Morphometric Assessment as a Predictor of Outcome in Older Vascular Surgery Patients.

BACKGROUND: Frailty is a recognized predictor of poor outcome in patients undergoing surgical intervention. Frailty is intricately linked with body morphology, which can be evaluated using morphometric assessment via computerized tomographic (CT) imaging. We aimed to assess the predictive power of such objective assessments in a broad cohort of vascular surgical patients. METHODS: A consecutive series of patients aged over 65 years admitted to a vascular unit, who had undergone CT imaging of the abdomen, were analyzed. Demographic and patient-specific data were collated alongside admission relevant information. Outcomes included mortality, length of stay, health care-related costs, and discharge destination. Images were analyzed for 4 morphometric measurements: (1) psoas muscle area, (2) mean psoas density, (3) subcutaneous fat depth, and (4) intra-abdominal fat depth, all taken at the level of the fourth lumbar vertebra. RESULTS: Two hundred and ten patients were initially analyzed. Forty-four patients had significant retroperitoneal and abdominal abnormalities that limited appropriate CT analysis. Decreased subcutaneous fat depth was significantly associated with mortality, readmission within 12 months, and increased cost of health care (P < 0.01, adjusted for confounders). Psoas muscle area was significantly associated with readmission-free survival. CONCLUSIONS: Morphometric analysis predicts poorer outcome in a broad cohort of vascular surgery patients. Such assessment is likely to enhance patient counseling regarding individual risk as well as enhancing the ability to undertake risk-modified surgical audit.

Reliability of a novel approach for quadriceps motor point assessment.

INTRODUCTION: We studied the ability of clinicians to identify quadriceps motor points using a transcutaneous electrical stimulation unit (TENS). METHODS: Twenty-two certified athletic trainers and 1 expert-rater identified the 7 motor points of the quadriceps at 2 time-points separated by 1 week. The difference was calculated between where each participant and the expert-rater identified each motor point using an x-y coordinate system. Bland-Altman plots were used to compare differences between 2 testing sessions. RESULTS: No differences were observed between participants and the expert-rater for motor point location. The smallest variability in the limits of agreements were observed in the distal vastus medialis oblique (-1.89 to 1.86 cm) and proximal vastus lateralis (-1.61 to 2.35 cm). DISCUSSION: Our results suggest the utilization of a TENS unit may be 1 way to identify quadriceps motor points to improve electrical stimulation applications. The smallest limits of agreement were over the most common quadriceps electrical stimulation electrode positions. Muscle Nerve 57: E1-E7, 2018.

Reproducibility analysis on shear wave elastography (SWE)-based quantitative assessment for skin elasticity.

Shear Wave Elastography (SWE) is an objective and non-invasive method widely used to quantify the tissue solidity. However, there are concerns about the accuracy of the skin SWE results due to the low signal-to-noise ratio (SNR) caused by subcutaneous fat, muscle and bone. This article analyzed the reproducibility of the result for skin SWE and therefore evaluated the availability of SME for skin elasticity involved diseases. Thirty volunteers (mean age: 37 ±â€Š12 years) were selected. SWE were taken on the skin of abdomen and the middle tibia in order to assess the impact of fat, muscle and bone on SWE results. Skin in the area of anterior and lateral tibia marked with seven parallel lines, and each line indicated an identical thickness of the subcutaneous fat from 1-7 mm. Intra-class correlation coefficients (ICC) were used to evaluate the intra-observer and inter-observer reproducibility. The solidity of abdominal skin showed soft and small individual differences (12.4 ±â€Š2.7 kPa), whereas high shear moduli (25-48 kPa) were observed in the skin above tibia and tibialis anterior muscle. When the subcutaneous fat was thicker than 3 mm (≥3), we obtained excellent intra-observer reproducibility (ICC range 0.78-0.98) and inter-observer reproducibility (ICC range 0.75-0.98). The thickness of subcutaneous fat could affect the reproducibility of skin SWE. The further study on skin SWE standardization should be taken.

Assessment of Fat distribution and Bone quality with Trabecular Bone Score (TBS) in Healthy Chinese Men.

Whether fat is beneficial or detrimental to bones is still controversial, which may be due to inequivalence of the fat mass. Our objective is to define the effect of body fat and its distribution on bone quality in healthy Chinese men. A total of 228 men, aged from 38 to 89 years, were recruited. BMD, trabecular bone score (TBS), and body fat distribution were measured by dual-energy X-ray absorptiometry. Subcutaneous and visceral fat were assessed by MRI. In the Pearson correlation analysis, lumbar spine BMD exhibited positive associations with total and all regional fat depots, regardless of the fat distribution. However, the correlation disappeared with adjusted covariables of age, BMI, HDL-C, and HbA1c%. TBS was negatively correlated with fat mass. In multiple linear regression models, android fat (and not gynoid, trunk, or limbs fat) showed significant inverse association with TBS (ß = -0.611, P < 0.001). Furthermore, visceral fat was described as a pathogenic fat harmful to TBS, even after adjusting for age and BMI (ß = -0.280, P = 0.017). Our findings suggested that body fat mass, especially android fat and visceral fat, may have negative effects on bone microstructure; whereas body fat mass contributes to BMD through mechanical loading.

Alcohol consumption and its relation to visceral and subcutaneous adipose tissues in healthy male Koreans.

AIMS: The purpose of the present study is to investigate the association of alcohol with visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) distribution and metabolic syndrome (MetS). DESIGN: We conducted a cross-sectional study in 951 healthy male Korean participants who underwent health checkups. We measured the cross-sectional areas of VAT and SAT by computed tomography of the abdomen and performed a study of alcohol consumption based on questionnaire responses and a 24-hour dietary recall assessment. We analyzed the relationship of alcohol consumption with VAT, SAT, and MetS. RESULTS: Alcohol consumption showed a negative association with SAT (ß = -18.76, p = 0.047) but a positive association with VAT (ß = 17.70, p = 0.037), independent of other factors. The adjusted odds ratios for MetS for those who consumed <7, 7 to <14, 14 to <28, and ≥28 standard drinks per week were 0.99 (0.59-1.68), 1.49 (0.84-2.63), 1.95 (1.10-3.45), and 1.99 (1.07-3.70), respectively (p for linear trend = 0.042). CONCLUSIONS: Alcohol consumption is associated with decreased SAT and increased VAT accumulation. Further, alcohol consumption of ≥14 standard drinks is associated with an increased risk of MetS. Light-to-moderate drinking, which has been regarded to lower the risk of cardiovascular diseases, did not show a protective effect on adipose tissue accumulation.

Sonographic assessment of abdominal fat distribution in infancy.

There is growing evidence that not only the total amount of fat, but also the distribution of body fat determines risks for metabolic and cardiovascular disease. Developmental studies on factors influencing body fat distribution have been hampered by a lack of appropriate techniques for measuring intraabdominal fat in early life. Sonography, which is an established method for assessing abdominal fat distribution in adults, has not yet been evaluated in infants. To adapt the sonographic measurement of abdominal fat distribution to infants and study its reliability. The Generation R study, a population-based prospective cohort study. We included 212 one- and 227 two-year old Dutch infants in the present analysis. Sixty-two infants underwent replicate measurements to assess reproducibility. We developed a standardized protocol to measure the thickness of (1) subcutaneous and (2) preperitoneal fat in the upper abdomen of infants. To this end we defined infancy specific measurement areas to quantify fat thickness. Reproducibility of fat measurements was good to excellent with intraclass correlation coefficients of 0.93-0.97 for intra-observer agreement and of 0.89-0.95 for inter-observer agreement. We observed a pronounced increase in preperitoneal fat thickness in the second year of life while subcutaneous fat thickness increased only slightly, resulting in an altered body fat distribution. Gender did not significantly influence fat distribution in the first two years of life. Our age specific protocol for the sonographic measurement of central subcutaneous and preperitoneal fat is a reproducible method that can be instrumental for investigating fat distribution in early life.

Hostility is associated with visceral, but not subcutaneous, fat in middle-aged African American and white women.

OBJECTIVE: To examine the cross-sectional association between hostility and measures of abdominal fat (visceral, subcutaneous) in middle-aged African American and white women. Because fat-patterning characteristics are known to differ by race, we were particularly interested in examining whether these associations were similar for women of both racial/ethnic groups. METHODS: Participants were 418 (45% African American, 55% white) middle-aged women from the Chicago site of the Study of Women's Health Across the Nation. Visceral and subcutaneous fat were measured by computed tomographic scans and hostility was assessed via questionnaire. Multivariate linear regression models were conducted to test associations among race/ethnicity, hostility, and measures of abdominal fat. RESULTS: In models adjusted for race/ethnicity and total percent fat, higher levels of hostility were associated with a greater amount of visceral fat (B = 1.8, standard error = 0.69, p = .01). This association remained significant after further adjustments for education, and multiple coronary heart disease (CHD) risk factors. Hostility was not associated with subcutaneous fat (p = .8). Although there were significant racial/ethnic differences in hostility (p < .001) and the amount of total body (p < .001), subcutaneous (p < .001) and visceral fat (p < .001), the associations between hostility and measures of abdominal fat did not differ for African American compared with white women (race/ethnicity x hostility interaction, p = .67 for visceral, p = .85 for subcutaneous). CONCLUSIONS: Hostility may affect CHD risk in women via the accumulation of visceral fat. Despite significant black-white differences in fat patterning and overall CHD risk, the association between hostility and visceral fat seems to be similar for both African American and white women.

Automated assessment of whole-body adipose tissue depots from continuously moving bed MRI: a feasibility study.

PURPOSE: To present an automated algorithm for segmentation of visceral, subcutaneous, and total volumes of adipose tissue depots (VAT, SAT, TAT) from whole-body MRI data sets and to investigate the VAT segmentation accuracy and the reproducibility of all depot assessments. MATERIALS AND METHODS: Repeated measurements were performed on 24 volunteer subjects using a 1.5 Tesla clinical MRI scanner and a three-dimensional (3D) multi-gradient-echo sequence (resolution: 2.1 x 2.1 x 8 mm(3), acquisition time: 5 min 15 s). Fat and water images were reconstructed, and fully automated segmentation was performed. Manual segmentation of the VAT reference was performed by an experienced operator. RESULTS: Strong correlation (R = 0.999) was found between the automated and manual VAT assessments. The automated results underestimated VAT with 4.7 +/- 4.4%. The accuracy was 88 +/- 4.5% and 7.6 +/- 5.7% for true positive and false positive fractions, respectively. Coefficients of variation from the repeated measurements were: 2.32 % +/- 2.61%, 2.25% +/- 2.10%, and 1.01% +/- 0.74% for VAT, SAT, and TAT, respectively. CONCLUSION: Automated and manual VAT results correlated strongly. The assessments of all depots were highly reproducible. The acquisition and postprocessing techniques presented are likely useful in obesity related studies.