Changes in mesenteric fat thickness and its clinical impact in bariatric surgery.

Obesity, especially central obesity is associated with increased risk of metabolic syndrome, non-alcoholic fatty liver disease (NAFLD) and type 2 diabetes mellitus. The study aimed to investigate the associations of the changes of abdominal fat thicknesses with changes of anthropometric indexes and improvements of metabolic phenotypes in patients with obesity and T2DM before and after bariatric surgery. Between April 2016 and January 2017, 34 adult patients with concurrent obesity and T2DM scheduled for different bariatric surgeries were prospectively evaluated by ultrasound before and 1-year after bariatric surgery to determine abdominal fat thicknesses (mesenteric fat, preperitoneal fat and subcutaneous fat) and NAFLD. At 1 year, of the 25 patients that finished the study, significant decrease in mesenteric-fat-thickness was associated with significant reduction of obesity, that is, BMI (-24%, p < .001), remission of metabolic syndrome (32%, p = .008), NAFLD (60%, p < .001) and T2DM (44%, p < .001). Lower baseline mesenteric fat thickness was associated with remission of metabolic syndrome. Lower baseline mesenteric-fat-thickness may have the potential to predict metabolic syndrome remission after bariatric surgery.

Sonographic Measurement of Mesenteric Fat Thickness Is a Better Predictor of Aortic Stiffness Compared With Conventional Obesity Indexes.

Increased aortic stiffness is closely associated with central obesity whereas mesenteric fat is the key adipose tissue in central obesity. We investigated the associations of mesenteric fat thickness with aortic stiffness, with comparison to conventional obesity measures. We used ultrasound to measure mesenteric, pre-peritoneal and subcutaneous fat thickness, carotid intima-media thickness (CIMT) and carotid-femoral pulse wave velocity (c-f PWV), an index of central aortic stiffness. Anthropometric indexes, blood pressure, fasting plasma glucose and lipid profile were measured. One hundred forty-seven healthy volunteers (age [mean ± standard deviation]: 43.2 ± 13.3 y; 41.5% men) were assessed. On univariate analysis, mesenteric, preperitoneal and subcutaneous fat thickness, body mass index (BMI), waist circumference (WC), waist/hip ratio (WHR) and waist/height ratio (WHtR) were associated with c-f PWV with or without adjustment for age. The mesenteric fat thickness had the highest correlation coefficient (r = 0.48, p < 0.001) with c-f PWV among all the investigated obesity indexes. Using multiple linear regression analysis, only mesenteric fat thickness remained to be an independent determinant of c-f PWV after adjustments for other abdominal fat thickness, anthropometric and metabolic indexes and CIMT. In conclusion, mesenteric fat thickness is an independent risk factor for aortic stiffness and has a stronger association with aortic stiffness compared with conventional obesity indexes.

Associations of Renal Augmented Velocity Index with Arterial Stiffness, Carotid Intima-Media Thickness and Blood Pressure, in Comparison with Renal Resistive Index.

The augmented velocity index (Avi) is a new Doppler index associated with arterial stiffness. We examined associations of renal Avi with blood pressure (BP), aortic stiffness and carotid intima-media thickness (IMT), and compared its performance with that of resistive index (RI). One hundred forty-seven volunteers were recruited. Renal Avi had significant positive correlations with systolic BP (r = 0.37, p < 0.001), diastolic BP (r = 0.2, p = 0.016), mean arterial pressure (r = 0.29, p < 0.001), pulse pressure (r = 0.31, p < 0.001), carotid-femoral pulse wave velocity (r = 0.49, p < 0.001) and carotid IMT (r = 0.23, p = 0.005). RI correlated positively with pulse pressure (r = 0.3, p < 0.001) only. After adjustments for co-variables, the associations remained similar. Patients with abnormal BP values (≥130/80 mm Hg), IMT and aortic stiffness (≥1 standard deviation of mean value) had higher Avi than those with normal values, but not RI. In conclusion, renal Avi had stronger associations with BP, arterial stiffness and carotid IMT than RI in apparently healthy volunteers, and was significantly increased in abnormal patients.

Intermediate phenotypes of childhood obstructive sleep apnea.

An intermediate phenotype of a disease is a trait in the path of pathogenesis from genetic predisposition to disease manifestation. Identifying intermediate phenotypes with high heritability is helpful in delineating the genetics of a disorder. In this study, we aimed to examine various traits with regards to obesity, cardiovascular risk and upper airway structure to identify potential intermediate phenotypes of childhood obstructive sleep apnea (OSA). Children aged between 6 and 18 years and their parents and siblings were recruited. All subjects underwent anthropometric measurements, cardiovascular risk assessment, sonographic measurement of lateral parapharyngeal wall (LPW) thickness, X-ray cephalometry and overnight polysomnography. A total of 34 phenotypes were examined. One hundred and one families consisting of 127 children (46 overweight) and 198 adults (84 overweight) were recruited. Heritability of obstructive apnea-hypopnea index (OAHI) was significant in overweight (h2  = 0.54) but not normal-weight individuals (h2  = 0.12). LPW thickness (h2  = 0.68) and resting blood pressure (h2  = 0.36 and 0.43 for systolic blood pressure [SBP] and diastolic blood pressure [DBP], respectively) were significantly heritable and associated with OAHI. Moreover, these traits were found to have shared genetic variance with OAHI in the overweight subgroup. Hyoid bone position also had significant heritability (h2  = 0.55) and association with OAHI but genetic correlation with OSA severity was not demonstrated. These findings suggest that LPW thickness and resting blood pressure are possible intermediate phenotypes of OSA independent of body mass index, especially in overweight patients. Identifying genes relevant to these phenotypes may help to elucidate the genetic susceptibility of OSA.

Progression of glucose intolerance and cardiometabolic risk factors over a decade in Chinese women with polycystic ovary syndrome: A case-control study.

BACKGROUND: Polycystic ovary syndrome (PCOS) is associated with increased metabolic risk, though data on long-term follow-up of cardiometabolic traits are limited. We postulated that Chinese women with PCOS would have higher risk of incident diabetes and cardiometabolic abnormalities than those without PCOS during long-term follow-up. METHODS AND FINDINGS: One hundred ninety-nine Chinese women with PCOS diagnosed by the Rotterdam criteria and with a mean age of 41.2 years (SD = 6.4) completed a follow-up evaluation after an average of 10.6 ± 1.3 years. Two hundred twenty-five women without PCOS (mean age: 54.1 ± 6.7 years) who underwent baseline and follow-up evaluation over the same period were used for comparison. Progression of glycaemic status of women both with and without PCOS was assessed by using 75-g oral glucose tolerance test (OGTT) screening with the adoption of 2009 American Diabetes Association diagnostic criteria. The frequency of impaired glucose regulation, hypertension, and hyperlipidaemia of women with PCOS at follow-up has increased from 31.7% (95% CI 25.2%-38.1%) to 47.2% (95% CI 40.3%-54.2%), 16.1% (95% CI 11.0%-21.2%) to 34.7% (95% CI 28.1%-41.3%), and 52.3% (95% CI 45.3%-59.2%) to 64.3% (95% CI 57.7%-71.0%), respectively. The cumulative incidence of diabetes mellitus (DM) in follow-up women with PCOS is 26.1% (95% CI 20.0%-32.2%), almost double that in the cohort of women without PCOS (p < 0.001). Age-standardised incidence of diabetes among women with PCOS was 22.12 per 1,000 person-years (95% CI 10.86-33.37) compared with the local female population incidence rate of 8.76 per 1,000 person-years (95% CI 8.72-8.80) and 10.09 per 1,000 person-years (95% CI 4.92-15.26, p < 0.001) for women without PCOS in our study. Incidence rate for women with PCOS aged 30-39 years was 20.56 per 1,000 person-years (95% CI 12.57-31.87), which is approximately 10-fold higher than that of the age-matched general female population in Hong Kong (1.88 per 1,000 person-years, [95% CI 1.85-1.92]). The incidence rate of type 2 DM (T2DM) of both normal-weight and overweight women with PCOS was around double that of corresponding control groups (normal weight: 8.96 [95% CI 3.92-17.72] versus 4.86 per 1,000 person-years [95% CI 2.13-9.62], p > 0.05; overweight/obese: 28.64 [95% CI 19.55-40.60] versus 14.1 per 1,000 person-years [95% CI 8.20-22.76], p < 0.05). Logistic regression analysis identified that baseline waist-to-hip ratio (odds ratio [OR] = 1.71 [95% CI 1.08-2.69], p < 0.05) and elevated triglyceride (OR = 6.63 [95% CI 1.23-35.69], p < 0.05) are associated with the progression to T2DM in PCOS. Limitations of this study include moderate sample size with limited number of incident diabetes during follow-up period and potential selection bias. CONCLUSIONS: High risk of diabetes and increased cardiovascular disease risk factors among Chinese women with PCOS are highlighted in this long-term follow-up study. Diabetes onset was, on average, 10 years earlier among women with PCOS than in women without PCOS.

Augmented Velocity Index: A New Doppler Index Associated with Arterial Stiffness.

Augmented Velocity Index (Avi) is a new Doppler index developed to quantify velocity changes at the late systolic peak. We examined its reliability, association with arterial stiffness and cardiovascular risk factors. The Avi is calculated as (late systolic peak velocity - early systolic peak velocity)/(highest peak systolic velocity - end-diastolic velocity). Fifty volunteers (mean age ± standard deviation: 43.5 ± 14.2 y, men: 52%) without known medical illnesses or drug use were recruited. Carotid Doppler waveforms with measurements of Avi were recorded. Carotid pressure waveforms were obtained by applanation tonometry for measurement of the Augmentation Index (AI). Clinical measurements including body mass index (BMI) and blood pressure (BP) were assessed, and fasting blood was taken for measurement of glycemia and lipid profile. Another 15 volunteers (age range: 22-60 y, men: 33.3%) were recruited to study the reliability of Avi measurement. The results revealed that carotid Avi closely correlated with the index of arterial stiffness, AI (r = 0.76, p < 0.001) on Pearson correlation. On multiple linear regression analysis, Avi remained a significant independent determinant of AI after adjustments for clinical variables. The Avi had significant associations with cardiovascular risk factors (age, BMI, total cholesterol, low-density lipoprotein cholesterol, systolic and diastolic BP). The intra-class correlation coefficients for inter-observer and intra-observer reliability of Avi measurements were 0.93 (95% confidence interval [CI]: 0.8-0.98) and 0.97 (95% CI: 0.92-0.99) respectively. In conclusion, the Avi is a reproducible new Doppler index, independently associated with arterial stiffness in terms of the AI, which initially correlated with cardiovascular risk factors.

Potential Anatomic Markers of Obstructive Sleep Apnea in Prepubertal Children.

STUDY OBJECTIVES: Adenotonsillar hypertrophy is the major cause of obstructive sleep apnea (OSA) in prepubertal children, but children without enlarged lymphoid tissues may still suffer from OSA. This study aimed to identify other potential anatomic features associated with childhood OSA. METHODS: This prospective study took place between January 2010 and April 2014. Prepubertal children suspected to have OSA, aged 6 to 11 years, were recruited. They underwent anthropometric measurements, nocturnal polysomnography, tonsil size evaluation, x-ray cephalometry, and sonographic measurement of lateral parapharyngeal wall (LPW) thickness. Linear regression analyses were used to test for the association between anatomic measurements and OSA severity. Logistic regression analyses were used to identify potential anatomic markers for different cutoffs (obstructive apneahypopnea index (OAHI) ≥ 1 and ≥ 5 events/h) for OSA. RESULTS: Forty-seven children with OSA (20 with moderate to severe disease) and 43 children for the control group were recruited. Sonographic measurement of LPW thickness and position of hyoid bone taken from x-ray cephalometry were risk factors associated with OSA. Linear regression analyses found that these two phenotypes were associated with OAHI. Multivariate models adjusted for age, sex, body mass index, z score, and tonsil size revealed that lower position of hyoid bone was independently associated with higher risk for OSA, whereas both lower position of hyoid bone and greater LPW thickness were associated with higher OAHI and also a higher risk for moderate to severe OSA. CONCLUSIONS: Position of hyoid bone and LPW thickness are anatomical markers of childhood OSA independent of obesity and tonsil size. Screening tools may include cephalometry and sonographic measurement of LPW to allow better delineation of OSA risk.

Mesenteric fat thickness is associated with metabolic syndrome independently of Apnoea-Hypopnoea Index in subjects with obstructive sleep apnoea.

BACKGROUND AND OBJECTIVE: Mesenteric fat thickness (MFT) was associated with metabolic syndrome (MetS) and obstructive sleep apnoea (OSA) in separate studies. This study aimed to assess whether the association of MFT with MetS was independent of OSA in subjects with suspected OSA. METHODS: Two hundred forty-two subjects (men: 181; women: 61) with suspected OSA underwent ultrasound examinations for measurements of mesenteric, subcutaneous and preperitoneal fat thicknesses after overnight polysomnography. Anthropometric measurements and metabolic risk profile were assessed. RESULTS: Two hundred twenty-one (91%) subjects were confirmed to have OSA with Apnoea-Hypopnoea Index (AHI) >5/h. MFT had significant correlation (P < 0.01) with AHI and most MetS components. In partial correlation with adjustment for AHI, MFT had significant correlation (P < 0.01) with most MetS components including fasting plasma glucose (r = 0.25), triglycerides (r = 0.24), HDL cholesterol (r = -0.29) and waist circumference (r = 0.56). In multivariate logistic regression with adjustments for the confounding variables including AHI, MFT was the only variable independently associated with MetS, with the odds ratio of 5.48 (95% CI: 1.5-20.0) for every 1 cm increase of MFT. When the subjects were subdivided into obese (BMI ≥ 27.5 kg/m(2) ) and non-obese (BMI < 27.5 kg/m(2) ) groups, the positive association of MFT with MetS persisted in the non-obese group only, with the odds ratio of 22 (95% CI 2.8-174.1) for every 1 cm increase of MFT. The AHI had significant association with MetS in male subjects only. CONCLUSION: MFT, rather than AHI, is the major independent determinant of MetS in subjects with suspected OSA, particularly in non-obese subjects. See Editorial, page 408.

Mesenteric fat thickness is associated with increased risk of obstructive sleep apnoea.

BACKGROUND AND OBJECTIVE: Mesenteric fat is a type of intraperitoneal adipose tissue draining into portal circulation. The objective of this study was to investigate the relationships between mesenteric fat thickness and obstructive sleep apnoea (OSA) in patients with suspected OSA. METHODS: One hundred forty-nine subjects (men: 114; women: 35) with suspected OSA underwent ultrasound examinations of mesenteric, preperitoneal and subcutaneous fat thickness after overnight polysomnography. Body mass index (BMI) and neck circumference were recorded. RESULTS: The subjects with OSA (n = 130, apnoea/hypopnoea index (AHI) >5/h) had greater neck circumference, higher BMI, and greater mesenteric and preperitoneal fat thickness than those without OSA (n = 19, AHI ≤ 5/h). There was positive correlation of AHI with mesenteric (r = 0.43, P < 0.001) and preperitoneal fat thickness (r = 0.3, P < 0.001), whereas no significant association was observed between AHI and subcutaneous fat thickness (r = 0.09, P = 0.27). On multivariate logistic regression, after adjustments for gender, age, BMI, neck circumference, and preperitoneal and subcutaneous fat thickness, the mesenteric fat thickness had a positive association with the presence of moderate OSA and severe OSA, with odds ratios of 7.18 and 7.45 for every 1 cm increase in mesenteric fat thickness when AHI was defined as ≥15/h and AHI ≥ 30/h, respectively. CONCLUSIONS: Mesenteric fat thickness is associated with increased risk of OSA, independent of other abdominal fat thickness, BMI and neck circumference. Sonographic measurement is potentially a useful tool for further evaluating the complex association of visceral fat, metabolic syndrome and OSA.

Intrarenal arterial resistance is associated with microvascular complications in Chinese type 2 diabetic patients.

BACKGROUND: Increased renal arterial resistance is associated with various types of chronic renal parenchymal diseases. A resistance index (RI) > 0.8 predicts deterioration in renal function in diabetic subjects. However, the association between renal RI and other diabetic complications has not been investigated. In this study, we examined the association between intrarenal arterial RI and diabetic complications in Chinese type 2 diabetic subjects. METHODS: Three hundred and eighty-seven Chinese type 2 diabetic patients were recruited from a structured assessment programme to evaluate their risk factors and complications as a part of the quality improvement programme at the Prince of Wales Hospital. All subjects underwent ultrasound examinations for the assessment of intrarenal arterial RI of both kidneys. Clinical and biochemical parameters, including diabetes-related microvascular complications (nephropathy, retinopathy and sensory neuropathy) and macrovascular diseases, were examined. RESULTS: The mean RI of patients with any microvascular complications (0.70 ± 0.09 versus 0.65 ± 0.06) such as nephropathy (0.71 ± 0.09 versus 0.66 ± 0.06), retinopathy (0.71 ± 0.08 versus 0.67 ± 0.08) and sensory neuropathy (0.75 ± 0.07 versus 0.68 ± 0.08) and with any macrovascular complications (0.71 ± 0.09 versus 0.68 ± 0.08) was higher than those without (P < 0.05). On multivariate analysis, after controlling for confounding variables, an RI ≥0.75 was associated with microvascular complications, nephropathy, retinopathy and sensory neuropathy, with odds ratio of 4.02 [95% confidence interval (CI) 1.72-9.4], 4.99 (2.61-9.56), 2.78 (1.52-5.09) and 5.74 (1.8-18.3), respectively. The association of RI with macrovascular complications was not significant in multivariate analysis. CONCLUSION: Increased intrarenal arterial resistance was independently associated with an increased risk of microvascular complications including diabetic nephropathy, diabetic retinopathy and diabetic sensory neuropathy in Chinese type 2 diabetic patients.

US assessment of medial arterial calcification: a sensitive marker of diabetes-related microvascular and macrovascular complications.

PURPOSE: To examine the sensitivity of ultrasonography (US) compared with conventional radiography in detection of lower limb (thigh) medial arterial calcification (MAC) in type 2 diabetic patients and evaluate its association with diabetes-related complications. MATERIALS AND METHODS: The study was approved by the local research ethics committee, and informed written consent was obtained. US was performed in 289 patients with type 2 diabetes mellitus, and MAC severity was assigned a score from 0 to 8. Among the patients, 263 underwent radiographic examinations. All subjects underwent clinical evaluation to detect the presence of diabetes-related complications. RESULTS: US helped detect MAC in more subjects compared with radiography (65.8% vs 12.2%). US helped detect MAC from mild (scores 1-4) to severe (scores 5-8) degrees, while mild degree of MAC was poorly demonstrated with radiography. The incidence of nephropathy, retinopathy, sensory neuropathy, and macrovascular complications increased with the severity of MAC (based on US scoring). With univariate analysis, the presence of MAC was associated with nephropathy (P<.001), retinopathy (P<.001), sensory neuropathy (P=.004), and macrovascular complications (P<.001). After adjustment for potential confounders, the presence of severe MAC was associated with nephropathy, retinopathy, and macrovascular complications, with the odds ratios of 3.4 (95% confidence interval [CI]: 1.53, 7.43; P=.003), 2.6 (95% CI: 1.22, 5.32; P=.013), and 3.8 (95% CI: 1.37, 10.6; P=.01), respectively. CONCLUSION: In type 2 diabetic Chinese patients, US was more sensitive than conventional radiography in the detection of MAC, particularly when the MAC was mild. The presence of severe MAC was associated with diabetic nephropathy, retinopathy, and macrovascular complications. US detection of MAC was a potential early marker to identify diabetes-related complications.

Associations of intra-renal arterial resistance index with chronic kidney disease and carotid intima-media thickness in type 2 diabetes mellitus.

Renal dysfunction can be evaluated by increased intra-renal arterial resistance index (RI). We evaluated 113 Chinese men with type 2 diabetes on their RI. Results suggest that RI is associated with chronic kidney disease and subclinical arteriosclerosis. RI may help monitoring the deterioration of intra-renal hemodynamics.

Cutoff values for central obesity in Chinese based on mesenteric fat thickness.

AIMS: Sonographic measurement of mesenteric fat thickness (MFT) is a novel, accurate and simple tool to evaluate regional distribution of obesity. We used MFT to determine the optimal waist circumference (WC) values and associated risk factors for cardiovascular disease (CVD). METHODS: 282 healthy Chinese (age 41.8+/-7.4 years, BMI 23.8+/-3.3 kg/m(2)) was assessed. High MFT was defined as mean+1 SD of the cohort. We compared the CVD risks including fatty liver amongst subjects with normal waist, central pre-obesity and central obesity. RESULTS: WC of 84.6 cm in men and 75.7 cm in women were the optimal cutoff values to predict high MFT with ROC analysis. Using WC cutoff values > or =85-90 cm and > or =90 cm to define central pre-obesity and obesity in men (> or =75-80 cm and > or =80 cm in women), both central obesity and pre-obesity had higher MFT and CVD risk than those with normal waist. The frequencies of fatty liver in these 3 categories were 15.9%, 56.7% and 96.7% in men and 6.9%. 17.9% and 63.2% in women (p<0.001 for trend). CONCLUSION: In addition to central obesity, "central pre-obesity" identifies subjects who harbor high CVD risks, fatty liver and excess visceral fat.

Sonographic measurement of lateral parapharyngeal wall thickness in patients with obstructive sleep apnea.

INTRODUCTION: Lateral parapharyngeal wall (LPW) thickness may be a predominant anatomic factor causing airway narrowing in apneic subjects. In this study, we explored sonographic measurement of the LPW thickness and compared the results with LPW thickness measured by magnetic resonance imaging (MRI). We also investigated the association between sonographic measurement of LPW thickness and apnea-hypopnea index (AHI). METHOD: Seventy-six patients with suspected obstructive sleep apnea (OSA) underwent ultrasound examination of LPW thickness after overnight polysomnography. Fifteen out of 76 subjects also participated in correlation and reliability studies of sonographic and MRI measurements of LPW thickness. RESULTS: There was good correlation between measurements of LPW thickness on ultrasound and MRI (r = 0.78, P = 0.001), although Bland-Altman analysis indicated overestimation of LPW thickness by ultrasound, when compared with the LPW as measured by MRI. The sonographic measurement of LPW thickness had high reproducibility, with intraclass correlation coefficients of 0.90 and 0.97 for intraoperator and interoperator reliability, respectively. Fifty-eight subjects with significant OSA (AHI > or = 10/h) had a higher body mass index, larger neck circumference, and greater LPW thickness measured by ultrasound than those (n = 18) with an AHI of less than 10 per hour. LPW thickness had a positive correlation with AHI on univariate analysis (r = 0.37, P = 0.001). On multivariate analysis, LPW thickness had a positive independent association with AHI after adjustment for age, sex, neck circumference, and body mass index. The positive association of LPW thickness with AHI remained significant in both univariate and multivariate analyses of men only (n = 62). CONCLUSIONS: Sonographic measurement of LPW thickness is a novel and reliable technique and had good correlations with measurement by MRI and the severity of OSA. Ultrasound may provide an alternative imaging modality with easy accessibility and lower cost in OSA research.

Mesenteric fat thickness is an independent determinant of metabolic syndrome and identifies subjects with increased carotid intima-media thickness.

OBJECTIVE: Mesenteric fat, a reflection of visceral adiposity, may play an important role in the pathogenesis of metabolic syndrome and cardiovascular diseases (CVD). In this study, we examined the independent relationship between mesenteric fat thickness and metabolic syndrome and defined its optimal cutoff value to identify high-risk subjects for metabolic syndrome and CVD. RESEARCH DESIGN AND METHODS: A total of 290 Chinese subjects had an ultrasound examination for measurements of thickness of mesenteric, preperitoneal, and subcutaneous fat as well as carotid intima-media thickness (IMT). Anthropometric measurements and metabolic risk profile were assessed by physical examination and blood taking. RESULTS: Twenty (6.9%) subjects had metabolic syndrome according to the National Cholesterol Education Panel Adult Treatment Panel III criteria with Asian definitions for central obesity (waist circumference >80 cm in women and >90 cm in men). Mesenteric fat thickness had significant correlations (P < 0.05) with various metabolic variables. On multivariate regression, mesenteric fat thickness was an independent determinant of all components of metabolic syndrome after adjustment for age, sex, homeostasis model assessment of insulin resistance, and other fat deposits. The odds ratio of metabolic syndrome was increased by 1.35 (95% CI 1.10-1.66)-fold for every 1-mm increase in mesenteric fat thickness. On receiver-operating characteristic curve analysis, mesenteric fat thickness of > or =10 mm was the optimal cutoff value to identify metabolic syndrome, with sensitivity of 70% and specificity of 75%. Subjects with mesenteric fat thickness > or =10 mm had higher carotid IMT than those with thickness <10 mm (0.73 +/- 0.19 vs. 0.64 +/- 0.16 mm, P = 0.001). CONCLUSIONS: Mesenteric fat thickness was an independent determinant of metabolic syndrome and identified subjects with increased carotid IMT.