scholarly journals Phenotypes of Sarcopenic Obesity: Exploring the Effects on Peri-Muscular Fat, the Obesity Paradox, Hormone-Related Responses and the Clinical Implications

Geriatrics ◽  
2020 ◽  
Vol 5 (1) ◽  
pp. 8 ◽  
Author(s):  
Tariq A. Alalwan
Keyword(s):  
Postoperative Complications ◽  
Visceral Fat ◽  
Polycystic Ovary ◽  
Subcutaneous Fat ◽  
Visceral Obesity ◽  
Obesity Paradox ◽  
Sarcopenic Obesity ◽  
Clinical Implications ◽  
Hormonal Responses ◽  
Definition Of

Sarcopenic obesity combines the words sarcopenia and obesity. This definition of obesity should be better differentiated between visceral and subcutaneous fat phenotypes. For this reason, this review lays the foundation for defining the subcutaneous and the visceral fat into the context of sarcopenia. Thus, the review aims to explore the missing links on pathogenesis of visceral fat and its relationship on age: defining the peri-muscular fat as a new entity and the subcutaneous fat as a first factor that leads to the obesity paradox. Last but not least, this review underlines and motivates the mechanisms of the hormonal responses and anti-inflammatory adipokines responsible for the clinical implications of sarcopenic visceral obesity, describing factor by factor the multiple axis between the visceral fat-sarcopenia and all mortality outcomes linked to cancer, diabetes, cardiovascular diseases, cirrhosis, polycystic ovary, disability and postoperative complications.

scholarly journals The Role of Visceral Obesity, Sarcopenia and Sarcopenic Obesity on Surgical Outcomes After Liver Resections for Colorectal Metastases

2021 ◽  
Author(s):  
M. Runkel ◽  
T. D. Diallo ◽  
S. A. Lang ◽  
F. Bamberg ◽  
M. Benndorf ◽  
...  
Keyword(s):  
Risk Factors ◽  
Postoperative Complications ◽  
Visceral Obesity ◽  
The Body ◽  
Postoperative Outcomes ◽  
Sarcopenic Obesity ◽  
Colorectal Metastases ◽  
Complication Rates ◽  
The Impact ◽  
Body Compositions

Abstract Background The impact of body compositions on surgical results is controversially discussed. This study examined whether visceral obesity, sarcopenia or sarcopenic obesity influence the outcome after hepatic resections of synchronous colorectal liver metastases. Methods Ninety-four consecutive patients with primary hepatic resections of synchronous colorectal metastases were identified from a single center database between January 2013 and August 2018. Patient characteristics and 30-day morbidity were retrospectively analyzed. Body fat and skeletal muscle were calculated by planimetry from single-slice CT images at the level of L3. Results Fifty-nine patients (62.8%) underwent minor hepatectomies, and 35 patients underwent major resections (37.2%). Postoperative complications occurred in 60 patients (62.8%) including 35 patients with major complications (Clavien–Dindo grade III–V). The mortality was nil at 30 days and 2.1% at 90 days. The body mass index showed no influence on postoperative outcomes (p = 1.0). Visceral obesity was found in 66 patients (70.2%) and was significantly associated with overall and major complication rates (p = .002, p = .012, respectively). Sarcopenia was observed in 34 patients (36.2%) without a significant impact on morbidity (p = .461), however, with longer hospital stay. Sarcopenic obesity was found in 18 patients (19.1%) and was significantly associated with postoperative complications (p = .014). Visceral obesity, sarcopenia and sarcopenic obesity were all identified as significant risk factors for overall postoperative complications. Conclusion Visceral obesity, sarcopenic obesity and sarcopenia are independent risk factors for overall complications after resections of CRLM. Early recognition of extremes in body compositions could prompt to perioperative interventions and thus improve postoperative outcomes.

scholarly journals The Incidence of Postoperative Complications after Gastrectomy Increases in Proportion to the Amount of Preoperative Visceral Fat

2019 ◽  
Vol 2019 ◽  
pp. 1-9 ◽  
Author(s):  
Kazuyuki Okada ◽  
Tatsuto Nishigori ◽  
Kazutaka Obama ◽  
Shigeru Tsunoda ◽  
Koya Hida ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Postoperative Complications ◽  
Visceral Fat ◽  
Visceral Obesity ◽  
Continuous Variable ◽  
University Hospital ◽  
Curative Gastrectomy ◽  
Visceral Fat Area ◽  
The Impact ◽  
The Relationship

Background. Visceral obesity is a risk factor for complications after gastrectomy in patients with gastric cancer. However, it is unclear whether postoperative complications decrease with preoperative reduction of visceral fat without the achievement of a nonobese state. This is because previous studies have performed categorical comparisons of obesity and nonobesity. The current study was performed to estimate the impact of the preoperative visceral fat area (VFA) as a continuous variable on postoperative complications after gastrectomy. Methods. Consecutive patients with gastric cancer who underwent curative gastrectomy between June 2006 and August 2017 at the Kyoto University Hospital were included in this retrospective study. The VFA at the level of the umbilicus was measured using preoperative computed tomography. The relationship between postoperative complications and VFA was investigated with univariate and multivariate analyses. Results. total of 566 patients were included in the study. Their mean VFA was 110 ± 58 cm2, and postoperative complications occurred in 121 patients (21.4%). The larger the VFA (<50, 50–99, 100–149, and ≥150 cm2), the higher the incidence of postoperative complications (11%, 14%, 21%, and 38%, respectively, P<0.001). Multivariate logistic regression analyses showed that the VFA was associated with postoperative complications (odds ratio: 1.009, 95% confidence interval (CI): 1.004–1.013, P<0.001), with an incidence of postoperative complications that was 9% (95% CI: 4%–12%) higher for every 10 cm2 increase in the VFA. Conclusion. The incidence of postoperative complications after gastrectomy increases in proportion to an increase in the preoperative VFA.

Reduced cardiovagal baroreflex gain in visceral obesity: implications for the metabolic syndrome

2002 ◽  
Vol 282 (2) ◽  
pp. H630-H635 ◽  
Author(s):  
Stacy D. Beske ◽  
Guy E. Alvarez ◽  
Tasha P. Ballard ◽  
Kevin P. Davy
Keyword(s):  
Metabolic Syndrome ◽  
Visceral Fat ◽  
Subcutaneous Fat ◽  
Visceral Obesity ◽  
Abdominal Fat ◽  
The Metabolic Syndrome ◽  
Increased Risk ◽  
Wide Range ◽  
Abdominal Visceral Fat ◽  
Total Body

The influence of excess total and abdominal adiposity on cardiovagal baroreflex gain remains unclear. We tested the hypotheses that cardiovagal baroreflex gain would be reduced in men with 1) higher [higher fat (HF), mass >20 kg, n = 11] compared with lower [lower fat (LF), mass <20 kg, n = 10] levels of total body and abdominal fat and 2) higher abdominal visceral fat (HAVF; n = 10) compared with total body weight- and subcutaneous fat-matched peers with lower abdominal visceral fat (LAVF; n = 7) levels. To accomplish this, we measured cardiovagal baroreflex gain (modified Oxford technique), body composition (dual energy X-ray absorptiometry), and abdominal visceral and subcutaneous fat (computed tomography) in sedentary men (age, 18–40 yr; body mass index, <34.9 kg/m2) across a wide range of adiposity. Cardiovagal baroreflex gain was significantly lower in HF compared with LF (14.3 ± 2.8 vs. 21.4 ± 2.8 ms/mmHg, respectively). In addition, cardiovagal baroreflex gain was lower in HAVF compared with LAVF (13.0 ± 2.0 vs. 21.4 ± 3.6 ms/mmHg, P< 0.05). Therefore, the results of the present study indicate that cardiovagal baroreflex gain is reduced in men with elevated total body and abdominal fat mass. The reduced cardiovagal baroreflex gain in these individuals appears to be linked to their higher level of abdominal visceral fat. Importantly, reduced cardiovagal baroreflex gain may contribute to the increased risk of cardiovascular disease observed in men with the metabolic syndrome.

scholarly journals P35: BODY COMPOSITION: ASSOCIATION WITH OPERATIVE AND ONCOLOGIC OUTCOMES IN THE MODERN MANAGEMENT OF RETROPERITONEAL SARCOMA – RESULTS OF A FEASIBILITY STUDY

2021 ◽  
Vol 108 (Supplement_1) ◽  
Author(s):  
TV McIntyre ◽  
JA Elliott ◽  
E Boyle ◽  
NE Donlon ◽  
M Barnes ◽  
...  
Keyword(s):  
Body Composition ◽  
Lean Body Mass ◽  
Body Mass ◽  
Fat Mass ◽  
Visceral Fat ◽  
Subcutaneous Fat ◽  
Visceral Obesity ◽  
Retroperitoneal Sarcoma ◽  
Oncologic Outcomes ◽  
Skeletal Muscle Index

Abstract Introduction Sarcopenia and obesity in cancer may confer negative outcomes, but their prevalence and impact on modern regimens for retroperitoneal sarcoma (RPS) have not been systematically studied. Sarcopaenia and obesity measurements by computed tomography (CT) measurements at L3 may be confounded by the disease process itself. The aim of this study is to determine feasibility in providing the prevalence of sarcopenia and visceral obesity in the management of RPS to assess their potential impact on operative and oncologic outcomes. Method Consecutive sample patients undergoing treatment for RPS from our database were retrospectively studied. Total, subcutaneous and visceral fat areas (VFA), myosteatosis, skeletal muscle index (SMI) lean body mass and fat mass were determined at diagnosis by CT. Sarcopenia will be defined by CT at L3 as SMI &lt;52.4 cm2/m2 for males and SMI &lt;38.5 cm2/m2 for females, and visceral obesity as VFA &gt;163.8cm2 for men and &gt;80.1cm2 for women. Result 40 consecutive patients, 21 [52.5%] female, 56.7±15.1 years, were studied. The most common histologic types were leiomyosarcoma (8 [20.0%]), dedifferentiated liposarcoma (7 [17.5%]), well differentiated liposarcoma (7 [17.5%]), myxoid liposarcoma (4 [10.0%]). Mean±SD body composition measures were: lean body mass, 50.4±12.0 kg; total fat mass, 27.2±8.6 kg; visceral fat area, 148.5±120.2 cm2; subcutaneous fat area, 222.2±20.4 cm2; myosteatosis, 8.9±7.3 cm2. Conclusion Assessment of body composition among patients with RPS is feasible. Analysis to identify the prevalence and significance of sarcopenia and visceral obesity and its relationship to operative and oncologic outcomes is ongoing. Take-home message Assessment of body composition in RPS is feasible and its effect on outcomes is under investigation

scholarly journals Visceral Obesity Determined by CT As a Predictor of Short-term Postoperative Complications in Ovarian Cancer

2022 ◽  
Author(s):  
Xianglin Nie ◽  
Lin Zhang ◽  
Huangyang Meng ◽  
Yi Zhong ◽  
Yi Jiang ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Postoperative Complications ◽  
Cytoreductive Surgery ◽  
Subcutaneous Fat ◽  
Visceral Obesity ◽  
Advanced Ovarian Cancer ◽  
Obese Group ◽  
Short Term ◽  
Postoperative Fever ◽  
Total Fat

Abstract Objective: To explore the association between visceral obesity and short-term postoperative complications in patients with advanced ovarian cancer undergoing cytoreductive surgery.Methods: Medical records were reviewed for patients with ovarian cancer. Visceral fat area, subcutaneous fat area and total fat area were measured on a single slice at the level of L3/4 of a preoperative CT scan. Univariable and multivariable analyses were performed to investigate the correlation between visceral obesity and short-term complications and to analyze the risk factors for complications after surgery.Results: Of the 130 patients, 53.8% (70/130) were presented visceral obesity. Patients with visceral obesity were older than those with nonvisceral obesity (58.3 years old vs. 52.3 years old, p = 0.001). The proportion of patients with hypertension was slightly higher (37.1% vs. 11.7%, p = 0.001). The total fat area and subcutaneous fat area were higher in patients with visceral obesity (296.9 ± 72.1 vs. 173.1 ± 67.3, p < 0.001; 168.8 ± 55.5 vs. 121.6 ± 54.3, p < 0.001). Compared with patients in the nonvisceral obese group, patients in the visceral obese group were more likely to have postoperative fever (21/70 30.0% vs. 8/60 1.25%, p = 0.023), leading to a longer length of hospital stay (21 days vs. 17 days, p = 0.009). Time from surgery to adjuvant chemotherapy for patients with visceral obesity has been delayed (24 days vs. 20 days, p = 0.037). Multivariate analysis showed that visceral obesity (OR 4.770, p < 0.001) and operation time (OR 1.008, p < 0.001) were independent predictors of postoperative complications. Conclusion: Visceral obesity is an important risk factor for short-term postoperative complications in patients with advanced ovarian cancer undergoing cytoreductive surgery.

scholarly journals A MODERATELY HIGH PROTEIN DIET IS AS EFFECTIVE DURING NEOADJUVANT CHEMOTHERAPY AS IT IS 2 YEARS AFTER BREAST CANCER SURGERY – A PILOT TRIAL

2017 ◽  
Vol 64 (2) ◽  
pp. 133-137
Author(s):  
Diana Viorela Artene ◽  
◽  
Cristian Ioan Bordea ◽  
Alexandru Blidaru ◽  
◽  
...  
Keyword(s):  
Breast Cancer ◽  
Weight Gain ◽  
Neoadjuvant Chemotherapy ◽  
Visceral Fat ◽  
Pilot Trial ◽  
Subcutaneous Fat ◽  
High Protein Diet ◽  
High Protein ◽  
Protein Diet ◽  
Sarcopenic Obesity

Introduction. Statistically, patients who achieve and maintain their optimal weight during breast cancer treatment have the best prognostic. Breast cancer associated weight gain starts during neoadjuvant chemotherapy when many patients either eat too little because of the decreased appetite or eat too much to emotionally cope with the treatment. Materials and method. To test if we can prevent weight gain during neoadjuvant chemotherapy we assigned 46 patients during neoadjuvant chemotherapy (CH) and of 50 patients 2 years after surgery (S) to follow a moderately high protein diet – based on eating only when hungry foods naturally high in protein, high quality fatty acids and carbohydrates, calcium, pre- and probiotics. We used no dietary supplements. We measured weight (W), subcutaneous fat (%SF) and visceral fat percentages (% VF) with a multi-frequency BIA scale at the beginning of the study and after 12 weeks of intervention (time needed to administrate 4 chemotherapy sessions). To validate BIA measurements, we also measured waist and hips circumferences. Results. Although S patients obtained better results on all measured parameters, CH patients also improved their body composition despite chemotherapy administration during the trial: 1.611±2.89%kg (p=0.005), 1.79±3.32% subcutaneous fat (p=0.006), 0.4±0,81% visceral fat (p=0.012) and had a 0.29±0.4 in the waist to hips ratio (p=0.001). Conclusion. A moderately lower carb diet is as effective for preventing sarcopenic obesity during chemotherapy as it is 2 years after surgery thus sarcopenic obesity prevention can begin from as early as diagnosis.

Are quantitative measures of visceral adiposity obtained after neoadjuvant chemoradiation associated with postoperative morbidity in patients with locally advanced rectal cancer?

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 514-514
Author(s):  
Leah E. Hendrick ◽  
Veronica Lippuner ◽  
Tyler Speaks ◽  
Travis S Scharr ◽  
Andrew M Fleming ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Postoperative Complications ◽  
Locally Advanced ◽  
Subcutaneous Fat ◽  
Visceral Obesity ◽  
Neoadjuvant Chemoradiation ◽  
Surgical Morbidity ◽  
Visceral Fat Area ◽  
The Impact ◽  
Metabolic Comorbidities

514 Background: Body mass index (BMI) is an inconsistent predictor of surgical morbidity in cancer patients. Increased visceral obesity measured before neoadjuvant chemoradiation (NCR) has been associated with post-operative morbidity in rectal cancer (RC). We sought to evaluate whether visceral obesity/BMI measured immediately after NCR correlates with postoperative complications in a heterogenous, largely underserved cohort of RC patients. Methods: 116 patients (64% white, 34% black, 2% other) underwent proctectomy for stage II/III RC after NCR. Automated CT segmentation software was used to determine body fat distribution at the L4/L5 level. Patients were classified as obese by BMI (≥ 30 kg/m2) and post-NCR CT measures of adiposity including visceral fat area (VFA; > 100cm2), visceral to subcutaneous fat area ratio (V/S; > 0.4), and perinephric fat thickness (PNF; > median) were obtained. Complications were classified (Clavien-Dindo) into low (1-2) or high (3-4) grade. Associations between measures of adiposity, short-term surgical outcomes and clinicopathologic factors were evaluated with one-way ANOVA, Chi-square, and Fischer’s exact test as appropriate for overall, white, and non-white cohorts. Results: Obese patients by adiposity measures (but not BMI) were more likely to be male by V/S (91.4% vs. 54.3%, p ≤ 0.001) and PNF (62.9% vs. 26.1%, p ≤ 0.001), Caucasian by VFA (mean 135.2 cm2vs. 93.8 cm2, p = 0.002), and have preexisting metabolic comorbidities by VFA and PNF ( p < 0.01). V/S was associated with the presence of key metabolic comorbidities in both white and non-white groups ( p < 0.05). Obesity by V/S but not BMI was associated with development of postoperative complications in the non-white group (65.5% vs. 30.8%, p = 0.049), but not in the overall or white cohorts. Conclusions: V/S as measured after NCR is associated with presence of key metabolic comorbidities in the entire cohort but with postoperative complications only in non-white patients. Given these observations, further evaluation of the impact of socioeconomic factors and change in adiposity between pre- and post-NCR time periods is warranted.

scholarly journals Does Body Fat Mass Define Survival in Patients Starting Peritoneal Dialysis?

2014 ◽  
Vol 34 (4) ◽  
pp. 376-382 ◽  
Author(s):  
Soo Jeong Choi ◽  
Eun Jung Kim ◽  
Moo Yong Park ◽  
Jin Kuk Kim ◽  
Seung Duk Hwang
Keyword(s):  
Peritoneal Dialysis ◽  
Fat Mass ◽  
Visceral Fat ◽  
Cox Regression ◽  
Survival Rates ◽  
Subcutaneous Fat ◽  
Visceral Obesity ◽  
Visceral Fat Area ◽  
Exit Site Infection ◽  
Cox Regression Analysis

Background and AimsPeritoneal dialysis (PD) is characterized by a gain in fat mass. Unlike subcutaneous fat, visceral fat is associated with metabolic syndrome and survival. We prospectively examined whether visceral or subcutaneous fat could predict outcome in patients undergoing PD.MethodsWe studied 117 new patients (57 men) undergoing PD between February 2006 and November 2011. Baseline body composition was measured on computed tomograms. Visceral obesity was defined as a visceral fat area exceeding 100 cm2, and subcutaneous obesity, as a subcutaneous fat area exceeding 130 cm2.ResultsAmong the 117 patients, 37 and 29 were diagnosed with visceral and subcutaneous obesity respectively. Visceral and subcutaneous obesity were both present in 21 patients. In the study population, the 1-year and 5-year survival rates were 94% and 59%. The rates of peritonitis and exit-infection were 0.31 and 0.14 episodes per patient–year. Mortality was greater in patients with visceral obesity than in those without visceral obesity ( p = 0.005). Visceral obesity had no influence on peritonitis and exit-infection rates. Subcutaneous obesity was associated neither with survival nor with peritonitis or exit-site infection. In a multivariate Cox regression analysis, visceral obesity was not a risk factor for poor outcome.ConclusionsIncreased visceral fat at PD initiation is not an independent predictor of poor survival. Any impact of visceral or subcutaneous fat mass on outcomes in patients undergoing PD would be better defined by larger, long-term studies.

scholarly journals Morphophenotypic predictor of the development of visceral obesity in patients with schizophrenia receiving antipsychotic therapy

2018 ◽  
Vol 17 (4) ◽  
pp. 54-64 ◽  
Author(s):  
E. G. Kornetova ◽  
V. V. Dubrovskaya ◽  
A. N. Kornetov ◽  
O. A. Lobacheva ◽  
S. A. Ivanova ◽  
...  
Keyword(s):  
Visceral Fat ◽  
Visceral Obesity ◽  
Statistical Processing ◽  
Antipsychotic Therapy ◽  
Russian Version ◽  
Icd 10 ◽  
Schizophrenic Patients ◽  
Student’S T ◽  
Definition Of

Objective:revealing the role of morphophenotypic indices in the development of visceral obesity in patients with schizophrenia receiving quetiapine and risperidone therapy.Materials and methods.56 indoor patients with schizophrenia who received quetiapine (n= 23) or risperidone (n= 33) at medium doses were examined. Included persons were from 18 to 65 years old with at least a 1 year history of disease, the condition of which met the criteria of schizophrenia according to ICD-10. The Basis map of sociodemographic and clinical-dynamic signs for patients with schizophrenia was filled in, PANSS in the adapted Russian version – SCI-PANSS, noninvasive bioimpedancemetry, measurement of growth, transversethoracic, biacromial and bicrystal diameter, with calculation of body mass indexes, Tanner and Rees – Eysenk and definition of integral morphophenotypic indicators were carried out. Statistical processing was performed using Student’s t-test with a preliminary estimate of Pearson’s χ2 normal distribution, the Mann – Whitney U test to compare independent samples, the Spearman correlation analysis, the two-sided Fisher test.Results.There were no significant differences in both subgroups in terms of bioimpedancemetry. The correlation between the level of visceral fat and the Rees – Eysenk index in patients receiving risperidone was a moderate inverse: the greater the value of the Rees – Eysenk index, the lower the level of visceral fat (r= –0.73381,t= –4.70833,p= 0.00015). The correlation between the Tanner index and the level of visceral fat in the quetiapine subgroup was strong: the larger the Tanner index, the higher the visceral fat level (r= 0.7763,t= 4.08481,p= 0.00181); in the risperidone subgroup, there was an average direct correlation (r= 0.48133,t= 2.39356,p= 0.02716).Conclusion.The magnitude of the Rees – Eysenk index of schizophrenic patients can be considered among other factors in the management of risperidone in individuals with asthenic physique. The determination of the Tanner index at the beginning of treatment can play the role of a prognostic factor in the development of visceral obesity in patients with schizophrenia in the planned use as a basic therapy for quetiapine.

scholarly journals Significance of Adipose Tissue Maintenance in Patients Undergoing Hemodialysis

Nutrients ◽  
2021 ◽  
Vol 13 (6) ◽  
pp. 1895
Author(s):  
Senji Okuno
Keyword(s):  
Nutritional Status ◽  
Fat Mass ◽  
Visceral Fat ◽  
Subcutaneous Fat ◽  
High Body Mass Index ◽  
Obesity Paradox ◽  
Nutritional Intervention ◽  
Hemodialysis Patients ◽  
Adverse Outcomes ◽  
Body Distribution

In the general population, obesity is known to be associated with adverse outcomes, including mortality. In contrast, high body mass index (BMI) may provide a survival advantage for hemodialysis patients, which is known as the obesity paradox. Although BMI is the most commonly used measure for the assessment of obesity, it does not distinguish between fat and lean mass. Fat mass is considered to serve as an energy reserve against a catabolic condition, while the capacity to survive starvation is also thought to be dependent on its amount. Thus, fat mass is used as a nutritional marker. For example, improvement of nutritional status by nutritional intervention or initiation of hemodialysis is associated with an increase in fat mass. Several studies have shown that higher levels of fat mass were associated with better survival in hemodialysis patients. Based on body distribution, fat mass is classified into subcutaneous and visceral fat. Visceral fat is metabolically more active and associated with metabolic abnormalities and inflammation, and it is thus considered to be a risk factor for cardiovascular disease and mortality. On the other hand, subcutaneous fat has not been consistently linked to adverse phenomena and may reflect nutritional status as a type of energy storage. Visceral and subcutaneous adipose tissues have different metabolic and inflammatory characteristics and may have opposing influences on various outcomes, including mortality. Results showing an association between increased subcutaneous fat and better survival, along with other conditions, such as cancer or cirrhosis, in hemodialysis patients have been reported. This evidence suggests that fat mass distribution (i.e., visceral fat and subcutaneous fat) plays a more important role for these beneficial effects in hemodialysis patients.

Sign in / Sign up

Export Citation Format

Share Document