Body fat distribution and circulating adipsin are related to metabolic risks in adult patients with newly diagnosed growth hormone deficiency and improve after treatment.

OBJECTIVE: The relationships between body fat distribution, the adipokine adipsin and metabolic risks were assessed in patients with adult growth hormone deficiency (AGHD) before and after growth hormone (GH) treatment. METHODS: Sixty newly diagnosed AGHD patients were included in our study, 24 of whom were evaluated after at least one year of GH treatment. Anthropometric parameters, glucolipid metabolism and the adipokine adipsin were measured. Visceral adipose tissue (VAT) and body composition were evaluated using a dual-energy X-ray-absorptiometry (DXA) scanner. RESULTS: At baseline, the higher VAT group had worse glucolipid metabolism parameters. Basal GH was negatively associated with VAT (r=-0.277, p = 0.045), while minimal correlations were found with fat mass depots, such as limbs and trunk fat (all p > 0.05). Adipsin was correlated with total body fat (r = 0.543, p < 0.001), VAT (r = 0.563, p < 0.001) and insulin resistance (r = 0.353, p = 0.006). The effect of GH administration on fat distribution was mainly reflected in the reduction in VAT. Partial improvements were found in lipid profiles, including increased high-density lipoprotein (HDL) and decreases in triglycerides (TGs) and lipoprotein(a), while glucose metabolism showed little change. The adipsin level also decreased significantly. The best predictors of VAT at baseline were trunk fat and IGF-I, and after treatment, VAT was predicted by decreased adipsin and an increase in lean mass. CONCLUSIONS: (1) VAT is an important metabolic risk factor for AGHD patients. (2) GH treatment decreased body fat predominantly in the visceral and central fat depots. (3) The lipid profiles partially improved after treatment, while glucose metabolism showed little change.

Body Fat Is Related to Sedentary Behavior and Light Physical Activity but Not to Moderate-Vigorous Physical Activity in Type 2 Diabetes Mellitus.

BACKGROUND: Sedentary behavior (SB) has emerged as a new risk factor for cardiovascular accidents. We investigated whether physical activity levels or SB were related to percent body fat (%BF) in type 2 diabetes mellitus (T2DM). METHODS: In this cross sectional study, we measured the duration of SB, light physical activity (LPA), moderate to vigorous physical activity (MVPA), total energy expenditure, and step counts using a wireless activity tracker (Fitbit HR; FB) for 7 days in free-living conditions, along with %BF using a bio impedance analyzer (Inbody; Biospace) in 120 smartphone users with T2DM. Subjects were divided into exercise (Exe, n=68) and non-exercise (nonExe, n=52) groups based on self-reports of whether the recommended exercises (30 min/day, 3 days/week for 3 months) were performed. SBt, LPAt, MVPAt were transformed from SB, LPA, MVPA for normally distributed variables. RESULTS: Participants were: female, 59.2%; age, 59.3±8.4 years; body mass index, 25.5±3.4 kg/m²; glycosylated hemoglobin (HbA1c), 7.6%±1.2%; %BF, 30.4%±7.1%. They performed SB for 15.7±3.7 hr/day, LPA for 4.4±1.7 hr/day, and MVPA for 0.9±0.8 hr/day. The %BF was related to SBt and LPAt, but not to MVPA after adjustments for age, gender, and HbA1c. VPA was significantly higher in the Exe group than in the nonExe group, but SB, LPA, and moderate physical activity were not different. Predicted %BF was 89.494 to 0.105 (age), -13.047 (gender), -0.507 (HbA1c), -7.655 (LPAt) (F[4, 64]=62.929, P<0.001), with an R² of 0.785 in multiple linear regression analysis. CONCLUSION: Reduced body fat in elderly diabetic patients might be associated with reduced inactivity and increased LPA.

Anatomy of the Facial Fat Compartments and their Relevance in Aesthetic Surgery.

OBJECTIVE: There has been a significant shift in the understanding of facial anatomy during the last decade. Newer minimally invasive therapeutic options for facial rejuvenation procedures are increasing the need for a better knowledge of anatomy. MATERIAL AND METHODS: The current literature is summarized, analyzed and presented along with the experience of the author for this narrative review, which summarizes the current understanding of the superficial and deep facial fat compartments and their relevance for minimally invasive facial procedures. A schematic facial model was created in order to facilitate a better understanding of the complexity of facial anatomy. RESULTS: The face is arranged in five layers as follows: layer 1: skin; layer 2: subcutaneous fat including the retinacula cutis (composed of fibrous connective tissue); layer 3: superficial musculo-aponeurotic system (SMAS); layer 4: deep fat; and layer 5: periosteum or deep fascia. This arrangement varies between facial regions, especially when the line of ligaments is incorporated into the model. The facial fat compartments are located in layers 2 and 4; each layer has unique characteristics and spatial relationships with the surrounding tissues. CONCLUSIONS: The concept of the layered arrangement is a new way to understand the spatial relationship and functional interplay of the soft tissues of the face. Understanding the layers, the precise location of the superficial and deep facial fat compartments and their boundaries is crucial for the conduct of safe and effective minimally invasive facial procedures.

B-type natriuretic peptide levels and benign adiposity in obese heart failure patients.

Obesity is a major risk factor for the development of chronic heart failure (CHF) and does not only pose diagnostic challenges, but also has prognostic implications for these patients. Paradoxically, obese patients with CHF have a better prognosis than thinner individuals. In recent years, it has been demonstrated that the adipose tissue, even in patients with HF, is not always detrimental, and that obesity may coexist with a phenotype of benign adiposity without systemic metabolic abnormalities. Experimental data have shown that natriuretic peptides (NPs), and in particular brain natriuretic peptide (BNP), play a major role in the communication of the heart with the adipose tissue. Body fat distribution and adipose tissue function show a large degree of heterogeneity among depots and may explain the complex relationship between NPs and body fat. NPs can affect both the quality and the behaviour of fatty tissue, promoting a healthy adipocyte phenotype, and can favourably affect body fat metabolism. In this article, we review the existing literature on the bidirectional effects of BNP and adipose tissue in HF and highlight the complexity of this relationship.

Para-perirenal distribution of body fat is associated with reduced glomerular filtration rate regardless of other indices of adiposity in hypertensive patients.

Obesity is a well-known risk factor for the development and progression of chronic kidney disease. Recently, para-perirenal ultrasonographic fat thickness (PUFT) has shown to correlate with both total and visceral fat better than body mass index (BMI), waist circumference (WC), and other indices of obesity. Moreover, a local paracrine and mechanical action of the PUFT on kidney has been described in recent studies. Aim of our study was to assess the relationship between glomerular filtration rate (GFR) and PUFT in comparison with other anthropometric and ultrasonographic indices of adiposity. Two hundred and ninety-six hypertensive patients were enrolled. PUFT, cutis-rectis thickness and rectis-aorta thickness were obtained by ultrasonography. Anthropometric measures of adiposity were also measured. Estimated GFR was calculated using the CKD-EPI equation. Higher PUFT values were observed in patients with impaired renal function (P < 0.001), whereas no differences in BMI and WC were shown between groups divided by GFR. PUFT significantly correlated with GFR in all patients (r = -0.284; P < 0.001), with no differences in groups divided by sex, diabetes, or BMI. This association held in multivariate analyses also after correction for confounding factors, including other adiposity indices (P < 0.001). When receiver operating characteristic curves were built to detect a eGFR < 60 mL/minutes per 1.73 m2 , a PUFT value ≤3.725 cm showed a negative predictive value of 94.0%, with the largest area under the curve (AUC: 0.700) among the variables considered. In conclusion, the relationship between PUFT and GFR seems to be more accurate and less influenced by the bias affecting traditional indices of adiposity.

Fat Distribution in Schizophrenia Patients: A Pilot Study Comparing First- and Second-Generation Antipsychotics.

BACKGROUND: Introduction of second-generation antipsychotics (SGAs) has reduced neurologic toxicity but are associated with increased weight gain and obesity. The objective of this pilot study is to compare the effects of first-generation antipsychotics (FGAs) and SGAs in patients with schizophrenia on body fat and presumed concomitant metabolic parameters. METHODS: Study compared schizophrenia nondiabetic men treated with FGAs (group 1, n = 5) and men treated with SGAs (group 2, n = 9). Each subject completed psychiatric and endocrine evaluation including severity of psychiatric symptoms, adverse effects, body weight, body composition, and measurements of glucose, insulin, adipokines, and inflammatory markers. Student t test was used for statistical analysis. RESULTS: Men treated with FGAs had a lower mean body mass index with a trend toward statistical significance (25.3 ± 1.4 vs 29.3 ± 1.7, P = 0.06). Treatment with FGAs was associated with lower waist/height ratio (0.55 ± 0.02 vs 0.62 ± 0.02, P = 0.036) and android fat mass index (0.62 ± 0.01 vs 0.96 ± 0.1, P = 0.03). Homeostasis Model Assessment for insulin resistance values were suggestive of significantly lower peripheral insulin resistance in men treated with FGAs (0.92 ± 0.15 vs 2.3 ± 0.34, P = 0.014). CONCLUSIONS: The results of this study are significant for decreased peripheral insulin resistance in men treated with SGAs in a setting of no significant age difference and only a trend toward higher body mass index, but consistent documentation of increased abdominal fat by 3 different methodologies. Future studies involving larger number of subjects are warranted to verify the present findings.

Circulating persistent organic pollutants and body fat distribution: Evidence from NHANES 1999-2004.

OBJECTIVE: To evaluate and compare the correlations of various circulating persistent organic pollutants (POPs) with fat mass percentages (FM%) of trunk, leg, and whole body measured by dual-energy X-ray absorptiometry. METHODS: This study included 2358 adults (≥20 years) in the National Health and Nutrition Examination Survey 1999-2004. Partial Pearson correlation coefficients were calculated, after adjusting for major confounders, including age, smoking status, and history of lactation and parity. Wolfe's method was used to compare correlation coefficients derived from the same participants. RESULTS: Twelve POPs showed significantly different correlations with fat depots in trunk and leg regions. ß-hexachlorocyclohexane, heptachlorodibenzo-p-dioxin, octachlorodibenzo-p-dioxin, and polychlorinated biphenyl (PCB)-126 showed stronger positive correlations with trunk FM% than with leg FM%, whereas PCBs with ≥6 chlorines were more inversely correlated with trunk FM% than leg FM%. Age-stratified analysis showed stronger inverse correlations between POPs and trunk FM% mainly in participants <40 years, whereas stronger positive correlations between POPs and trunk FM% were observed in older participants. CONCLUSIONS: Stronger associations between POPs and trunk fat as compared to leg fat possibly indicated a more important role of trunk fat in the pharmacokinetics of POPs, or a stronger effect of POPs, as endocrine disruptors, on trunk fat metabolism.

Thigh circumference and low ankle brachial index in US adults: results from the National Health and Nutrition Examination Survey 1999-2004.

OBJECTIVE: Recent studies have suggested that smaller thighs are a disadvantage for health and survival, but the association of thigh circumference with atherosclerosis remains uncertain. The purpose of this study was to investigate the association between thigh circumference and peripheral arterial disease (PAD), as measured by ankle brachial index (ABI). METHODS: This study used data from the National Health and Nutrition Examination Survey (1999-2004), in which participants' ABI and thigh circumference were measured simultaneously. A total of 5716 participants (2959 men and 2757 women) were included in the final analysis. A diagnosis of PAD was determined on the basis of ABI <0.9. RESULTS: The overall prevalence of PAD in this sample was 6.6%. Thigh circumference of those with PAD was 50.1cm compared to 52.2 cm for those without PAD (p < 0.0001). After adjusting for potential covariates, the prevalence of PAD generally decreased as thigh circumference increased up to 55 cm. In the first quantile (smallest thigh circumference), men and women had as much as a 4.8-fold (95% CI, 2.28-10.29) and a 3-fold (95% CI, 1.45-6.18) increased risk of PAD, respectively. Above 55 cm, PAD was no longer related to thigh circumference. CONCLUSIONS: Small thigh circumference may be associated with PAD, as measured by ABI.

Trends in obesity and its distribution: data from the Northern Sweden MONICA Survey, 1986-2004.

OBJECTIVE: Obesity, especially abdominal, is a risk factor for many diseases. This study explored trends in the prevalence of general and abdominal obesity, 1986-2004, in northern Sweden. METHODS AND PROCEDURES: Cross-sectional population surveys were performed in 1986, 1990, 1994, 1999, and 2004; 250 men and 250 women aged 25-34, 35-44, 45-54, and 55-64 years (from 1994, also 65-74 years) were randomly selected; the overall participation rate was 77%. Anthropometric data were used. RESULTS: Weight and BMI increased in all men, most significantly in men aged 25-64 years (P<0.0005). Weight increased in women aged 25-64 years (P<0.005) and BMI in women aged 25-44 years (P<0.005). Prevalence of obesity (BMI>or=30) increased significantly in men aged 25-44 and 55-74 years (P<0.005; for men 65-74 years old, P<0.05) and in women aged 25-44 years (P<0.005). Waist circumference decreased significantly between 1986 and 1990 in all women (P<0.005) and in men aged 55-64 years (P<0.05). After 1990 waist circumference increased, most markedly so in women; by 2004 circumference measurements for women, and for men aged 55-64 years, were equal to those of 1986, while for men aged 25-54 years they were higher. Prevalence of abdominal obesity has increased since 1990, most markedly so in women aged 45-64 years (P<0.0005). DISCUSSION: The rapid increase in both general and central obesity raises concern for the future; increasing abdominal obesity in women is particularly alarming.

Ten-year changes in central obesity and BMI in rural and urban Cameroon.

OBJECTIVE: To compare the 10-year changes in the distribution of adiposity in rural and urban Cameroonian populations. METHODS AND PROCEDURES: Two cross-sectional surveys of populations in the same rural and urban areas of Cameroon, aged>or=24 years, were carried out in 1994 (1,762 subjects) and 2003 (1,398 subjects) using similar methodology. All eligible subjects answered a structured questionnaire on their educational level, alcohol consumption, and tobacco smoking and weight, height, and waist circumference (WC) were measured. RESULTS: Between 1994 and 2003, the age-standardized prevalence of BMI>or=25 kg/m2 increased significantly only in the rural area (+54% for women and +82% for men), while the age-standardized prevalence of central obesity (WC>or=80 cm (women), >or=94 cm (men)) increased significantly only in the urban population (+32% for women and +190% for men). These differences persisted after adjustments for age group, alcohol consumption, tobacco smoking, and level of education, and within almost all the strata of the studied risk factors. DISCUSSION: Changes in adiposity over time in Cameroon were characterized by an increase of BMI in the rural area and of WC in the urban area.

Fetal programming of body dimensions and percentage body fat measured in prepubertal children with a 4-component model of body composition, dual-energy X-ray absorptiometry, deuterium dilution, densitometry, and skinfold thicknesses.

BACKGROUND: Intrauterine programming of body composition [percentage body fat (%BF)] has been sparsely examined with multiple independent reference techniques in children. The effects on and consequences of body build (dimensions, mass, and length of body segments) are unclear. OBJECTIVE: The study examined whether percentage fat and relation of percentage fat to body mass index (BMI; in kg/m2) in prepubertal children are programmed during intrauterine development and are dependent on body build. It also aimed to examine the extent to which height can be predicted by parental height and birth weight. DESIGN: Eighty-five white children (44 boys, 41 girls; aged 6.5-9.1 y) had body composition measured with a 4-component model (n = 58), dual-energy X-ray absorptiometry (n = 84), deuterium dilution (n = 81), densitometry (n = 62), and skinfold thicknesses (n = 85). RESULTS: An increase in birth weight of 1 SD was associated with a decrease of 1.95% fat as measured by the 4-component model (P = 0.012) and 0.82-2.75% by the other techniques. These associations were independent of age, sex, socioeconomic status, physical activity, BMI, and body build. Body build did not decrease the strength of the associations. Birth weight was a significantly better predictor of height than was self-reported midparental height, accounting for 19.4% of the variability at 5 y of age and 10.3% at 7.8 y of age (17.8% and 8.8% of which were independent of parental height at these ages, respectively). CONCLUSIONS: Consistent trends across body-composition measurement techniques add strength to the suggestion that percentage fat in prepubertal children is programmed in utero (independently of body build and BMI). It also suggests birth weight is a better predictor of prepubertal height than is self-reported midparental height.

Secular changes in fatness and fat distribution in Australian children matched for body size.

OBJECTIVE: To investigate secular trends in waist girth and skinfold measures among Australian children from 1985 and 1997/2002, matched for body size. SUBJECTS: A total of 2604 children (10-12 years old) measured in the 1985 Australian Health and Fitness Survey and in two later surveys of South Australian schoolchildren (1997/2002), were matched for age, stature, weight and body mass index (BMI). Measurements. The matched children were compared by ANOVA on waist and hip girths, waist-to-hip ratio (WHR) and abdominal and triceps skinfolds, taken by trained anthropometrists. RESULTS: Between the survey periods, there were significant increases in waist girth, WHR, and the two skinfold measures, but more so for abdominal skinfold. The differences in abdominal skinfold, waist girth and WHR were greater for girls than boys. CONCLUSIONS: In Australian children matched for body size, there have been increases in measures of fatness and central adiposity over the last 20 years. This suggests that reported secular trends in BMI may be under-estimating the looming public health crisis.