Abdominal visceral adiposity influences CD4+ T cell cytokine production in pregnancy

Women with pre-gravid obesity are at risk for pregnancy complications. While the macrophage response of obese pregnant women categorized by body mass index (BMI) has been documented, the relationship between the peripheral CD4⁺ T cell cytokine profile and body fat compartments during pregnancy is unknown. In this study, third trimester peripheral CD4⁺ T cell cytokine profiles were measured in healthy pregnant women [n = 35; pre-pregnancy BMI: 18.5–40]. CD4⁺ T cells were isolated from peripheral blood mononuclear cells and stimulated to examine their capacity to generate cytokines. Between 1 and 3 weeks postpartum, total body fat was determined by dual-energy X-ray absorptiometry and abdominal subcutaneous and visceral fat masses were determined by magnetic resonance imaging. Pearson’s correlation was performed to assess relationships between cytokines and fat mass. Results showed that greater abdominal visceral fat mass was associated with a decrease in stimulated CD4⁺ T cell cytokine expression. IFN-gamma, TNF-alpha, IL-12p70, IL-10 and IL-17A were inversely related to visceral fat mass. Chemokines CCL3 and IL-8 and growth factors G-CSF and FLT-3L were also inversely correlated. Additionally, total body fat mass was inversely correlated with FGF-2 while abdominal subcutaneous fat mass and BMI were unrelated to any CD4⁺ T cell cytokine. In conclusion, lower responsiveness of CD4⁺ T cell cytokines associated with abdominal visceral fat mass is a novel finding late in gestation.     

Central visfatin potentiates glucose-stimulated insulin secretion and β-cell mass without increasing serum visfatin levels in diabetic rats

IntroductionOur previous study revealed that plasma visfatin levels were lower in pregnant women with gestational diabetes (GDM) than non-GDM independent of prepreganacy BMI. We examined whether central visfatin modulates energy and glucose homeostasis via altering insulin resistance, insulin secretion or islet morphometry in diabetic rats.MethodsPartial pancreatectomized, type 2 diabetic, rats were interacerbroventricularly infused with visfatin (100 ng/rat/day, Px-VIS), visfatin + visfatin antagonist, CHS-828 (100 μg/rat/day, Px-VIS-ANT), or saline (control, Px-Saline) via osmotic pump, respectively, for 4 weeks.ResultsCentral visfatin improved insulin signaling (pAkt → pFOXO-1) but not pSTAT3 in the hypothalamus. Central visfatin did not alter serum visfatin levels in diabetic rats whereas the levels were higher in non-diabetic rats than diabetic rats. Body weight at the 2nd week was lowered in the Px-VIS group due to decreased food intake in the first two weeks compared to the Px-Saline group and energy expenditure was not significantly different among the treatment groups of diabetic rats. Visfatin antagonist treatment nullified the central visfatin effect. Px-VIS increased whole body glucose disposal rates in euglycemic hyperinsulinemic clamp compared to Px-Saline and lowered hepatic glucose output, whereas Px-VIS-ANT blocked the visfatin effect on insulin resistance (P < 0.05). In hyperglycemic clamp study, the area under the curve of insulin in first and second phase were significantly higher in the Px-VIS group than the Px-Saline group without modifying insulin sensitivity at the hyperglycemic state, whereas the increase in serum insulin levels was blocked in the Px-VIS-ANT group. Central visfatin also increased β-cell mass by increasing β-cell proliferation.ConclusionsCentral visfatin improved glucose homeostasis by increasing insulin secretion and insulin sensitivity at euglycemia through the hypothalamus in diabetic rats. Therefore, visfatin is a positive modulator of glucose homeostasis by delivering the hypothalamic signals into the peripheries.     

The Quételet index revisited in children and adults

BackgroundThe body mass index (BMI) is based on the original concept that body weight increases as a function of height squared. As an indicator of obesity the modern BMI assumption postulates that adiposity also increases as a function of height in states of positive energy balance.ObjectiveTo evaluate the BMI concept across different adiposity magnitudes, in both children and adults.MethodsWe studied 975 individuals who underwent anthropometric evaluation: 474 children and 501 adults. Tetrapolar bioimpedance analysis was used to assess body fat and lean mass.ResultsBMI significantly correlated with percentage of body fat (%BF; children: r = 0.893; adults: r = 0.878) and with total fat mass (children: r = 0.967; adults: r = 0.953). In children, body weight, fat mass, %BF and waist circumference progressively increased as a function of height squared. In adults body weight increased as a function of height squared, but %BF actually decreased with increasing height both in men (r = −0.406; p < 0.001) and women (r = −0.413; p < 0.001). Most of the BMI variance in adults was explained by a positive correlation of total lean mass with height squared (r² = 0.709), and by a negative correlation of BMI with total fat mass (r = −0.193).ConclusionsBody weight increases as a function of height squared. However, adiposity progressively increases as a function of height only in children. BMI is not an ideal indicator of obesity in adults since it is significantly influenced by the lean mass, even in obese individuals.     

Anthropometric and body composition characteristics during pregnancy: A study from West Bengal,India

The present cross-sectional study was aimed at investigating changes in anthropometric, body composition and blood pressure characteristics during pregnancy. A total of 406 healthy, pregnant women aged between 16 and 33 years participated in the study. Pregnant women were recruited from the outpatient department of the two-referral hospital in Bolpur subdivision of Birbhum district, West Bengal, India. Anthropometric measures such as height, weight, three circumferences and skinfold thickness at four sites (biceps, triceps, subscapular and suprailaic) were obtained using standard techniques. Percentages of body fat (%BF), intra abdominal visceral fat (IVF), basal metabolic rate (BMR) and body mass index (BMI) were measured using an Omron body fat analyser. Two forenoon blood pressure measurements were also taken and averaged for analysis. Subjects were categorized into three trimester groups: Group I, n = 30; Group II, n = 163; and Group III, n = 213. ANOVA with Scheffe's post-hoc test revealed that Group I had significantly lower mean than both Group II and Group III for systolic blood pressure and IVF, whereas Group I had significantly lower mean than Group III for BMI, BMR, %BF, diastolic blood pressure and skinfolds. The mean change in maternal weight from the first to the third trimester was merely 3 kg. Mean waist circumference varied from the first to the third trimester but not from the first to the second trimester. Furthermore, significantly increased systolic and diastolic blood pressure was observed across the trimesters. However, longitudinal studies involving interaction of body fat topography and pregnancy-induced hormones are required to further our understanding of gestation mechanism.     

High leptin/adiponectin ratio and serum triglycerides are associated with an "at-risk" phenotype in young severely obese patients

"At-risk" severely obese subjects are characterized by insulin resistance, and higher visceral fat and plasma lipid levels compared with metabolically healthy obese (MHO) subjects, although both groups have a high BMI and fat mass. The aim of this study was to measure several serum adipokines and gastrointestinal hormones in a young severely obese population from Southern Italy to identify biochemical markers of the "at-risk" insulin-resistant obese profile. We studied 160 unrelated white young adults (mean age = 25.2 years, mean BMI = 44.9 kg/m(2), 65% women) affected by obesity for at least 5 years. Serum concentrations of glucagon, ghrelin, gastric inhibitory peptide, glucagon like peptide-1, interleukin-6, tumor necrosis factor α, leptin, adiponectin, adipsin, and visfatin were measured. The leptin/adiponectin (L/A) ratio and fatty liver index (FLI) were calculated. We found a prevalence of 21.3% of MHO patients in our young severely obese patients. At univariate analysis, the "at-risk" group had higher mean levels of BMI (P < 0.0001), leptin (P = 0.039, men) and the L/A ratio (P = 0.003), and lower mean levels of visfatin (P = 0.026) than the MHO group. The L/A ratio, serum triglycerides, and male sex were significantly associated with "at-risk" obesity and accounted for 19.5% of insulin resistance at multivariate analysis. In conclusion, we demonstrate that a high serum L/A ratio and high levels of serum triglycerides may be markers of "at-risk" obesity, independent of waist circumference (WC) and BMI, in young severely obese population.     

Serum Uric Acid Levels and Risk of Metabolic Syndrome in Healthy Adults

ObjectiveTo investigate the relationship between hyperuricemia and metabolic syndrome in a population of healthy subjects.MethodsWe studied 1,573 healthy adults (25 to 64 years old) in the population laboratory of the Tehran University of Medical Sciences. The study was designed according to the World Health Organization MONICA (Multinational Monitoring of Trends and Determinants in Cardiovascular Disease) project with use of the National Cholesterol Education Program Adult Treatment Panel III criteria for metabolic syndrome.ResultsThe crude prevalence of the metabolic syndrome was 29.9% (age-adjusted, 27.5%). The rate of metabolic syndrome significantly increased in higher quartiles of serum uric acid in both sexes but especially in women (P < .0001 versus P = .026). The bivariate correlation was significant between uric acid levels and age, total serum cholesterol, high-density lipoprotein cholesterol, triglycerides, body mass index, waist and hip circumferences, waist-to-hip ratio, and systolic and diastolic blood pressures; however, there was not a significant correlation between serum uric acid concentrations and fasting plasma glucose.ConclusionThese data indicate that an independent relationship exists between hyperuricemia and the metabolic syndrome. Moreover, hyperuricemia is significantly correlated with hypertriglyceridemia, hypertension, and visceral obesity. Early detection of hyperuricemia seems to be essential for prevention of the metabolic syndrome. (Endocr Pract. 2008;14:298-304)     

Evaluation of Para- and Perirenal Fat Thickness and its Association with Metabolic Disorders in Polycystic Ovary Syndrome

Objective: The aim of this study was to compare para- and perirenal fat (PFT) and subcutaneous abdominal fat (SFT) measurements between patients with polycystic ovary syndrome (PCOS) and control subjects and to assess the possible relation with metabolic disorders.Methods: This study included 68 patients with PCOS and 40 age- and body mass index (BMI)-matched healthy controls. We evaluated anthropometric, hormonal, and metabolic parameters, and abdominal ultrasonography was performed to measure PFT and SFT.Results: The mean PFT values were 6.1 ± 2.9 mm in patients with PCOS and 4.3 ± 2.3 mm in healthy controls (P = .002). SFT values were also higher in the patient group (9.6 ± 5 mm) compared to healthy subjects (3.5 ± 0.5 mm) (P = .017). A significant positive correlation was found between PFT and BMI (r = 0.368), waist circumference (WC) (r = 0.441), Ferriman-Gallwey (FG) score (r = 0.313), blood pressure (systolic, SBP, r = 0.213; diastolic, DBP, r = 0.215), plasma glucose (r = 0.195), homeostasis model assessment-insulin resistance (HOMA-IR, r = 0.273), SFT (r = 0.555). Conversely, negative correlations were found between PFT and estradiol (r = -0.218) and sex hormone-binding globulin (SHBG, r = -0.304). Nonobese PCOS patients (6.1 ± 3.07 mm) had higher PFT values than nonobese controls (3.47 ± 1.5 mm); however, SFT measurements did not differ (P = .086). In multiple linear regression analysis, SFT (P = .006) was a significant and independent predictor for PFT, along with WC (P = .023). In a stepwise model, SFT was the predictor of PFT (P = .001).Conclusion: PFT values were higher particularly in nonobese PCOS patients compared to nonobese control subjects. There was a significant interaction between PCOS and obesity on PFT.Abbreviations: BMI = body mass index; CT = computed tomography; DBP = diastolic blood pressure; FPG = fasting plasma glucose;; HDL-cholesterol = high-density lipoprotein cholesterol; HOMA-IR = homeostasis model assessment-insulin resistance; hsCRP = high-sensitivity C-reactive protein; LDL-cholesterol = low-density lipoprotein cholesterol; LH = luteinizing hormone; NCAH = nonclassic congenital adrenal hyperplasia; 17-OHP = 17-hydroxyprogesterone; PCOS = polycystic ovary syndrome; PFT = para- and perirenal fat; SAT = subcutaneous abdominal adipose tissue; SBP = systolic blood pressure; SFT = abdominal subcutaneous fat thickness; TG = triglyceride; US = ultrasound; VAT = visceral abdominal adipose tissue; WC = waist circumference     

Particular characteristics of the metabolic syndrome in patients with morbid obesity

BackgroundCriteria for the diagnosis of the metabolic syndrome are currently being reconsidered, as their usefulness is not the same for all phenotypes in relation to the risk of cardiovascular disease.AimWe analyzed the changes in metabolic parameters after a fat overload in different groups of patients.Materials and methodsThe study included 20 healthy persons, 30 metabolic syndrome patients without morbid obesity, 80 metabolic syndrome patients with morbid obesity and 16 patients with morbid obesity without the metabolic syndrome. All the participants received a fat overload of 60 g. Measurements were made before the overload and 3 h afterwards of triglycerides, free fatty acids, insulin and uric acid.ResultsMetabolic syndrome patients with morbid obesity had a lower waist-to-hip ratio, and lower plasma free fatty acid and triglycerides levels at baseline and after the overload than patients without morbid obesity. Plasma uric acid levels rose after the fat overload in the metabolic syndrome patients who had morbid obesity but not in the patients without morbid obesity. A positive relation was found between plasma triglycerides and free fatty acid levels in all the patients but not in the controls after the fat overload. A positive relation was also found between uric acid and insulin levels in the metabolic syndrome patients with morbid obesity.ConclusionsMetabolic syndrome patients with and without morbid obesity presented different metabolic characteristics. This suggests that there are 2 different clinical phenotypes, both grouped under the metabolic syndrome umbrella.     

Association of serum amyloid A levels with adipocyte size and serum levels of adipokines: Differences between men and women

The aim of this study was to characterize the association between adipocyte enlargement and circulating levels of serum amyloid A (SAA). Furthermore, we wanted to search for possible associations with measures of glycemic control and levels of circulating adipokines and/or inflammatory markers in men and women with a large range in body mass index. The study cohort consisted of 167 subjects, 114 non-diabetic and 53 with Type 2 diabetes. Adipocyte diameter as well as circulating levels of SAA, C-reactive protein (CRP), adiponectin, leptin, interleukin-6, tumor necrosis factor alpha, glucose and insulin were measured. Women had higher serum levels of SAA than men (p = 0.044). SAA levels were weakly but positively correlated with BMI (p = 0.043) and % body fat (p = 0.027) in all subjects as well as subcutaneous adipocyte diameter (p = 0.034) in women. Furthermore, in all subjects we found correlations between SAA levels and levels of CRP (p < 0.001), interleukin-6 (p < 0.001), leptin (p = 0.003), insulin (p = 0.006), HbA1c (p = 0.02) and HOMA-IR (p = 0.002). A majority of the correlations were strongest in women. In conclusion, serum levels of SAA are strongly correlated with serum levels of inflammatory markers as well as measures of glycemic control. There seems to be large sex differences in these associations suggesting that sex-specific factors need to be considered when analyzing SAA levels in relation to metabolic disease.     

High frequency body mass measurement,feedback, and health behaviors

We analyze weight and fat percentage measurements of respondents in an online general population panel in the Netherlands, collected using wireless scales, with an average frequency of 1.6 measurements per week. First, we document the existence of a weekly cycle; body mass is lowest on Fridays and highest on Mondays, showing significant (p < 0.01) differences of, on average, 0.2 kilogram in weight, 0.06 in BMI value, and 0.03 in fat percentage. Second, we find that in the general population fat-based measures of obesity point at a three times larger prevalence of obesity (53%) than BMI-based measures (17%). Third, we find that feedback that includes a recommended weight range increases the temporal variation in individual body mass by almost ten percent (sd for weight increases from 1.13 to 1.22; sd for BMI increases from 0.37 to 0.41; sd for fat percentage increases from 0.55 to 0.61.     

Visfatin levels in prepubertal children born small or large for gestational age

Children born small (SGA) or large (LGA) for gestational age are prone to develop insulin resistance (IR) during childhood. Visfatin, a hormone with insulin-mimetic actions, has been associated with IR. This study was designed to examine whether serum level of visfatin is correlated with metabolic indices of IR, in prepuberty in association with the intrauterine growth pattern. The following parameters were evaluated at a mean age of 6.5±1.2 years in 155 prepubertal children born appropriate for the gestational age (AGA) (n=63), or SGA (n=42), or LGA (n=50): serum levels of visfatin, adiponectin, leptin, fasting glucose (G(F)) and insulin (I(F)), the homeostasis model assessment IR index (HOMA-IR), plasma lipids, anthropometric indices at birth and the time of evaluation, and obesity indices [waist circumference (WC), body mass index (BMI) and skinfold thickness]. The mean serum level of visfatin was lower in the SGA than in the AGA and the LGA children (9±5.2 vs. 11.8±5.1 and 12.7±5.6?ng/ml, respectively, p<0.01). Girls had lower visfatin levels than boys (10.4±4.3?ng/ml vs. 12.5±6.7?ng/ml, p<0.05). Visfatin was not correlated with IR indices. In multiple regression analysis visfatin level was positively correlated with birth weight z-score (t=2.56, beta=0.24, p<0.01) and crown to heel z-score (t=2.46, beta=0.22, p=0.014), independent of age, gender, maternal weight before pregnancy, maternal weight gain during pregnancy, BMI z-score, WC z-score, serum leptin and adiponectin, and HOMA-IR. In conclusion serum visfatin level was lower in prepubertal SGA children but not correlated with IR indices. Low birth weight was an independent predictor of visfatin level.     

Xanthohumol lowers body weight and fasting plasma glucose in obese male Zucker fa/fa rats

Obesity contributes to increased risk for several chronic diseases including cardiovascular disease and type 2 diabetes. Xanthohumol, a prenylated flavonoid from hops (Humulus lupulus), was tested for efficacy on biomarkers of metabolic syndrome in 4 week old Zucker fa/fa rats, a rodent model of obesity. Rats received daily oral doses of xanthohumol at 0, 1.86, 5.64, and 16.9 mg/kg BW for 6 weeks. All rats were maintained on a high fat (60% kcal) AIN-93G diet for 3 weeks to induce severe obesity followed by a normal AIN-93G (15% kcal fat) diet for the last 3 weeks of the study. Weekly food intake and body weight were recorded. Plasma cholesterol, glucose, insulin, triglyceride, and monocyte chemoattractant protein-1 (MCP-1) levels were assessed using commercial assay kits. Plasma and liver tissue levels of XN and its metabolites were determined by liquid–chromatography tandem mass spectrometry. Plasma and liver tissue levels of xanthohumol were similar between low and medium dose groups and significantly (p < 0.05) elevated in the highest dose group. There was a dose-dependent effect on body weight and plasma glucose levels. The highest dose group (n = 6) had significantly lower plasma glucose levels compared to the control group (n = 6) in male but not female rats. There was also a significant decrease in body weight for male rats in the highest dose group (16.9 mg/kg BW) compared to rats that received no xanthohumol, which was also not seen for female rats. Plasma cholesterol, insulin, triglycerides, and MCP-1 as well as food intake were not affected by treatment. The findings suggest that xanthohumol has beneficial effects on markers of metabolic syndrome.     

Traditional Anthropometric Parameters Still Predict Metabolic Disorders in Women With Severe Obesity

It is well established that fat distribution rather than the total quantity of fat is the major determinant of cardiovascular risk in overweight subjects. However, it is not known whether the concept of fat distribution still makes sense in severely obese subjects. Particularly, the role of visceral fat accumulation and/or of adipocyte hypertrophy in insulin resistance (IR) has not been studied in this population. Therefore, the aim of this study was to clarify the determinants of metabolic disorders in severely obese women. We performed a cross‐sectional study in 237 severely obese women (BMI >35 kg/m²). We assessed total body fat mass and fat distribution by anthropometric measurements (BMI and waist‐to‐hip ratio (WHR)) and by dual‐energy X‐ray absorptiometry (DXA). In 22 women, we measured subcutaneous and visceral adipocyte size on surgical biopsies. Mean BMI was 44 ± 7 kg/m² (range 35–77), mean age 37 ± 11 years (range 18–61). Lipid parameters (triglycerides, high‐density lipoprotein cholesterol) and IR markers (fasting insulin and homeostasis model assessment (HOMA) index) correlated with fat distribution, whereas inflammatory parameters (C‐reactive protein, fibrinogen) correlated only with total fat mass. An association was observed between android fat distribution and adipocyte hypertrophy. Visceral adipocyte hypertrophy was associated with both IR and hypertension, whereas subcutaneous fat‐cell size was linked only to hypertension. Our results obtained in a large cohort of women showed that fat distribution still predicts metabolic abnormalities in severe obesity. Furthermore, we found a cluster of associations among fat distribution, metabolic syndrome (MS), and adipocyte hypertrophy.     

Human Immunodeficiency Virus-Associated Lipodystrophy: An Objective Definition Based on Dual-Energy X-RAY Absorptiometry-Derived Regional Fat Ratios In A South Asian Population

ObjectiveTo develop an objective definition of human immunodeficiency virus (HIV)-associated lipodystrophy by using regional fat mass ratios and to assess the utility of anthropometric and skinfold measurements in the initial screening for lipodystrophy.MethodsMale patients between 25 and 50 years old with proven HIV infection (highly active antiretroviral therapy [HAART]-naïve subjects and those receiving successful HAART) were studied and compared with body mass index (BMI)-matched HIV-negative control subjects. Anthropometric variables, body composition, dual-energy x-ray absorptiometry findings, and metabolic variables were compared among the 3 study groups and between those patients with and those without lipodystrophy.ResultsTrunk fat/lower limb fat mass ratio > 2.28 identified 54.3% of patients with HIV receiving HAART as having lipodystrophy and had the highest odds ratio for predicting metabolic syndrome. The “clinical diagnosis of many false-positive and false-negative results. Triceps skinfold thickness (SFT)/BMI ratio ≤ 0.49 and abdominal SFT/triceps SFT ratio > 1.385 have good sensitivity but poor specificity in identifying lipodystrophy. In comparison with HAART-naïve patients with HIV, those receiving HAART had significantly higher insulin resistance, and a significantly greater proportion had impaired glucose tolerance and dyslipidemia. Among patients receiving HAART, those with lipodystrophy had a greater degree of insulin resistance, higher triglyceride levels, and lower levels of high-density lipoprotein cholesterol.ConclusionThe trunk fat/lower limb fat mass ratio in BMI-matched normal subjects can be used to derive cutoff values to define lipodystrophy objectively in HIV-infected patients. Defining lipodystrophy in this way is better than other methods of identifying those patients with increased cardiovascular risk. Triceps SFT/BMI and abdominal SFT/ triceps SFT ratios may be useful as screening tools in resource-poor settings. (Endocr Pract. 2012;18:158-169)     

In urban South Africa, 16 year old adolescents experience greater health equality than children

Despite the strongly established link between socio-economic status (SES) and health across most stages of the life-course, the evidence for a socio-economic gradient in adolescent health outcomes is less consistent. This paper examines associations between household, school, and neighbourhood SES measures with body composition outcomes in 16 year old South African Black urban adolescents from the 1990 born Birth to Twenty (Bt20) cohort. Multivariable regression analyses were applied to data from a sub-sample of the Bt20 cohort (n = 346, 53% male) with measures taken at birth and 16 years of age to establish socio-economic, biological, and demographic predictors of fat mass, lean mass, and body mass index (BMI). Results were compared with earlier published evidence of health inequality at ages 9–10 years in Bt20. Consistent predictors of higher fat mass and BMI in fully adjusted models were being female, born post term, having a mother with post secondary school education, and having an obese mother. Most measures of SES were only weakly associated with body composition, with an inconsistent direction of association. This is in contrast to earlier findings with Bt20 9–10 year olds where SES inequalities in body composition were observed. Findings suggest targeting obesity interventions at females in households where a mother has a high BMI.     

Visceral fat obesity is highly associated with primary gout in a metabolically obese but normal weighted population: a case control study

IntroductionGout is a chronic inflammatory disease the development of which is associated with obesity-induced metabolic abnormalities. However, a substantial number of non-obese patients (body mass index [BMI] <25 kg/m²) also develop gout in Korea. It was suggested that accumulation of visceral fat rather than subcutaneous fat is associated with metabolic abnormalities and hyperuricemia in patients with gout; therefore, we hypothesized that visceral fat accumulation was increased in non-obese gout patients.MethodsOne hundred and three male patients with primary gout and 204 age-matched healthy controls who attended a health check-up examination were recruited after the review of medical charts. The visceral fat area (VFA) was measured using the bioelectrical impedance analysis (BIA) method, and a VFA >100 cm² was defined as visceral fat obesity (VFO). The frequency of VFO was compared in patients and control groups. The frequencies of metabolic syndrome and related parameters were also investigated.ResultsBMI, waist circumference, total fat mass, serum triglycerides, and serum glucose levels were significantly greater in patients compared with controls. VFA and the prevalence of VFO was increased in gout patients compared with controls. There were positive correlations between VFA and serum triglyceride levels and serum glucose levels. Multivariate regression analysis revealed that VFO is an independent risk factor for gout (odds ratio 2.488, 95% confidence interval 1.041–4.435). In non-obese subgroup analyses (gout patients, n = 38; healthy controls, n = 150), VFA (98.7 ± 19.3 vs. 91.0 ± 16.7, P = 0.016) and the frequency of VFO (47.4 vs. 27.3%, P = 0.017) remained significantly higher in gout patients. There was no difference in either BMI or total fat mass between patients and controls in the non-obese subgroup. The prevalence of metabolic syndrome in patients with gout was 31.7% (33/104), compared with 13.2% (5/38) in the non-obese subgroup according to modified ATP III criteria.ConclusionVFO, measured using BIA, is observed more frequently in patients with primary gout compared with healthy controls, even in non-obese individuals. Therefore, VFO might more properly represent metabolic derangements in patients with gout than general obesity.     

Plasma visfatin,associated with a genetic polymorphism −1535C > T,is correlated with C-reactive protein in Chinese Han patients with traumatic brain injury

Visfatin is a newly identified pro-inflammatory adipokine and a genetic polymorphism −1535 C > T located in the visfatin gene promoter has been suggested to be associated with the regulation of visfatin expression in some inflammatory illness. However, there were some conflicting results regarding whether this variant is functional or not. This study aimed to examine the relations of the −1535 C > T single nucleotide polymorphism (SNP) of visfatin gene to the plasma visfatin and C-reactive protein concentrations in traumatic brain injury (TBI). 318 Chinese Han patients with TBI were recruited in this study. Plasma visfatin and C-reactive protein levels were significantly different between the genotypes in the SNP-1535 C > T even after adjustment for age, sex and body mass index. The genotype C–C had the highest plasma visfatin and C-reactive protein concentrations. The plasma visfatin and C-reactive protein concentrations between the variant genotypes C–T and T–T did not differ significantly. Plasma visfatin level was significantly associated with plasma C-reactive protein level using multivariate linear regression. Thus, the SNP-1535 C > T of visfatin gene seemed to be potentially involved in the inflammatory component of TBI through a decreased production of visfatin.     

Circulating levels of irisin in patients with anorexia nervosa and different stages of obesity – Correlation with body mass index

Irisin was recently identified as cleavage product of fibronectin type III domain containing 5 (FNDC5) and shown to increase energy expenditure in mice and humans and therefore was discussed as potential treatment option in obesity. However, the regulation of irisin under conditions of severely altered body weight such as anorexia nervosa and obesity remains to be investigated. We analyzed circulating irisin levels over a broad spectrum of body weight in 40 patients with anorexia nervosa (mean body mass index, BMI 12.6 ± 0.7 kg/m²), normal weight controls (22.6 ± 0.9 kg/m²) and obese patients with BMI of 30–40 (36.9 ± 1.2 kg/m²), 40–50 (44.9 ± 1.1 kg/m²) and >50 (70.1 ± 2.7 kg/m², n = 8/group). Correlation analyses were performed between irisin and different body indices, parameters of body composition and hormones involved in various homeostatic processes. Obese patients showed higher circulating irisin levels compared to normal weight and anorexic patients (p < 0.05) resulting in a correlation of irisin with body weight (r = 0.47, p < 0.01) and BMI (r = 0.50, p < 0.001). Plasma irisin was also positively correlated with fat mass (r = 0.48, p < 0.01), body cell mass (r = 0.45, p < 0.01) and fat free mass (r = 0.40, p < 0.05). Insulin levels were positively correlated with irisin (r = 0.45, p < 0.01), whereas circulating ghrelin, cortisol, thyroid-stimulating hormone or C-reactive protein were not (p > 0.05). These data indicate that circulating irisin is affected under conditions of altered BMI with highest levels in severely obese patients. The increase of irisin under conditions of obesity may indicate a physiological function to improve glucose tolerance which is often impaired in obese subjects.     

Distribución de la circunferencia de la cintura y de la relación circunferencia de la cintura con respecto a la talla según la categoría del índice de masa corporal en los pacientes atendidos en consultas de endocrinología y nutrición

IntroductionWaist circumference (WC) and the waist-to-height ratio (WHtR) are anthropometric measures widely used in clinical practice to evaluate visceral fat and the consequent cardiovascular risk. However, risk thresholds should be standardized according to body mass index (BMI).ObjectiveTo determine the distribution of WC and WHtR according to the BMI cut-points currently used to describe overweight and obesity.Materials and methodsWC, WHtR and BMI were measured in 3521 adult patients (>18 years) attended in Endocrinology and Nutrition units.ResultsA total of 20.8% (734 patients) were diabetic. Obesity was found in 82.1% of diabetic patients and in 75% of non-diabetic patients. The WC thresholds proposed by the National Institute of Health (102 cm in men, 88 cm in women), Bray (100 cm in men, 90 cm in women) and the International Diabetes Federation (94 cm in men, 80 cm in women) were exceeded by 92.9%, 94.8% and 98.4% of obese men, 96.8%, 95.5% and 99.7% of obese women, 79.1%, 83.1% and 90% of diabetic men and 95.5%, 81.5% and 97.4% of diabetic women, respectively. Thresholds adapted to the degree of obesity (90, 100, 110 and 125 cm in men and 80, 90, 105 and 115 cm in women for normal BMI, overweight, obesity I and obesity greater than I) were exceeded by 58.4% of obese men, 54.2% of obese women, 57.5% of diabetic men and 60.7% of diabetic women. WC was higher in men, and BMI and the WHtR were higher in women. The WC of diabetic women equalled that of men, and WC, WHtR and BMI were higher in diabetic than in non-diabetic women (p<0.001). WC (p<0.005), WHtR (p<0.001) and BMI (p<0.5) were also higher in diabetic than in non-diabetic men.ConclusionWC and WHtR thresholds by BMI discriminated diabetic and obese patients better than single thresholds, and can be represented graphically by the distribution of percentile ranks of WC and WHtR by BMI.ik