The burden of disease attributable to excess body fat (EBF) in type 2 diabetes mellitus (T2DM) may be underestimated due to problems correlating BMI with body fat. The aim of this study is to compare the population attributable fraction (PAF) of EBF in T2DM assessed with various parameters.

Prevalence study based on the baseline visit of the IBERICAN study. Mixed unconditional logistic regression models were used to estimate the risk of T2DM for the various categories of BMI, of the estimation of EBF according to the CUN-BAE (Clínica Universidad de Navarra-Body Adiposity Estimator) and of waist circumference (WC), stratifying by sex. The PAF was calculated for each of the EBF estimates.

A total of 7752 patients from IBERICAN study were eligible, of them 1536 (19.8 %) achieved T2DM criterion, The prevalence of diabetes was higher in men, in those with a lower level of education, and in those who reported a low level of physical activity. Subjects with diabetes were older, had a higher BMI, a higher CUN-BAE-estimated body fat percentage (eBFP) and a higher waist circumference. One in three cases T2DM risk was attributed to elevated BMI, whereas in the CUN-BAE case it was attributed to 9 out of 10 men and 2 out of 3 women. One out of two cases of T2DM in women, and less in men, was attributed to an excess WC.

The burden of disease attributable to EBF in the case of T2DM may be underestimated. Therefore, EBF should be used, together with BMI, WC -especially in women-, and the CUN-BAE to better estimate the risk of T2DM and to adapt dietary or lifestyle recommendations in daily clinical practice.

Obesity is a risk factor for diverticulitis. However, it remains unclear whether visceral fat area, a more precise measurement of abdominal fat, is associated with the risk of diverticulitis.

To estimate the risk of incident and recurrent diverticulitis according to visceral fat area.

A retrospective cohort study.

The Mass General Brigham Biobank.

A total of 6654 patients who underwent abdominal CT for clinical indications and had no diagnosis of diverticulitis, IBD, or cancer before the scan were included.

Visceral fat area, subcutaneous fat area, and skeletal muscle area were quantified using a deep-learning model applied to abdominal CT. The main exposures were z -scores of body composition metrics normalized by age, sex, and race. Diverticulitis cases were identified using the International Classification of Diseases codes for the primary or admitting diagnosis from the electronic health records. The risks of incident diverticulitis, complicated diverticulitis, and recurrent diverticulitis requiring hospitalization according to quartiles of body composition metrics z -scores were estimated.

A higher visceral fat area z -score was associated with an increased risk of incident diverticulitis (multivariable HR comparing the highest vs lowest quartile, 2.09; 95% CI, 1.48-2.95; p for trend <0.0001), complicated diverticulitis (HR, 2.56; 95% CI, 1.10-5.99; p for trend = 0.02), and recurrence requiring hospitalization (HR, 2.76; 95% CI, 1.15-6.62; p for trend = 0.03). The association between visceral fat area and diverticulitis was not materially different among different strata of BMI. Subcutaneous fat area and skeletal muscle area were not significantly associated with diverticulitis.

The study population was limited to individuals who underwent CT scans for medical indication.

Higher visceral fat area derived from CT was associated with incident and recurrent diverticulitis. Our findings provide insight into the underlying pathophysiology of diverticulitis and may have implications for preventive strategies. See Video Abstract .

ANTECEDENTES:La obesidad es un factor de riesgo de la diverticulitis. Sin embargo, sigue sin estar claro si el área de grasa visceral, con medida más precisa de la grasa abdominal esté asociada con el riesgo de diverticulitis.OBJETIVO:Estimar el riesgo de diverticulitis incidente y recurrente de acuerdo con el área de grasa visceral.DISEÑO:Un estudio de cohorte retrospectivo.AJUSTE:El Biobanco Mass General Brigham.PACIENTES:6.654 pacientes sometidos a una TC abdominal por indicaciones clínicas y sin diagnóstico de diverticulitis, enfermedad inflamatoria intestinal o cáncer antes de la exploración.PRINCIPALES MEDIDAS DE RESULTADOS:Se cuantificaron, área de grasa visceral, área de grasa subcutánea y área de músculo esquelético, utilizando un modelo de aprendizaje profundo aplicado a la TC abdominal. Las principales exposiciones fueron puntuaciones z de métricas de composición corporal, normalizadas por edad, sexo y raza. Los casos de diverticulitis se definieron con los códigos ICD para el diagnóstico primario o de admisión de los registros de salud electrónicos. Se estimaron los riesgos de diverticulitis incidente, diverticulitis complicada y diverticulitis recurrente que requiriera hospitalización según los cuartiles de las puntuaciones z de las métricas de composición corporal.RESULTADOS:Una puntuación z más alta del área de grasa visceral se asoció con un mayor riesgo de diverticulitis incidente (HR multivariable que compara el cuartil más alto con el más bajo, 2,09; IC del 95 %, 1,48-2,95; P para la tendencia < 0,0001), diverticulitis complicada (HR, 2,56; IC del 95 %, 1,10-5,99; P para la tendencia = 0,02) y recurrencia que requiriera hospitalización (HR, 2,76; IC del 95 %, 1,15-6,62; P para la tendencia = 0,03). La asociación entre el área de grasa visceral y la diverticulitis no fue materialmente diferente entre los diferentes estratos del índice de masa corporal. El área de grasa subcutánea y el área del músculo esquelético no se asociaron significativamente con la diverticulitis.LIMITACIONES:La población del estudio se limitó a individuos sometidos a tomografías computarizadas por indicación médica.CONCLUSIÓN:Una mayor área de grasa visceral derivada de la tomografía computarizada se asoció con diverticulitis incidente y recurrente. Nuestros hallazgos brindan información sobre la fisiopatología subyacente de la diverticulitis y pueden tener implicaciones para las estrategias preventivas. (Traducción: Dr. Fidel Ruiz Healy ).

Obesity is currently a pandemic and a cardinal risk factor for incident diabetes, a parallel growing pandemic. Measures commonly used to define obesity, i.e., BMI and waist circumference, do not accurately reflect body fatness.

We examined the prognostic value of body fatness assessed with the 'Clínica Universidad de Navarra-Body Adiposity Estimator' (CUN-BAE, range: 18.4-65.0 %) in 18,594 participants of the "Seguimiento Universidad de Navarra" prospective longitudinal cohort (60.5% women) without diabetes at baseline. Participants were followed-up with biennial questionnaires and multivariable-adjusted Cox models were used to estimate incident diabetes.

During 13.7 years of median follow-up, 209 participants developed diabetes. Progressively ascending quartiles of CUN-BAE were significantly associated with incident diabetes in multivariable-adjusted models, even after adjusting for BMI > 30 kg/m2. For each 2-unit increment in the CUN-BAE index, diabetes risk relatively increased by 46% in men and women (95% CI: 33%-62%). When comparing ROC AUC for CUN-BAE and BMI the association was stronger for CUN-BAE (p < 0.001).

CUN-BAE index, an easy equation that can be used in any clinical setting, predicted better the risk of incident diabetes compared to BMI. Our results emphasize the importance of reducing and maintaining a low adiposity in order to prevent diabetes.

Previous studies have demonstrated that adiposity, particularly obesity during midlife, may have a detrimental effect on cognitive function. This study aims to estimate the global prevalence of mild cognitive impairment (MCI) and dementia in elderly aged 60 years or above with overweight, obesity, and central obesity.

We searched PubMed, Embase, Web of Science, and Cochrane Library from inception to November 2023. DerSimonian-Laird random-effects model with Logit transformation was used. Sensitivity analysis, meta-regression, and subgroup analysis were employed to investigate determinants of the prevalence of MCI and dementia.

A total of 72 studies involving 2,980,947 elderly with distinct adiposity status were included. Pooled prevalence of MCI and dementia in elderly with overweight and obesity was 32.54% and 9.47%, respectively. Univariate meta-regression analysis indicated that the heterogeneity in dementia prevalence was attributable to variations in study size (R2 = 0.01, p < 0.05), while the multivariable analysis underscored that the income of country or area had the most significant predictive importance (60.3% and 90.3%) for both MCI and dementia prevalence. Subgroup analysis revealed regional disparities and diagnostic technique variations contributing to heterogeneity. Based on currently available but inadequate epidemiological data, the pooled prevalence of MCI and dementia in elderly with central obesity was calculated as 10.18% and 9.75%, respectively.

Strategies to address adiposity-associated cognitive impairment should consider multifaceted interventions beyond simple weight reduction. Macro-level initiatives such as improvement of income levels and micro-level interventions including the adoption of accurate diagnostic techniques also represent equally pivotal components.

Evidence links body composition and inflammatory markers with type 2 diabetes (T2D). However, the comparative analysis of body composition markers derived from different modalities and inflammatory markers in relation to T2D remains unexplored. This study aims to evaluate and compare the association of body composition and inflammatory markers with T2D.

We included 4043 participants (2081 female, 51.4%) aged 20-84 enrolled in the population-based Study of Health in Pomerania. Multivariable logistic regression models adjusted for confounding were used to analyse associations of standardized body composition markers derived from classic anthropometry, bioelectrical impedance analysis, magnetic resonance imaging as well as inflammatory markers C-reactive protein, white blood cell count, fibrinogen, ferritin and CRP-to-albumin ratio with prevalent T2D.

Body composition markers were more strongly associated with T2D than inflammatory markers. Waist circumference exhibited the strongest association with T2D (female: odds ratio (OR) = 2.55; 95% confidence interval [CI]: 2.17-3.00; male: OR = 2.20; 95% CI: 1.86-2.60). Similarly, body weight (female: 2.07; 1.78-2.41; male: OR = 1.99; 95% CI = 1.71-2.31), waist-to-height ratio (female: OR = 2.39; 95% CI = 2.05-2.77; male: 2.28; 1.92-2.70) and visceral adipose tissue (female: 3.02; 95% CI = 2.11-4.32; male: 1.50; 1.19-1.89) showed strong associations with T2D. Among inflammatory markers, white blood cell count in male and CRP-to-albumin ratio in female exhibit the strongest association with T2D.

Body composition markers seem to be more tightly associated with prevalent T2D compared to inflammatory markers.

Obesity is a risk factor for poor asthma control. Previous research suggests that patients with asthma and obesity have reduced responsiveness to corticosteroids. Recent studies indicate that body fat percentage may be more strongly associated with obesity-related diseases compared with body mass index. However, the relationship between body fat percentage and asthma, particularly regarding steroid sensitivity, remains unclear.

To investigate the association between body fat percentage and steroid sensitivity in patients with asthma and elucidate the potential mechanisms underlying this association.

Adult patients with asthma were enrolled and categorized into patients with high body fat percentage (HBF) and control groups. Peripheral blood mononuclear cells were isolated from the blood samples. These cells were cultured with dexamethasone followed by stimulation with tumor necrosis factor-α to assess the half-maximal inhibitory concentration of dexamethasone (IC50-Dex). Serum adipocytokines and oxidative stress markers were also measured. The effects of metformin on steroid sensitivity and oxidative stress in peripheral blood mononuclear cells were evaluated ex vivo.

The HBF group exhibited significantly higher IC50-Dex values than the control group. In the HBF group, IC50-Dex correlated with the number of acute exacerbations per year and serum oxidative stress marker levels. Treatment with metformin significantly reduced both IC50-Dex and oxidative stress marker levels in the HBF group.

Oxidative stress associated with increased body fat may contribute to impaired steroid sensitivity in patients with asthma. Metformin may improve steroid sensitivity by reducing oxidative stress, suggesting a potential therapeutic approach in this patient population.

Kidney stones are a prevalent disorder that is linked to a range of metabolic variables. The cardiometabolic index (CMI) is a newly developed combined measure used to evaluate the state of cardiometabolic health. Nevertheless, the association between CMI and kidney stone remains little investigated.

In this study, cross-sectional analysis was done on NHANES data from 2007 to 2018. The association between the prevalence of kidney stones and the CMI was investigated using a logistic regression analysis. To look into the nonlinear link between them, we used restricted cubic spline (RCS) analysis. The study was made more reliable and accurate by using sensitivity analysis and subgroup analysis to look for factors that may have contributed to the different results.

A significant association was seen between increased CMI and the prevalence of kidney stones (OR = 1.19, 95% CI: 1.06-1.32). The RCS analysis revealed crucial CMI values that exhibited a robust association within a certain range. Subgroup studies revealed that this link was particularly prominent among those below the age of 50, females, obese, CKD and diabetes patients. The dependability of the study's conclusions was further established using sensitivity analysis.

This study established a notable association between CMI and a higher prevalence of kidney stones, emphasizing the significance of CMI as a comprehensive measure for evaluating metabolic risk. Furthermore, it suggests that monitoring CMI levels could be beneficial in identifying populations with a high prevalence of kidney stones.

Background. The association between malnutrition and poor outcomes in stroke patients has, to date, been evaluated using composite scores derived from laboratory measurements. However, Bioelectrical Impedance Analysis (BIA) and its advanced application, Bioelectrical Impedance Vector Analysis (BIVA), offer a non-invasive, cost-efficient, and rapid alternative. These methods enable precise assessment of body composition, nutritional status, and hydration levels, making them valuable tools in the clinical evaluation of stroke patients. Objective. This study aimed to compare the ordinal distribution of modified Rankin Scale (mRS) scores at 90 days following an acute ischemic stroke, stratifying patients based on their nutritional status at the time of Stroke Unit admission, as determined by the Bioelectrical Impedance Vector Analysis (BIVA) malnutrition parameter. Methods. We conducted a single-centre prospective observational study on all consecutive patients admitted for acute ischemic stroke to our Stroke Unit between 1 April 2024, and 30 September 2024. We applied the IPW (Inverse Probability Weighting) statistical technique and ordinal logistic regression to compare mRS scores in malnourished and non-malnourished patients. Results. Overall, our study included 195 patients with ischemic stroke assessed using BIVA. Of these, 37 patients (19%) were malnourished. After IPW, we found that malnourished patients had significantly lower rates of favorable 90-day functional outcomes (cOR 3.34, 95% CI 1.74-6.41; p = 0.001). Even after accounting for relevant covariates, malnutrition remained an independent predictor of unfavorable outcomes (acOR 2.79, 95% CI 1.37-5.70; p = 0.005), along with NIHSS score at admission (acOR 1.19, 95% CI 1.11-1.28; p < 0.001), intravenous thrombolysis (acOR 0.28, 95% CI 0.15-0.52; p < 0.001), absolute lymphocyte count (cOR 1.01, 95% CI 1.00-1.02; p = 0.027), and albumin concentration (cOR 0.82, 95% CI 0.75-0.89; p < 0.001). Conclusions. Malnutrition, assessed through Bioelectrical Impedance Vector Analysis (BIVA) at the time of admission to the Stroke Unit, is associated with worse clinical outcomes at 90 days following the ischemic cerebrovascular event.

Gallstones have been linked to obesity. Relative fat mass (RFM) has emerged as a novel obesity index that more precisely represents the body fat distribution. The correlation between RFM and the risk of developing gallstones remains unclear. This study aims to explore the correlation between RFM and the prevalence of gallstones.

A cross-sectional analysis was conducted on the data from the NHANES 2017-2020. The correlation between RFM and the formation of gallstones was examined through multivariate logistic regression, receiver operating characteristic (ROC) curve, sensitivity analysis, subgroup analysis, and restricted cubic spline regression.

Among the 12,947 subjects, 1362 were categorized as having gallstones. It was observed that as the quartile range of RFM increased, with a notable rise in the prevalence of gallstones (3.7% vs. 7.5% vs. 9.8% vs. 21.1%, P < 0.001). Logistic and RCS regression analyses indicated a significantly positive linear correlation between RFM and the prevalence of gallstones, even after accounting for confounders potential (adjusted OR = 1.075, 95% CI: 1.050, 1.101). There is still a significant correlation between RFM and the prevalence of gallstones across both subgroup and sensitivity analyses. ROC analysis indicated that RFM (AUC = 0.696, 95%CI: 0.682, 0.711) can serve as a more robust identify for developing gallstones compared to traditional anthropometric indices.

This study is the first to provide the evidence of a significantly positive correlation between RFM and the formation of gallstones. However, further prospective studies are needed to validate these findings.

Obesity affects the adaptability of adipose tissue (AT), impairing its ability to regulate energy and metabolism. Obesity is associated with many metabolic disorders, including dyslipidemia, hypertension, sleep disorders, non-alcoholic liver disease, and some types of cancer. Toll-like receptors (TLRs) are important in obesity and related metabolic disorders. TLRs are pattern-recognizing receptors (PRRs) involved in the innate immune system and recognize pathogen-associated molecular patterns (PAMPs) and endogenous ligands. TLRs, especially TLR2 and TLR4, are activated by fatty acids, endotoxins, and other ligands. TLR2 and TLR4 activation triggers inflammatory responses. Chronic inflammation driven by TLR activation is a hallmark of obesity and metabolic diseases. The inflammatory response triggered by TLR activation alters insulin signaling, contributing to insulin resistance, a key feature of metabolic syndrome and type 2 diabetes. Modulation of TLR activity through lifestyle changes (diet and exercise), obesity surgery, and pharmacological agents is under study as a possible therapeutic approach to controlling obesity and its complications.

Obesity is a global public health crisis, contributing to chronic disease development and poor prognosis. A large body of evidence consistently demonstrates that increased adiposity leads to many cardiovascular diseases (CVDs) and complications, such as coronary artery disease, heart failure, and arrhythmias, via direct and indirect mechanisms. Therefore, weight management is crucial to reduce and prevent cardiovascular risk. The recent emergence of glucose-like peptide-1 receptor agonists shows remarkable weight reduction and cardiovascular prevention. Despite the clear benefits, controversies and challenges on obesity-related CVD remain. This review aims to provide a comprehensive understanding of obesity-related CVD and explore current remaining tasks.

The cardiometabolic index (CMI) is a new comprehensive measure that reflects visceral obesity and metabolic function. This study aimed to examine associations between CMI and adult mortality from all causes and specific causes, as well as gender differences, using the National Health and Nutrition Examination Survey (NHANES) database.

We included 37,539 adult participants with complete data from the 1999-2018 NHANES database. We categorized the participants according to gender and constructed three models to investigate the relationship between CMI and the outcome variables. These were analyzed using Kaplan-Meier curve analysis, COX proportional risk models, and restricted cubic spline (RCS).

Baseline characteristics showed that among both male and female participants, those who died exhibited higher levels of CMI compared to those who survived. Kaplan-Meier curves showed an increasing trend in all-cause and specific mortality with increasing follow-up time. When CMI was categorized according to quartiles (Q1-Q4), the probability of survival was lower in the Q4 group compared to Q1. We found no gender differences between all three mortality rates. In COX regression analyses, all-cause, cardiovascular, and diabetes mortality were significantly higher in Q4 in the whole population and female participants, whereas no significant differences were identified among male participants. The RCS showed a nonlinear positive correlation in diabetes mortality for females and a linear positive correlation in all-cause and cardiovascular mortality. As for males, CMI was positively and nonlinearly associated with all-cause and diabetes mortality. Besides, there is no statistically significant correlation for males in cardiovascular mortality.

There were gender differences in the correlation between CMI and all-cause mortality, cardiovascular mortality, and diabetes mortality in the adult population. The findings indicated that adult females with elevated CMI levels were at an elevated risk of mortality from all causes, cardiovascular disease, and diabetes. At the same time, there were no significant associations in adult males.

Individuals with normal weight obesity (NWO) often escape the attention of healthcare providers who may assume that a normal body mass index (BMI) correlates with low health risks. However, it remains unknown whether NWO increases the risk of breast cancer.

This study included 22,257 and 52,506 pre- and postmenopausal females with normal BMI in the UK Biobank. NWO was defined as participants with a normal BMI (18.5-24.9 kg/m2) and an excess percent body fat (PBF > 33.3%). Cox proportional hazard models were used to investigate the associations of NWO and NWO-related biomarkers with incident breast cancer.

NWO was not associated with premenopausal breast cancer, whereas it was associated with a higher risk of postmenopausal breast cancer (hazard ratio = 1.19, 95% CI: 1.08-1.31). In our meta-analysis, per 5-unit increment in percent body fat level was linked to a 15% (95% CI: 10-19%) elevated risk of postmenopausal breast cancer in females with normal BMI. Stratified analyses showed a stronger positive association in females with higher genetic risk. In our NWO-biomarkers analyses, NWO was linked to 34 identified biomarkers, of which three inflammation markers (monocyte count, neutrophil count, and C-reactive protein), and one ketone body metabolite (β-Hydroxybutyrate) also indicated a positive association with postmenopausal breast cancer.

NWO is associated with an increased risk of postmenopausal breast cancer, indicating that relying solely on BMI neglects the higher risk faced by non-obese postmenopausal women.

Normal weight obesity (NWO) is characterized by excess body fat in individuals with normal body mass index (BMI). This study aimed to investigate gut microbiota alterations in NWO and their potential associations with cardiometabolic diseases (CMD) risk in two independent cohorts.

Our NWO-CMD mortality analysis included 168 099 adults with normal BMI from two large open-access databases, while our NWO-gut microbiota study involved 5467 adults with normal BMI from two independent cohorts: the WELL-China cohort and the Lanxi cohort. NWO was defined as having a normal BMI (18.5-23.9 kg/m2) but an excess per cent body fat (PBF, ≥ 25% in men and ≥ 35% in women). Normal weight lean was defined as having a normal BMI and normal PBF. The 16S rRNA gene sequencing method was used to analyse gut microbiota data.

The study comprised 3620 (64.0% female, median age 58 years) and 1847 (64.3% female, median age 56 years) participants from the WELL-China and Lanxi cohorts. In our meta-analysis, NWO is associated with 26% (95% CI: 1.07-1.41) higher risk of CMD mortality. Gut microbial analyses indicated that the NWO group exhibited reduced levels of observed species (p = 0.009 and p = 0.013) and Chao 1 index (p = 0.002 and p = 0.002) and altered gut microbial compositions (p = 0.009 and p < 0.001) compared with the NWL group. Seven genera were consistently observed to be associated with NWO in both two cohorts (all Q < 0.25). Among them, five (Fusobacterium, Ruminococcus gnavus group, Ruminococcus torques group, Coprococcus and Christensenellaceae_R7_group) have been previously linked to obesity, while the other two (Phascolarctobacterium and Clostridia_UCG-014) were minimally reported. We also found statistically significant differences in the microbial composition between the NWO group and the obesity group (p = 0.001 and p = 0.001). Furthermore, the NWO-related gut microbiome was associated with an elevated risk of hypertension, dyslipidaemia and metabolic syndrome, the corresponding HR (95% CIs) were 1.11 (1.01-1.22), 1.19 (1.10-1.29) and 1.17 (1.05-1.30) in the WELL-China cohort and 1.14 (1.02-1.27), 1.15 (1.02-1.29) and 1.16 (1.02-1.32) in the Lanxi cohort.

These two large cohorts provided reliable evidence that gut microbiota alterations in NWO resemble those found in obesity, yet also display unique aspects. This distinct microbiota profile may contribute to heightened cardiometabolic risks in adults with normal BMI.

Body mass index (BMI) determines general corpulence and health, whatever age, sex or clinical background. Normal BMI (18.5-24.9 kgm2) is defined as healthy, normal, weight leading to a false impression that no intervention is needed.

Assess the prevalence of body impairments in the presence of normal BMI.

Cross-sectional design. Bivariate and a multivariate regression analysis assessed the association of body composition with clinical parameters in the presence of normal BMI.

Community dwelling older adults attending the Toulouse Frailty Clinic at the University Hospital, Toulouse.

876 community dwelling, autonomous older adults, 70 years and over.

Dual X-ray Absorptiometry (DXA) assessment, and cognitive, physical, nutritional, and demographic evaluations were included in the present analysis.

Of the initial sample, 347 (39.61 %) patients had normal BMI, and among them, 152 (43.80 %) had low lean mass, 144 (41.49 %) were osteoporotic and 2 (0.58 %) increased fat mass. A poor nutritional status (Mini-Nutritional Assessment score, MNA-score, <24) was the only independent variable associated with body impairments in the presence of normal BMI (Odd Ratio 2.83; 95 % Confidence Interval 1.64-4.89).

Nearly 70 % of the adults with normal BMI had at least one impairment in body composition (low lean mass, osteoporosis, or obesity). In the light of the present study, older adults with normal BMI and an MNA-score under 24 should be assessed with DXA to identify the age-associated impairments in body composition in order to lead to specific interventions.

We investigated the correlation between Triglyceride-glucose (TyG) index and cardiovascular disease (CVD) mortality in type 2 diabetes mellitus (T2DM) population across different obesity classications using a cohort study. We analyzed 7867 T2DM participants from the National Health and Nutrition Examination Survey 1999-2018, categorizing them into obese or non-obese group by body mass index (BMI) and waist circumference (WC). Cox regression models were used to estimate the correlation between TyG index and CVD mortality risk, comparing the results across the two obesity classifications. Over a 9.1-year follow-up, 691 CVD deaths occurred. Among non-obese T2DM participants (BMI-defined), the hazard ration for CVD mortality was 1.73 in the fourth quartile group of TyG index compared with the first quartile group. Conversely, among obese T2DM participants (WC-defined), the fourth quartile group of TyG index held a 1.51-fold risk of CVD mortality compared with the first quartile group. The association between obesity and higher CVD risk was observed in WC-defined obesity but not in BMI-defined obesity. A totally opposite relationship appeared between TyG index and CVD mortality based on how obesity was defined using BMI or WC in the T2DM participants, suggesting a reevaluation of BMI's accuracy in predicting mortality risk.

Erectile Dysfunction (ED) is the leading cause of sexual dysfunction affecting hundreds of millions of men worldwide, and has been described as an important public health problem. The association of five novel anthropometrics related to obesity, lipids and glucose with ED remains unclear. To investigate the association of lipid accumulation products index (LAP), triglyceride glucose index (TyG), waist triglyceride index (WTI), weight-adjusted-waist index (WWI) and a body shape index (ABSI) with ED. Cross-sectional data from the NHANES were used. Participants were adults aged 20-85 y from 2001 to 2004. The analysis of logistic regressions, smooth curve fitting, subgroup analyses and generalized addition model were performed to examine the relationship between five novel anthropometric indicators and the prevalence of ED. An overall 1413 adult men were included in the study. After adjusting for confounding factors, the results of multiple regression analysis showed, ED positively correlated with LAP(OR = 1.0031, P < 0.05), TyG(OR = 1.2981, P < 0.05), WTI(OR = 1.4220, P < 0.05), WWI(OR = 1.6043, P < 0.001), and ABSI(OR = 1.6211, P < 0.05). Smoothed curve fitting and subgroup analyses proved the stability of the relationship. This cross-sectional study showed a positive correlation between these five novel anthropometric indicators (LAP, TyG, WTI, WWI, ABSI) and ED. Further studies are needed to explore their association better and the underlying mechanisms.

Background/Objectives: Alterations in the body mass index (BMI) and percent body fat (PBF) have been considered to be related to aging-induced changes in bone and muscle. This study aimed to evaluate the associations of the BMI and PBF with osteoporosis, sarcopenia, and osteosarcopenia in postmenopausal women. Methods: A total of 342 participants who underwent musculoskeletal function assessments at the First Affiliated Hospital of Sun Yat-sen University between January 2015 and December 2022 were retrospectively screened. The diagnosis of osteoporosis was based on the WHO criteria, and sarcopenia was diagnosed according to the 2019 consensus of the Asian Working Group for Sarcopenia. Results: The BMI was positively correlated with the musculoskeletal function assessment parameters (bone mineral density, relative skeletal muscle index, and grip strength) and identified as an independent protective factor for sarcopenia alone (OR = 0.592, 95% CI: 0.455-0.769) or osteosarcopenia (OR = 0.411, 95% CI: 0.319-0.529), with a moderate diagnostic accuracy (area under the curve [AUC] = 0.682) for the former and a high diagnostic accuracy (AUC = 0.823) for the latter. However, the PBF was negatively correlated with the relative skeletal muscle index and identified as a risk factor for osteosarcopenia (OR = 1.404, 95% CI: 1.007-1.959), with a moderate diagnostic accuracy (AUC = 0.613). Conclusions: A higher BMI and lower PBF were associated with a lower prevalence of osteosarcopenia in postmenopausal women. Further research is required to elucidate the independent effects of the BMI and PBF on bone health.

Triggering Receptor Expressed on Myeloid Cells 2 (TREM2), a transmembrane receptor initially linked to neurodegenerative diseases, has recently emerged as a key player in conditions such as obesity and cancer. This review explores the structure, function, and mechanisms of TREM2 across these diverse pathological contexts, with a particular focus on its critical roles in immune regulation and neuroprotection. TREM2 primarily modulates cellular activity by binding extracellular ligands, thereby activating downstream signaling pathways and exerting immunomodulatory effects. Additionally, the therapeutic potential of targeting TREM2 is discussed, emphasizing its promise as a future treatment strategy for various diseases.

Background and Objectives: In this study, the effects of an eight-week exercise and nutrition program on blood lipids, glucose, insulin, insulin resistance (HOMA-IR), leptin, ghrelin, irisin, malondialdehyde (MDA), and Growth Differentiation Factor 15 (GDF15) in overweight women were investigated. Materials and Methods: A total of 48 women volunteers participated in this study. The participants were randomly divided into four groups: control (C), exercise (E), nutrition (N), exercise + nutrition (E + N). While no intervention was applied to group C, the other groups participated in the predetermined programs for 8 weeks. At the beginning and end of this study, body composition was measured and blood samples were taken. Results: It was determined that the body composition components, lipid profile indicators, insulin, glucose, insulin resistance, leptin, ghrelin, irisin, and MDA parameters examined in this study showed positive changes in the intervention groups. Group E had a greater effect on body muscle percentage, MDA, and irisin levels, while group N had a greater effect on blood lipids and ghrelin levels. Conclusions: As a result, it is thought that lifestyle changes are important to improve cardiovascular health and combat obesity, and that maintaining a healthy diet together with exercise may be more effective.

Type 2 diabetes is a complex metabolic disorder characterized by insulin resistance and impaired insulin secretion, with growing evidence highlighting the critical role of the gut-microbiota-brain axis in modulating glucose and lipid metabolism.

To evaluate the effects of Jiang Tang San Hao Formula (JTSHF) on blood glucose control in type 2 diabetic mouse model and to explore its mechanism through the gut- microbiota-brain axis.

A type 2 diabetes model was established using six-week-old male C57BL6/J mice, induced by a high-fat diet combined with streptozotocin injection. The diabetic mice then randomly assigned to the model group, metformin (Glucophage) group and JTSHF group, receiving 11 weeks of treatment by gavage. Body weight and fasting blood glucose were monitored biweekly. The oral glucose tolerance test was performed during the fifth and 10th weeks of the intervention. The measurements of body composition were conducted pre- and post-treatment. After the intervention, serum insulin, lipid levels, glucagon like peptide-1 (GLP-1), peptide YY, ghrelin, and leptin were detected. The fresh feces of mice were collected before sacrifice for gut microbiota analysis and short chain fatty acids quantification. The colon tissues of mice in each group were collected to observe the morphological structure and to measure the expression levels of GPR41 and GPR43. The hypothalamus was collected to assess the expression of POMC, AgRP and NPY.

JTSHF significantly boosted sugar and lipid metabolism and contributed to weight reduction in diabetic mice (p < 0.05). At the genus level, JTSHF increased the relative abundance of Bacteroides, Prevotella, and Parabacteroides, and decreased Clostridium, Lactobacillus, and Oscillibacter in the gut microbiota. JTSHF enhanced the content of short chain fatty acids, improved the expression level of GPR43/41 in colonic tissue (p < 0.05), and increased POMC expression while decreasing AgRP and NPY expression in the hypothalamus (p < 0.05). Serum GLP-1 was increased, and ghrelin was decreased significantly after JTSHF intervention (p < 0.05).

By affecting the composition, relative abundance, and metabolites of gut microbiota, JTSHF regulates various gut brain peptides, affects the hypothalamic feeding center, improves glucose and lipid metabolism, and thus plays the anti-diabetic role. The study provides novel insights into how traditional Chinese medicine modulates the gut-brain connection to exert anti-diabetic effects, highlighting the innovative potential of JTSHF in metabolic disease management.

Normal Weight Obesity (NWO) and Overweight Obesity (OWO) are prevalent conditions, yet knowledge of management is limited. This review aims to assess the effectiveness of physical activity and nutritional interventions in the management of NWO and OWO (together defined as BMI <30 kg/m2 with raised body fat).

Clinical trials including any physical activity or nutritional interventions, published between 2012 and 2022, evaluating body fat change were selected. Seven trials met inclusion criteria, including one single arm intervention, and six RCTs. A high intensity interval training intervention (high risk of bias) had the largest effect on reducing percentage body fat (MD: -6.8%, SE: 0.06). High protein intake interventions were also found to be effective (MD: -2.8%, SE: 0.27, MD: -2.0%, SE: 0.05). These three interventions led to greater increases in fat free mass. Two energy restricted interventions resulted in the highest mean weight loss (MD: -3.10 kg, SD: 0.87 (intervention only), MD: -2.90 kg, SE: 0.06), but also loss of fat free mass, resulting in low reductions in percentage body fat (MD: -1.10%, SD: 0.57 (intervention only), MD: -0.8%, SE 0.30). There was considerable heterogeneity between studies.

There are physical activity and nutritional interventions that could be efficacious for the management of NWO and OWO. However, there was considerable heterogeneity between studies. The most promising nutritional intervention is high protein intake and the least is energy restriction (without increased protein intake). More high-quality trials are needed to evaluate interventions, and to determine the best tools to measure adiposity.

Women typically have a higher body fat content than men. Fat accumulation is associated with muscle weakness and alterations in mechanical properties. This study aims to determine the relationship between BMI and weight status with the mechanical properties of muscle and tendon. It was hypothesized that the stiffness and tone of the forearm muscle and Achilles tendon would be correlated with weight status and BMI.

A cross-sectional study was conducted with 136 female university students. Grip strength was assessed using a dynamometer, body composition was analyzed through bioimpedance, and countermovement jump performance was evaluated with a force platform. Stiffness and tone were measured using the MyotonPro device. ANOVA was used to compare grip strength and countermovement jump performance according to body composition. The Pearson correlation coefficient was used to examine bivariate associations.

Relative grip strength decreased with an increase in fat content, while forearm muscle stiffness and tone decreased with rising weight status and BMI. Stiffness of the Achilles tendon increased with an increase in fat content and showed a significant positive correlation with BMI. Multiple regression analysis revealed a weak correlation between BMI, body composition, and stiffness of the forearm muscles.

The results of this study support the notion that the stiffness of the forearm muscles and Achilles tendon is correlated with BMI in young adult women. Furthermore, an increase in body fat percentage is linked to a decrease in mechanical properties and poorer muscle function.

Chronic kidney disease (CKD) is a major global health concern with increasing prevalence and associated complications. Obesity and obesity-related metabolic disorders have been linked to chronic kidney disease (CKD), although the evidence is still inconsistent. To investigate the relationship between different obesity phenotypes and the risk of CKD, we conducted a systematic review and meta-analysis.

We conducted a comprehensive search of databases for all relevant studies up to February 2024, without imposing a specific start date, for observational studies assessing the relationship between obesity phenotypes and incident kidney dysfunction. We used fixed and random effects models for the meta-analysis, subgroup analyses were carried out to explore heterogeneity, and Egger's and Begg's tests were used to assess publication bias.

This meta-analysis included 13 eligible observational studies with 492,829 participants. Pooling the studies regardless of the effect measure showed that individuals with metabolically unhealthy normal weight (MUNW) (ES = 1.58, 95% CI = 1.43-1.76), metabolically healthy obese (MHO) (ES = 1.20, 95% CI = 1.06-1.34), and metabolically unhealthy obese (MUO) (ES = 1.90, 95% CI = 1.63-2.20) phenotypes had a significantly increased risk for kidney dysfunction (KD) events. On the other hand, MUOW individuals did not significantly correlate with risk of CKD (ES = 1.63, 95% CI = 0.97-2.23) compared to the MHNW phenotype.

Healthy overweight and obese individuals had higher risk for the incident KD events; refuting the notion that metabolically healthy overweight and obese phenotypes are benign conditions.

III Evidence obtained from well-designed cohort or cross-sectional studies.

Systemic inflammation is reported in normal-weight obesity (NWO) and metabolically healthy obesity (MHO), which may be linked to their increased cardiovascular disease (CVD) risk. Yet, drivers of this inflammation remain unclear. We characterized factors known to influence inflammatory status (i.e., intestinal permeability, adipose tissue, diet quality, microbiota), and their relationships with measured inflammation, in NWO and MHO, healthy control subjects (CON), and metabolically unhealthy obesity (MUO; N = 80; n = 20/group). Serum indicators of intestinal permeability and inflammation were assessed by ELISA and/or multiplex. Total, visceral, and percent body fat were measured with dual-energy X-ray absorptiometry (DXA). Fecal microbiota composition was assessed via 16S rRNA sequencing (n = 9-10/group). For C-reactive protein (CRP), MUO > NWO > CON (P < 0.0001). In MHO, CRP was intermediate and similar to both MUO and NWO. Lipopolysaccharide binding protein (LBP) and the ratio of LBP to soluble CD14 (sCD14) were higher in MHO and MUO vs. CON/NWO (P < 0.0001). Across correlation and regression analyses, LBP consistently displayed the strongest relationships with CRP in the entire sample (r = 0.78; β = 0.57; P < 0.0001) and in MHO (r = 0.74; P < 0.01) but not NWO (r = 0.37; P = 0.11). Shannon index was higher in CON compared with MUO (P < 0.05) and inversely correlated with CRP in the full sample (r = -0.37; P < 0.05). These data are consistent with the notion that intestinal permeability is associated with low-grade inflammation in MHO, which could be implicated in this population's reported CVD risk.NEW & NOTEWORTHY This is the first study to our knowledge to examine biomarkers of intestinal permeability in normal-weight obesity and one of few assessing microbiota compositions in this population. Additionally, we report that individuals with metabolically healthy obesity and metabolically unhealthy obesity displayed similar evidence of intestinal permeability, which was more strongly associated with systemic inflammation than total and visceral adipose tissue mass.

Normal-weight obesity (NWO) and normal-weight central obesity (NWCO) have been linked to higher cardiometabolic risks, but their etiological bases and attributable dietary factors remain unclear. In this study we therefore aimed to identify lipidomic signatures and dietary factors related to NWO and NWCO and to explore the mediation associations of lipids in diet-adiposity associations.

Using a high-coverage targeted lipidomic approach, we quantified 1245 serum lipids in participants with NWO (n = 150), NWCO (n = 150), or propensity-score-matched normal-weight controls (n = 150) based on the Regional Ethnic Cohort Study in Northwest China. Consumption frequency of 28 major food items was recorded using a food frequency questionnaire.

Profound lipidomic perturbations of NWCO relative to NWO were observed, and 249 (dominantly glycerolipids) as well as 48 (dominantly glycerophospholipids) lipids were exclusively associated with NWCO or NWO. Based on strong lipidomic signatures identified by a LASSO model, phospholipid biosynthesis was the top enriched pathway of NWCO, and sphingolipid metabolism was the top pathway of NWO. Remarkably, sphingolipids were positively associated with NWO and NWCO, but lyso-phosphatidylcholines were negatively associated with them. Rice, fruit juice, and carbonated drink intakes were positively associated with the risk of NWCO. Both global and individual lipidomic signatures, including SE(28:1_22:6) and HexCer(d18:1/20:1), mediated these diet-NWCO associations (mediation proportion: 15.92%-26.10%).

Differential lipidomic signatures were identified for overall and abdominal adiposity accumulation in normal-weight individuals, underlining their core mediation roles in dietary contributions to adiposity deposition.

Normal weight obesity can be associated with an increased risk of metabolic abnormalities, systemic inflammation and mortality. The main aim of the study was to analyze the changes in the prevalence of normal weight obesity in 8-18-year-olds from Kraków (Poland) between 2010 and 2020.

The study was based on two sets of cross-sectional, school-based data obtained in 2010 and 2020. Body height, weight, and fat percentage were obtained. Body mass index was calculated, and only normal-weight individuals were included. Normal weight obesity was defined as normal BMI with adiposity >85 percentile for age and sex.

The prevalence of normal weight obesity among Polish children and adolescents has been alarming for at least the last 10 years. Depending on the sex and age, normal weight obesity was present in more than 10% up to even more than 20% of the examined population.

Alarming numbers of Polish children and adolescents suffer from NWO and this problem seems to be present for at least the last decade. A need for a maximally universal definition and cut-offs to diagnose normal weight obesity should also be stressed, as it will be helpful in providing the best prophylaxis and help to persons already suffering from normal weight obesity.

This study's purpose was to evaluate the relationship between dance training volume, body composition, and habitual diet in female collegiate dancers.

Thirty-three female collegiate dancers from three dance programs (20.4 ± 1.05 yrs.; 165.4 ± 11.3 cm, BMI 21.3 ± 3.4 kg/m2) participated in "The Intercollegiate Artistic Athlete Research Assessment (TIAARA)" study. We assessed dance training volume, body composition, and habitual diet. Data were analyzed using descriptive statistics (means ± SD). Two-sample t-tests were conducted to compare reported intake values versus sports nutrition recommendations. Two-tailed Pearson correlations (r) were computed for body composition and dietary intake (p < 0.05).

Collegiate dancers were enrolled in 16 ± 2.09 semester credits, with 7.7 ± 3.8 credits as dance movement courses and an additional 3.0 ± 1.5 h/week of rehearsal time. Body composition assessments included fat mass (24.4 ± 6.8%), lean mass (LM) (42.4 ± 10.1 kg), and total body water (32.6 ± 4.6 L). Habitual diets reflected a low-calorie diet (1399 ± 648 kcal/d), with ~20% of dancers consuming a very low-calorie diet (≤1000 kcal/d). Dancers reported under-consuming dietary protein (54.3 ± 26.2 g) and carbohydrate (171.8 ± 77.8 g). LM was positively correlated with daily total energy (r = 0.333), fat (r = 0.37), protein (r = 0.349), and leucine intake (r = 0.352).

Our findings emphasize the positive effect of adequate nutritional quantity and quality on body composition in female collegiate dancers.

'Obesity' has, for decades, been a subject of intense scientific and public interest, and remains a key target for postgenomic science. I examine the emergence of determinism in research into 'obesity' in the postgenomic field of metabolomics. I argue that determinism appears in metabolomics research in two ways: firstly, fragmentation and narrow construal of the environment is evident in metabolomics studies on weight loss interventions, resulting in particular features of the environment (notably, dietary intake) having outsized influence while the wider social environment is neglected. Secondly, studies aiming to characterize the metabolic signature of 'obesity' are guided by a commitment to a deterministic connection between 'obesity' and dysfunction, leading to a neglect or distortion of metabolic heterogeneity across individuals regardless of body size.

To assess associations between dietary fibre intake, adiposity, and odds of metabolic syndrome in Pacific and New Zealand European women.

Pacific (n = 126) and New Zealand European (NZ European; n = 161) women (18-45 years) were recruited based on normal (18-24.9 kg/m2) and obese (≥30 kg/m2) BMIs. Body fat percentage (BF%), measured using whole body DXA, was subsequently used to stratify participants into low (<35%) or high (≥35%) BF% groups. Habitual dietary intake was calculated using the National Cancer Institute (NCI) method, involving a five-day food record and semi-quantitative food frequency questionnaire. Fasting blood was analysed for glucose and lipid profile. Metabolic syndrome was assessed with a harmonized definition.

NZ European women in both the low- and high-BF% groups were older, less socioeconomically deprived, and consumed more dietary fibre (low-BF%: median 23.7 g/day [25-75-percentile, 20.1, 29.9]; high-BF%: 20.9 [19.4, 24.9]) than Pacific women (18.8 [15.6, 22.1]; and 17.8 [15.0, 20.8]; both p < 0.001). The main source of fibre was discretionary fast foods for Pacific women and whole grain breads and cereals for NZ European women. A regression analysis controlling for age, socioeconomic deprivation, ethnicity, energy intake, protein, fat, and total carbohydrate intake showed an inverse association between higher fibre intake and BF% (β= -0.47, 95% CI = -0.62, -0.31, p < 0.001), and odds of metabolic syndrome (OR = 0.91, 95% CI = 0.84, 0.98, p = 0.010) among both Pacific and NZ European women (results shown for both groups combined).

Low dietary fibre intake was associated with increased metabolic disease risk. Pacific women had lower fibre intakes than NZ European women.

Obesity is a well-known cause of cardiovascular disease and metabolic disorders. Normal-weight obesity, where the body mass index(BMI) is within the normal range but the body fat percentage is high, also adversely impacts cardiovascular and metabolic health. This study explored the effects of whole-body circuit training using a weighted vest on serum resistin, insulin resistance, and cardiovascular disease risk factors in normal-weight obese women.

Thirty-six normal-weight obese women were divided into three groups: Weighted Vest Circuit Training(WVCT)(n = 12), Body Weight Circuit Training(BWCT)(n = 12), and a Control group(CON)(n = 12). Participants in the WVCT and BWCT groups engaged in whole-body circuit training three times per week for eight weeks. Serum resistin, cardiovascular disease risk factors, and insulin resistance were measured before and after the intervention.

The study revealed significant and impactful findings. There were substantial improvements in body composition(Skeletal Muscle Mass: +7.5 %, p = 0.042, d = 0.80), Serum Resistin(-38.2 %, p = 0.001, d = 0.85), insulin resistance(HOMA-IR: 27.1 %, p < 0.001, d = 0.88), and a reduction in IL-6 levels(-25.4 %, p = 0.082, d = 0.60) in the WVCT group compared to the BWCT and CON groups. The WVCT group outperformed the other groups, demonstrating greater effectiveness in reducing cardiovascular risk factors.

These findings have significant implications for healthcare. Whole-body circuit training with weighted vests has effectively improved body composition, reduced serum resistin, and lowered insulin resistance, reducing cardiovascular disease risk factors in normal-weight obese women. These results could inform and enhance the treatment and management of obesity-related cardiovascular and metabolic disorders.

A high body mass index (BMI) increases the risk of hypertension. However, little is known about the dose-dependent association between BMI and hypertension. Therefore, this study investigated the prevalence of hypertension in 7568 subjects from the Jiangsu Province, Eastern China, and analyzed the dose-response relationship between BMI and hypertension risk.

The eligible subjects completed a structured questionnaire and clinical biochemical indicators were measured according to standardized protocols. Multivariate logistic regression models were used to evaluate the association between BMI and hypertension. Restricted cubic spline (RCS) analysis was used to analyze the dose-response relationship between BMI and hypertension risk. Moreover, sensitivity analysis was performed to verify the robustness of our findings.

The prevalence of hypertension was 35.3 % in the total population. BMI was significantly associated with systolic and diastolic blood pressure. The fully-adjusted odds ratio (OR) with 95 % confidence interval (CI) for hypertension was 1.17 (1.15, 1.19) for every 1 kg/m2 increase in BMI. Furthermore, the OR (95 % CI) for hypertension in the highest BMI group (Obesity) was 4.14 (3.45, 4.96) after adjusting for covariates compared with the normal group. Multivariable adjusted RCS analysis showed a positive and linear dose-response relationship between BMI and hypertension risk both in male and female populations (all P for non-linearity > 0.05).

Our study demonstrated a positive and linear dose-response relationship between BMI and the risk of hypertension. The results of this study provide evidence for BMI-related clinical interventions to reduce the risk of hypertension.

Children with spina bifida (SB) face an elevated risk of obesity, which necessitates precise methods for assessing body composition to ensure effective weight management. Conventional measures like BMI are inadequate for this population because of variations in growth patterns and skeletal structure. Bioelectrical impedance analysis (BIA) is a method that offers a clearer picture of body composition, yet its use in children with SB remains underexplored.

Conducted on 57 children with SB and 28 healthy controls, with a median age of 11 years, this study evaluated anthropometrics, including BMI and BIA-derived metrics. The Hoffer's scale to assess physical activity was applied in SB children.

Results showed that while 32% of SB patients were classified as overweight or obese based on BMI, 62% exhibited high body fat percentage via BIA. Fat-free mass, muscle and fat mass, and fat-to-muscle ratio (FMR) differed significantly compared to the reference group. Non-ambulators showed a higher median body fat mass percentage (25.9% vs. 17.8%, p = 0.01) and FMR (0.92 vs. 0.44, p = 0.003) in comparison to the community walkers.

In SB children, BIA-measured fat mass is a better obesity indicator than BMI. Non-ambulatory, SB patients with obesity had the highest FMR values, indicating a higher risk for metabolic syndrome.

Recent years have seen the emergence of numerous novel indicators for visceral obesity. This study investigates the potential correlation between the Chinese visceral adiposity index (CVAI) and hyperuricemia (HUA).

This research, derived from a 2011 cross-sectional analysis in Dalian, China, employed restricted cubic spline (RCS) plots to identify inflection points. Subsequently, one-way and multifactorial logistic regression models were utilized, with HUA as the outcome variable. Additionally, subgroup analyses and interaction tests were conducted. Eventually, receiver operating characteristic (ROC) curves were calculated to assess the effectiveness of CVAI and other body composition indices in predicting HUA.

The study included 10,061 individuals, with a HUA prevalence of 14.25%. Significant relationships with HUA were observed for CVAI. RCS analysis revealed a J-shaped relationship between CVAI and HUA. Compared to those in the low CVAI category, HUA was notably associated with individuals in the high CVAI category in multifactorial logistic regression (OR = 2.661, 95% CI: 2.323, 3.047). Subgroup analyses demonstrated stronger relationships in women, participants without hypertension, and participants without diabetes. Additional modeling via ROC curves suggested that the CVAI may offer effective predictive value for HUA.

This study confirmed that an elevated CVAI elevates the risk of HUA in middle-aged and elderly populations in the Dalian community. The findings advance obesity prevention strategies that mitigate HUA risk and support healthcare initiatives for China's aging population.

Heterogenous deposition and homeostasis roles of physiologic and ectopic adipose tissues underscore the impact of fat compartmentalization on cardiometabolic risk. We aimed to characterize the distribution of abdominal visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), epicardial adipose tissue (EAT), and liver fat on magnetic resonance imaging (MRI), and evaluate their associations with anthropometric indices and adverse cardiac remodeling.

In this cross-sectional observational study, 149 Asian adults (57.0 ± 12.8 years; 65% males) with at least one cardiometabolic risk factor underwent multiparametric fat and cardiovascular MRI. Anthropometric indices included body mass index (BMI), waist circumference (WC), waist-hip ratio (WHR), and bioimpedance body fat mass (BFM). Associations between fat depots and anthropometric measures as well as cardiac remodeling features were examined as a single cohort and stratified by type 2 diabetes mellitus (T2DM) status.

VAT and SAT had opposing associations with liver fat and EAT. Therefore the VAT/SAT ratio was explored as an integrated marker of visceral adiposity. VAT/SAT was positively associated with EAT (β=0.35, P<0.001) and liver fat (β=0.32, P=0.003) independent of confounders. Of the anthropometric measurements assessed, only WHR was independently associated with VAT/SAT (β=0.17, P=0.021). Individuals with T2DM had higher VAT and lower SAT compared to those without T2DM, translating to a significantly higher VAT/SAT ratio. EAT volume was independently associated with adverse features of cardiac remodeling: increased left ventricular (LV) mass (β=0.24, P=0.005), larger myocyte volume (β=0.26, P=0.001), increased myocardial fibrosis (β=0.19, P=0.023), higher concentricity (β=0.18, P=0.035), and elevated wall stress (β=-0.18, P=0.023).

Multiparametric MRI revealed abdominal VAT and SAT have differential associations with anthropometric indices and ectopic fats in a single cohort of Asians at risk of cardiometabolic disease. People with T2DM have expanded VAT and diminished SAT, endorsing the VAT/SAT ratio beyond usual anthropometric measurements as a marker for multiorgan visceral fat composition. Among the fat depots examined, EAT is uniquely associated with adverse cardiac remodeling, suggesting its distinctive cardiometabolic properties and implications.