Risk assessment for pancreatic fistula by intraoperative image analysis of laparoscopic and robotic gastrectomy.

BACKGROUND: Pancreatic fistula (PF) is one of the most serious postoperative complications of gastrectomy. Misidentification of the boundary between the pancreas and the dissected fat is a primary concern. In this study, we focused on differences in the appearance of the pancreas and the dissected fat in actual surgical images and statistically analyzed the relationship between the pancreas and the dissected fat. METHODS: We analyzed data from 109 gastric cancer patients who underwent curative gastrectomy between November 2018 and March 2023. Intraoperative images were taken from videos of lymph node dissections of Nos.6 and 8a regions, and the mean gray value of the areas was measured using ImageJ software for analysis. The visceral fat area (VFA) was evaluated by preoperative axial CT at the umbilical level using Ziostation software. RESULTS: A significant correlation was observed between the fat/pancreas gray value ratio in the No.8a lymph node region and the drain/serum amylase ratio (P < 0.001). The fat/pancreas gray value ratio in the No.6 lymph node region correlated with VFA (P < 0.001). The VFA and drain/serum amylase ratio were significantly higher in the group with intra-abdominal complications (P = 0.004). CONCLUSIONS: We revealed significant relationships between the fat/pancreas gray value ratio with drain/serum amylase and VFA. Detecting differences in gray values between the pancreas and the dissected fat may lead to a decrease in the drain/serum amylase ratio and PF.

Towards visceral fat estimation at population scale: correlation of visceral adipose tissue assessment using three-dimensional cross-sectional imaging with BIA, DXA, and single-slice CT.

Background: In terms of assessing obesity-associated risk, quantification of visceral adipose tissue (VAT) has become increasingly important in risk assessment for cardiovascular and metabolic diseases. However, differences exist in the accuracy of various modalities, with a lack of up-to-date comparison with three-dimensional whole volume assessment. Aims: Using CT or MRI three-dimensional whole volume VAT as a reference, we evaluated the correlation of various commonly used modalities and techniques namely body impedance analysis (BIA), dual-energy x-ray absorptiometry (DXA) as well as single slice CT to establish how these methods compare. Methods: We designed the study in two parts. First, we performed an intra-individual comparison of the 4558 participants from the UK Biobank cohorts with matching data of MRI abdominal body composition, DXA with VAT estimation, and BIA. Second, we evaluated 174 CT scans from the publicly available dataset to assess the correlation of the commonly used single-slice technique compared to three-dimensional VAT volume. Results: Across the UK Biobank cohort, the DXA-derived VAT measurement correlated better (R2 0.94, p<0.0001) than BIA (R2 0.49, p<0.0001) with reference three-dimensional volume on MRI. However, DXA-derived VAT correlation was worse for participants with a BMI of < 20 (R2 = 0.62, p=0.0013). A commonly used single slice method on CT demonstrated a modest correlation (R2 between 0.51 - 0.64), with best values at L3- and L4 (R2 L3 = 0.63, p<0.0001; L4 = 0.64, p<0.0001) compared to reference three-dimensional volume. Combining multiple slices yielded a better correlation, with a strong correlation when L2-L3 levels were combined (R2 = 0.92, p<0.0001). Conclusion: When deployed at scale, DXA-derived VAT volume measurement shows excellent correlation with three-dimensional volume on MRI based on the UK Biobank cohort. Whereas a single slice CT technique demonstrated moderate correlation with three-dimensional volume on CT, with a stronger correlation achieved when multiple levels were combined.

Visceral Adipose Tissue Assessment Enhances the Prognostic Value of GLIM Criteria in Patients with Gastric Cancer Undergoing Radical Gastrectomy after Neoadjuvant Treatment.

BACKGROUND: The Global Leadership Initiative on Malnutrition (GLIM) criteria has been recently published for diagnosing malnutrition in adults. However, the validity of the GLIM criteria has not been well-established in patients with gastric cancer (GC) treated with neoadjuvant treatment (NT) followed by radical gastrectomy. The present study aimed to explore the prognostic value of GLIM-defined malnutrition before NT and after NT in GC patients and to investigate whether additional visceral adipose tissue (VAT) assessment could improve the predictive power of the GLIM criteria for NT-related adverse events (AEs) and long-term survival. METHODS: GC patients who underwent radical surgery after NT from June 2016 to June 2020 were enrolled in this study. The cross-sectional areas of total skeletal muscle (TSM) and VAT were measured using computed tomography (CT) before NT and after NT. GLIM-defined malnutrition was diagnosed using the two-step approach, including nutritional risk screening and diagnostic assessment. Low VAT was also added to the diagnosis of malnutrition in this study. The predictive value of these malnutrition diagnoses for NT-related AEs, and long-term survival was evaluated in GC patients. RESULTS: A total of 182 GC patients were included in this study, of which 66 (36.3%) patients before NT and 55 (30.2%) patients after NT were diagnosed with GLIM-defined malnutrition, respectively. In addition to GLIM-defined malnutrition, 54 (29.7%) patients had additional low VAT before NT, and 39 (21.4%) patients had additional low VAT after NT. GLIM-defined malnutrition alone before NT was not associated with NT-related AEs in GC patients. The addition of low VAT to GLIM-defined malnutrition led to a significant predictive value for NT-related AEs. Furthermore, GLIM-defined malnutrition before NT and after NT were both identified as independent risk factors for overall survival (OS) and disease-free survival (DFS). The combination of low VAT and GLIM-defined malnutrition showed a higher hazard ratio for the prediction of OS and DFS both before NT and after NT. CONCLUSIONS: The addition of VAT assessment using CT improved the predictive value of GLIM-defined malnutrition for NT-related AEs and long-term survival in GC patients treated with NT followed by radical gastrectomy, which further supports the prognostic importance of assessing adipose tissue simultaneously during the routine nutritional assessment in patients with cancer.

Assessment of Visceral Fat Volume and Its Correlation with the Severity of Hepatic Fibrosis in Patients with NAFLD.

INTRODUCTION: Nonalcoholic fatty liver disease (NAFLD) is one of the leading causes of chronic liver disease. The spectrum of NAFLD includes simple steatosis, nonalcoholic steatohepatitis (NASH), advanced fibrosis, and cirrhosis. Our study aimed to calculate visceral fat volume at the L3-L4 vertebral level and its association with hepatic fibrosis assessed by transient elastography. METHODS: All patients above 18 years undergoing computed tomography (CT) abdomen in the Department of Radiodiagnosis of Medical College Thiruvananthapuram during the study period with NAFLD were included. Transient elastography was done. Patients were categorized to advanced fibrosis (>10 kPa) and without advanced fibrosis (<10 kPa). The area under the receiver operating characteristic (AUROC) curve was plotted. RESULTS: Sixty-four patients comprised 36 males and 28 females. Thirty-one (46%) were having advanced fibrosis (transient elastography>10 kPa) and 34 (54%) patients were without advanced fibrosis. About 0.733 was the AUROC for visceral fat in predicting advanced fibrosis. The cutoff was 167.5cm3 (sensitivity was 77.4% and specificity was 51.5% in predicting advanced fibrosis). CONCLUSION: About 0.733 was the AUROC for visceral fat in predicting advanced fibrosis. The cutoff was 167.5cm3 (sensitivity was 77.4% and specificity was 51.5% in predicting advanced fibrosis).

Subcutaneous and visceral fat assessment by DXA and MRI in older adults and children.

OBJECTIVE: Given the importance of body fat distribution in chronic disease development, feasible methods to assess body fat are essential. This study compared dual-energy x-ray absorptiometry (DXA) in measuring visceral and subcutaneous adipose tissue (VAT and SAT) with magnetic resonance imaging (MRI). METHODS: VAT and SAT were assessed using similar DXA and MRI protocols among 1,795 elderly participants of the Adiposity Phenotype Study (APS) and 309 children/adolescents in Shape Up! Kids (SKids). Spearman correlations, Bland-Altman plots, and coefficients of determination (R2 ) assessed agreement between DXA and MRI measures. RESULTS: DXA overestimated SAT values in APS (315 vs. 229 cm2 ) and SKids (212 vs. 161 cm2 ), whereas DXA underestimated VAT measures (141 vs. 167 cm2 ) in adults only. The correlations between DXA and MRI values were stronger for SAT than VAT (APS: r = 0.92 vs. 0.88; SKids: 0.90 vs. 0.74). Bland-Altman plots confirmed better agreement for SAT than VAT despite differences by sex, ethnicity, and weight status with respective R2 values for SAT and VAT of 0.88 and 0.84 (APS) and 0.81 and 0.69 (SKids). CONCLUSION: These findings indicate that SAT by DXA reflects MRI measures in children and older adults, whereas agreement for VAT is weaker for individuals with low VAT levels.

Comparison between DXA and MRI for the Visceral Fat Assessment in Athletes.

The use of dual-energy X-ray absorptiometry (DXA) may be invalid for assessing athletes with larger bodies, larger lean body mass, and thicker trunks. This study compared the athletes' visceral adipose tissue (VAT) assessed using DXA and magnetic resonance imaging (MRI). Eighty-two Japanese male collegiate athletes from 18 sports participated in this study. VAT was assessed using the dual-energy scan that coincided with the 4th lumbar vertebra. The sum of eight magnetic resonance slices corresponding to the region of the dual-energy scan was used for comparison. The VAT volume was higher with the dual-energy scan than with MRI (difference: 35 cm3, p<0.01). A significant correlation was noted between the volumes measured using both modalities (r=0.88, p<0.01). Magnetic resonance-derived volumes less than 600 cm3 showed a stronger significant correlation with dual-energy-derived volumes. However, magnetic resonance-derived VAT volumes exceeding 600 cm3 were not significantly correlated with dual-energy-derived volumes. In conclusion, VAT volumes derived from DXA were larger and significantly correlated with those derived from MRI across a wide range of values. Methods using DXA for assessing the visceral fat volume may require adjustment to estimate abdominal visceral fat volume in athletes, with care taken when using such methods for heavyweight athletes.

Skeletal muscle radiodensity and visceral adipose tissue index are associated with survival in renal cell cancer - A multicenter population-based cohort study.

INTRODUCTION: Body composition has been associated with disease outcome in several cancer types. Results for localized and metastatic renal cell cancer (RCC) are limited and inconsistent. Our aim was to examine the association between body composition and survival in RCC. METHODS: We conducted a population-based historical cohort study including patients diagnosed with RCC from 2008 to 2012. Diagnostic Computed Tomography images at the third lumbar vertebra (L3) were assessed for skeletal muscle index (SMI), skeletal muscle density (SMD), visceral adipose tissue index (VATI) and subcutaneous adipose tissue index (SATI). Clinical data was retrieved from medical records. Multivariable Cox regressions with restricted cubic splines were used to determine hazard ratios (HRs) and 95% confidence intervals (95%CIs) for 10-unit increases in body composition features with overall survival (OS) and recurrence-free survival (RFS). RESULTS: We included 719 stage I-III (of whom 254 (35.3%) died and 148 (21.9%) experienced recurrence) and 320 stage IV RCC patients (of whom 298 (93.1%) died). Median follow-up was 6.35 years (interquartile range; 1.41-8.23). For stage I-III, higher SMD was associated with better OS (men: HR 0.86; 95% CI 0.68-1.08; women: HR 0.69; 95% CI 0.50-0.95). Lower compared to median VATI was associated with worse OS for both men (HR 1.38; 95%CI 1.05-1.83 for VATI = 25) and women (HR 1.67; 95%CI 1.01-2.78 for VATI = 20). For stage IV, higher SMD and higher VATI were associated with better OS among men (HR 0.74; 95% CI 0.59-0.94 and HR 0.93; 95% CI 0.88-0.99, respectively). Results for women were similar but non-significant. No statistically significant associations were found for SMI or SATI. CONCLUSION: Higher SMD and higher VATI were marginally associated with better survival in RCC patients and might be useful for better prognostication. However, the added value to current prognostic scores needs to be investigated.

Image-based assessment of sarcopenic obesity predicts mortality in major trauma.

BACKGROUND: Patients with obesity are also at risk for sarcopenia, which is difficult to recognize in this population. Our study examines whether sarcopenic-obesity (SO) is independently associated with mortality in trauma. METHODS: Using a retrospective database, we performed logistic regression analysis. . Admission CT scans were used to identify SO by calculating the visceral fat to skeletal muscle ratio >3.2. RESULTS: Of 883 patients, the prevalence of SO was 38% (333). Patients with SO were more likely to be male (79% versus 43%, p < 0.001), older (mean 66.5 years versus 46.3 years, p < 0.001), and less likely to have an injury severity score (ISS) ≥ 24 (43% versus 55%, p = 0.0003). Using multivariable logistic regression analysis, SO was independently associated with mortality (OR 2.8; 95% CI 1.6-4.8, p < 0.001). Causal mediation analysis found admission hyperglycemia as a mediator for mortality. CONCLUSIONS: Sarcopenic obesity is an independent predictor of mortality in major trauma.

Deep neural network for automatic volumetric segmentation of whole-body CT images for body composition assessment.

BACKGROUND & AIMS: Body composition analysis on CT images is a valuable tool for sarcopenia assessment. We aimed to develop and validate a deep neural network applicable to whole-body CT images of PET-CT scan for the automatic volumetric segmentation of body composition. METHODS: For model development, one hundred whole-body or torso 18F-fluorodeoxyglucose PET-CT scans of 100 patients were retrospectively included. Two radiologists semi-automatically labeled the following seven body components in every CT image slice, providing a total of 46,967 image slices from the 100 scans for training the 3D U-Net (training, 39,268 slices; tuning, 3116 slices; internal validation, 4583 slices): skin, bone, muscle, abdominal visceral fat, subcutaneous fat, internal organs with vessels, and central nervous system. The segmentation accuracy was assessed using reference masks from three external datasets: two Korean centers (4668 and 4796 image slices from 20 CT scans, each) and a French public dataset (3763 image slices from 24 CT scans). The 3D U-Net-driven values were clinically validated using bioelectrical impedance analysis (BIA) and by assessing the model's diagnostic performance for sarcopenia in a community-based elderly cohort (n = 522). RESULTS: The 3D U-Net achieved accurate body composition segmentation with an average dice similarity coefficient of 96.5%-98.9% for all masks and 92.3%-99.3% for muscle, abdominal visceral fat, and subcutaneous fat in the validation datasets. The 3D U-Net-derived torso volume of skeletal muscle and fat tissue and the average area of those tissues in the waist were correlated with BIA-derived appendicular lean mass (correlation coefficients: 0.71 and 0.72, each) and fat mass (correlation coefficients: 0.95 and 0.93, each). The 3D U-Net-derived average areas of skeletal muscle and fat tissue in the waist were independently associated with sarcopenia (P < .001, each) with adjustment for age and sex, providing an area under the curve of 0.858 (95% CI, 0.815 to 0.901). CONCLUSIONS: This deep neural network model enabled the automatic volumetric segmentation of body composition on whole-body CT images, potentially expanding adjunctive sarcopenia assessment on PET-CT scan and volumetric assessment of metabolism in whole-body muscle and fat tissues.

Regional Adiposity and Risk of Heart Failure and Mortality: The Jackson Heart Study.

Background Visceral adipose tissue (VAT) is associated with incident heart failure (HF) and HF with preserved ejection fraction, yet it is unknown how pericardial and abdominal adiposity affect HF and mortality risks in Black individuals. We examined the associations of pericardial adipose tissue (PAT), VAT, and subcutaneous adipose tissue (SAT) with incident HF hospitalization and all-cause mortality in a large community cohort of Black participants. Methods and Results Among the 2882 Jackson Heart Study Exam 2 participants without prevalent HF who underwent body computed tomography, we used Cox proportional hazards models to examine associations between computed tomography-derived regional adiposity and incident HF hospitalization and all-cause mortality. Fully adjusted models included demographics and cardiovascular disease risk factors. Median follow-up was 10.6 years among participants with available VAT (n=2844), SAT (n=2843), and PAT (n=1386). Fully adjusted hazard ratios (95% CIs) of distinct computed tomography-derived adiposity measures (PAT per 10 cm3, VAT or SAT per 100 cm3) were as follows: for incident HF, PAT 1.08 (95% CI, 1.02-1.14) and VAT 1.04 (95% CI, 1.01-1.08); for HF with preserved ejection fraction, PAT 1.13 (95% CI, 1.04-1.21) and VAT 1.07 (95% CI, 1.01-1.13); for mortality, PAT 1.07 (95% CI, 1.03-1.12) and VAT 1.01 (95% CI, 0.98-1.04). SAT was not associated with either outcome. Conclusions High PAT and VAT, but not SAT, were associated with incident HF and HF with preserved ejection fraction, and only PAT was associated with mortality in the fully adjusted models in a longitudinal community cohort of Black participants. Future studies may help understand whether changes in regional adiposity improves HF, particularly HF with preserved ejection fraction, risk predictions. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT00005485.

Assessment of visceral and subcutaneous obesity to understand the efficiency of adipose tissue in acute pancreatitis.

BACKGROUND: Fat accumulation in the visceral and subcutaneous regions can trigger fat necrosis during acute pancreatitis (AP). AIMS: We investigated the role of visceral and subcutaneous fat in acute pancreatitis. In this study, we investigated the role of visceral and subcutaneous fat to understand the efficiency of adipose tissue in the AP. MATERIALS AND METHODS: Computed tomography of 68 patients and 68 healthy at the level of L4-5 intervertebral disc were analyzed for body adiposity composition using designated software. Body subcutaneous and visceral composition was measured by using the designated software of the CT. RESULTS: Visceral fat was higher in the control group (198 ± 146) than the group of the AP (155 ± 118) (P = 0.038), whereas the subcutaneous fat was found higher in the AP instead (292 ± 133 to 139 ± 102; P = 0,001). Visceral fat (B = 0,29; P = 0,0013), gender (male) (B = -0.3; P = 0.0122), age (B = 0.274; P = 0.0087), and complication (B = -0.229; P = 0.007) predicted the subcutaneous fat as the dependent variable. In the receiver operating characteristic (ROC), the area under curve was 0.562 (0.402-0.636; 95% CI, P = 0.038) for the visceral fat, while it was 0.906 (0.824-0.962; 95% CI, P < 0.0001) for the subcutaneous fat. Its cutoff was calculated as 183.7 for subcutaneous fat. CONCLUSION: Visceral fat analysis showed a contradiction according to subcutaneous fat that AP was strongly associated with subcutaneous one. The result supports that visceral and subcutaneous fat tissues should have different path of inflammation affecting the AP.

Comparison of ultrasound speed-of-sound of the lower extremity and lumbar muscle assessed with computed tomography for muscle loss assessment.

ABSTRACT: To compare the speed of propagation of ultrasound (US) waves (SoS) of the lower leg with the clinical reference standard computed tomography (CT) at the level of lumbar vertebra 3 (L3) for muscle loss assessment. Both calf muscles of 50 patients scheduled for an abdominal CT were prospectively examined with ultrasound. A plexiglas-reflector located on the opposite side of the probe with the calf in between was used as a timing reference for SoS (m/s). CT measurements were performed at the level of L3 and included area (cm2) and attenuation (HU) of the psoas muscle, abdominal muscles, subcutaneous fat, visceral fat and abdominal area. Correlations between SoS, body mass index (BMI) and CT were determined using Pearson's correlation coefficient. Based on reported CT sarcopenia threshold values, receiver operating characteristic (ROC) analysis was performed for SoS. Inter-examiner agreement was assessed with the median difference, inter-quartile range (IQR) and intraclass correlation coefficients. SoS of the calf correlated moderately with abdominal muscle attenuation (r = 0.48; P < .001), psoas muscle attenuation (r = 0.40; P < .01), abdominal area (r = -0.44; P < .01) and weakly with subcutaneous fat area (r = -0.37; P < .01). BMI correlated weakly with psoas attenuation (r = -0.28; P < .05) and non-significantly with abdominal muscle attenuation. Normalization with abdominal area resulted in moderate correlations with abdominal muscle area for SoS (r = 0.43; P < .01) and BMI (r = -0.46; P < .001). Based on sarcopenia threshold values for skeletal muscle attenuation (SMRA), area under curve (AUC) for SoS was 0.724. Median difference between both examiners was -3.4 m/s with IQR = 15.1 m/s and intraclass correlation coefficient = 0.794. SoS measurements of the calf are moderately accurate based on CT sarcopenia threshold values, thus showing potential for muscle loss quantification.

The effect of high-intensity focused electromagnetic procedure on visceral adipose tissue: Retrospective assessment of computed tomography scans.

BACKGROUND: High levels of visceral adipose tissue (VAT) are associated with abdominal obesity and increased risk of metabolic deterioration. Recent studies showed that intensive physical exercise results in the reduction of subcutaneous and visceral fat. AIMS: This study investigates the effect of supramaximal muscle contractions induced by a HIFEM procedure for abdominal VAT changes. METHODS: Computed tomography (CT) scans of 22 subjects (47.3 ± 8.4 years, BMI of 23.5 ± 3.5 kg/m2 ) who received 8 HIFEM treatments of the abdomen (2-3 days apart) were retrospectively evaluated for the changes in VAT. The CT scans were obtained at baseline and 1 month after the last treatment. The transverse slices at umbilical, infraumbilical, and supraumbilical levels were used to determine the cross-sectional area (CSA) of VAT through a semi-automated segmentation method. RESULTS: Analysis of the CSA revealed a significant (P = .004) and uniform reduction of the abdominal VAT area by 14.3% (-16.7 cm2 ) from 110.6 ± 69.0 cm2 to 93.9 ± 54.6 cm2 . In general, a higher relative improvement was seen infraumbilically (17.1%), followed by supraumbilical (15.5%) and umbilical (10.7%) levels. The reduction of VAT was strongly correlated to the reduction of subcutaneous fat (r(17) = 0.66; P = .002). A decrease in VAT volume contributed to the overall aesthetic enhancement visible on digital photographs. CONCLUSIONS: The outcomes indicate that HIFEM technology has a positive effect on VAT. However, further studies are necessary to validate these outcomes and to clarify the exact mechanism of a VAT reduction. Based on our results, the HIFEM procedure may be a beneficial treatment option for patients with high VAT deposits.

Toward a Routine Assessment of Visceral Adipose Tissue Volume from Computed Tomographic Data.

OBJECTIVE: The study's aim was to determine to what extent total visceral adipose tissue (VAT) volume (VVAT-T ) measured from segmented VAT areas (AVAT ) on all axial computed tomography (CT) sections (thickness of 5 mm) between the diaphragm and pelvic floor can be predicted by the AVAT of commonly selected landmark sections in patients with overweight or obesity. METHODS: A total of 113 patients (31 females, 82 males) with images of full abdominopelvic coverage and proper image quality were included (BMI = 25.0-64.1 kg/m2 , 29.5 ± 4.9 kg/m2 ). Linear regression between AVAT and VVAT-T (reference) was used to determine approximate equations for VAT volume for all parameters (single sex, different anatomical landmarks or lumbar intervertebral disc spaces, one or five axial sections). Agreement was evaluated by the multivariate coefficient of determination and by the SD of the percentage difference (sd% ) between the estimated VAT volume on one or five sections and VVAT-T . RESULTS: The VVAT-T was 0.9 to 8.4 (3.8 ± 2.2) L for females and 2.7 to 11.7 (5.6 ± 2.1) L for males. Best agreement was found at L2-3 (sd% = 14.3%-15.5%) for females and at L1-2 or L2-3 (11.7%-12.4%) for males. Agreement at the umbilicus or the femoral heads was poor (20.2%-57.9%). Segmentation of one or five sections was substantially faster (11/70 seconds) than whole-abdomen processing (15 minutes). CONCLUSIONS: VVAT-T can be rapidly estimated by VAT segmentation of axial CT sections at sex-specific lumbar intervertebral disc spaces.

Increases in DXA-Derived Visceral Fat Across One Season in Professional Rugby Union Players: Importance of Visceral Fat Monitoring in Athlete Body Composition Assessment.

INTRODUCTION: In rugby, the average player body mass has increased by approximately 25% since 1955. Visceral adipose tissue (VAT) is associated with low grade inflammation, and chronic diseases, such as cardiovascular diseases. The purpose of this study was to investigate changes in VAT in relation to other indices of body composition, across 1 season in professional rugby. METHODOLOGY: One hundred and sixteen male rugby union players' (age: 26.2 ± 4.6 y, BMI: 29.40 ± 3.22 kg.m2) total body composition dual energy X-ray absorptiometry scans from 4 time points across the season (baseline, preseason, midseason, and postseason) were analyzed. Players were grouped by playing position, forwards (n = 65) and backs (n = 51). Players followed individually tailored diet plans. RESULTS: Mean baseline VAT was 404.67 ± 229.43 g (forwards: 469.36 ± 263.16 g, backs: 311.40 ± 121.15 g). Total mass, lean mass, body fat percentage (%BF), and VAT were greater in forwards than backs at all 4 timepoints. Meaningful increases in VAT across the season, were observed in 37.5% of backs and 53.6% of forwards. There was a positive linear relationship between lean mass and total mass, up to 116.04 kg total mass. Beyond this threshold, lean mass accumulation reduced and %BF and VAT mass increased. There were significant relationships between %BF, VAT, and BMI (p < 0.001), but no physiological relevant pattern was discerned. CONCLUSIONS: Despite regular high-intensive exercise and individually tailored dietary control across a professional rugby season, players from both playing positions demonstrated increases in VAT, although the cause remains unknown. Our findings indicate the importance of monitoring VAT in athletes alongside standard measures of body composition. Additionally, our findings suggest there may be an upper threshold of body mass beyond which lean mass may not increase further and instead %BF and VAT are more likely to accumulate. Further research is required to identify how increasing player size may impact long-term cardiometabolic health given the known links between VAT and cardiometabolic risk.

Use of Anthropometry Versus Ultrasound for the Assessment of Body Fat and Comorbidities in Children With Obesity.

OBJECTIVES: We aimed to examine the association between abdominal fat measured by ultrasound and anthropometric indices in children with obesity, and those with normal weight. We also examined the association between anthropometry and fat measures in the prediction of comorbidities in children with obesity. METHODS: Forty children with body mass index of >95th percentile were included as cases, and a comparable group of 32 healthy average-weight peers were included as controls in this study. All children underwent clinical assessment, anthropometric measures, and evaluation of abdominal subcutaneous fat (SCF) and visceral fat by ultrasound. Fasting blood sugar, serum transaminases, and lipid profile of all the included children were also evaluated. RESULTS: Children with obesity had a mean age of 8.7 ±â€Š2.9 years (range 3-13). The SCF and intraperitoneal fat (IPF) values correlated well with each other and with anthropometric measurements in children with obesity. Among all the included cases, 90% were metabolically unhealthy, 70% had hypertension, 52.5% had dyslipidemia, and 22.5% had echogenic liver. Anthropometric measures, abdominal SCF and IPF were higher in children with complications. SCF was observed as a good predictor for hepatic echogenicity among the measured ultrasound parameters (P: 0.03, odds ratio 4.6). The best cutoff value for SCF in cases with hepatic echogenicity was 23.2 mm with an overall accuracy of 80%. CONCLUSIONS: In children with obesity, abdominal SCF and IPF correlated well with anthropometric measures and were higher in children with comorbidities. This finding, however, did not predict comorbidities apart from those with echogenic liver.

Precision of the Hologic DXA in the Assessment of Visceral Adipose Tissue.

INTRODUCTION: Visceral fat, also known as visceral adipose tissue (VAT), has been the focus of intensive research over the past several yr, as ground breaking studies have investigated its possible role in predicting long-term cardiac dysfunction, hypertension, and diabetes. Historically, magnetic resonance imaging and computed tomography were the instruments of choice for visceral fat quantification. However, with the introduction of visceral fat assessment software for Dual-energy X-ray Absorptiometry (DXA) scanners, DXA's use for VAT assessment has become increasingly common. To effectively utilize DXA in future VAT research studies, information about their precision and accuracy must be known. This study provides novel information regarding the precision of the Hologic Horizon DXA scanner in the assessment of VAT. METHODS: Sixty individuals (32.7 ± 17.1 yr, 51% male, 40% with body mass index (BMI) > 25 kg/m2) above the age of 16 years were recruited to participate in this study. Subjects found to be pregnant, have a lumbar vertebral compression fracture, nonremovable metal implants in the abdomen, or scoliosis/lordosis/kyphosis were excluded from the study. All subjects underwent 3 consecutive whole body scans on a Hologic Horizon A DXA scanner. RESULTS: VAT mass ranged from 102 g to 1454 g. VAT precision improved with increasing BMI (p = 0.025): coefficient of variation (%CV) was 15.2% for underweight subjects (n = 2), 7.1% for healthy subjects (n = 34), 6.4% for overweight subjects (n = 18), and 4.7% for obese subjects (n = 6). CONCLUSIONS: VAT measurement by Hologic DXA displays a satisfactory level of precision in individuals with a BMI of >18.5 kg/m2. Precision was found to be higher in those with the greatest risk of cardio-metabolic dysfunction (individuals with high VAT). Due to its low cost, brief examination time, noninvasiveness, and limited radiation exposure, DXA may be considered the tool of choice for VAT determination in future studies.

Hepatic and pancreatic fat as imaging biomarkers of metabolic syndrome. / Valoración de la grasa hepática y pancreática como biomarcadores de imagen en el síndrome metabólico.

OBJECTIVE: To objectively evaluate hepatic and pancreatic involvement in metabolic syndrome through magnetic resonance imaging (MRI) biomarkers. MATERIAL AND METHODS: From an initial retrospective sample of 407 patients diagnosed with metabolic syndrome studied by MRI in a single center during a 2-year period, 154 were excluded because of a lack of clinical and/or laboratory data, pancreatic abnormalities, or inadequate quality of MRI studies. To measure hepatic and pancreatic fat, we used chemical shift imaging (in-phase and out-of-phase), measuring the fat fraction (%) in regions of interest in the pancreas and liver. Associations between the fat fraction and selected clinical and laboratory variables were assessed with beta regression models. RESULTS: In the end, 253 patients were included. The hepatic fat fraction was 4.9% and the pancreatic fat fraction was 7.9%. We found no significant associations between the hepatic fat fraction and any of the clinical or laboratory variables. However, the pancreatic fat fraction was positively associated with age (OR=1.025, p<0.001) and baseline glucose (OR=1.005, p<0.001). Patients with diabetes had higher values of pancreatic fat fraction (OR=2.64, p=0.038). Pancreatic fat fraction and hepatic fat fraction were positively associated (OR=69.44, p<0.001). CONCLUSIONS: Pancreatic steatosis can be considered a marker of metabolic syndrome and diabetes. Quantitative MRI enables the diagnosis and grading of fatty pancreas through simple chemical shift techniques.

Stomach Volume Assessment Using Three-dimensional Computed Tomography Gastrography for Bariatric Treatment.

BACKGROUND: Most bariatric treatments employ gastric volume reduction. However, there has been no appropriate tool that could assess the anatomical factors of the stomach, and few studies have investigated proper stomach measurement for bariatric treatment. Thus, this study aimed to objectively estimate the individual stomach using three-dimensional (3D) computed tomography (CT) gastrography for the possible acquisition of information that could facilitate bariatric treatment and to validate these factors. METHODS: A total of 100 consecutive patients with different degrees of obesity who underwent 3D CT gastrography were enrolled. Using semiautomatic and manual segmentation tools, 3D volume-rendered images were constructed, and the total volume of the distended stomach, abdominal diameter, and abdominal fat volume (visceral and subcutaneous fat) were measured. Data on patients' baseline characteristics and laboratory findings were collected. RESULTS: The stomach volume measured using 3D CT gastrography ranged from 268 to 751 mL, whereas the stomach capacity was 572 ± 301.6 mL and 438.5 ± 163.4 mL in patients with body mass index (BMI) ≥ 25 kg/m2 and < 25 kg/m2, respectively. Visceral fat volume, abdominal circumference, and visceral-to-subcutaneous fat ratio tended to be associated with increased stomach volume. Multivariate analysis showed that BMI and visceral fat volume were significantly associated with stomach volume in female patients. CONCLUSIONS: The results of this study indicated the association of stomach volume with obesity status. Objective estimation of the individual stomach presented the possibility of tailored therapeutic approach to obese patients requiring more effective bariatric treatment.