New Pandemic: Obesity and Associated Nephropathy

Incidence of obesity related renal disorders have increased 10-folds in recent years. One of the consequences of obesity is an increased glomerular filtration rate (GFR) that leads to the enlargement of the renal glomerulus, i.e., glomerulomegaly. This heightened hyper-filtration in the setting of type 2 diabetes irreparably damages the kidney and leads to progression of end stage renal disease (ESRD). The patients suffering from type 2 diabetes have progressive proteinuria, and eventually one third of them develop chronic kidney disease (CKD) and ESRD. For ameliorating the progression of CKD, inhibitors of renin angiotensin aldosterone system (RAAS) seemed to be effective, but on a short-term basis only. Long term and stable treatment strategies like weight loss via restricted or hypo-caloric diet or bariatric surgery have yielded better promising results in terms of amelioration of proteinuria and maintenance of normal GFR. Body mass index (BMI) is considered as a traditional marker for the onset of obesity, but apparently, it is not a reliable indicator, and thus there is a need for more precise evaluation of regional fat distribution and amount of muscle mass. With respect to the pathogenesis, recent investigations have suggested perturbation in fatty acid and cholesterol metabolism as the critical mediators in ectopic renal lipid accumulation associated with inflammation, increased generation of ROS, RAAS activation and consequential tubulo-interstitial injury. This review summarizes the renewed approaches for the obesity assessment and evaluation of the pathogenesis of CKD, altered renal hemodynamics and potential therapeutic targets.

Association Between Fat Distribution and Low Back Pain: Results From The Korean National Health and Nutrition Examination Survey

Obesity is associated with chronic low back pain (CLBP), but the association between fat distribution and CLBP is currently unclear. We designed a cross-sectional study to evaluate the relationship between the two, including 10,606 people who participated in the Korean National Health and Nutrition Examination Survey. We estimated the regional fat distribution as well as waist circumference and body fat proportion, and compared the values in people with and without CLBP. We also stratified the estimates by sex and obesity status. The average waist circumference was not significantly different between the CLBP (80.8 cm) and non-CLBP groups (80.7 cm, p = 0.606). There were no statistically significant differences in the average fat proportion between the CLBP (26.5%) and non-CLBP groups (26.6%, p = 0.631). The average regional fat distribution in the lower limbs was significantly higher in the CLBP (31.9%, 95% confidence interval [CI]: [31.6, 32.2]) than in the CLBP groups (31.4%, 95% CI: [31.2, 31.6], p < 0.001); this pattern was more obvious in men with obesity. People, particularly men, with CLBP and obesity tend to have a higher fat mass distribution in the lower limbs than those without CLBP, suggesting that fat reductions in the lower body may aid in CLBP management.

Regional adiposity, cardiorespiratory fitness, and left ventricular strain: an analysis from the Dallas Heart Study

Background Low cardiorespiratory fitness (CRF), high body mass index, and excess visceral adiposity are each associated with impairment in left ventricular (LV) peak circumferential strain (Ecc), an intermediate phenotype that precedes the development of clinical heart failure (HF). However, the association of regional fat distribution and CRF with Ecc independent of each other and other potential confounders is not known. Methods Participants from the Dallas Heart Study Phase 2 who underwent dual energy X-ray absorptiometry assessment of regional fat distribution, CRF assessment by submaximal treadmill test, and Ecc quantification by tissue-tagged cardiovascular magnetic resonance were included in the analysis. The cross-sectional associations of measures of regional adiposity, namely visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), and lower-body fat (LBF) with Ecc after adjustment for CRF and other potential confounders (independent variables) were assessed using multivariable linear regression analysis. Results The study included 1089 participants (55% female, 39% black). In the unadjusted analysis, higher VAT was associated with greater impairment in Ecc. After adjustment for baseline risk factors, CRF, parameters of LV structure and function, and other fat depots such as SAT and LBF, higher VAT remained associated with greater impairment in Ecc (β: 0.19, P = 0.002). SAT and LBF were not significantly associated with Ecc, however, CRF remained associated with Ecc in the fully adjusted model including all fat depots (β: − 0.15, P < 0.001). Conclusions VAT and CRF are each independently associated with impairment in Ecc, suggesting that higher VAT burden and low CRF mediate pathological cardiac remodeling through distinct mechanisms.

Changes in Regional Fat Distribution and Anthropometric Measures Across the Menopause Transition

Context The relation between the menopause transition (MT) and changes in regional fat distribution is uncertain. Objective To determine whether the MT is associated with the development of central adiposity. Design Longitudinal analysis from the Study of Women’s Health Across the Nation, spanning 1996-2013 (median follow-up 11.8 years). Setting Community-based. Participants 380 women with regional body composition measures by dual energy X-ray absorptiometry. Mean baseline age was 45.7 years; racial/ethnic composition was 16% Black, 41% Japanese and 43% White. Outcomes Changes in android, gynoid and visceral fat and waist and hip circumferences. Results Android fat increased by 1.21% per year (py) and 5.54% py during premenopause and the MT, respectively (each p&lt;0.05). Visceral and gynoid fat began increasing at the MT, annualized changes were 6.24% and 2.03%, respectively (each p &lt;0.05). Postmenopausal annual trajectories decelerated to 1.47% (visceral), 0.90% (android), and -0.87% (gynoid), (all non-zero, p &lt;0.05). Waist girth grew during premenopause (0.55% py), the MT (0.96% py), and postmenopause (0.55% py) (all non-zero, p&lt;0.05; not statistically different from each other). Hip girth grew during premenopause (0.20% py) and the MT (0.35% py) (each non-zero, p&lt;0.05; not statistically different from each other) and decelerated to zero slope in postmenopause. Results are for the White referent; there were statistically significant differences in some trajectories in Black and Japanese women. Conclusions The MT is associated with the development of central adiposity. Waist or hip circumferences are less sensitive to changes in fat distribution.

Metabolic Disorder Perturb Renal Homeostasis

Obesity related nephropathy disorders have increased ten-folds in recent years. One of the consequences of obesity is an increased Glomerular Filtration Rate (GFR) that leads to an enlargement of the renal glomerulus, i.e., glomerulomegaly. This heightened hyper-filtration in the setting of type 2 diabetes irreparably damages the kidney and leads to the progression of an End Stage Renal Disease (ESRD). Patients suffering from type 2 diabetes have progressive proteinuria, and eventually one third of them develop Chronic Kidney Disease (CKD) and ESRD. For ameliorating the progression of CKD inhibitors of Renin Angiotensin Aldosterone System (RAAS) seemed to be effective, but for short-term basis only. Long term and stable treatment strategies like weight loss via restricted or hypo-caloric diet or bariatric surgery have yielded more promising results in terms of proteinuria and maintenance of GFR. Body Mass Index (BMI) is considered as a traditional marker for obesity onset, but apparently, it is not a reliable indicator, and thus there is a need for more precise evaluation of regional fat distribution and amount of muscle mass. With respect to the pathogenesis, recent investigations have suggested perturbation in fatty acid and cholesterol metabolism as the critical mediators in ectopic renal lipid accumulation, inflammation, increased generation of ROS, RAAS activation and consequential tubulo-interstitial fibrosis. This review summarizes the renewed approaches for obesity assessment and evaluation of the pathogenesis of CKD, altered renal hemodynamics and potential therapeutic targets.

Volumes of coronary plaque disease in relation to body mass index, waist circumference, truncal fat mass and epicardial adipose tissue in patients with type 2 diabetes mellitus and controls

Objectives: Coronary atherosclerosis in patients with type 2 diabetes mellitus may be promoted by regional fat distribution. We investigated the association between anthropometric measures of obesity, truncal fat mass, epicardial adipose tissue and coronary atherosclerosis in asymptomatic patients and matched controls. Methods: We examined 44 patients and 59 controls [mean (standard deviation) age 64.4 ± 9.9 vs 61.8 ± 9.7, male 50% vs 47%, diabetes duration mean (standard deviation) 7.7 ± 1.5] with coronary computed tomography angiography. Coronary plaques were quantified as total, calcified, non-calcified and low-density non-calcified plaque volumes (mm3). Regional fat distribution was assessed by dual-energy X-ray absorptiometry, body mass index (kg/m2), waist circumference (cm) and epicardial fat volume (mm3). Endothelial function and systemic inflammation were evaluated by peripheral arterial tonometry (log transformed Reactive Hyperemia Index) and C-reactive protein (mg/L). Results: Body mass index and waist circumference ( p < 0.02) were associated with coronary plaque volumes. Body mass index was associated with low-density non-calcified plaque volume after adjustment for age, sex and diabetes status ( p < 0.01). Truncal fat mass ( p > 0.51), waist circumference ( p > 0.06) and epicardial adipose tissue ( p > 0.17) were not associated with coronary plaque volumes in adjusted analyses. Conclusion: Body mass index is associated with coronary plaque volumes in diabetic as well as non-diabetic individuals.