Longitudinal associations of total and trunk fat in childhood and adolescence and risk of hepatic steatosis at 24 years.

BACKGROUND: The importance of body fat distribution in the development of nonalcoholic fatty liver disease (NAFLD) is unclear. OBJECTIVE: To examine whether total and truncal fat deposition patterns in childhood/adolescence are associated with NAFLD risk at 24 years. METHODS: Data were from 1657 participants in the Avon Longitudinal Study of Parents and Children. Transient elastography was used to assess hepatic steatosis (low/moderate/severe) at 24 years and dual-energy X-ray absorptiometry was used to assess total body fat percent (TBF%) and trunk fat percent (TrF%) at 9, 13, 15, 17, and/or 24 years. Linear mixed models were constructed with quadratic age to examine trajectories of TBF% and TrF% by steatosis at 24 years, adjusting for confounders. RESULTS: In both sexes, TBF% trajectories from 9 to 24 years followed a similar pattern based on steatosis group (P = .83 for boys and P = .14 for girls for age2 *steatosis fixed effect). However, at all ages TBF% was higher for moderate/severe vs low steatosis at 24 years (P < .05). In contrast, TrF% trajectories diverged based on steatosis group (P = .001 for boys and P = .0002 for girls for age2 *steatosis fixed effect), such that, in both sexes, participants with moderate/severe steatosis at 24 yrs exhibited less decline in TrF% from adolescence to adulthood compared to participants with low steatosis at 24 yrs. Similar to TBF%, TrF% was higher at nearly all ages for moderate/severe vs low steatosis. Results were similar after adjusting for BMI category at each age, except in boys some differences for TrF% were attenuated. CONCLUSIONS: These findings suggest that sex-specific body fat distribution patterns in childhood/adolescence may help to identify those at risk of developing NAFLD in adulthood.

Upper airway lengthening caused by weight increase in obstructive sleep apnea patients.

BACKGROUND: The longer upper airway is more collapsible during sleep. This study aims to reveal relationships among upper airway length, weight, and obstructive sleep apnea (OSA), particularly to answer why the upper airway of OSA patients is longer than that of healthy people and why some obese people suffer from OSA while others do not. METHODS: We perform head and neck MRI on male patients and controls, and measure > 20 morphological parameters, including several never before investigated, to quantify the effect of weight change on upper airway length. RESULTS: The upper airway length is longer in patients and correlates strongly to body weight. Weight increase leads to significant fat infiltration in the tongue, causing the hyoid to move downward and lengthen the airway in patients. The apnea-hypopnea index (AHI) strongly correlates to airway length and tongue size. Surprisingly, a distance parameter h and angle ß near the occipital bone both show significant differences between healthy males and patients due to their different head backward tilt angle, and strongly correlates with AHI. The contributions of downward hyoid movement and head tilt on airway lengthening are 67.4-80.5% and19.5-32.6%, respectively, in patients. The parapharyngeal fat pad also correlates strongly with AHI. CONCLUSIONS: The findings in this study reveal that the amount of body weight and distribution of deposited fat both affect airway length, and therefore OSA. Fat distribution plays a larger impact than the amount of weight, and is a better predictor of who among obese people are more prone to OSA.

Impact of body fat distribution and sarcopenia on the overall survival in patients with spinal metastases receiving radiotherapy treatment: a prospective cohort study.

Introduction: An increasing number of patients is diagnosed with spinal metastases due to elevated cancer incidence and improved overall survival. Patients with symptomatic spinal bone metastases often receive radiotherapy with or without surgical stabilisation. Patients with a life expectancy of less than 3 months are generally deemed unfit for surgery, therefore adequate pre-treatment assessment of life expectancy is necessary. The aim of this study was to assess new factors associated with overall survival for this category of patients.Patients and methods: Patients who received radiotherapy for thoracic or lumbar spinal metastases from June 2013 to December 2016 were included in this study. The pre-treatment planning CT for radiotherapy treatment was used to assess the patient's visceral fat area, subcutaneous fat area, total muscle area and skeletal muscle density on a single transverse slice at the L3 level. The total muscle area was used to assess sarcopenia. Furthermore, data were collected on age, sex, primary tumour, Karnofsky performance score, medical history, number of bone metastases, non-bone metastases and neurological symptoms. Univariable and multivariable cox regressions were performed to determine the association between our variables of interest and the survival at 90 and 365 days.Results: A total of 310 patients was included. The median age was 67 years. Overall survival rates for 90 and 365 days were 71% and 36% respectively. For 90- and 365-day survival, the Karnofsky performance score, muscle density and primary tumour were independently significantly associated. The visceral or subcutaneous fat area and their ratio and sarcopenia were not independently associated with overall survival.Conclusions: Of the body morphology, only muscle density was statistically significant associated with overall survival after 90 and 365 days in patients with spinal bone metastases. Body fat distribution was not significantly associated with overall survival.

Efeitos da eletroestimulação neuromuscular na ação biomecânica dos músculos masseter e temporal, nas variáveis fisiológicas do sono e na distribuição de gordura corporal em pacientes com síndrome de Down / Effects of neuromuscular electrical stimulation on the biomechanics of masseter and temporalis muscle activity, physiological sleep variables, and body fat distribution in patients with Down syndrome

Avaliamos os efeitos terapêuticos da eletroestimulação neuromuscular de superfície (EENMs) sobre a biomecânica dos músculos masseter e temporal e as variáveis fisiológicas do sono em pacientes jovens e adultos com síndrome de Down (SD). A distribuição da gordura corporal foi também analisada, antes e após a terapia proposta, a fim de averiguar a presença de possíveis variações, particularmente na região do pescoço. Seis sujeitos com SD foram selecionados e submetidos à terapia com EENMs. Os efeitos terapêuticos sobre as atividades elétricas dos músculos masseter (porção superficial) e temporal (porção anterior), a amplitude de abertura de boca e a intensidade de força de mordida foram investigados por meio de eletromiografia de superfície (EMGs), paquímetro analógico e transdutor de força, respectivamente. As variáveis fisiológicas do sono foram analisadas através da polissonografia ­ tipo II (PSG-II); enquanto que a distribuição de gordura corporal foi mensurada através de análise antropométrica, incluindo o índice de massa corporal (IMC), circunferência do pescoço (CP), circunferência abdominal e razão cintura e quadril (RCQ). Esses métodos de análise foram realizados antes e após terapia proposta. Observamos que a terapia EENMs reduziu a CP (valores) e a RCQ (valores) sugerindo benefício ao risco de disfunções cardiovasculares. A EMG dos músculos mastigatórios em repouso foi maior em todos os grupos estudados e a redução da abertura máxima bucal (controle 5,6 ±1,2 cm x 4,8 ± 0,7 cm pós tratamento), sinalizam que houve um aumento do tônus muscular. Já a EMGs em contração máxima voluntária e intercuspidação máxima não mostraram alterações significativas, embora a Força Máxima Mandibular tenha aumentado de 39,8±13,5 para 44,0±14,8 KgF pós tratamento, tais achados mostraram um benefício no incremento de unidades motoras, e sugerem que a presença de interferências oclusais e ausência de elementos dentários comumente encontrados na SD, prejudicaram os registros eletromiográficos, nesta condição de coleta. Em relação a PSG, observamos a redução no grau de severidade no índice de apneia/hipopnéia, mostrando que a EENMs interferiu nos parâmetros do sono e no risco de AOS nestes pacientes. Portanto, nossos resultados em conjunto, sugerem que terapia aplicada no pressente estudo pode agregar fatores positivos na saúde e na qualidade de vida para os indivíduos portadores de SD(AU)

We evaluated the therapeutic effects of neuromuscular surface electrostimulation (NMES) on the biomechanics of the masseter and temporal muscles and the physiological variables of sleep in young and adult patients with Down syndrome (DS). The distribution of body fat was also analyzed, before and after the proposed therapy, in order to ascertain the presence of possible variations, particularly in the neck region. Six subjects with DS were selected and submitted to therapy with NMES. The therapeutic effects on the electrical activities of the masseter (superficial portion) and temporal (anterior portion) muscles, the amplitude of mouth opening and the intensity of the bite force were investigated by means of surface electromyography (EMGs), analog caliper and transducer of strength, respectively. The physiological variables of sleep were analyzed using polysomnography - type II (PSG-II); whereas, the distribution of body fat was measured through anthropometric analysis, including body mass index (BMI), neck circumference (CP), abdominal circumference and waist and hip ratio (WHR). These methods of analysis were performed before and after proposed therapy. We observed that NMES therapy reduced CP (values) and WHR (values) suggesting a benefit to the risk of cardiovascular dysfunction. The EMG of the masticatory muscles at rest was greater in all groups studied and the reduction in maximum mouth opening (control 5.6 ± 1.2 cm x 4.8 ± 0.7 cm after treatment), indicates that there was an increase in the muscle tone. The EMGs in maximum voluntary contraction and maximum intercuspation did not show significant changes, although the Maximum Mandibular Strength increased from 39.8 ± 13.5 to 44.0 ± 14.8 KgF after treatment, such findings showed a benefit in the increase of motor units, and suggest that the presence of occlusal interference and the absence of dental elements commonly found in DS, impaired the electromyographic records, in this collection condition. Regarding PSG, we observed a reduction in the degree of severity in the apnea / hypopnea index, showing that NMES interfered with sleep parameters and the risk of OSA in these patients. Therefore, our results together suggest that therapy applied in the present study may add positive factors in health and quality of life for individuals with D(AU)

Body composition changes in diabetes and aging.

Aging is associated with changes in body composition, including both fat gain and muscle loss beginning in middle age, and is associated with increased risk of type 2 diabetes. Moreover, changes in fat distribution take place in adults as they age and may contribute to the increased risk of type 2 diabetes. Recent literature has shown differences in the age-related changes in body composition by diabetes status suggesting that some of these changes might not only be a risk factor of the development of diabetes but could also be a consequence of the disease. In this article, we review the current evidence on body composition changes that take place in adults after the diagnosis of type 2 diabetes and compare them to those observed in adults without diabetes as they age. We also review the effect of various lifestyle, pharmacological, and surgical treatments that lower blood glucose on body composition in adults with type 2 diabetes.

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.

Relationship between fat distribution and cardiometabolic risk in Hispanic girls.

OBJECTIVE: In adults, certain body fat depots have greater impact on cardiometabolic risk than total adiposity. Whether similar relationships exist in children is uncertain. The aim of this study was to examine the relationships among dual x-ray absorptiometry (DXA) measures of body fat distribution and total body adiposity with cardiometabolic risk factors in Hispanic girls. METHODS: Measures of total percent body fat, percent of total fat within the android, gynoid, leg, and trunk regions, and cardiometabolic biomarkers (insulin, glucose, homeostatic model assessment of insulin resistance (HOMA-IR), triglycerides (TG), low and high lipoprotein cholesterol (LDL-C, HDL-C)) were obtained from 232 Hispanic girls (age 10.7 ±1.1 years). Regression models for each metabolic parameter were run against adiposity measures. Partial correlations of the adiposity measures were used to compare associations between adiposity measures and the cardiometabolic risk factors, controlling for somatic maturation. RESULTS: Total and regional adiposity were significantly related with cardiometabolic risk factors (P < 0.05) except fasting glucose. The partial correlations of total and regional adiposity measures with each cardiometabolic biomarker were similar. More variance was explained for insulin and the HOMA-IR (33%-43%) than other risk factors. Partial correlations for the percentage of total fat in the gynoid and leg regions with insulin, HOMA-IR, TG, and LDL-C were negative, and positive with HDL-C. CONCLUSION: Measures of total and regional fat perform similarly in predicting cardiometabolic risk in Hispanic girls. A higher proportion of fat distributed in the gynoid or leg region is associated with lower cardiometabolic risk.

Systemic and local adipose tissue in knee osteoarthritis.

Knee osteoarthritis (OA) is the most common joint disease. Body adipose tissue has been shown to be related to the development and progression of knee OA. Among systemic adipose tissues, subcutaneous adipose tissue is significantly and negatively associated with muscle mass and forces, and could be related to the presence and progression of knee OA. Visceral adipose tissue is associated with increased cartilage loss and production of pro-inflammatory cytokines. Intra-muscular adipose tissue is associated with knee osteoarthritic changes, but it remains controversial if inter-muscular adipose tissue has a role to play in the pathogenesis for knee OA. Knee local adipose tissue such as infrapatellar fat pad (IPFP) can interact with neighbouring tissues, and may have a biphasic effect in knee OA. The underlying mechanisms for the roles of the systemic and local fat in knee OA could be related to biomechanical, metabolic, inflammatory factors and fat fibrosis, which may have a separated or combined effect on OA. Tissue engineering from systemic or local adipose tissue is a new research direction, and adipose tissue-derived stem cells from systemic or local adipose tissue may be beneficial for OA cartilage repair. Research on systemic and local adipose tissue would provide novel approaches for prevention and treatment of knee OA, but further studies are required to explore the roles of different adipose tissues in knee OA and the effects of stem cells derived from different adipose tissues on knee OA.

The relationship of body habitus and respiratory function in Duchenne muscular dystrophy.

BACKGROUND: The multidisciplinary care of Duchenne muscular dystrophy (DMD) incorporates management of nutrition and the respiratory system, however the effect of body habitus on respiratory function in DMD is poorly understood. The present study examined the impact of nutritional status on respiratory function in DMD to guide further treatment strategies. METHODS: Anthropometric and respiratory parameters, such as body mass index (BMI) z-scores, forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) were retrospectively analysed with a mixed linear model in 34 DMD patients. Cross-sectional analysis of cough peak flow (CPF) in upright and supine positions and body fat mass were examined in 12 DMD patients. RESULTS: Respiratory function in DMD patients was significantly related to BMI Z-score (P < 0.001), age (P < 0.05) and mobility (P < 0.001). DMD patients with greater BMI Z-score had increased respiratory function, even when adjusting for age and mobility status, with a 1 unit increase in BMI z-score associated with a 7.43% increase in FVC% predicted (P < 0.001). Body fat mass was adversely associated with FVC with a 1% body fat increase associated with a 1.5% reduction in FVC (P < 0.05). CPF values were significantly lower in supine compared to upright position (P = 0.005) and greater postural reductions in CPF were associated with higher body fat percent, with a 1% body fat increase associated with a 1.5% increase in postural CPF difference (P < 0.05). CONCLUSION: The present study reinforces the importance of weight management in DMD, showing that a higher weight profile and lower adiposity have better respiratory outcomes. Furthermore, attention to body position with airway clearance techniques will maximize their effectiveness.

The distribution and adipogenic potential of perivascular adipose tissue adipocyte progenitors is dependent on sexual dimorphism and vessel location.

There are sex associated differences in the risk for cardiovascular comorbidities in obesity and metabolic syndrome. A common clinical finding in these diseases is the expansion of perivascular adipose tissues (PVAT) which is associated with alterations in their role as regulators of vessel function. PVAT hyperplasia and hypertrophy are dependent on the biology of populations of adipocyte progenitor cells (APC). It is currently unclear if PVAT enlargement diverges between males and females and the mechanisms linking APC biology with sexual dimorphism remain poorly understood. This study tested the hypothesis that vessel location and sexual dimorphism affect the distribution and adipogenic capacity of APC in cardiovascular disease risk relevant PVAT sites. PVAT from thoracic aorta (aPVAT) and mesenteric resistance arteries (mPVAT) was collected from 10-week-old female and male Sprague-Dawley rats. Differences in APC distribution in stromal vascular fraction cells from PVAT were determined. APC were defined as cells expressing CD34, CD44, and platelet derived growth factor α In both sexes aPVAT had fewer APC compared to mPVAT and perigonadal adipose tissue (GON). Sex-related differences were observed in the expression of CD34, where females had fewer CD34+ cells in PVATs. APC proliferation and adipogenic capacity in vitro were not affected by sex. However, APC from aPVAT had a lower proliferation capacity compared to mPVAT These data demonstrate that the distribution of APC within PVAT exhibits sexual dimorphism and is affected by anatomical location.

Regional Fat Distribution and Blood Pressure Level and Variability: The Dallas Heart Study.

Our aim was to investigate the associations of regional fat distribution with home and office blood pressure (BP) levels and variability. Participants in the Dallas Heart Study, a multiethnic cohort, underwent 5 BP measurements on 3 occasions during 5 months (2 in home and 1 in office) and quantification of visceral adipose tissue, abdominal subcutaneous adipose tissue, and liver fat by magnetic resonance imaging, and lower body subcutaneous fat by dual x-ray absorptiometry. The relation of regional adiposity with short-term (within-visit) and long-term (overall visits) mean BP and average real variability was assessed with multivariable linear regression. We have included 2595 participants with a mean age of 44 years (54% women; 48% black), and mean body mass index was 29 kg/m(2) Mean systolic BP/diastolic BP was 127/79 mm Hg and average real variability systolic BP was 9.8 mm Hg during 3 visits. In multivariable-adjusted models, higher amount of visceral adipose tissue was associated with higher short-term (both home and office) and long-term mean systolic BP (ß[SE]: 1.9[0.5], 2.7[0.5], and 2.1[0.5], respectively; all P<0.001) and with lower long-term average real variability systolic BP (ß[SE]: -0.5[0.2]; P<0.05). In contrast, lower body fat was associated with lower short-term home and long-term mean BP (ß[SE]: -0.30[0.13] and -0.24[0.1], respectively; both P<0.05). Neither subcutaneous adipose tissue or liver fat was associated with BP levels or variability. In conclusion, excess visceral fat was associated with persistently higher short- and long-term mean BP levels and with lower long-term BP variability, whereas lower body fat was associated with lower short- and long-term mean BP. Persistently elevated BP, coupled with lower variability, may partially explain increased risk for cardiac hypertrophy and failure related to visceral adiposity.

Hyperemesis gravidarum and its relation with maternal body fat composition.

The objective of this study was to determine if maternal body fat composition and body mass index were associated with hyperemesis gravidarum (HG) in the first trimester of pregnancy. Healthy pregnant women (n = 30) without nausea and vomiting (control group) and women with HG (n = 54; study group), all with singleton pregnancy at 6-14 weeks gestational age, were included. Body mass index was measured before and during pregnancy. Visceral adipose tissue (VAT) and subcutaneous fat thickness were measured during pregnancy. Comparison of the groups revealed that VAT and pre-pregnancy body mass index but not subcutaneous fat thickness were significantly higher in the HG group versus controls. VAT and pre-pregnancy body mass index predicted 83.8% and 67.1% of HG cases, respectively. VAT and pre-pregnancy body mass index were correlated with the development of hyperemesis gravidrum and hence could be considered as predictive markers for HG.

Modic changes in the lumbar spine and their association with body composition, fat distribution and intervertebral disc height - a 3.0 T-MRI study.

BACKGROUND: Vertebral endplate (Modic) abnormalities are important structural lesions in the spine, but their association with body composition and fat distribution have not been examined. Moreover, no study has examined whether Modic change are related to other structural features of low back pain, such as reduced intervertebral disc height. METHODS: Seventy-two community-based individuals not selected for low back pain had lumbar vertebral Modic change and intervertebral disc height assessed from MRI. Dual energy x-ray absorptiometry measured body composition and fat distribution. RESULTS: The predominance of Modic change was type 2. Modic change was associated with an increased fat mass index (OR 1.20, 95 % CI 1.01 to 1.43), and tended to be associated with a reduced fat-free mass index (OR 0.62, 95 % CI 0.37 to 1.03, p = 0.07). While an increased percentage of gynoid fat was associated with a reduced risk (OR 0.62, 95 % CI 0.43 to 0.89), an increased percentage of android fat was associated with an increased risk of Modic change (OR 2.11, 95 % CI 1.18 to 3.76). Modic change was also associated with reduced intervertebral disc height at L2/3, L4/5 and L5/S1 (OR range 1.4 to 1.8; all p ≤ 0.03). CONCLUSION: Modic type 2 change is associated with reduced intervertebral disc height and an increased fat mass index. Whereas gynoid fat distribution protected against Modic type 2 change, an android pattern increased the risk of this lesion. Modic type 2 change, which histologically represent fat replacement, might have a metabolic component to its aetiology.

Associação da ingestão de macronutrientes com o padrão de sono de adolescentes obesos / Associations of macronutrients intake with sleep pattern among obese adolescents

Introdução: A obesidade tornou-se uma preocupação mundial. Estudos mostraram relação negativa entre a duração do sono e o Índice de Massa Corporal (IMC), adicionalmente, pesquisas revelam que a privação do sono está relacionada com a inadequação alimentar. Objetivos: Avaliar e relacionar a qualidade do sono, ingestão alimentar e percentual de gordura de adolescentes obesos. Métodos: A amostra foi composta por 41 adolescentes obesos. Foi realizada avaliação da composição corporal, ingestão alimentar por recordatório e análise do sono por questionários. Resultados: Foi observada alta prevalência de dietas hiperlipídicas (60,98%), além de má qualidade do sono (82,93%) e sonolência (56,10%). Além disso,a sonolência apresentou correlação positiva com massa corporal (r=0,327), com IMC (r=0,363) e ingestão hiperproteíca (r=0,343). A má qualidade do sono apresentou correlação com a massa corporal (r=0,336). Conclusão: Os sujeitos apresentaram importantes alterações no padrão de sono, possivelmente associada à ingestão exacerbada de nutrientes e a adiposidade.

Introduction: Obesity has become a global concern. Studies show negative relationship between sleep duration and body mass index (BMI), additionally, research shows that sleep deprivation is related to inadequate diet. Objectives: To analyze the quality of sleep, food intake and body fat percentage of obese adolescents. Methods: The sample consisted of 41 obese adolescents. The assessment of body composition has been carried out by food intake recall, sleep analysis questionnaires. Results: We found a high prevalence of high fat diet (60.98%), and poor sleep quality (82.93%) and somnolence (56.10%). In addition, sleepiness was positively correlated with body weight (r = 0.327), BMI (r = 0.363) and the high protein intake (r = 0.343). The poor sleep quality correlated with body mass (r = 0.336). Conclusion: The subjects showed significant changes in sleep patterns, possibly associated with exacerbated nutrient intake and adiposity.

Increase in waist circumference over 6 years predicts subsequent cardiovascular disease and total mortality in nordic women.

OBJECTIVE: Despite solid evidence of an association between centralized body fatness and subsequent disease risk, little is known about the consequences of changes in body fat distribution. Recently it was shown that large hip circumference (HC), measured once, was protective against total and cardiovascular disease (CVD) mortality in women but that gain or loss in HC was unrelated to these outcomes. This study examines whether a 6-year change in waist circumference (WC) predicts mortality and CVD in the same study sample. METHODS: Baseline WC and 6-year change in WC as predictors of mortality and CVD were analyzed in 2,492 women from the Danish MONICA study and the Prospective Population Study of Women in Gothenburg, Sweden. RESULTS: Increase in WC was significantly associated with increased subsequent mortality and CVD adjusting for BMI and other covariates, with some evidence of a J-shaped association. Associations between increase in WC and outcomes were restricted to women with normal weight at baseline and to ever-smokers. CONCLUSIONS: In contrast to changes in HC which did not predict mortality and CVD, a 6-year increase in WC is strongly predictive, particularly among initially lean women and ever-smokers. This implies the importance of developing strategies to prevent central fat deposition.

Obesity, body fat distribution, and risk of breast cancer subtypes in African American women participating in the AMBER Consortium.

African American (AA) women are more likely than white women to be obese and to be diagnosed with ER- and triple-negative (TN) breast cancer, but few studies have evaluated the impact of obesity and body fat distribution on breast cancer subtypes in AA women. We evaluated these associations in the AMBER Consortium by pooling data from four large studies. Cases were categorized according to hormone receptor status as ER+, ER-, and TN (ER-, PR-, and HER2-) based on pathology data. A total of 2104 ER+ cases, 1070 ER- cases (including 491 TN cases), and 12,060 controls were included. Odds ratios (OR) and 95 % confidence intervals (CI) were computed using logistic regression, taking into account breast cancer risk factors. In postmenopausal women, higher recent (most proximal value to diagnosis/index date) BMI was associated with increased risk of ER+ cancer (OR 1.31; 95 % CI 1.02-1.67 for BMI ≥ 35 vs. <25 kg/m(2)) and with decreased risk of TN tumors (OR 0.60; 95 % CI 0.39-0.93 for BMI ≥ 35 vs. <25). High young adult BMI was associated with decreased premenopausal ER+ cancer and all subtypes of postmenopausal cancer, and high recent waist-to-hip ratio with increased risk of premenopausal ER+ tumors (OR 1.35; 95 % CI 1.01-1.80) and all tumor subtypes combined in postmenopausal women (OR 1.26; 95 % CI 1.02-1.56). The impact of general and central obesity varies by menopausal status and hormone receptor subtype in AA women. Our findings imply different mechanisms for associations of adiposity with TN and ER+ breast cancers.

Pericardial fat volume is an independent risk factor for the severity of coronary artery disease in patients with preserved ejection fraction.

OBJECTIVES: The aim of this study was to assess the relationship between the pericardial fat volume (PFV) and the characteristics of coronary plaques in patients with ischemic heart disease (IHD). BACKGROUND: It has been suggested that pericardial adipose tissue promotes plaque development in coronary artery disease (CAD). METHODS: We analyzed the cardiac computed tomography scans in consecutive patients suspected of CAD. PFV was quantified using validated software and indexed to body surface area, and the severity of coronary stenosis was evaluated in the patients who underwent coronary angiography. A total of 105 subjects (mean age, 68±10 years) with IHD were categorized into tertiles of body surface area-indexed PFV values (PFVi, cm3/m2): low-tertile, PFVi < 81.2 cm3/m2; mid-tertile, 81.2 cm3/m2 ≤ PFVi ≤ 114 cm3/m2; high-tertile, PFVi > 114 cm3/m2. Their body mass index (BMI), waist circumference, Gensini score (GS), and coronary plaque component were evaluated. RESULTS: The GS was significantly different between the high-tertile and the low-tertile groups, indicating a stepwise decrease in GS from high-tertile to mid-tertile and to low-tertile. PFVi had a significant positive correlation with BMI (p=0.0001) and GS (p<0.0001). However, no significant association was found between GS and BMI. On the multivariate analysis, high PFVi remained an independent predictor for the coronary artery disease severity (p<0.001), while BMI and waist circumference were not independent predictors. CONCLUSIONS: Obese patients were found to have more PFVi, and the characteristics of their coronary lesions were more severe. Pericardial adipose tissue as unique ectopic fat might be more highly associated with IHD progression.

Effect modification of body mass index and body fat percentage on fatty liver disease in a Japanese population.

BACKGROUND AND AIM: No previous study has performed multivariate analysis of the risk factors of fatty liver disease (FL), focusing on the effect of weight gain of ≥ 10 kg since the age of 20, and no analysis model exists that simultaneously evaluates body mass index (BMI) and body fat percentage (BFP) as adjustment variables. METHODS: To investigate these, we collected anthropometric data from health checkups, and conducted a cross-sectional study (targeting 1851 males and 1259 females aged 30 years or over). RESULTS: Regardless of sex, weight gain of ≥10 kg since the age of 20 was positively associated with FL. Our stratified analysis of BFP into two categories, to evaluate the interaction between BMI and BFP in FL, indicated an approximately fivefold increase in the odds ratio in the male group with high BMI and BFP values compared to those with low BMI and BFP values, with a synergy index of 1.77 > 1. On the other hand, females demonstrated no significant additive interaction, with a synergy index of 0.49 < 1. CONCLUSIONS: We revealed that weight gain ≥ 10 kg since the age of 20 is significantly associated with FL regardless of sex. In addition, by performing a synergy index (S), we showed that the additive interaction between BMI and BFP in FL differs according to gender.