Coexistence of visceral fat accumulation and sleep-disordered breathing correlates with coronary artery disease

Aim: Visceral adiposity is linked with sleep-disordered breathing (SDB) (called Syndrome Z), and both correlate with coronary artery disease (CAD). The aim of the present study was to determine the significance of excess visceral fat, SDB and circulating levels of biomarkers in CAD in Japanese men.Methods: SDB, visceral fat area (VFA), and circulating levels of biomarkers were assessed in 60 Japanese male patients who underwent coronary angiography and overnight cardiorespiratory monitoring.Results: Age-adjusted logistic analysis showed a significant relationship between CAD and diabetes, hypertension, dyslipidemia, SDB (AHI ≥5 events/hour), visceral fat accumulation (VFA ≥100 cm(2)), the combination of visceral fat accumulation and hypertension or dyslipidemia, as well as the combination of visceral fat accumulation and SDB. Patients with VFA ≥100 cm(2) and SDB had significantly lower serum adiponectin levels and higher serum soluble CD40 ligand levels than those with VFA<100 cm(2) and SDB. The prevalence of CAD was significantly higher in patients with VFA ≥100 cm(2) and SDB than in patients with VFA <100 cm(2) and AHI <5 events/hour, patients with VFA<100 cm(2) and AHI ≥5 events/hour or patients with VFA ≥100 cm(2) and AHI <5 events/hour (93% versus 14%, p <0.001, 53%, p <0.01 or 63%, p <0.01, respectively).Conclusions: The present study indicates that patients with both visceral fat accumulation and SDB develop CAD in association with hypoadiponectinemia and inflammatory activity.     

Characteristics of sleep-disordered breathing in Japanese patients with type 2 diabetes mellitus

Sleep-disordered breathing (SDB), especially sleep apnea-hypopnea syndrome, is often observed in patients with type 2 diabetes mellitus; but there are only a few studies on SDB in Japanese diabetic subjects. We investigated the prevalence of SDB in diabetic patients; associations between severity of sleep apnea (SA) and clinical factors, visceral fat, and adiponectin; and associations between type of SA and clinical factors. In the present study, 40 Japanese diabetic patients underwent overnight cardiorespiratory monitoring, and night and morning measurements of serum adiponectin concentrations. Sleep apnea was detected in Japanese diabetic patients at a high prevalence (77.5%). The following variables were associated with SDB: age, body mass index, estimated visceral fat area, and nocturnal reduction in serum adiponectin concentrations. The prevalence of central sleep apnea (CSA, ≥5/h) was 32.3% among diabetic SDB patients. Diabetic SDB patients with CSA had higher hemoglobin, increased intima-media thickness, and higher plasma brain natriuretic peptide levels than those without CSA (<5/h). In conclusion, our study demonstrated a high prevalence of SDB in Japanese diabetic patients, which correlated with visceral fat area and adiponectin. A high frequency of CSA was noted in diabetic SDB patients, together with high hemoglobin, high brain natriuretic peptide, and increased intima-media thickness. The present results of prevalence of SDB may be relevant to the higher incidence of cardiovascular disease in diabetic patients, which need to be clarified in future studies.     

Differences in the pathology of the metabolic syndrome with or without visceral fat accumulation: a study in pre-diabetic Japanese middle-aged men

To elucidate the role of visceral fat accumulation in the metabolic syndrome, differences in the pathology of the metabolic syndrome with or without visceral fat accumulation were investigated. A total of 472 prediabetic Japanese men (mean age, 47.5 +/- 7.2 yr) with impaired fasting glycemia (IFG) levels of 110-125 mg/dL were eligible for participation in the study. The study subjects were divided into the following four groups, and intergroup comparisons were made: group I without visceral fat area [VFA] > or = 100 cm2 but presenting with fewer than two other risk factors (i.e., TG > or =150 mg/dL, HDL-C < 40 mg/dL, BP > or = 130/ > or = 85 mmHg, or FPG > or = 110 mg/dL) (n = 231); group II without VFA of > or = 100 cm2 but presenting with three or more other risk factors (n = 57); group III with VFA of > or = 100 cm2 accompanied by FPG 110 mg/dL alone (n = 27); and group IV with VFA > or =100 cm2 and two or more other risk factors (n = 157). The prevalence of patients who had three or more risk factors with or without VFA > or = 100 cm2 was 45.3% (214 out of 472 patients), while that of those with VFA > or = 100 cm2 who had two or more other risk factors was 33% (157 out of 472 patients). Group II had significantly higher VFA values than group I (p < 0.05), and group IV had significantly higher VFA values than group II (p < 0.001). While no significant differences in HOMA-R values were seen between groups I and II, these values were significantly higher in group IV compared to groups I and II (p < 0.001 and p < 0.05, respectively). Furthermore, group IV showed significantly higher 2-h insulin levels after glucose loading compared to group I (p < 0.001). While no significant differences were seen between groups II and IV, insulin levels tended to be higher in group IV. Adiponectin levels showed an incremental fall in VFA from group I through groups II and III to group IV. Groups III and IV showed significantly lower adiponectin levels compared to group I (p < 0.05, p < 0.001, respectively); and group IV showed significantly lower adiponectin levels than group II (p < 0.05). A logistic regression analysis using VFA, TG and HDL-C, and BP as explanatory variables showed that the relative risk for high HOMAR values were 2.65 (p < 0.001) for patients with VFA > or =100 cm2; 1.64 (p < 0.05) for those with TG > or = 150 mg/dL and HDL < 40 mg/dL; and 1.79 (p < 0.01) for those with BP > or = 130/ > or = 85 mmHg. These findings demonstrate that the degree of insulin resistance and the risk of arteriosclerosis vary depending on whether or not the metabolic syndrome accompanied by a clustering of risk factors has visceral fat accumulation as an underlying pathology, strongly suggesting a crucial role for visceral fat accumulation in the metabolic syndrome.     

Increase of visceral fat area in Indonesians and Japanese with normal BMI

We compared the visceral fat accumulation between Indonesians and Japanese. Non-obese (25>BMI> or =18.5) men aged between their 20s and 50s were collected in Toban including moderately populated middle-sized cities of Hyogo Prefecture in Japan, and Sangsit town and Pedawa village in Indonesia. Their visceral fat accumulation was assessed by determination of visceral fat area (VFA) that was measured through bio-electrical impedance analysis. VFA as well as VFA per body weight in those aged in their 20s did not vary significantly among Toban, Sangsit and Pedawa. In these three districts, they increased with age. Compared with VFA as well as VFA per body weight among those aged in their 20s, they increased in their 30s and over in the urban area of both Japan and Indonesia, whereas it did in their 40s and over in Pedawa, economically poor district. The inhabitants in their 40s and over in Sangsit and those in their 30s and over in Pedawa had less VFA than those with the corresponding age in Toban, while those in the 30s and 40s in Pedawa and those in their 40s in Sangsit had less VFA per body weight than those with corresponding age in Toban. In conclusion, the visceral fat appears to accumulate progressively with aging and urbanization of lifestyle even in those with normal body mass index. It is recommended that some preventive measures against visceral fat accumulation should be taken in their 20s or under for urban dwellers and in their 30s or under for rural inhabitants.     

Increased visceral fat accumulation further aggravates the risks of insulin resistance in gout

We performed the present study to determine the degree of visceral fat accumulation and incidence of visceral fat obesity in 138 gout patients who were classified as overexcretion type (n = 53) and underexcretion type (n = 85) by their levels of uric acid clearance and urinary uric acid excretion. We also investigated the relationship between visceral fat accumulation and insulin resistance expressed by the homeostasis model assessment (HOMA) index. Visceral fat area (VFA)/surface body area (SBA) was significantly increased in patients with gout as compared with control subjects (79.7 +/- 30.8 cm(2)/m(2) v 65.1 +/- 24.1 cm(2)/m(2), P <.001). It was also shown that VFA/SBA in the gout overexcretion group was significantly increased as compared with the gout underexcretion group (88.3 +/- 32.8 cm(2)/m(2) v 74.3 +/- 28.3 cm(2)/m(2), P <.01). Although the incidence of visceral fat obesity (VFO) was not different between gout patients and control subjects, the incidence of VFO was significantly higher in the gout overexcretion type than the gout underexcretion type (19 of 53 v 11 of 85, P <.01). Further, there was a significant relationship between visceral fat area and HOMA index. Gout patients possess some factors that are included in the insulin resistance syndrome, irrespective of the presence of VFO, and the insulin resistance risk factors observed in gout become more prominent when it is complicated with VFO. Our results suggest that gout patients, especially the overexcretion type who have greater levels of visceral fat accumulation, may be more vulnerable to atherosclerotic diseases.     

Sleep oxygen desaturation and circulating leptin in obstructive sleep apnea-hypopnea syndrome

BACKGROUND: Obstructive sleep apnea-hypopnea syndrome (OSAHS) is characterized by repeated oxygen desaturation. Obesity and visceral fat accumulation (VFA) are risk factors for the development of OSAHS. Circulating leptin increases in accordance with body mass index (BMI), and under experimental conditions intermittent hypoxia stimulates leptin production. METHODS: The primary objective of this study was to investigate whether hypoxemia during sleep influences the levels of circulating leptin and whether the location of body fat deposits, ie, the distribution of VFA and subcutaneous fat accumulation (SFA), affects circulating leptin levels in patients with OSAHA who are not obese. We assessed VFA and SFA by abdominal CT scan and measured circulating levels of leptin in 96 male patients with OSAHS and 52 male patients without OSAHS matched for BMI. To be matched for BMI in the two groups, patients whose BMIs were < 27 were selected for the OSAHS group. RESULTS: In the whole study group, circulating leptin levels correlated with BMI (r = 0.30), VFA (r = 0.44), SFA (r = 0.28), apnea-hypopnea index (AHI) [r = 0.48], sleep mean arterial oxygen saturation (Sao(2)) [r = 0.59], and sleep lowest Sao(2) (r = 0.37). Multiple regression analysis showed that average Sao(2) (p < 0.01) and lowest Sao(2) (p = 0.03) were explanatory variables for serum leptin values, but AHI (p = 0.054), BMI (p = 0.33), VFA (p = 0.11), and SFA (p = 0.36) were not. CONCLUSIONS: These results suggest that sleep hypoxemia may be the main determinant of circulating leptin levels, although the location of body fat deposits could contribute to the elevated circulating leptin levels in patients with OSAHS who are not obese.     

Fat accumulation, leptin, and hypercapnia in obstructive sleep apnea-hypopnea syndrome

BACKGROUND: Obesity and visceral fat accumulation (VFA) are risk factors for the development of obstructive sleep apnea-hypopnea syndrome (OSAHS), and a subgroup of OSAHS patients acquire hypoventilation. Circulating leptin, an adipocyte-derived signaling factor, increases in accordance with body mass index (BMI); under experimental conditions, leptin selectively decreases visceral adiposity and it is also a respiratory stimulant. OBJECTIVE: To investigate whether the location of body fat deposits, ie, the distribution of VFA and subcutaneous fat accumulation (SFA), contributes to hypoventilation and whether circulating levels of leptin are involved in the pathogenesis of hypoventilation, which is often observed in OSAHS. METHODS: We assessed VFA and SFA by abdominal CT scan, and measured lung function and circulating levels of leptin in 106 eucapnic and 79 hypercapnic male patients with OSAHS. RESULTS: In the whole study group, circulating leptin levels correlated with BMI (r = 0.56), VFA (r = 0.24), and SFA (r = 0.47), but not with Po(2) or sleep mean arterial oxygen saturation (Sao(2)). BMI, percentage of predicted vital capacity, FEV(1)/FVC ratio, apnea-hypopnea index, sleep mean Sao(2), VFA, and SFA were not significantly different between two groups. Circulating leptin levels were higher in the hypercapnic group than in the eucapnic group. Logistic regression analysis indicated that serum leptin was the only predictor for the presence of hypercapnia (beta = 0.21, p < 0.01). CONCLUSIONS: These results suggest that the location of body fat deposits may not contribute to the pathogenesis of hypoventilation, and circulating leptin may fail to maintain alveolar ventilation in hypercapnic patients with OSAHS.     

Relative contributions of cardiorespiratory fitness and visceral fat to metabolic syndrome in patients with diabetes mellitus

The objective of this study was to examine the contribution of endurance fitness and visceral fat accumulation on the prevalence of metabolic syndrome in Japanese male patients with either an impaired glucose tolerance (IGT) or type 2 diabetes mellitus (DM). The subjects of this cross-sectional study consisted of 135 Japanese male patients with either IGT or type 2 DM who had not taken any medication or intervention. They were classified into three fitness categories (low, moderate, and high) based on the tertiles of their maximal oxygen uptake ( [Formula: see text] O(2)max) predicted by the Astrand nomogram using a cycle ergometer. Metabolic syndrome was defined based on the WHO criteria. The visceral fat area (VFA) was determined using a computed tomography scan. The age- and VFA-adjusted odds ratio was 3.49 (95% CI, 1.13-10.82) for subjects in the low fitness category in comparison to those in the high fitness category. We calculated the odds ratio for the prevalence of metabolic syndrome in the nine categories classified based on the three VFA and three [Formula: see text] (2)max levels. In Moderate- and Low- [Formula: see text] (2) max categories, the odds ratios increased in line with increases in the VFA level. The highest odds ratios were observed in the low fitness and high visceral fat group. In the High- [Formula: see text] O(2)max category, no significant odds ratios were observed in the Moderate- and High-VFA categories. These results indicate that a high degree of cardiorespiratory fitness positively contributed to the low prevalence of metabolic syndrome in Japanese male patients with IGT and type 2 DM.     

Hepatitis C virus infection enhances insulin resistance induced by visceral fat accumulation

Background/Aims: To clarify the impact of visceral obesity on hepatitis C virus (HCV)‐infected patients, we examined the relationship between insulin resistance development and visceral fat accumulation. Methods: We analyzed 87 HCV‐infected patients with mild fibrosis (stage 1 or 2) in comparison with 125 sex‐ and age‐matched patients with non‐alcoholic fatty liver disease (NAFLD). The degree of visceral fat area (VFA; cm²) at the umbilical level was measured by abdominal computed tomography and divided into two grades: no visceral obesity, VFA<100 and visceral obesity, VFA≥100. Insulin resistance was evaluated by homeostasis model assessment of insulin resistance (HOMA‐IR) and the quantitative insulin sensitivity check index (QUICKI). Pancreatic β‐cell function was evaluated by homeostasis model assessment of β‐cell function (HOMA‐β). Serum soluble tumour necrosis factor (TNF)‐receptors 1 and 2 and adiponectin were measured. Results: Insulin resistance evaluated by HOMA‐IR and QUICKI was correlated with visceral fat accumulation, and was higher in HCV patients than in NAFLD patients with visceral obesity. HOMA‐β was higher in HCV patients than in NAFLD patients for each VFA grade. Serum‐soluble TNF‐receptors 1 and 2 were higher in HCV patients than in NAFLD patients with visceral obesity. Conclusions: Hepatitis C virus infection is a risk factor for development of insulin resistance, particularly in patients with visceral obesity.     

Systemic oxidative stress is associated with visceral fat accumulation and the metabolic syndrome.

BACKGROUND: The metabolic syndrome (MetS) is a major target for prevention of atherosclerotic cardiovascular diseases and visceral fat accumulation is an underlying component of MetS. The aim of this study was to investigate the association of systemic oxidative stress with visceral fat accumulation and MetS. METHODS AND RESULTS: The study group consisted of Japanese men (n=44; 51.2+/-11.4 years) and women (n=61; 55.4 +/-13.4 years). Urinary 8-epi-prostaglandin F2alpha (8-epi-PGF2 alpha) concentration, a biomarker of systemic oxidative stress, was significantly high in the subjects with MetS. As the urinary concentration of 8-epi-PGF2alpha increased, the number of criteria for MetS were significantly met (abdominal obesity, hypertriglyceridemia, low high-density lipoprotein-cholesterol, hypertension, and high fasting glucose). Among parameters associated with MetS, the correlation coefficient of visceral fat area (VFA) with urinary 8-epi-PGF2alpha concentration was the highest (r=0.636, p<0.0001). In non-obese subjects, the correlation coefficient of VFA with urinary 8-epi-PGF2alpha concentration was higher (r=0.728, p<0.0001), although there was no significant correlation between subcutaneous fat area and urinary 8-epi-PGF2 alpha. Stepwise multiple regression analysis identified VFA as the strongest and independent determinant of urinary 8-epi-PGF2 alpha (p<0.0001) followed by adiponectin (p=0.0212) and, high sensitive C-reactive protein (p=0.0365). CONCLUSIONS: Systemic oxidative stress, as measured by urinary 8-epi-PGF2alpha , is strongly associated with visceral fat accumulation and MetS.     

Visceral fat accumulation contributes to insulin resistance, small-sized low-density lipoprotein, and progression of coronary artery disease in middle-aged non-obese Japanese men

Visceral fat accumulation plays an important role in the occurrence of coronary artery disease (CAD) associated with a cluster of multiple risk factors, such as glucose intolerance, insulin resistance and hyperlipoproteinemia. To clarify the detailed features of these factors, based on visceral fat accumulation, the present study examined the relationship between fat distribution and the characteristics of glucose metabolism and serum lipoproteins in middle-aged non-obese Japanese men. First, the influence of visceral fat accumulation on glucose metabolism, insulin sensitivity, and the extent and severity of coronary artery lesions was investigated in 50 subjects with CAD and compared with 15 control subjects without CAD (Study 1) and with the lipoprotein characteristics in 44 subjects without CAD who were not treated with lipid-lowering drugs (Study 2). Body fat distribution was determined by abdominal computed tomography. In Study 1, the visceral fat area (VFA), blood pressure, fasting immunoreactive insulin (FIRI), and the plasma insulin area (PIA) obtained by oral glucose tolerance test in the subjects with CAD were all significantly higher than in the control subjects. The VFA was significantly correlated with FIRI, the homeostasis model of insulin resistance, PIA and steady state plasma glucose (SSPG) concentration as an index for insulin resistance (r=0.57, p<0.001, r=0.49, p<0.01, r=0.36, p<0.01, and r=0.50, p<0.05, respectively). Although the SSPG concentration did not correlate with the coronary atherosclerosis index as a score of the extent and severity of coronary lesions, the VFA was significantly correlated with this index (r=0.43, p<0.01). In Study 2, the VFA had significant positive correlations with serum total cholesterol, triglyceride, and apolipoprotein B and E levels and the cholesterol and triglyceride concentrations of very-low-density lipoprotein, intermediate-density lipoprotein, and low-density lipoprotein (LDL) fractions. There was a negative correlation between the VFA and LDL particle size (r=-0.34, p<0.05). In conclusion, visceral fat accumulation may contribute to the development of CAD through the progression of insulin resistance and the increase of apo B-containing lipoproteins and small-sized LDLs in middle-aged non-obese Japanese men.     

Relationship between the serum concentrations of C-reactive protein and parameters of adiposity and insulin resistance in patients with type 2 diabetes mellitus

Serum C-reactive protein (CRP) concentrations have been reported to be associated with body fat, especially visceral fat accumulation, but most studies up to now have been conducted on non-diabetic subjects. In this study, we investigated the association between the serum CRP concentrations and parameters of adiposity and insulin resistance in both Japanese type 2 diabetes patients and non-diabetic subjects. A total of 248 Japanese subjects (140 type 2 diabetes patients and 108 non-diabetic subjects) were enrolled for the study. The degree of insulin resistance was estimated by the homeostasis model assessment (HOMA-R) method. Fat accumulation was evaluated by measuring visceral and subcutaneous fat areas at the level of the umbilicus in abdominal CT scans. To assess hepatic fat content, the ratio of CT attenuation value of the liver to that of the spleen (L/S ratio) was calculated. Serum CRP was found to be significantly correlated with various indices of adiposity, including L/S ratio, visceral fat area (VFA), subcutaneous fat area (SFA), and HOMA-R, in both the diabetic patients and the non-diabetic subjects. After adjustment for five variables (age, gender, serum CRP, HbA1c, and smoking), serum CRP was still significantly correlated with L/S ratio, VFA, SFA, and HOMA-R in the diabetic patients. We also found that changes in serum CRP concentrations were correlated with changes in the VFA and SFA at 1 year after the baseline in 24 diabetic patients. We conclude that serum CRP may be closely related to the degree of liver steatosis and visceral fat accumulation in Japanese type 2 diabetes mellitus patients.     

Contribution of visceral fat accumulation to carotid intima-media thickness in a Chinese population

Objective:Recent observational studies have reported that body fat distribution might be differentially associated with subclinical atherosclerosis. We previously reported that visceral fat area (VFA) 80?cm(2) is the optimal cutoff for identifying abdominal obesity in Chinese subjects. We examined whether VFA 80?cm(2) reflects the association between abdominal obesity and subclinical atherosclerosis, and if determination of the visceral fat quantity is useful for assessing subclinical atherosclerosis in asymptomatic individuals.Methods and results:Participants (N=1005, men 515, women 490, 34-66 years) free of cardiovascular disease underwent magnetic resonance imaging and carotid ultrasound assessment to quantify VFA and carotid intima-media thickness (C-IMT). Overweight/obese subjects (body mass index (BMI) 25.0?kg?m(-2)) had a higher C-IMT than lean subjects (BMI <25.0?kg?m(-2)) (P<0.01). Subjects with VFA 80?cm(2) had significantly higher C-IMT than those without abdominal obesity regardless of BMI (P<0.01). By multivariate regression analysis adjusted for anthropometric measurements and cardiovascular risk factors, waist circumference but not BMI was independently correlated with C-IMT in men (P<0.001). Similar findings were observed with an accurate obesity indices adjusted model, which showed that VFA was an independent risk factor for increased C-IMT in men but not in women.Conclusions:VFA 80?cm(2) effectively identified carotid atherosclerosis for both lean and obese individuals in middle-aged Chinese men.     

Influence of metabolic syndrome on upper gastrointestinal disease

A recent increase in the rate of obesity as a result of insufficient physical exercise and excess food consumption has been seen in both developed and developing countries throughout the world. Additionally, the recent increased number of obese individuals with lifestyle-related diseases associated with abnormalities in glucose metabolism, dyslipidemia, and hypertension, defined as metabolic syndrome (MS), has been problematic. Although MS has been highlighted as a risk factor for ischemic heart disease and arteriosclerotic diseases, it was also recently shown to be associated with digestive system disorders, including upper gastrointestinal diseases. Unlike high body weight and high body mass index, abdominal obesity with visceral fat accumulation is implicated in the onset of various digestive system diseases because excessive visceral fat accumulation may cause an increase in intra-abdominal pressure, inducing the release of various bioactive substances, known as adipocytokines, including tumor necrosis factor-α, interleukin-6, resistin, leptin, and adiponectin. This review article focuses on upper gastrointestinal disorders and their association with MS, including obesity, visceral fat accumulation, and the major upper gastrointestinal diseases.     

Waist circumference correlates with hepatic fat accumulation in male Japanese patients with non-alcoholic fatty liver disease, but not in females

Background and Aim:  Abdominal obesity, a component of metabolic syndrome, is a major risk factor for non-alcoholic fatty liver disease (NAFLD). In recent worldwide definitions of metabolic syndrome, waist measurement has been proposed as a simple and useful estimate of abdominal obesity, taking into account gender differences in waist circumference. The present cross-sectional study investigated the correlation of hepatic fat accumulation and waist circumference in Japanese NAFLD patients to determine if there are gender differences in this relationship.
Methods:  Consecutive patients ( n  = 2111) who had at least one of two criteria for liver disease (alanine aminotransferase [ALT] level >30 IU/mL and aspartate aminotransferase [AST]/ALT ratio <1) underwent abdominal ultrasonography. Patients positive for hepatitis B virus, hepatitis C virus or autoimmune antibodies and whose alcohol intake was >20 g/day were excluded. Patients with NAFLD underwent abdominal computed tomography. Hepatic fat accumulation was estimated by liver/spleen attenuation ratio (L/S ratio) and visceral adipose accumulation was measured as visceral fat area (VFA) at the umbilical level.
Results:  Of the 221 NAFLD patients, 103 were females. In males, the relationship between L/S ratio and waist circumference was negative ( r  =−0.356, P  < 0.01), and there was no correlation in the female group. The relationship between L/S ratio and VFA was negative in both groups (males: r  = −0.269, P  < 0.01; females: r  = −0.319, P  < 0.01). Subcutaneous fat area/total fat area ratio at the umbilical level was larger in females than in males ( P  < 0.01).
Conclusions:  In NAFLD patients, waist measurement is more susceptible to gender differences than VFA.     

Analysis of waist circumference in Japanese subjects with type 2 diabetes mellitus: lack of propriety to define the current criteria of metabolic syndrome

A necessary condition of advocated criteria to determine the metabolic syndrome (MetS) in Japan is waist circumference (WC), which varies among races. In this study, we measured WC and visceral fat area (VFA) in subjects with type 2 diabetes (T2DM) and assessed the propriety of new criteria of MetS in Japan. Four hundred and nineteen patients (M/F: 258/161, age: 60.4+/-0.7 years, BMI: 24.4+/-0.2 kg/m(2)) who received abdominal CT examination were analyzed, and 178 (M/F: 111/67) subjects sufficed the criteria of MetS. Average VFA was significantly larger in subjects with MetS (162+/-3 cm(2) versus 82+/-3 cm(2), p<0.01). The WC and VFA were correlated significantly in both male (r=0.78, p<0.001) and female (r=0.82, p<0.001), and corresponding VFA at 85 cm of WC in male and at 90 cm in female were 125 cm(2) and 120 cm(2). Incidence of cardio- and cerebro-vascular diseases (CVD) was not different between subjects with and without MetS. The present cross-sectional study strongly suggests that the recommended WC is not suitable to define the current criteria of MetS (VFA, > or =100 cm(2)) and its criteria is not appropriate to segregate a risk of CVD in Japanese T2DM subjects. Further prospective analysis should be required to validate the criteria and clinical significance of MetS in T2DM.     

Excess visceral fat accumulation is a risk factor for postoperative systemic inflammatory response syndrome in patients with esophageal cancer

Background  Although visceral fat accumulation influences various body systems, its significance as a preoperative risk factor is unknown. This study analyzed the relationship between visceral fat accumulation and postoperative morbidity. Methods  The study group consisted of 64 male patients with body mass index (BMI) of 18.5 or more who underwent esophagectomy for esophageal cancer. Clinicopathological, surgical, and postoperative data were collected from medical records. Visceral fat area (VFA) was calculated at the navel level of preoperative CT scan by FatScan ver. 3.0. Results  Based on visceral fat area, patients were divided into high-VFA group (VFA ≥ 100 cm², n = 30) and low-VFA group (VFA < 100 cm², n = 34). Postoperative maximal CRP level was higher in the high-VFA group (23.4 ± 5.7 mg/dl) than the low-VFA group (18.5 ± 7.1 mg/dl, P = 0.004). The duration of systemic inflammatory response syndrome (SIRS) was significantly longer in high-VFA group (3.1 ± 3.4 days) than low-VFA group (1.7 ± 1.9 days, P = 0.048). There were no significant differences in postoperative complications. Differences in CRP and SIRS duration were not evident when the population was divided according to BMI. Visceral fat area (P = 0.001), blood loss (P = 0.029), and field of lymphadenectomy (P = 0.005) correlated with longer duration of SIRS postoperatively (>3 days). Multivariate analysis identified visceral fat area as the only significant determinant of longer duration of SIRS (P = 0.034; HR, 0.984). Conclusions  Patients with visceral fat area of more than 100 cm² are at high risk for prolonged postoperative SIRS.     

Characteristics of sleep–wake cycle and sleep duration in Japanese type 2 diabetes patients with visceral fat accumulation

Sleep pattern has been shown to be associated with type 2 diabetes mellitus. Here, we investigated the difference in bedtime, waking time and estimated sleep duration in type 2 diabetes mellitus patients with or without visceral fat accumulation, using a questionnaire on sleep patterns. The study participants were 59 Japanese type 2 diabetes mellitus patients (men/women 34/25, age 64.5 ± 12.1 years). Visceral fat accumulation was defined as estimated visceral fat area ≥100 cm². The patients with visceral fat accumulation (n = 40) showed significantly later bedtime (23.51 ± 01.27 h in the [+] group vs 22.49 ± 01.23 h in the [?] group) and shorter estimated sleep duration (6.6 ± 1.4 h in the [+] group vs 7.9 ± 1.0 h in the [?] group) on weekdays, compared with those without (n = 19). Later bedtime and shorter estimated sleep duration existed in the type 2 diabetes mellitus patients with visceral fat accumulation, compared with those without.     

Visceral obesity in Japanese patients with metabolic syndrome: reappraisal of diagnostic criteria by CT scan.

To reappraise the cutoff level of abdominal circumference (AC) for diagnosis of visceral obesity in Japanese, we examined the association of visceral fat deposition with other constituents of metabolic syndrome and atherosclerotic cardiovascular disease (ASCD). CT was used for determination of visceral-fat area (VFA), subcutaneous-fat area (SFA) and AC on CT (AC(CT)) in 420 Japanese patients with (n=180) or without ASCD (n=240). VFA cutoff levels were calculated by receiver operating characteristic (ROC) analysis. AC(CT) correlated with VFA (r=0.828), SFA (r=0.795), and AC measured with an anthropometric tape (AC(M), r=0.96). The VFA cutoff levels yielding the maximum sensitivity and specificity to predict two or more components of metabolic syndrome were 92 cm(2) in males and 63 cm(2) in females, which correspond to AC(M) values of 83 cm and 78 cm, respectively. The male AC(M) cutoff level was similar to the AC in current Japanese criteria (85 cm), but the female AC(M) cutoff level was considerably smaller than the criteria, and this change in cutoff level increased the prevalence of metabolic syndrome in females three-fold. The cutoff levels of VFA for predicting presence of ASCD were 98 cm(2) in males and 75 cm(2) in females, corresponding to AC(M) values of 84 cm and 80 cm, respectively. The present results obtained by CT support the validity of the current Japanese criteria for visceral obesity in males but not in females. AC(M) of 78 cm appears to be a cutoff level suitable for diagnosing visceral obesity in Japanese females, though further confirmation is needed.     

Risk factors for small bowel angioectasia: The impact of visceral fat accumulation

AIM: To investigate visceral fat accumulation in association with the risk of small bowel angioectasia.METHODS: We retrospectively investigated 198 consecutive patients who underwent both capsule endoscopy and CT for investigation of obscure gastrointestinal bleeding(OGIB) from January 2009 to September 2013. The visceral fat area(VFA) and subcutaneous fat area were measured by CT, and information on comorbidities, body mass index, and medications was obtained from their medical records.Logistic regression analysis was used to evaluate associations.RESULTS: Capsule endoscopy revealed small bowel angioectasia in 18/198(9.1%) patients with OGIB.Compared to patients without small bowel angioectasia,those with small bowel angioectasia had a significantly higher VFA(96 ± 76.0 cm2 vs 63.4 ±51.5 cm2, P = 0.016) and a higher prevalence of liver cirrhosis(61% vs 22%, P 0.001). The proportion of patients with chronic renal failure was higher in patients with small bowel angioectasia(22% vs 9%,P = 0.11). There were no significant differences in subcutaneous fat area or waist circumference. The prevalence of small bowel angioectasia progressively increased according to the VFA. Multivariate analysis showed that the VFA [odd ratio(OR) for each 10-cm2 increment = 1.1; [95% confidence interval(CI):1.02-1.19; P = 0.021] and liver cirrhosis(OR = 6.1,95%CI: 2.2-18.5; P 0.001) were significant risk factors for small bowel angioectasia.CONCLUSION: VFA is positively associated with theprevalence of small bowel angioectasia, for which VFA and liver cirrhosis are independent risk factors in patients with OGIB.