The importance of visceral fat mass in obese pregnant women and relation with pregnancy outcomes

Background Maternal obesity is a well established risk factor for gestational diabetes but it is not known if the pattern of maternal fat distribution predicts adverse pregnancy outcomes. Methods Body composition was assessed by bioimpedance using Inbody 720® in 302 consecutive obese pregnant women attending a weight management clinic. The relation of visceral fat mass and total percentage body fat with the development of gestational diabetes and perinatal outcomes was evaluated. Results Women developing gestational diabetes (Group 1; n = 72) were older, had higher body mass indices and greater central obesity (waist:hip ratio, visceral fat mass) compared with those remaining normoglycaemic. Visceral fat mass, but not percentage body fat, correlated with fasting glucose in all patients ( r = 0.2, p < 0.001) and particularly those in Group 1 ( r = 0.35, p = 0.002). Visceral fat mass, but not percentage body fat, also correlated strongly with glycaemia, particularly in Group 1 ( r = 0.47, p < 0.0001). Visceral fat mass also showed a weak but significant correlation with baby weight ( r = 0.17, p = 0.01). Discussion Central obesity, as assessed by early pregnancy waist:hip ratio and particularly by visceral fat mass, is a predictor of gestational diabetes in addition to classical risk factors and may help identify those obese patients at increased risk of complications.

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Thyroid Hormone Changes in Early Pregnancy Along With the COVID-19 Pandemic

Frontiers in Endocrinology ◽

10.3389/fendo.2020.606723 ◽

2020 ◽

Vol 11 ◽

Author(s):

Ting-Ting Lin ◽

Chen Zhang ◽

Han-Qiu Zhang ◽

Yu Wang ◽

Lei Chen ◽

...

Keyword(s):

Thyroid Hormone ◽

Pregnant Women ◽

Early Pregnancy ◽

Pregnancy Outcomes ◽

First Trimester ◽

Thyroid Peroxidase ◽

Free Triiodothyronine ◽

Increased Risk ◽

Group 2 ◽

Group 1

PurposeCOVID-19 (Coronavirus Disease 2019) was first reported in December 2019 and quickly swept across China and around the world. Levels of anxiety and depression were increased among pregnant women during this infectious pandemic. Thyroid function is altered during stressful experiences, and any abnormality during early pregnancy may significantly affect fetal development and pregnancy outcomes. This study aimed to determine whether the COVID-19 pandemic induces thyroid hormone changes in early pregnant women.MethodsThis study comprised two groups of pregnant women in Shanghai in their first trimester – those pregnant women before the COVID-19 outbreak from January 20, 2019, to March 31, 2019 (Group 1) and those pregnant during the COVID-19 outbreak from January 20, 2020, to March 31, 2020 (Group 2). All women were included if they had early pregnancy thyrotropin (TSH), free triiodothyronine (FT3), free thyroxine (FT4), total triiodothyronine (TT3), and total thyroxine (TT4) concentrations, thyroid peroxidase (TPO) antibody or thyroglobulin antibody (TgAb) available and did not have a history of thyroid diseases or received thyroid treatment before or during pregnancy. We used propensity score matching to form a cohort in which patients had similar baseline characteristics.ResultsAmong 3338 eligible pregnant women, 727 women in Group 1 and 727 in Group 2 had similar propensity scores and were included in the analyses. Pregnant women in Group 2 had significantly higher FT3 (5.7 vs. 5.2 pmol/L, P<0.001) and lower FT4 (12.8 vs. 13.2 pmol/L, P<0.001) concentrations compared with those in Group 1. Pregnant women in Group 2 were more likely to develop isolated hypothyroxinemia (11.6% vs. 6.9%, OR, 1.75 [95% CI, 1.20–2.53], P=0.003) than those in Group 1 but had a significantly lower risk of TgAb positivity (12.0% vs. 19.0%, OR, 0.58 [95% CI, 0.43–0.78], P<0.001).ConclusionPregnant women in their first trimester in Shanghai during the COVID-19 outbreak were at an increased risk of having higher FT3 concentrations, lower FT4 concentrations, and isolated hypothyroxinemia. The association between thyroid hormones, pregnancy outcomes, and the COVID-19 outbreak should be explored further.

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Reductions in visceral fat during weight loss and walking are associated with improvements inV˙o 2 max

Journal of Applied Physiology ◽

10.1152/jappl.2001.90.1.99 ◽

2001 ◽

Vol 90 (1) ◽

pp. 99-104 ◽

Cited By ~ 24

Author(s):

Nicole A. Lynch ◽

Barbara J. Nicklas ◽

Dora M. Berman ◽

Karen E. Dennis ◽

Andrew P. Goldberg

Keyword(s):

Weight Loss ◽

Adipose Tissue ◽

Postmenopausal Women ◽

Body Fat ◽

Fat Mass ◽

Visceral Fat ◽

Subcutaneous Adipose Tissue ◽

Increased Risk ◽

Tissue Area ◽

Subcutaneous Adipose

The accumulation of visceral fat is independently associated with an increased risk for cardiovascular disease. The aim of this study was to determine whether the loss of visceral adipose tissue area (VAT; computed tomography) is related to improvements in maximal O2 uptake (V˙o 2 max) during a weight loss (250–350 kcal/day deficit) and walking (3 days/wk, 30–40 min) intervention. Forty obese [body fat 47 ± 1 (SE) %], sedentary (V˙o 2 max 19 ± 1 ml · kg−1 · min−1) postmenopausal women (age 62 ± 1 yr) participated in the study. The intervention resulted in significant declines in body weight (−8%), total fat mass (dual-energy X-ray absorptiometry; −17%), VAT (−17%), and subcutaneous adipose tissue area (−17%) with no change in lean body mass (all P < 0.001). Women with an average 10% increase in V˙o 2 max reduced VAT by an average of 20%, whereas those who did not increaseV˙o 2 max decreased VAT by only 10%, despite comparable reductions in body fat, fat mass, and subcutaneous adipose tissue area. The decrease in VAT was independently related to the change in V˙o 2 max( r 2 = 0.22; P < 0.01) and fat mass ( r 2 = 0.08; P = 0.05). These data indicate that greater improvements inV˙o 2 max with weight loss and walking are associated with greater reductions in visceral adiposity in obese postmenopausal women.

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Association of total body and visceral fat mass with iron deficiency in preadolescents: the Healthy Growth Study

British Journal Of Nutrition ◽

10.1017/s0007114511005952 ◽

2011 ◽

Vol 108 (4) ◽

pp. 710-719 ◽

Cited By ~ 23

Author(s):

George Moschonis ◽

George P. Chrousos ◽

Christos Lionis ◽

Vassilis Mougios ◽

Yannis Manios

Keyword(s):

Body Fat ◽

Fat Mass ◽

Visceral Fat ◽

Transferrin Saturation ◽

Tanner Stage ◽

Normal Weight ◽

Fe Deficiency ◽

Percentage Body Fat ◽

Healthy Growth ◽

Total Body

The aim of the present study was to examine the associations of obesity, percentage body fat and visceral fat mass with body Fe status in a representative sample of 1493 schoolchildren aged 9–13 years. Anthropometric, body composition, biochemical, clinical (Tanner stage, age of menarche) and dietary intake data were collected. Fe deficiency (ID) was defined as transferrin saturation (TS) < 16 %; and Fe-deficiency anaemia (IDA) as ID with Hb < 120 g/l. Obese boys and girls and those in the highest quartiles of percentage body fat mass had significantly higher levels of serum ferritin (P ≤ 0·05) compared to their normal-weight peers and those in the corresponding lowest quartiles. Similarly, obese boys and girls and those in the highest quartiles of percentage body fat and visceral fat mass had significantly lower levels of TS (P ≤ 0·05) compared to normal-weight children and those in the corresponding lowest quartiles. The prevalence of ID and IDA was significantly higher in boys and girls in the highest quartiles of percentage body fat than in peers in the lowest quartile. Higher quartiles of percentage body fat and visceral fat mass were the main significant predictors of ID in boys, after controlling for other important confounders, with OR of 2·48 (95 % CI, 1·26, 4·88) and 2·12 (95 % CI, 1·07, 4·19), respectively. Similar significant associations were observed for girls. In conclusion, percentage body fat and visceral fat mass were positively associated with ID in both sexes of preadolescents. These associations might be attributed to the chronic inflammation induced by excess adiposity.

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Visceral fat mass as a novel risk factor for predicting gestational diabetes in obese pregnant women

Obstetric Medicine ◽

10.1177/1753495x17754149 ◽

2018 ◽

Vol 11 (3) ◽

pp. 121-125 ◽

Cited By ~ 7

Author(s):

J Balani ◽

SL Hyer ◽

H Shehata ◽

F Mohareb

Keyword(s):

Diabetes Mellitus ◽

Risk Factor ◽

Gestational Diabetes ◽

Decision Tree ◽

Gestational Diabetes Mellitus ◽

Pregnant Women ◽

Predictive Model ◽

Fat Mass ◽

Visceral Fat ◽

Composition Analysis

Objective To develop a model to predict gestational diabetes mellitus incorporating classical and a novel risk factor, visceral fat mass. Methods Three hundred two obese non-diabetic pregnant women underwent body composition analysis at booking by bioimpedance analysis. Of this cohort, 72 (24%) developed gestational diabetes mellitus. Principal component analysis was initially performed to identify possible clustering of the gestational diabetes mellitus and non-GDM groups. A machine learning algorithm was then applied to develop a GDM predictive model utilising random forest and decision tree modelling. Results The predictive model was trained on 227 samples and validated using an independent testing subset of 75 samples where the model achieved a validation prediction accuracy of 77.53%. According to the decision tree developed, visceral fat mass emerged as the most important variable in determining the risk of gestational diabetes mellitus. Conclusions We present a model incorporating visceral fat mass, which is a novel risk factor in predicting gestational diabetes mellitus in obese pregnant women.

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Sex difference of the predictive value of BMI, waist circumference and percentage body fat mass for gallstone disease

British Journal Of Nutrition ◽

10.1017/s000711451900028x ◽

2019 ◽

Vol 121 (8) ◽

pp. 955-960 ◽

Cited By ~ 3

Author(s):

Hsin-Yin Hsu ◽

Chun-Yuan Huang ◽

Lee-Ching Hwang

Keyword(s):

Waist Circumference ◽

Body Fat ◽

Fat Mass ◽

Central Obesity ◽

Gallstone Disease ◽

Multiple Logistic Regression Analysis ◽

Health Examination ◽

Body Fat Mass ◽

Roc Curve Analysis ◽

Percentage Body Fat

AbstractGallstone disease (GSD) represents a significant health burden and is reported to be strongly related to obesity. This study examined the effect of sex on the association of BMI, waist circumference (WC) and percentage body fat mass (%FM) with GSD. We enrolled 15 671 middle-aged Taiwanese adults undergoing a physical check-up at a health examination centre. Multiple logistic regression analysis was conducted to identify the association of BMI, WC and %FM with the presence of GSD. AUC of the receiver–operating characteristic (ROC) curves were calculated for BMI, WC and %FM to compare their respective ability to correctly classify patients with GSD. From our findings, GSD prevalence was 8·1 % in men and 6·3 % in women. The percentage of markedly increased obesity indicators was significantly higher in patients with GSD than in those without GSD. Multivariate analysis showed that all obesity indicators were significant predictors of the presence of GSD in women after adjustment. In men, only BMI and WC were significantly associated with the presence of GSD. In the ROC curve analysis, BMI and WC were the best predictors of GSD risk in women and men, respectively. The obesity indicators better predicted the presence of GSD in women than in men. In conclusion, the best obesity indicator of GSD risk differed by sex. In addition to body weight, fat mass and central obesity were associated with GSD risk in women. In men, central obesity may play a more important role in predicting GSD risk.

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Elevated Circulating Glutamate Is Associated With Subclinical Atherosclerosis Independently of Established Risk Markers: A Cross-Sectional Study

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/clinem/dgaa898 ◽

2020 ◽

Author(s):

Angela Lehn-Stefan ◽

Andreas Peter ◽

Jürgen Machann ◽

Fritz Schick ◽

Elko Randrianarisoa ◽

...

Keyword(s):

Insulin Sensitivity ◽

Body Fat ◽

Fat Mass ◽

Visceral Fat ◽

Fat Content ◽

Liver Fat ◽

Body Fat Mass ◽

Elevated Plasma ◽

Liver Fat Content ◽

Increased Risk

Abstract Objective Elevated plasma glutamate levels are associated with an increased risk of cardiovascular disease (CVD). Because plasma glutamate levels are also strongly associated with visceral adiposity, nonalcoholic fatty liver disease, insulin resistance, and high circulating levels of branched-chain amino acids (BCAAs), it is unknown to what extent elevated circulating glutamate is an independent marker of an increased risk of atherosclerosis. Methods Plasma levels of glutamate and BCAAs were measured in 102 individuals who were precisely phenotyped for body fat mass and distribution (magnetic resonance [MR] tomography), liver fat content (1H-MR spectroscopy), insulin sensitivity (oral glucose tolerance test and hyperinsulinemic, euglycemic clamp [N = 57]), and carotid intima media thickness (cIMT). Results Plasma glutamate levels, adjusted for age, sex, body fat mass, and visceral fat mass, correlated positively with liver fat content and cIMT (all std β ≥ .22, all P ≤ .023) and negatively with insulin sensitivity (std β ≤ –.31, P ≤ .002). Glutamate levels also were associated with cIMT, independently of additional adjustment for liver fat content, insulin sensitivity and BCAAs levels (std β ≥ .24, P ≤ .02). Furthermore, an independent positive association of glutamate and interleukin-6 (IL-6) levels was observed (N = 50; std β = .39, P = .03). Although glutamate, adjusted for age, sex, body fat mass, and visceral fat mass, also correlated positively with cIMT in this subgroup (std β = .31, P = .02), after additional adjustment for the parameters liver fat content, insulin sensitivity, BCAAs, or IL-6 levels, adjustment for IL-6 most strongly attenuated this relationship (std β = .28, P = .05). Conclusions Elevated plasma glutamate levels are associated with increased cIMT, independently of established CVD risk factors, and this relationship may in part be explained by IL-6-associated subclinical inflammation.

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The association between soy intake and risk of gestational diabetes mellitus: a prospective cohort study

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-04175-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Yan Wang ◽

Biru Luo ◽

Jie Xiang

Keyword(s):

Diabetes Mellitus ◽

Gestational Diabetes ◽

Cesarean Section ◽

Gestational Diabetes Mellitus ◽

Pregnant Women ◽

Pregnancy Outcomes ◽

Adverse Pregnancy Outcomes ◽

Control Group ◽

Increased Risk ◽

Adverse Pregnancy

Abstract Background The association between soy intake and adverse pregnancy outcomes remains unclear. The objectives of this study were to investigate the soy consumption of pregnant women in the second trimester and explore the prospective association between soy intake and the risk of adverse pregnancy outcomes. Methods Pregnant women between 13 and 24 weeks of gestation were recruited at a women’s and children’s hospital in southwest China from June to December 2019. Dietary intakes in the middle trimester were assessed by a semi-quantitative food frequency questionnaire. Participants were divided into the insufficient group (< 40 g/day) and the control group (≥40 g/day) according to daily soy consumption. Participants were followed up until delivery. Pregnancy outcomes including gestational diabetes mellitus (GDM), cesarean section, and macrosomia were obtained. Multiple logistic regression was used to analyze the association between soy intake and risk of adverse pregnancy outcomes. Sociodemographic information, histories of diseases, and duration of physical activities were obtained and used for covariate adjustments. Results A total of 224 participants were included in this study, of which identified 36 (16.1%) cases of GDM, and 120 (53.6%) cases of cesarean section. More than half (125, 55.8%) pregnant women consumed less soy than 40 g/day. Daily soy intake less than 40 g was associated with the increased risk of GDM (OR = 2.755 95%CI 1.230-6.174, P = 0.014) and cesarean section (OR = 1.792 95%CI 1.035-3.101, P = 0.037) without adjustment for confounders such as age, pre-pregnancy body mass index, parity, daily intake of vegetables, fruits, seafood and, nuts. After adjusting for these factors, daily soy intake of less than 40 g increased 2.116-fold risk of GDM (95%CI 1.228-7.907, P = 0.017), but not with the significantly increased risk of cesarean section. Conclusion Insufficient soy intake may increase the risk of GDM, suggesting adequate soy intake may have a beneficial role in the prevention of GDM. Trial registration Registration number: ChiCTR1900023721. Date of registration: June 9, 2019.

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The Need for Personalized Risk-Stratified Approaches to Treatment for Gestational Diabetes: A Narrative Review

Seminars in Reproductive Medicine ◽

10.1055/s-0041-1723778 ◽

2021 ◽

Author(s):

Shamil D. Cooray ◽

Jacqueline A. Boyle ◽

Georgia Soldatos ◽

Shakila Thangaratinam ◽

Helena J. Teede

Keyword(s):

Gestational Diabetes ◽

Pregnancy Outcomes ◽

Population Based ◽

Adverse Pregnancy Outcomes ◽

Therapeutic Interventions ◽

Clinical Prediction Model ◽

Increased Risk ◽

Adverse Pregnancy ◽

The Individual ◽

Personalized Risk

AbstractGestational diabetes mellitus (GDM) is common and is associated with an increased risk of adverse pregnancy outcomes. However, the prevailing one-size-fits-all approach that treats all women with GDM as having equivalent risk needs revision, given the clinical heterogeneity of GDM, the limitations of a population-based approach to risk, and the need to move beyond a glucocentric focus to address other intersecting risk factors. To address these challenges, we propose using a clinical prediction model for adverse pregnancy outcomes to guide risk-stratified approaches to treatment tailored to the individual needs of women with GDM. This will allow preventative and therapeutic interventions to be delivered to those who will maximally benefit, sparing expense, and harm for those at a lower risk.

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Gestational Diabetes Mellitus and Infant Adiposity at Birth: A Systematic Review and Meta-Analysis of Therapeutic Interventions

Journal of Clinical Medicine ◽

10.3390/jcm10040835 ◽

2021 ◽

Vol 10 (4) ◽

pp. 835

Author(s):

Manoja P. Herath ◽

Jeffrey M. Beckett ◽

Andrew P. Hills ◽

Nuala M. Byrne ◽

Kiran D. K. Ahuja

Keyword(s):

Diabetes Mellitus ◽

Adipose Tissue ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Fat Mass ◽

Metabolic Disorders ◽

Later Life ◽

Therapeutic Interventions ◽

Increased Risk ◽

The Impact

Exposure to untreated gestational diabetes mellitus (GDM) in utero increases the risk of obesity and type 2 diabetes in adulthood, and increased adiposity in GDM-exposed infants is suggested as a plausible mediator of this increased risk of later-life metabolic disorders. Evidence is equivocal regarding the impact of good glycaemic control in GDM mothers on infant adiposity at birth. We systematically reviewed studies reporting fat mass (FM), percent fat mass (%FM) and skinfold thicknesses (SFT) at birth in infants of mothers with GDM controlled with therapeutic interventions (IGDMtr). While treating GDM lowered FM in newborns compared to no treatment, there was no difference in FM and SFT according to the type of treatment (insulin, metformin, glyburide). IGDMtr had higher overall adiposity (mean difference, 95% confidence interval) measured with FM (68.46 g, 29.91 to 107.01) and %FM (1.98%, 0.54 to 3.42) but similar subcutaneous adiposity measured with SFT, compared to infants exposed to normal glucose tolerance (INGT). This suggests that IGDMtr may be characterised by excess fat accrual in internal adipose tissue. Given that intra-abdominal adiposity is a major risk factor for metabolic disorders, future studies should distinguish adipose tissue distribution of IGDMtr and INGT.

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Influence of methyltestosterone postmenopausal therapy on plasma lipids, inflammatory factors, glucose metabolism and visceral fat: a randomized study

Acta Endocrinologica ◽

10.1530/eje.1.02065 ◽

2006 ◽

Vol 154 (1) ◽

pp. 131-139 ◽

Cited By ~ 18

Author(s):

Lenora M Camarate S M Leão ◽

Mônica Peres C Duarte ◽

Dalva Margareth B Silva ◽

Paulo Roberto V Bahia ◽

Cláudia Medina Coeli ◽

...

Keyword(s):

Risk Factors ◽

Insulin Resistance ◽

Blood Pressure ◽

Cardiovascular Disease ◽

Cardiovascular Risk ◽

Cardiovascular Risk Factors ◽

Postmenopausal Women ◽

Fat Mass ◽

Visceral Fat ◽

Increased Risk

Background: There has been a growing interest in treating postmenopausal women with androgens. However, hyperandrogenemia in females has been associated with increased risk of cardiovascular disease. Objective: We aimed to assess the effects of androgen replacement on cardiovascular risk factors. Design: Thirty-seven postmenopausal women aged 42–62 years that had undergone hysterectomy were prospectively enrolled in a double-blind protocol to receive, for 12 months, percutaneous estradiol (E2) (1 mg/day) combined with either methyltestosterone (MT) (1.25 mg/day) or placebo. Methods: Along with treatment, we evaluated serum E2, testosterone, sex hormone-binding globulin (SHBG), free androgen index, lipids, fibrinogen, and C-reactive protein; glucose tolerance; insulin resistance; blood pressure; body-mass index; and visceral and subcutaneous abdominal fat mass as assessed by computed tomography. Results: A significant reduction in SHBG (P < 0.001) and increase in free testosterone index (P < 0.05; Repeated measures analysis of variance) were seen in the MT group. Total cholesterol, triglycerides, fibrinogen, and systolic and diastolic blood pressure were significantly lowered to a similar extent by both regimens, but high-density lipoprotein cholesterol decreased only in the androgen group. MT-treated women showed a modest rise in body weight and gained visceral fat mass relative to the other group (P < 0.05), but there were no significant detrimental effects on fasting insulin levels and insulin resistance. Conclusion: This study suggests that the combination of low-dose oral MT and percutaneous E2, for 1 year, does not result in expressive increase of cardiovascular risk factors. This regimen can be recommended for symptomatic postmenopausal women, although it seems prudent to perform baseline and follow-up lipid profile and assessment of body composition, especially in those at high risk of cardiovascular disease.

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