ca++ levels were also increased of 4 times compared to non–fructose exposed cardiomyocytes; MDA and 4–HNA levels were increased of 48,3 and 51,2 % compared to non–fructose exposed cells (p<0.001). Fructose increases IL–1, IL–6 and CXCL–12 expression in cardiomyocytes in a concentration dependent manner, compard to doxorubicin–trastuzumab group (p<0.05). Conclusion Data of the present study indicate that fructose induces a pro–inflammatory phenotype in human cardiac cells exposed to anticancer cardiotoxic drugs, providing even more data on the harmful role of fructose as a key player of cardiotoxic phenomena.

Estrogen restores disordered lipid metabolism in visceral fat of prediabetic mice.

Visceral obesity is increasingly prevalent among adolescents and young adults and is commonly recognized as a risk factor for type 2 diabetes. Estrogen [17β-estradiol (E2)] is known to offer protection against obesity via diverse me-chanisms, while its specific effects on visceral adipose tissue (VAT) remain to be fully elucidated. To investigate the impact of E2 on the gene expression profile within VAT of a mouse model of prediabetes. Metabolic parameters were collected, encompassing body weight, weights of visceral and subcutaneous adipose tissues (VAT and SAT), random blood glucose levels, glucose tolerance, insulin tolerance, and overall body composition. The gene expression profiles of VAT were quantified utilizing the Whole Mouse Genome Oligo Microarray and subsequently analyzed through Agilent Feature Extraction software. Functional and pathway analyses were conducted employing Gene Ontology and Kyoto Encyclopedia of Genes and Genomes analyses, respectively. Feeding a high-fat diet (HFD) moderately increased the weights of both VAT and SAT, but this increase was mitigated by the protective effect of endogenous E2. Conversely, ovariectomy (OVX) led to a significant increase in VAT weight and the VAT/SAT weight ratio, and this increase was also reversed with E2 treatment. Notably, OVX diminished the expression of genes involved in lipid metabolism compared to HFD feeding alone, signaling a widespread reduction in lipid metabolic activity, which was completely counteracted by E2 administration. This study provides a comprehensive insight into E2's local and direct protective effects against visceral adiposity in VAT at the gene level. In conclusion, the present study demonstrated that the HFD-induced over-nutritional challenge disrupted the gene expression profile of visceral fat, leading to a universally decreased lipid metabolic status in E2 deficient mice. E2 treatment effectively reversed this condition, shedding light on the mechanistic role and therapeutic potential of E2 in combating visceral obesity.

Contribution of obesity, insulin resistance and diabetes mellitus to cognitive impairment

Obesity is a vivid example of one of the most common chronic non-infectious multifactorial diseases in today’s world. Not only the conventional elements of an “unhealthy lifestyle” such as hypodynamia and overeating, but also external socio-economic and psychosocial factors play an important role in the development of this disease. This review summarizes the main pathogenetic components that combine the development of both metabolic and vascular, including cerebrovascular, complications of obesity. The authors present the current classification of obesity adopted by domestic endocrinologists, which includes an assessment of the risk of obesity-associated complications. The mechanisms of pathological effects of insulin resistance, which morphological substrate is visceral obesity, are considered in detail. Its key role in the initiation and progression of diabetes mellitus, cardiovascular and cerebrovascular diseases has been shown. The mechanisms involved in the development of cognitive impairment in patients with obesity, insulin resistance and diabetes mellitus are described. Due to the urgency of the problem raised, the prospective of choosing a therapeutic and preventive approach to the management of such patients are assessed. With regard to this category of patients, the use of fonturacetam was discussed. Fonturacetam has been shown to have the proven clinical effects that not only improve the cognitive and emotional status in patients with cerebrovascular pathology, but also have a direct effect on the potential root cause of the development and progression of vascular and metabolic disorders, i.e. on the obesity. Fonturacetam that has an anorexigenic effect can also be prescribed as a weight corrector in addition to the diet therapy. Thus, the use of fonturacetam can become a promising trend in the treatment and prevention of today’s most common diseases.

Are Young People with Turner Syndrome Who Have Undergone Treatment with Growth and Sex Hormones at Higher Risk of Metabolic Syndrome and Its Complications?

Metabolic syndrome (MetS), characterized by visceral obesity, glucose abnormalities, hypertension and dyslipidemia, poses a significant risk of diabetes and cardiovascular disease. Turner syndrome (TS), resulting from X chromosome abnormalities, carries health complications. Despite growing evidence of an increased risk of MetS in women with TS, its prevalence and risk factors remain under investigation. These considerations are further complicated by the varying timing and dosages of treatment with growth hormone and sex hormones. We conducted a cross-sectional study comparing 44 individuals with TS with 52 age-matched control subjects. Growth hormone treatment in the study group was administered for varying lengths of time, depending on clinical response. We collected anthropometric, metabolic, endocrine and body composition data. Statistical analyses included logistic regression. Baseline characteristics, including age, BMI and height, were comparable between the TS and control groups. Hormonally, individuals with TS showed lower levels of testosterone, DHEA-S, and cortisol, as well as elevated FSH. Lipid profiles indicated an atherogenic profile, and the body composition analysis showed increased visceral adipose tissue in those with TS. Other metabolic abnormalities were common in individuals with TS too, including hypertension and impaired fasting glucose levels. The risk of MetS components was assessed in subgroups according to karyotypes: monosomy 45X0 vs. other mosaic karyotypes. Logistic regression analysis showed a significant association between increased visceral adipose tissue in subjects with TS. Those with metabolic complications tended to have less muscle strength compared to those without these complications in both the study and control groups. This study highlights the unique metabolic and cardiovascular risk profile of individuals with TS, characterized by atherogenic lipids, higher levels of visceral adipose tissue and increased metabolic abnormalities. These findings underscore the importance of monitoring metabolic health in individuals with TS, regardless of age, BMI or karyotype, and suggest the potential benefits of lifestyle modification, building more muscle strength, and weight control strategies. Further research is needed to better understand and address the metabolic challenges faced by women with TS.

Effect of contrast phase on quantitative analysis of skeletal muscle and adipose tissue by computed tomography

ObjectivesSignificant variability exists in the contrast phases applied during computed tomography (CT) studies when assessing morphometric measurements of muscle area (CT-assessed sarcopenia) and density (CT-assessed myosteatosis) and visceral adipose tissue area (CT-assessed visceral obesity). This study explored the impact of contrast phase timing on changes in morphometric measurements of body composition. MethodsThis single-center retrospective cohort study included 459 patients undergoing a multiphase CT scan. Morphometric measurements were obtained at the third lumbar vertebra level. Patients were classified as sarcopenic, myosteatotic, or visceral obese using predefined cutoff values. The intraclass correlation coefficient was used to assess correlations across different enhancement phases, and Cohen's κ measured the inter-enhancement agreement for sarcopenia, myosteatosis, and visceral obesity. ResultsSignificant differences were observed in mean visceral adipose tissue area, muscle density, and muscle area (P < 0.001). The intraclass correlation coefficient between unenhanced and arterial phases was 0.987 (95% confidence interval [CI], 0.759–0.996) for adipose tissue, 0.995 (95% CI, 0.989–0.997) for muscle area, and 0.850 (95% CI, 0.000–0.956) for muscle density. However, when morphometric measurements were categorized using predefined cutoffs, the κ agreement was considerably lower, particularly for CT-assessed myosteatosis, ranging from 0.635 (unenhanced to arterial) to 0.331 (unenhanced to late venous phase). ConclusionsDifferent CT contrast phases induce small but clinically significant alterations in the measurements of muscle area and density and visceral fat. Such minor changes can result in misclassification issues when fixed cutoff values are used to diagnose myosteatosis with CT. This underscores the importance of reporting absolute values and the specific contrast phase used in future studies.

Association Between Visceral Obesity Index and Diabetes: A Systematic Review and Meta-analysis.

The correlation between visceral obesity index (VAI) and diabetes and accuracy of early prediction of diabetes are still controversial. This study aims to review the relationship between high level of VAI and diabetes and early predictive value of diabetes. The databases of PubMed, Cochrane, Embase, and Web of Science were searched until October 17, 2023. After adjusting for confounding factors, the original study on the association between VAI and diabetes was analyzed. We extracted odds ratio (OR) between VAI and diabetes management after controlling for mixed factors, and the sensitivity, specificity, and diagnostic 4-grid table for early prediction of diabetes. Fifty-three studies comprising 595 946 participants were included. The findings of the meta-analysis elucidated that in cohort studies, a high VAI significantly increased the risk of diabetes mellitus in males (OR = 2.83 [95% CI, 2.30-3.49]) and females (OR = 3.32 [95% CI, 2.48-4.45]). The receiver operating characteristic, sensitivity, and specificity of VAI for early prediction of diabetes in males were 0.64 (95% CI, .62-.66), 0.57 (95% CI, .53-.61), and 0.65 (95% CI, .61-.69), respectively, and 0.67 (95% CI, .65-.69), 0.66 (95% CI, .60-.71), and 0.61 (95% CI, .57-.66) in females, respectively. VAI is an independent predictor of the risk of diabetes, yet its predictive accuracy remains limited. In future studies, determine whether VAI can be used in conjunction with other related indicators to early predict the risk of diabetes, to enhance the accuracy of prediction of the risk of diabetes.

Long-Term Improvement in Cardiorespiratory Fitness Ameliorates Insulin Sensitivity beyond Changes in Visceral/Ectopic Fat among Men with Visceral Obesity.

The SYNERGIE study documented the effects on cardiometabolic risk (CMR) indices of a 1-year lifestyle intervention targeting physical activity (PA) and diet followed by a 2-year maintenance period in men with visceral obesity. Improvements in CMR markers and a decrease in low-attenuation muscle (LAM) area were observed after 1 year. Despite a rebound in visceral adipose tissue (VAT) during the maintenance period, insulin resistance (IR) improved. We tested the hypothesis that variations in cardiorespiratory fitness (CRF) and LAM could explain the long-term improvement in IR. A health (n = 88; mean age 49.0 ± 8.2 years) and fitness (n = 72) evaluation was performed at 0, 1, and 3 years. Participants were classified into two groups based on their CRF response over the maintenance period (worsening: CRF- vs. maintenance/improvement: CRF+). During the maintenance period, changes in the psoas and core LAM areas correlated with changes in IR (r = 0.27; p < 0.05 and r = 0.34; p < 0.005) and changes in CRF (r = -0.31; p < 0.01 and r = -0.30; p < 0.05). IR improved in the CRF+ group (p < 0.05) but remained stable in the CRF- group. Men in the CRF+ group regained half of the changes in VAT volume and LAM at the psoas and mid-thigh compared to the CRF- group (p < 0.05). These results support the importance of targeting VAT and CRF/PA for the long-term management of CMR in men with visceral obesity.

RELEVANCE OF THE OBESITY-RELATED ORGAN DAMAGE AND METABOLIC SYNDROME CLASSIFICATION IN CARDIOVASCULAR AND RENAL RISK STRATIFICATION IN PATIENTS WITH ESSENTIAL HYPERTENSION

Objective: Hypertension is relevant cardiovascular comorbidity. Adipose tissue represents a metabolically active tissue involved in the regulation of blood pressure and metabolic alterations. In recent decades several classifications for the Metabolic Syndrome (MS) have been proposed. Recently, a new syndrome called “Cardiovascular-kidney-metabolic” was identified, in order to identify patients at high cardiovascular and metabolic risk; the aim of the study was to compare different classifications in a large population of hypertensive patients. Design and method: Between September 2022 and August 2023, we have consecutively enrolled 772 hypertensive patients (407M; 365W; mean age 52.2±15.1yrs), evaluating anthropometrics, biochemical and instrumental parameters (transthoracic echocardiogram, carotid echo-Doppler, 24-h ambulatory blood pressure monitoring, fundus oculi). Results: Using different classifications we have found MS prevalence: ATP-III 28.8%, IDF 31.5%, CKM 40.7%. CKM Class 3 and 4 showed higher BMI and waist circumference with respect to other groups. Compared to ATP-III and IDF, CKM Class 4 showed higher 24-hrs systolic blood pressure, lower percentage of controlled hypertension, increased interventricular septum and posterior wall, reduced ejection fraction and greater prevalence of hypertensive arterial retinal damage. Conclusions: visceral obesity and MS are frequent conditions with healthy impact, becoming an important trigger for the development of cardiovascular and metabolic complications. The different MS classifications allow the early identification of patients at high risk of cardio-metabolic complications. The new CKM syndrome proves useful to identify individuals at high risk for CKM morbidity and mortality.

AORTIC STENOSIS AND HEART FAILURE: DIFFERENCES AND SIMILARITIES BEYOND PRESERVED EJECTION FRACTION

Objective: Degenerative aortic stenosis (AS) is highly prevalent in Western countries and shows a strong association with age and other cardiovascular risk factors such as arterial hypertension, diabetes mellitus, dyslipidaemia, and visceral obesity. The same risk factors are involved in the development of heart failure with preserved ejection fraction (HFpEF). Notwithstanding several similarities, patients with AS and preserved left ventricular ejection fraction (ASpEF) are not considered to actually have HFpEF. We sought to investigate the haemodynamic and metabolic features of patients with ASpEF both at rest and during physical effort and highlight similarities and differences with HFpEF. Design and method: We enrolled 148 patients with HFpEF, 150 with ASpEF (with at least moderate aortic transvalvular gradient), and 80 age- and sex-matched healthy controls. All patients received a comprehensive laboratory evaluation, a resting echocardiographic examination, and a combined cardiopulmonary-echocardiographic stress test. Patients with ASpEF who fulfilled the criteria for transcatheter aortic valve replacement (n=125) underwent cardiac computed tomography to measure aortic valve calcium score and volume. Results: Serum levels of N-terminal prohormone of brain natriuretic peptide were similar between HFpEF and ASpEF patients after excluding subjects with atrial fibrillation. As a marker of deregulated inflammation, epicardial adipose tissue (EAT) thickness was significantly greater in ASpEF than HFpEF and controls and was inversely related to peak oxygen consumption (VO2) in all subgroups (Figure). Furthermore, all patients showed a significant impairment in peak VO2 caused by a reduction in bith cardiac output (CO) and peripheral arteriovenous oxygen difference (AVO2diff). HFpEF patients displayed increased arterial stiffness, worse left ventricular-arterial coupling, and worse left atrial function. On the other hand, patients with ASpEF showed worse right ventricular-pulmonary arterial coupling. In ASpEF, disease severity, evaluated by aortic transvalvular peak velocity, mean gradient at rest and peak exercise, and aortic valve calcium score and volume, was directly related to EAT thickness. Conclusions: ASpEF shows substantial similarities to HFpEF. ASpEF could represent a separate phenotype in the spectrum of HFpEF; further and larger studies should investigate this hypothesis to give further insight into the pathophysiology of ASpEF.

BENEFICIAL ROLE OF DIETARY CHANGES IN MENOPAUSE: IMPACT ON CARDIOVASCULAR RISK

Objective: The changing hormonal milieu in post-menopausal women (PMW) predisposes them to increase cardiovascular (CV) risk, due to a constellation of risk factors, such as visceral obesity, atherogenic dyslipidemia and arterial hypertension. Our ongoing study aims to evaluate the impact of dietary changes in CV risk in PMW. Design and method: For 1 year, 65 PMW with BMI 24-39 Kg/m2 and at least another CV risk factor were followed. Anthropometric parameters, plicometry and blood pressure (BP) were taken. Questionnaires on medical history, physical activity, and food frequency (FFQ) were administered. Balanced low-calorie dietary plan with quantitative advice were released. Repeated measures ANOVA at 1 year were performed. Results: We observed at 1 year significant reductions (p&lt;0.01) in weight (δ=-4.5 Kg), BMI (δ=-1.7 Kg/m2), waist (δ=-4.3cm) and hips (δ=-3.1cm) circumferences, subscapular (δ=-5.8mm), suprailiac (δ=-3.3mm) and triceps (δ=-5.5mm) skinfolds, adipose area of the arm (AFA) (δ=-7.3cm2), and fat mass (δ=-4.5kg) without variation of the lean mass (δ=-0.1 kg, p=0.48). All those reductions were followed by change in the obesity prevalence (-21.1%), in the fat mass distribution with 10% reduction in abdominal and truncular obesity and 5.2% reduction on waist-to-height ratio, and in systolic (δ=-8.8 mmHg) and diastolic (δ=-4.3 mmHg) BP. Significant positive correlations (p&lt;0.0001) were observed between weight reduction and the following variables: waist (r=0.61) and hip (r=0.77) circumferences, subscapularis (r=0.56) and triceps (r=0.66) skinfolds, and AFA (r=0.73). Significant reductions (p&lt;0.05) were observed in daily caloric intake (δ=-99.8Kcal/day), due to the reduction in fat intake (36.6-&gt;33.6%), specially saturated fatty acids (12-&gt;10.8%) and cholesterol (δ=-23.1mg/day), with maintenance of the average level of physical activity and in agreement with a significant reductions in consumption of animal meats, visible fat, processed meats, olive oil, sweets and baked goods detected by FFQ. Conclusions: The study underlines the medium-term utility of a 1 year balanced low-calorie diet in PMW with elevated CV risk factors with a clear reduction in CV risk.

The aging of neutrophils is actively involved in the metabolic consequences of high fat diet

Aim: The epigenetic modifications induced by High Fat Diets (HFDs) in long-living hematopoietic cells have been well described, but whether they affect the “aging” of neutrophils, characterized by far shorter half-life, is less clear. Neutrophils "age" through a reciprocal regulation of CXCR4, promoting a "fresh" status when leaving the BM, and CXCR2, accelerating their aging in the circulation. We study whether derailed aging exacerbates the metabolic and inflammatory consequences of HFD. Methods: We immunophenotyped neutrophils and characterized the metabolic responses in physiology (wild-type mice, WT) and in mice with either constitutively aged neutrophils (MRP8 driven conditional deletion of CXCR4; herein CXCR4fl/flCre+) or with constitutively fresh neutrophils (MRP8 driven conditional deletion of CXCR2; CXCR2fl/flCre+), following 20 weeks of HFD feeding (45% Kcal from fat). Results: CXCR4fl/flCre+ mice display higher plasma triglycerides levels versus WT, despite comparable glucose levels, when monitored during standard feeding. This metabolic difference was exacerbated by feeding mice a HFD for 20 weeks. Indeed, despite a comparable gluco-metabolic profile between CXCR4fl/flCre+ and WT mice, liver damage was increased in CXCR4fl/flCre+, linked to the higher accumulation of CXCR4fl/flCre+ neutrophils in the liver after 20 weeks and two hours after intragastric gavage with olive oil versus fasting. As this finding was not observed after 20 weeks of standard fat diet, these results suggest that HFD feeding redirects aged neutrophil to the liver, resulting in enriched oxidative metabolism and NETosis- and inflammation-related pathways in the liver of CXCR4fl/flCre+ mice. Conversely, CXCR2fl/flCre+ mice were protected from obesity and insulin resistance, exhibiting a proresolutive phenotype. In humans, increased plasma levels of Cxcl1 (ligand of CXCR2) correlated with visceral obesity and metabolic syndrome. Conclusions: Neutrophil aging might contribute to the cardio-metabolic consequences of HFD. This aging could represent a new therapeutic target beyond the current anti-inflammatory therapies approved for the treatment of cardiovascular diseases.

Clinical Significance of the Lipid Profile Ratios and Triglyceride Glucose Index in the Diagnosis of Metabolic Syndrome.

Introduction: Metabolic syndrome (MetS) is a pathophysiological condition defined by a set of metabolic alterations such as hypertriglyceridemia, hyperglycemia, hypertension, low HDL-c levels, and visceral obesity. Its presence identifies people with an increased risk of developing cardiovascular diseases and type 2 diabetes; however, the lack of practical and reliable methods for its diagnosis limits the identification of people with this condition. In this sense, the objective of this study was to analyze the diagnostic utility of markers derived from the lipid profile [triglyceride-glucose (TyG) index and the ratios total cholesterol (TC)/high-density lipoprotein cholesterol (HDL-c), triglyceride (TG)/HDL-c, low-density lipoprotein cholesterol/HDL-c, fasting blood glucose (FBG)/HDL-c, and white blood cell/HDL-c] in the determination of MetS. Methods: A retrospective study was designed that included 619 individuals. A logistic regression model was used to evaluate the associations of the different markers with MetS, and the cutoff points of the markers were determined through an analysis of receiver operating characteristic curves and the Youden Index. Results: A positive and significant association was observed between all markers and the presence of MetS. The cutoff values for the markers that best predicted MetS were TyG ≥ 4.8 (sensitivity = 91.4%, specificity = 74.3%), TC/HDL-c ≥ 3.7 (sensitivity = 74.3%, specificity = 75.7%), TG/HDL-c ≥ 3.3 (sensitivity = 82.5%, specificity = 84.0%), and FBG/HDL-c ≥ 2.0 (sensitivity = 85.1%, specificity = 79.7%). Conclusion: Our study demonstrated the diagnostic relevance of the different markers in detecting MetS, suggesting that these ratios may be useful in clinical practice for the opportune and accurate diagnosis of MetS.

Mitochondrial dysfunction of the inner membrane of hepatocytes in the development of glutamate-induced steatohepatosis and its correction

Elucidation of the mechanisms of the development of liver steatosis, which are at the heart of the pathogenesis of nonalcoholic fatty liver disease (NAFLD), will allow the introduction of new effective treatment methods into medical practice, as well as the development of new measures for the correction of this disease and accompanying pathologies. The purpose of the research is to establish the enzymatic activity of the complexes of the electron transport chain of the mitochondrial membrane of rat hepatocytes and to evaluate the corrective effect of the multiprobiotic “Symbiter acidophilic” concentrated or nanocrystalline cerium dioxide on the formation of steatohepatosis induced by neonatal sodium glutamate administration. The experiments were carried out on 50 white non-linear male rats; the direction included the study of the mechanisms of the development of steatohepatosis in 4-month-old rats, which were administered monosodium glutamate in the neonatal period, and the study of the functional state of the liver in rats after the neonatal administration of monosodium glutamate against the background of periodic administration of a multiprobiotic or nanocrystalline dioxide cerium. It was established that neonatal administration of monosodium glutamate causes metabolic changes in 4-month-old rats, manifested in the disproportionate accumulation of fat with the development of visceral obesity without hyperphagia, dyslipidemia, and steatohepatosis. In 4-month-old rats, after neonatal administration of sodium glutamate, the development of steatohepatosis was accompanied by mitochondrial dysfunction, which was manifested by changes in the lipid composition of the inner membrane of hepatocyte mitochondria with an increase in oxidized products and a change in the enzymatic activity of all complexes of the respiratory chain. In rats injected with monosodium glutamate in the neonatal period, periodic use of the multiprobiotic “Symbiter acidophilic” concentrated or nanocrystalline cerium dioxide significantly restored the functional state of the liver, reduced the manifestations of oxidative stress and prevented the development of steatohepatosis, which indicates the antioxidant effect of these drugs and the possibility of their use for prevention of steatohepatosis.

Metabolic dysfunction-associated fatty liver disease/metabolic dysfunction-associated steatotic liver disease: general provisions

The literature review deals with the problem of metabolic dysfunction-associated fatty liver disease that is poorly studied in pediatric gastroenterology. Until recently, primary hepatic steatosis not associated with alcohol intake was defined as non-alcoholic fatty liver disease. Given the unity of the pathogenetic mechanisms underlying primary steatosis, associated steatohepatitis, liver fibrosis with metabolic disorders, such as visceral obesity, insulin resistance, meta-inflammation of adipose tissue, it was proposed to change the terminology. The authors present data on modern nomenclature definitions, etiological factors, prevalence, criteria of metabolic disorders and meta-inflammation associated with this nosology and specific to childhood. Metabolic dysfunction-associated fatty liver disease and nonalcoholic fatty liver disease are characterized by the development of hepatosteatosis. However, a distinguishing feature of metabolic dysfunction-associated fatty liver disease is the presence of metabolic disorders in a patient. It is believed that the use of the term “metabolic dysfunction-associated fatty liver disease” in clinical practice allows doctors to make a diagnosis more reliably and more accurately modify the patient’s lifestyle. Much attention is paid to the description of the heterogeneity of metabolic dysfunction-associated fatty liver disease in clinical practice, and a concise list of therapeutic options for metabolic dysfunction-associated fatty liver disease in childhood is presented.

Novel anthropometric indicators of visceral obesity predict the severity of hyperlipidemic acute pancreatitis

BackgroundObesity substantially contributes to the onset of acute pancreatitis (AP) and influences its progression to severe AP. Although body mass index (BMI) is a widely used anthropometric parameter, it fails to delineate the distribution pattern of adipose tissue. To circumvent this shortcoming, the predictive efficacies of novel anthropometric indicators of visceral obesity, such as lipid accumulation products (LAP), cardiometabolic index (CMI), body roundness index (BRI), visceral adiposity index (VAI), A Body Shape Index (ABSI), and Chinese visceral adiposity index (CVAI) were examined to assess the severity of AP.MethodThe body parameters and laboratory indices of 283 patients with hyperlipidemic acute pancreatitis (HLAP) were retrospectively analysed, and the six novel anthropometric indicators of visceral obesity were calculated. The severity of HLAP was determined using the revised Atlanta classification. The correlation between the six indicators and HLAP severity was evaluated, and the predictive efficacy of the indicators was assessed using area under the curve (AUC). The differences in diagnostic values of the six indicators were also compared using the DeLong test.ResultsPatients with moderate to severe AP had higher VAI, CMI, and LAP than patients with mild AP (all P < 0.001). The highest AUC in predicting HLAP severity was observed for VAI, with a value of 0.733 and 95% confidence interval of 0.678–0.784.ConclusionsThis study demonstrated significant correlations between HLAP severity and VAI, CMI, and LAP indicators. These indicators, particularly VAI, which displayed the highest predictive power, were instrumental in forecasting and evaluating the severity of HLAP.

Comparison of robotic versus laparoscopic surgery for visceral obesity in mid-low rectal cancer: a propensity-matched analysis.

Obesity is becoming more and more common, and measuring visceral fat area (VFA) is a useful diagnostic technique for visceral obesity (VO). The purpose of this research is to compare the surgical results of robotic versus laparoscopic rectal surgery, with a focus on assessing the benefits of the latter method for treating both VO and mid-low rectal cancer. Patients receiving laparoscopic or robotic anterior rectal excision at Northern Jiangsu People's Hospital's general surgery department were included in the retrospective analysis. 242 people in all took part in the study; 121 cases were assigned to the robotic surgery (RS) group and another 121 cases to the laparoscopic surgery (LS) group. In comparison to LS, our results show that RS led to a shorter period for the recovery of bowel function (p = 0.03), a shorter hospital stay (p < 0.001), a smaller intraoperative blood loss (p < 0.001), and a shorter time until the commencement of oral intake (p = 0.041). However, there were no statistically significant differences between the two groups in terms of the indices of histopathologic specimens, the proportion of temporary loop ileostomy, and the incidence of early postoperative problems (p > 0.05). When patients with VO undergo surgery for rectal cancer, RS has the added benefit of accelerating patient recovery while producing results that are similar to LS in the near run.

Visceral Adipose Tissue Reduction Measured by Deep Neural Network Architecture Improved Reflux Esophagitis Endoscopic Grade.

Visceral obesity is a risk factor for reflux esophagitis (RE). We investigated the risk of RE according to visceral adipose tissue (VAT) measured by deep neural network architecture using computed tomography (CT) and evaluated the longitudinal association between abdominal adipose tissue changes and the disease course of RE. Individuals receiving health checkups who underwent esophagogastroduodenoscopy (EGD) and abdominal CT at Seoul National University Healthcare System Gangnam Center between 2015 and 2016 were included. Visceral and subcutaneous adipose tissue areas and volumes were measured using a deep neural network architecture and CT. The association between the abdominal adipose tissue area and volume and the risk of RE was evaluated. Participants who underwent follow-up EGD and abdominal CT were selected; the effects of changes in abdominal adipose tissue area and volume on RE endoscopic grade were investigated using Cox proportional hazards regression. We enrolled 6,570 patients who underwent EGD and abdominal CT on the same day. RE was associated with male sex, hypertension, diabetes, excessive alcohol intake, current smoking status, and levels of physical activity. The VAT area and volume increased the risk of RE dose-dependently. A decreasing VAT volume was significantly associated with improvement in RE endoscopic grade (hazard ratio: 3.22, 95% confidence interval: 1.82-5.71). Changes in subcutaneous adipose tissue volume and the disease course of RE were not significantly correlated. Visceral obesity is strongly associated with RE. VAT volume reduction was prospectively associated with improvement in RE endoscopic grade dose-dependently. Visceral obesity is a potential target for RE treatment.

Dose-response association between Chinese visceral adiposity index and cardiovascular disease: a national prospective cohort study.

Chinese visceral adiposity index (CVAI) is a reliable visceral obesity index, but the association between CVAI and risk of cardiovascular disease (CVD) remains unclear. We explored the associations of CVAI with incident CVD, heart disease, and stroke and compared the predictive power of CVAI with other obesity indices based on a national cohort study. The present study included 7,439 participants aged ≥45 years from China Health and Retirement Longitudinal Study (CHARLS). Cox regression models were applied to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Restricted cubic splines analyses were adopted to model the dose-response associations. Receiver operator characteristic (ROC) analyses were used to compare the predictive ability of different obesity indices (CVAI, visceral adiposity index [VAI], a body shape index [ABSI], conicity index [CI], waist circumference [WC], and body mass index [BMI]). During 7 years' follow-up, 1,326 incident CVD, 1,032 incident heart disease, and 399 stroke cases were identified. The HRs (95% CI) of CVD, heart disease, and stroke were 1.50 (1.25-1.79), 1.29 (1.05-1.57), and 2.45 (1.74-3.45) for quartile 4 versus quartile 1 in CVAI. Linear associations of CVAI with CVD, heart disease, and stroke were observed (P nonlinear >0.05) and per-standard deviation (SD) increase was associated with 17% (HR 1.17, 1.10-1.24), 12% (1.12, 1.04-1.20), and 31% (1.31, 1.18-1.46) increased risk, respectively. Per-SD increase in CVAI conferred higher risk in participants aged<60 years than those aged ≥60 years (P interaction<0.05). ROC analyses showed that CVAI had higher predictive value than other obesity indices (P<0.05). CVAI was linearly associated with risk of CVD, heart disease, and stroke and had best performance for predicting incident CVD. Our findings indicate CVAI as a reliable and applicable obesity index to identify higher risk of CVD.

Anxiety-depressive disorders in patients with coronary artery disease with borderline coronary artery stenosis and visceral obesity

Aim. To assess the prevalence of anxiety-depressive disorders in pa­tients with coronary artery disease (CAD) with borderline coronary artery (CA) stenosis and visceral obesity.Material and methods. The study involved 201 patients with stable CAD with class I-III angina pectoris with borderline (50-70%) coronary stenosis. The first group consisted of patients with stable borderline CAD with increased epicardial fat thickness (EFT) — 57 (28,4%) people, the second group — patients without increased EFT — 144 (71,6%) people. Blood biochemical tests, levels of inflammatory markers (high-sensitivity C-reactive protein, interleukin (IL)-1, IL-6, IL-8, IL-10, tumor necrosis factor alpha, N-terminal pro-brain natriuretic peptide) were assessed. Cardiac ultrasound was used to determine EFT. All patients underwent coronary angiography. Levels of anxiety and depression were assessed using the Hospital Anxiety and Depression Scale (HADS).Results. The average EFT in group 1 was 6,00 [5,00; 6,50] mm, in group 2 — 3,00 [2,30; 4,00] mm (p&lt;0,001). In group 1 patients, hypertension (p&lt;0,001), coronary artery disease (p&lt;0,001) in general and myocardial infarction (p=0,003) in particular debuted at a younger age. The groups did not differ significantly in the incidence of obesity, type 2 diabetes, functional class of angina, or the intake rate of all 4 main drug groups. Patients with increased EFT were more likely to have elevated levels of N-terminal pro-brain natriuretic peptide (p=0,002), high-sensitivity C-reactive protein (p=0,027), as well as higher values (p=0,005) and a higher frequency of increasing (p&lt;0,001) the antiinflammatory cytokine IL-10. When analyzing the anxiety-depressive profile, the sum of depression scores and the incidence of subclinical depression were significantly (p&lt;0,001) higher in the group of patients with increased EFT.Conclusion. Patients with stable CAD with borderline coronary artery stenosis and increased EFT, which is a marker of visceral obesity, are characterized by an earlier age of manifestation of hypertension and coronary artery disease, the presence of a pro-inflammatory phenotype and a higher level of subclinical depression.

Age-specific association of physical activity on visceral obesity: Cross-sectional study

AimsObesity is a chronic disease that needs to be managed worldwide. High-intensity physical activity has a positive effect on the improvement and prevention of metabolic diseases. The purpose of this study was to investigate the age-specific association of physical activity on abdominal and visceral obesity. MethodsThe study involved 456 health check-up participants who underwent abdominal computed tomography scans for the assessment of visceral fat area from January 2017 to December 2017. Physical activity levels were categorized as none-to-low-intensity or moderate-to-vigorous-intensity based on the International Physical Activity Questionnaire. Logistic regression analysis, adjusted for covariates, assessed the association of physical activity with abdominal and visceral obesity across 10-year age intervals. ResultsThe moderate-to-vigorous physical activity group showed 56.5% visceral obesity, while the none-to-low-intensity physical activity group had 63.2%. Most age groups exhibited no significant differences in abdominal or visceral obesity according to physical activity. However, the 50 to 59 age group demonstrated a noteworthy association between visceral obesity and none-to-low-intensity physical activity (odds ratio 3.79, 95% confidence interval 1.12–12.84). ConclusionsThis study highlights a distinct age-related response to physical activity, emphasizing the 50 to 59 age group's significant association between visceral obesity and none-to-low-intensity physical activity.