Visceral-to-subcutaneous Fat Ratio Research Articles

Impact of preoperative subcutaneous adipose, visceral adipose and skeletal muscle on the outcomes of the oldest-old colorectal cancer patients after surgery

BackgroundColorectal cancer (CRC) is one of the most common tumors worldwide, with rising numbers of elderly patients affected. Nutritional status significantly influences tumor prognosis. We aimed to investigate the association of subcutaneous and visceral adipose tissue and skeletal muscle mass with the prognosis of the oldest-old patients with CRC, after surgery. PatientsWe retrospectively reviewed 210 patients >75 years who underwent surgical treatment at the Department of Gastrointestinal Surgery, Beijing Hospital, between December 2010 and December 2020. MaterialsSubcutaneous adipose, visceral adipose, and skeletal muscle areas were measured using BMI_CT. The cut-off values of the CT measurements were then confirmed using receiver operating characteristic (ROC) curve analysis. ResultsSubcutaneous adipose tissue index (SATI), visceral adipose tissue index (VATI), and total adipose tissue index (TATI) were significantly associated with sex and BMI. Notably, the oldest-old CRC patients with high SATI, VATI, and TATI scores exhibited significantly higher rates of wound complications and reduced postoperative hospitalization durations. Intriguingly, patients with high VATI and TATI demonstrated significantly better 5-year Overall survival (OS), Cancer-specific survival (CSS), and Disease-free survival (DFS) than patients in the other groups. Similar results were observed in patients with a high visceral-to-subcutaneous fat ratio (VSR) and skeletal muscle index (SMI) scores. ConclusionSignificantly improving skeletal muscle content while concurrently managing the total adipose content, especially visceral adipose tissue, may aid in extending the survival time of oldest-old patients with CRC after surgery.

Parameters of body composition do not predict survival in patients with multiple myeloma undergoing autologous stem cell transplantation

Studies regarding the influence of body composition parameters as predictors on overall survival (OS) in patients with multiple myeloma (MM) are scarce. OS and progression-free survival (PFS) were retrospectively assessed in 129 patients with MM undergoing autologous stem cell transplantation (ASCT) after a follow-up of 2 years. A computed tomography (CT) based semi-automated assessment of body composition was performed. No statistically significant differences were noted in 2-year OS, PFS, or post-transplant adverse events in the body composition groups of subcutaneous adipose tissue (SAT) (low vs. high-SAT), visceral adipose tissue (VAT) (low vs. high-VAT), visceral-to-subcutaneous fat ratio (VSR) (low vs. high VSR), and sarcopenia in terms of skeletal muscle index (SMI) (non-sarcopenic vs. sarcopenic). In conclusion, adipose and muscle tissue do not limit OS or affect the PFS in patients with MM undergoing ASCT.

Comparing fully automated AI body composition measures derived from thin and thick slice CT image data.

To compare fully automated artificial intelligence body composition measures derived from thin (1.25mm) and thick (5mm) slice abdominal CT data. In this retrospective study, fully automated CT-based body composition algorithms for quantifying bone attenuation, muscle attenuation, muscle area, liver attenuation, liver volume, spleen volume, visceral-to-subcutaneous fat ratio (VSR) and aortic calcium were applied to both thin (1.25 × 0.625mm) and thick (5 × 3mm) abdominal CT series from two patient cohorts: unenhanced scans in asymptomatic adults undergoing colorectal cancer screening, and post-contrast scans in patients with colorectal cancer. Body composition measures derived from thin and thick slice data were compared, including correlation coefficients and Bland-Altman analysis. A total of 9882 CT scans (mean age, 57.0years; 4527 women, 5355 men) were evaluated, including 8947 non-contrast and 935 contrast-enhanced CT exams. Very strong positive correlation was observed for all soft tissue measures: muscle attenuation (r2 = 0.97), muscle area (r2 = 0.98), liver attenuation (r2 = 0.99), liver volume (r2 = 0.98) and spleen volume (r2 = 0.99), VSR (r2 = 0.98), and aortic calcium (r2 = 0.92); (p < 0.001 for all). Moderate positive correlation was observed for bone attenuation (r2 = 0.35). Bland-Altman analysis showed strong agreement for muscle attenuation, muscle area, liver attenuation, liver volume and spleen volume. Mean percentage differences amongst body composition measures were less than 5% for VSR (4.6%), muscle area (-0.5%), liver attenuation (0.4%) and liver volume (2.7%) and less than 10% for muscle attenuation (-5.5%) and spleen volume (5.1%). For aortic calcium, thick slice overestimated for Agatston scores between 0 and 100 and > 400 burden in 3.1% and 0.3% relative to thin slice, respectively, but underestimated scores between 100 and 400. Automated body composition measures derived from thin and thick abdominal CT data are strongly correlated and show agreement, particularly for soft tissue applications, making it feasible to use either series for these CT-based body composition algorithms.

Effects of the abdominal fat distribution on the relationship between exposure to air pollutants and thyroid hormones among Korean adult males

BackgroundSeveral significant associations between air pollution and thyroid function have been reported, but few studies have identified whether these associations differ by obesity, particularly its regional distribution. We assessed the relationship between ambient air pollution and thyroid hormone, and whether this relationship is modified by abdominal adiposity, as indicated by the waist circumference, visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), and visceral-to-subcutaneous fat ratio (VSR) in Korean men.MethodsWe included 2440 male adults in the final analysis and used each person’s annual average exposure to four air pollutants: particulate matter with an aerodynamic diameter ≤ 10 μm (PM10), nitrogen dioxide, sulfur dioxide (SO2), and carbon monoxide (CO). Abdominal fat deposition was quantified by computed tomography. Serum thyrotropin (TSH) and free thyroxine (FT4) concentrations were measured for thyroid hormone. To evaluate the relationship between air pollution and thyroid hormone according to adiposity, we performed multiple linear regression analysis on the two subgroups stratified by abdominal fat level.ResultsAbdominal adiposity was significantly related to FT4 concentration. The exposures to air pollutants were associated with increased TSH and decreased FT4 concentrations. In stratified analysis using abdominal fat traits, ambient air pollution except for SO2 was significantly related to increased TSH and decreased FT4 concentrations in the high adiposity group (all p < 0.05), but not in the normal adiposity group. Among the air pollutants, PM10 showed an association with an increase of TSH concentration in all group with high adiposity, including high VAT, high SAT, and high VSR groups (all p < 0.05). In case of FT4, CO showed a similar pattern. Among the abdominal fat-related traits, the VSR in the high adiposity group had the largest effect on the relationship between exposure to air pollutants and thyroid hormone.ConclusionsThis study suggests the first clue that the relationship between air pollution exposure and thyroid hormone differs according to abdominal fat distribution among Korean adult males.

Association of Visceral Fat Obesity, Sarcopenia, and Myosteatosis with Non-Alcoholic Fatty Liver Disease without Obesity.

To investigate whether non-alcoholic fatty liver disease (NAFLD) in individuals without generalized obesity is associated with visceral fat obesity (VFO), sarcopenia, and/or myosteatosis. This cross-sectional analysis included 14,400 individuals (7,470 men) who underwent abdominal computed tomography scans during routine health examinations. The total abdominal muscle area (TAMA) and skeletal muscle area (SMA) at the 3rd lumbar vertebral level were measured. The SMA was divided into the normal attenuation muscle area (NAMA) and low attenuation muscle area, and the NAMA/TAMA index was calculated. VFO was defined by visceral to subcutaneous fat ratio, sarcopenia by body mass index-adjusted SMA, and myosteatosis by the NAMA/TAMA index. NAFLD was diagnosed with ultrasonography. Of the 14,400 individuals, 4,748 (33.0%) had NAFLD, and the prevalence of NAFLD among non-obese individuals was 21.4%. In regression analysis, both sarcopenia (men: odds ratio [OR] 1.41, 95% confidence interval [CI] 1.19-1.67, P<0.001; women: OR=1.59, 95% CI 1.40-1.90, P<0.001) and myosteatosis (men: OR=1.24, 95% CI 1.02-1.50, P=0,028; women: OR=1.23, 95% CI 1.04-1.46, P=0.017) were significantly associated with non-obese NAFLD after considering for VFO and other various risk factors, whereas VFO (men: OR=3.97, 95% CI 3.43-4.59 [adjusted for sarcopenia], OR 3.98, 95% CI 3.44-4.60 [adjusted for myosteatosis]; women: OR=5.42, 95% CI 4.53-6.42 [adjusted for sarcopenia], OR=5.33, 95% CI 4.51-6.31 [adjusted for myosteatosis]; all P<0.001) was strongly associated with non-obese NAFLD after adjustment with various known risk factors. In addition to VFO, sarcopenia and/or myosteatosis were significantly associated with non-obese NAFLD.

Body Composition of Patients Undergoing Radical Cystectomy for Bladder Cancer: Sarcopenia, Low Psoas Muscle Index, and Myosteatosis Are Independent Risk Factors for Mortality

We assessed a wide array of body composition parameters to identify those most relevant as prognostic tools for patients undergoing radical cystectomy (RC) due to bladder cancer (BC). In this retrospective, single-center study, preoperative computed tomography (CT) scans of 657 patients were measured at the level of the 3rd lumbar vertebra (L3) to determine common body composition indices including sarcopenia, myosteatosis, psoas muscle index (PMI), subcutaneous and visceral fat index (SFI and VFI), visceral-to-subcutaneous fat ratio (VSR), and visceral obesity. Predictors of overall survival (OS) and cancer-specific survival (CSS) were identified in univariate and multivariate survival analysis. Sarcopenia and a low PMI were independently associated with shorter OS (Sarcopenia: HR 1.30; 95% CI 1.02-1.66; p = 0.04 and a low PMI: HR 1.32; 95% CI 1.02-1.70; p = 0.03) and CSS (Sarcopenia: HR 1.64; 95% CI 1.19-2.25; p < 0.01 and a low PMI: HR 1.41; 95% CI 1.02-1.96; p = 0.04). Myosteatosis, measured as decreasing average Hounsfield units of skeletal muscle, was an independent risk factor for OS (HR 0.98; 95% CI 0.97-1.00; p = 0.01) and CSS (HR 0.98; 95% CI 0.96-1.00; p < 0.05). The assessed adipose tissue indices were not significant predictors for OS and CSS. Sarcopenia, a low PMI, and myosteatosis are independent predictors for OS and CSS in patients undergoing radical cystectomy for bladder cancer.

High Visceral-To-Subcutaneous Fat Ratio Is Associated with an Increased Risk of Gastroesophageal Reflux Disease in Nonobese Adults

Introduction: Abdominal obesity increases the risk of gastroesophageal reflux disease (GERD). This study aimed to determine the association between GERD and abdominal fat area quantified by computed tomography (CT). Methods: We analyzed the effect of abdominal fat area on gastroesophageal reflux symptoms and erosive esophagitis using logistic regression models in 5,338 participants who underwent abdominal fat measurement CT and screening esophagogastroduodenoscopy. Results: Participants with reflux symptoms and erosive esophagitis were diagnosed in 1,168 (21.9%) and 671 (12.5%), respectively. Multivariate analysis showed that subcutaneous and visceral fat areas were significantly associated with reflux symptoms and erosive esophagitis. The adjusted odds ratio (OR) in the fourth quartile of visceral fat area compared with that in the lowest quartile was 1.98 (95% confidence interval (CI) 1.63–2.39) for reflux symptoms and 2.33 (95% CI 1.80–3.01) for erosive esophagitis. Visceral fat area had a stronger effect in the younger age-group. In the group <50 years, the adjusted OR in fourth quartile of visceral fat area was 2.70 (95% CI 1.86–3.94) for reflux symptoms and 3.59 (95% CI 2.22–5.80) for erosive esophagitis. High visceral-to-subcutaneous fat ratio (VSR) increased the risk of reflux symptoms and erosive esophagitis in participants with body mass index <25 kg/m² and normal waist circumference. Conclusion: Subcutaneous and visceral fat areas were associated with an increased risk of reflux symptoms and erosive esophagitis. High VSR increased the risk of reflux symptoms and erosive esophagitis in participants with normal body weight and waist circumference.

Body Composition as a Biomarker for Disease Recurrence in Patients with Triple Negative Breast Cancer

<h3>Purpose/Objective(s)</h3> Obesity is associated with a higher risk of hormone receptor-positive breast cancer, disease stage, grade, and poor disease outcome. The effect of obesity in triple negative breast cancer (TNBC), as well as its effect on patients undergoing radiation, is less well studied. Body Mass Index (BMI) is used as a crude measure for obesity but does not reliably detect patients with high visceral fat which is associated with inflammation and angiogenesis that drives the development and progression of cancer. The purpose of this study was to evaluate the feasibility of using semi-automated measures of visceral-to-subcutaneous fat ratio (VSR) for risk stratification in TNBC patients undergoing radiation. <h3>Materials/Methods</h3> This retrospective analysis included 56 women who received radiation for stage II-III TNBC. Patients included in this study were followed for at least 5 years or until disease progression (DP). Baseline characteristics including age, clinical stage, T-stage, grade, and BMI were collected. Waist circumference and VSR were obtained using a semi-automatic freely available segmentation software tool with demonstrated reproducibility. Computed Tomography (CT) images at the level of lumbar spine L2-L3 were used for this analysis because prior studies have shown that measures performed at this level have the least intra-patient variability. BMI, waist circumference, and VSR were assessed in both patients with and without DP. <h3>Results</h3> Of the 56 patients, 34 presented with stage II disease. Mean age was 51 ± 13 years. Mean follow-up after radiation was 88 ± 53 months. Mean time from CT scan to radiation was 12 ± 142 days. BMI, waist circumference, or VSR was not significantly different between clinical stage, T-stage, or grade. Of the 56 patients, 25 had DP, and 14 of these patients initially presented with clinical stage III disease. In patients with DP, BMI was similar (31.9 ± 8.0 kg/ m² vs. 31.1 ± 7.0 kg/ m²) while there was an increasing trend in VSR (64.4 ± 39.6% vs. 51.5 ± 22.5%). Waist circumference was lower in patients with DP (100.9 ± 17.3 cm vs. 107.8 ± 21.9 cm). <h3>Conclusion</h3> With this work, we demonstrated the feasibility of using a semi-automated software tool to evaluate body fat compartments. In this small cohort of TNBC patients, we established a trend toward higher VSR in patients with DP, and our data suggest that VSR has more discriminatory power to risk stratify patients with TNBC than BMI. Waist circumference, on the other hand, seems less reliable as it contradicts prior studies utilizing BMI as a risk stratifier. Corroborating our findings in a larger cohort of patients is of importance as it may have implications for trials investigating lifestyle modifications in TNBC patients, or for trials evaluating adaptive radiation based upon risk stratification. Our future efforts will focus on accruing more patients to further establish the relationship between body fat compartments, inflammation, and disease progression.

Visceral obesity as a risk factor of incisional hernia after single-port laparoscopic gynecologic surgery

ObjectiveWe aimed to evaluate associations between abdominal fat distribution (AFD) parameters and incisional hernia (IH) in patients who underwent transumbilical single-port laparoscopic surgery (SPLS) for gynecological disease. MethodsMedical records of 2116 patients who underwent SPLS for gynecological disease at Daejeon St. Mary's Hospital between March 2014 and February 2021 were reviewed. Among 21 (1.0%) patients who developed IH requiring surgical treatment after SPLS, 18 had preoperative abdominopelvic computed tomography (CT) images. As a control group, we randomly selected 72 patients who did not develop IH and who had undergone preoperative abdominopelvic CT scan, matched to test patients by type of surgery. Total fat area (TFA), visceral fat area (VFA), subcutaneous fat area (SFA), visceral-to-subcutaneous fat ratio (VSR), and waist circumference (WC) were measured at the level of the third lumbar vertebral body on the preoperative abdominopelvic CT images, using National Institutes of Health (NIH) ImageJ version 1.53 k. ResultsReceiver operating curve analysis showed that VFA has the highest predictive value for IH among AFD parameters (AUC = 0.749, 95% CI 0.630–0.869, p < 0.001). Univariate analysis showed that age, BMI, hypertension, dyslipidemia, TFA, VFA, VSR and WC were significant factors for IH. In multivariate analysis, only high VFA was identified as an independent risk factor for IH (HR 6.18, 95% CI 1.13–33.87, p = 0.04), whereas BMI, TFA, SFA, VSR, and WC failed to show statistical significance. ConclusionWe could find high VFA as an independent risk factor of IH in patients who underwent SPLS for gynecologic disease.

Myosteatosis is associated with toxicity and recurrence free survival in women with serous endometrial cancer (475)

Myosteatosis is associated with toxicity and recurrence free survival in women with serous endometrial cancer (475)

Sex Differences of Visceral Fat Area and Visceral-to-Subcutaneous Fat Ratio for the Risk of Incident Type 2 Diabetes Mellitus.

BackgroundThis study aimed to determine the optimal cut-off values of visceral fat area (VFA) and visceral-to-subcutaneous fat ratio (VSR) for predicting incident type 2 diabetes mellitus (T2DM).MethodsA total of 10,882 individuals (6,835 men; 4,047 women) free of T2DM at baseline aged between 30 and 79 years who underwent abdominal computed tomography scan between 2012 and 2013 as a part of routine health check-ups were included and followed. VFA, subcutaneous fat area, and VSR on L3 vertebral level were measured at baseline.ResultsDuring a median follow-up of 4.8 years, 730 (8.1% for men; 4.3% for women) incident cases of T2DM were identified. Receiver operating characteristic curve analysis showed that the optimal cut-off values of VFA and VSR for predicting incident T2DM were 130.03 cm2 and 1.08 in men, respectively, and 85.7 cm2 and 0.48 in women, respectively. Regardless of sex, higher VFA and VSR were significantly associated with a higher risk of incident T2DM. Compared with the lowest quartiles of VFA and VSR, the highest quartiles had adjusted odds ratios of 2.62 (95% confidence interval [CI], 1.73 to 3.97) and 1.55 (95% CI, 1.14 to 2.11) in men, respectively, and 32.49 (95% CI, 7.42 to 142.02) and 11.07 (95% CI, 3.89 to 31.50) in women, respectively.ConclusionHigher VFA and VSR at baseline were independent risk factors for the development of T2DM. Sex-specific reference values for visceral fat obesity (VFA ≥130 cm2 or VSR ≥1.0 in men; VFA ≥85 cm2 or VSR ≥0.5 in women) are proposed for the prediction of incident T2DM.

The role of muscle depletion and visceral adiposity in HCC patients aged 65 and over undergoing TACE

BackgroundThe incidence of hepatocellular carcinoma (HCC) has been increasing among the elderly populations. Trans-arterial chemoembolization (TACE), a widely used first-line non-curative therapy for HCCs is an issue in geriatrics. We investigated the prognosis of elderly HCC patients treated with TACE and determined the factors that affect the overall survival.MethodsWe included 266 patients who were older than 65 years and had received TACE as initial treatment for HCC. We analyzed the skeletal muscle index (SMI) and visceral-to-subcutaneous fat ratio (VSR) around the third lumbar vertebrae using computed tomography scans. Muscle depletion with visceral adiposity (MDVA) was defined by falling below the median SMI and above the median VSR value sex-specifically. We evaluated the overall survival in association with MDVA and other clinical factors.ResultsThe mean age was 69.9 ± 4.5 years, and 70.3% of the patients were men. According to the Barcelona Clinic Liver Cancer (BCLC) staging system, 29, 136, and 101 patients were classified as BCLC 0, A, and B stages, respectively, and 79 (29.7%) had MDVA. During the median follow-up of 4.1 years, patients with MDVA had a shorter life expectancy than those without MDVA (P = 0.007) even though MDVA group had a higher objective response rate after the first TACE (82.3% vs. 75.9%, P = 0.035). Multivariate analysis revealed that MDVA (Hazard ratio [HR] 1.515) age (HR 1.057), liver function (HR 1.078), tumor size (HR 1.083), serum albumin level (HR 0.523), platelet count (HR 0.996), tumor stage (stage A, HR 1.711; stage B, HR 2.003), and treatment response after the first TACE treatment (HR 0.680) were associated with overall survival.ConclusionsMDVA is a critical prognostic factor for predicting survival in the elderly patients with HCC who have undergone TACE.

Visceral-to-Subcutaneous Fat Ratio Is a Potential Predictor of Postoperative Complications in Colorectal Cancer.

BackgroundColorectal cancer (CRC) is one of the most common malignant tumors. Surgery is the primary treatment for CRC. Recent studies have shown that visceral-to-subcutaneous fat ratio (VSR) may be a potential indicator of risk. The aim of the present study was to determine whether VSR is a suitable predictor of the impact of postoperative complications in CRC.Material/MethodsClinical data from 129 patients were analyzed retrospectively. All patients underwent laparoscopic surgery for CRC. Preoperative imaging was used to quantify VSR. The primary outcome was 30-day postoperative complications. Multivariate logistic regression was used to determine the association between obesity indexes and postoperative complications.ResultsThere were 129 patients who underwent primary resections of colorectal cancer. At 30 days after surgery, postoperative complications had occurred in 33 (25.6%) patients. VSR was significantly associated with postoperative complications in multivariate analysis (P=0.032, OR 6.103, 95% CI 1.173–31.748). In ROC analysis, VSR was a potential predictor of complications (AUC 0.650). A cutoff value of VSR ≥0.707 was associated with 60% sensitivity and 29% specificity for postoperative complications. Patients with VSR ≥0.707 had 41.7% risk of morbidity, whereas those with <0.707 had 16.0% risk (P=0.001).ConclusionsOur study shows that VSR is superior to VFA for prediction of the risk of complications following CRC laparoscopic surgery. We have also identified the optimal cutoff values for the use of VSR for this purpose. Measurement of VSR and identifying patients with increased risk of postoperative complications facilitate making perioperative decisions.

Effect of abdominal fat distribution on severity of acute pancreatitis.

Aim of the studyObesity is a well-determined risk factor for acute pancreatitis. Increased visceral fat has been shown to increase the proinflammatory environment experienced by patients. In this study, we aimed to research the correlation between abdominal fat distribution parameters measured with computed tomography (CT) and severity of acute pancreatitis (AP).Material and methodsThe study included patients monitored due to AP in the internal medicine clinic of GOP Education and Research Hospital from January 2015 to December 2018. The Acute Physiology and Chronic Health Evaluation (APACHE) score, the Imrie score and the Bedside Index of Severity in Acute Pancreatitis (BISAP) scores were calculated. Advanced image processing analysis software (INFINIT Xelis, v 1.0.6.3) was used to calculate individual abdominal fat distribution parameters from CT screening with division of abdominal tissues. Measurements were performed from –50 to –250 Hounsfield units (HU) between vertebrae L2-L3.ResultsWhen mild and moderate AP groups were compared, there were statistically significant differences in duration of hospital stay and scoring (APACHE, Imrie and BISAP) (p < 0.001), while there were no significant differences in abdominal fat distribution parameters (p > 0.05). There was no significant correlation of visceral and subcutaneous fat volumes with development of systemic complications, while a significant correlation was identified for visceral to total fat tissue area ratio (VTR) with local complications (p < 0.001). Pearson correlation analysis found no correlations of mortality and pancreatitis severity with visceral (VFA) and subcutaneous fat area (SFA) (p > 0.05). Positive correlations were identified for VFA with Imrie, BISAP and APACHE scores (p < 0.01), and positive correlations were identified for visceral adipose tissue (VAT) with visceral to subcutaneous fat ratio (VSR) and APACHE scores (r = 0.256 and 0.252, respectively, p < 0.001). Positive correlations were identified for VTR and VSR ratios with BISAP scores (r = 0.266 and r = 0.277, respectively, p < 0.001).ConclusionsIn patients with AP diagnosis and abdominal CT scans, increased VFA and VTR ratio were found to be associated with increased AP clinical scores with no significant correlation identified in terms of local/systemic complication development. Our study shows that VFA is linked to AP clinical scoring systems and should be included in AP predictive scoring systems.

Impact of progressive resistance training on CT quantified muscle and adipose tissue compartments in pancreatic cancer patients.

Loss of body weight is often seen in pancreatic cancer and also predicts poor prognosis. Thus, maintaining muscle mass is an essential treatment goal. The primary aim was to investigate whether progressive resistance training impacts muscle and adipose tissue compartments. Furthermore, the effect of body composition on overall survival (OS) was investigated. In the randomized SUPPORT-study, 65 patients were assigned to 6-month resistance training (2x/week) or a usual care control group. As secondary endpoint, muscle strength of the upper and lower extremities was assessed before and after the intervention period. Routine CT scans were assessed on lumbar L3/4 level for quantification of total-fat-area, visceral-fat-area, subcutaneous-fat-area, intramuscular-fat-area, visceral-to-subcutaneous fat ratio (VFR), muscle-area (MA), muscle-density and skeletal-muscle-index (SMI). OS data were retrieved. Of 65 patients, 53 had suitable CT scans at baseline and 28 completed the intervention period with suitable CT scans. There were no significant effects observed of resistance training on body composition (p>0.05; effect sizes ω2p <0.02). Significant moderate to high correlations were found between MA and muscle strength parameters (r = 0.57-0.85; p<0.001). High VFR at baseline was a predictor of poor OS (VFR≥1.3 vs. <1.3; median OS 14.6 vs. 45.3 months; p = 0.012). Loss of muscle mass was also a predictor of poor OS (loss vs. gain of SMI; median OS 24.6 vs. 50.8 months; p = 0.049). There is anabolic potential in patients with resectable pancreatic cancer. A progressive resistance training may help patients to maintain their muscle mass and avoid muscle depletion. CT-quantified muscle mass at the level of L3/4 showed a good correlation to muscle strength. Therefore, maintaining muscle mass and muscle strength through structured resistance training could help patients to maintain their physical functioning. A high VFR at baseline and a high loss of muscle mass are predictors of poor OS. Registered on ClinicalTrials.gov (NCT01977066).

Interaction between visceral adiposity and ambient air pollution on LDL cholesterol level in Korean adults.

Although previous reports have found that obesity intensifies the negative impact of long-term air pollution exposure on the low-density lipoprotein-cholesterol (LDL-C) level, few studies have examined whether the type of abdominal adiposity, such as visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT), and the visceral-to-subcutaneous fat ratio (VSR) affects this relationship. We investigated the association between ambient air pollution and LDL-C in Korean adults and identified whether this association is different by the type of abdominal adiposity. A total of 2737 adults were included. Abdominal fat areas were quantified by computed tomography, and the annual average concentration of air pollutants was included in this analysis. In the total sample, none of the air pollutants was associated with LDL-C level in either the crude or adjusted model (all p > 0.05). The association was not significant even in subgroups stratified according to the obesity status defined by body mass index, and no interaction on the LDL-C level was also found (all pint > 0.05). In the subgroup analysis stratified according to adiposity level, particulate matter with an aerodynamic diameter of ≤10 μm (PM10) [β (SE) = 3.58 (1.59); p = 0.0245] and sulfur dioxide (SO2) exposures [β (SE) = 2.71 (1.27); p = 0.0330] in the high-VAT group were associated with the increased LDL-C level. Interactions on LDL-C level were also found between VAT level and ambient air pollutants such as PM10 and SO2 (both pint < 0.05). In the analysis of the VSR, PM10 exposure showed a significant interaction on LDL level (pint = 0.0032). However, the strength of these associations was not significant across all SAT subgroup (all pint > 0.05). In conclusion, we found that association between air pollution exposure and LDL-C level is different by abdominal fat distribution.

Influence of body composition, muscle strength, and physical performance on the postoperative complications and survival after radical gastrectomy for gastric cancer: A comprehensive analysis from a large-scale prospective study

Few studies have comprehensively analyzed the correlations among body composition parameters, muscle strength, and physical performance, as well as the influence of these factors on the postoperative complications and survival after radical gastrectomy for gastric cancer. A prospective study was conducted including patients who underwent radical gastrectomy for gastric cancer from August 2014 to June 2019. Skeletal muscle index (SMI), skeletal muscle density (SMD), visceral fat area (VFA), subcutaneous fat area (SFA) was obtained by measurement of preoperative computed tomography (CT) images. Grip strength and 6-m gait speed were measured to assess muscle strength and physical performance before surgery. There was a positive correlation between SMI and SMD, as well as between SFA and VFA. SMD negatively correlated with SFA and VFA. SMI had a positive correlation with VFA, but showed minimal correlation with SFA and visceral to subcutaneous fat ratio (VSR). Grip strength and gait speed were both positively correlated with SMI and SMD, but showed minimal correlation with SFA, VFA and VSR. SMI and grip strength independently predicted postoperative complications, rather than SMD or gait speed. Whereas SMD and gait speed had independent predictive value for overall survival (OS) and/or disease-free survival (DFS), rather than SMI or grip strength. VSR independently predicted postoperative complications, rather than VFA or SFA alone. Low SFA was an independent risk factor for OS and DFS. High VFA was associated with worse survival in overweight patients (body mass index, BMI ≥25), but was associated with better survival in non-overweight patients (BMI <25). High SFA did not significantly influence survival in overweight patients, but was associated with better survival in non-overweight patients. There is an extensive and complex correlation among body composition parameters, grip strength, and gait speed in patients with operable gastric cancer. A comprehensive analysis of these parameters has significant predictive value for postoperative complications and survival.

Associations between visceral obesity and renal impairment in health checkup participants: a retrospective cohort study.

Obesity is a risk factor for chronic kidney disease. Although body mass index (BMI) or waist circumference is indicators of obesity, actual measurements of visceral fat area (VFA) more accurately reflect the amount of visceral fat. We aimed to determine the most sensitive obesity indicator for predicting renal impairment among VFA, BMI, waist circumference, waist-to-height ratio, and visceral-to-subcutaneous fat ratio (VSR). Subjects who underwent VFA measurements during health checkups in 2012 were included. Obesity was defined using a separate baseline value for each indicator [VFA (100cm2), BMI (25kg/m2), waist circumference (85cm for men and 90cm for women), waist-to-height ratio (0.5), VSR (0.4)]. Changes in estimated glomerular filtration rate (eGFRcr) and time to new-onset proteinuria were measured. The relationships between obesity indicators and eGFRcr were evaluated using a linear mixed-effects model. The relationships between obesity indicators and new-onset proteinuria were evaluated using Poisson regression analysis. Analysis was performed on 2753 subjects (mean age 50.3years). The VFA ≥ 100cm2 group exhibited a larger annual difference in eGFRcr compared to the < 100cm2 group (- 0.24mL/min/1.73m2, P = 0.03). There was a statistically significant difference in the proteinuria incidence rate ratio, which was 1.54 times (95% confidence interval 1.01-2.35) in the VFA ≥ 100cm2 group. Statistically significant correlations were not observed with any of the other obesity indicators. VFA is suggested to be the most sensitive obesity indicator for decline in kidney function and new-onset proteinuria.

Comparison of Computed Tomography-based Abdominal Adiposity Indexes as Predictors of Non-alcoholic Fatty Liver Disease Among Middle-aged Korean Men and Women

Objectives:We compared the associations of 3 computed tomography (CT)-based abdominal adiposity indexes with non-alcoholic fatty liver disease (NAFLD) among middle-aged Korean men and women.Methods:The participants were 1366 men and 2480 women community-dwellers aged 30-64 years. Three abdominal adiposity indexes—visceral fat area (VFA), subcutaneous fat area (SFA), and visceral-to-subcutaneous fat ratio (VSR)—were calculated from abdominal CT scans. NAFLD was determined by calculating the Liver Fat Score from comorbidities and blood tests. An NAFLD prediction model that included waist circumference (WC) as a measure of abdominal adiposity was designated as the base model, to which VFA, SFA, and VSR were added in turn. The area under the receiver operating characteristic curve (AUC), integrated discrimination improvement (IDI), and net reclassification improvement (NRI) were calculated to quantify the additional predictive value of VFA, SFA, and VSR relative to WC.Results:VFA and VSR were positively associated with NAFLD in both genders. SFA was not significantly associated with NAFLD in men, but it was negatively associated in women. When VFA, SFA, and VSR were added to the WC-based NAFLD prediction model, the AUC improved by 0.013 (p<0.001), 0.001 (p=0.434), and 0.009 (p=0.007) in men and by 0.044 (p<0.001), 0.017 (p<0.001), and 0.046 (p<0.001) in women, respectively. The IDI and NRI were increased the most by VFA in men and VSR in women.Conclusions:Using CT-based abdominal adiposity indexes in addition to WC may improve the detection of NAFLD. The best predictive indicators were VFA in men and VSR in women.

Depot-specific UCP1 expression in human white adipose tissue and its association with obesity-related markers.

This study investigated depot-specific mRNA expression of uncoupling protein 1 (UCP1) in human white adipose tissue (WAT) and its association with obesity-related markers. We recruited 39 normal-weight, 41 nondiabetic obese, and 22 diabetic obese women. We measured UCP1 mRNA expression in abdominal visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT), and investigated the associations between UCP1 mRNA expression in VAT and SAT, and obesity-related markers including mRNA expression of leptin, adiponectin, CCAAT-enhancer-binding protein homologous protein (CHOP), and positive regulatory domain-containing protein 16 (PRDM16). We also evaluated UCP1 mRNA expression in differentiated human white adipocytes after treatment with various stressors and metabolic improvement agents in vitro. UCP1 mRNA in VAT was significantly higher than in SAT in all groups. UCP1 mRNA in SAT was negatively correlated with BMI, total abdominal fat area, visceral fat area, blood pressure, fasting glucose, insulin, HOMA-IR score, triglyceride, hsCRP, fasting leptin levels, and adipocyte size. UCP1 mRNA in SAT was positively correlated with fasting adiponectin levels. UCP1 mRNA in VAT was negatively correlated with visceral-to-subcutaneous fat ratio (VSR), fasting glucose, and triglyceride levels. In SAT, UCP1 mRNA was negatively correlated with mRNA expression of leptin and CHOP, and positively correlated with mRNA expression of adiponectin. The expression of PRDM16 was positively correlated with UCP1 mRNA in both VAT and SAT. UCP1 mRNA expression in differentiated human white adipocytes was significantly reduced after incubation with thapsigargin, tunicamycin, homocysteine, TNF-α, or IL-β, and significantly increased after incubation with exendin 4, dapagliflozin, and telmisartan. This study demonstrated depot-specific mRNA expression of UCP1 and its association with obesity-related markers in human WAT. UCP1 mRNA in human white adipocytes was suppressed by inflammatory agents and enhanced by metabolic improvement agents. UCP1 in human WAT might participate in the pathogenesis of obesity-related metabolic diseases.