Chronic diseases are closely linked to alterations in body composition, yet there is a need for reliable biomarkers to assess disease risk and progression. This study aimed to develop and validate a biological age indicator based on body composition derived from dual-energy X-ray absorptiometry (DXA) scans, offering a novel approach to evaluating health status and predicting disease outcomes.

A deep learning model was trained on a reference population from the UK Biobank to estimate body composition biological age (BCBA). The model's performance was assessed across various groups, including individuals with typical and atypical body composition, those with pre-existing diseases, and those who developed diseases after DXA imaging. Key metrics such as c-index were employed to examine BCBA's diagnostic and prognostic potential for type 2 diabetes, major adverse cardiovascular events (MACE), atherosclerotic cardiovascular disease (ASCVD), and hypertension.

Here we show that BCBA strongly correlates with chronic disease diagnoses and risk prediction. BCBA demonstrated significant associations with type 2 diabetes (odds ratio 1.08 for females and 1.04 for males, p < 0.0005), MACE (odds ratio 1.10 for females and 1.11 for males, p < 0.0005), ASCVD (odds ratio 1.07 for females and 1.10 for males, p < 0.0005), and hypertension (odds ratio 1.06 for females and 1.04 for males, p < 0.0005). It outperformed standard cardiovascular risk profiles in predicting MACE and ASCVD.

BCBA is a promising biomarker for assessing chronic disease risk and progression, with potential to improve clinical decision-making. Its integration into routine health assessments could aid early disease detection and personalised interventions.

Effective diabetes management requires a multimodal approach involving lifestyle changes, pharmacological treatment, and continuous patient education. Self-management demands can be overwhelming for patients, leading to lowered motivation, poor adherence, and compromised therapeutic outcomes. In this context, digital health apps are emerging as vital tools to provide personalized support and enhance diabetes management and clinical outcomes.

This study evaluated the impact of the digital health application Vitadio on glycemic control in patients with type 2 diabetes mellitus (T2DM). Secondary objectives included evaluating its effects on cardiometabolic parameters (weight, BMI, waist circumference, blood pressure, and heart rate) and self-reported measures of diabetes distress and self-management.

In this 6-month, 2-arm, multicenter, unblinded randomized controlled trial, patients aged 18 years or older diagnosed with T2DM were randomly assigned (1:1) to an intervention group (IG) receiving standard diabetes care reinforced by the digital health app Vitadio or to a control group (CG) provided solely with standard diabetes care. Vitadio provided a mobile-based self-management support tool featuring educational modules, motivational messages, peer support, personalized goal setting, and health monitoring. The personal consultant was available in the app to provide technical support for app-related issues. The primary outcome, assessed in the intention-to-treat population, was a change in glycated hemoglobin (HbA1c) levels at 6 months. Secondary outcomes included changes in cardiometabolic measures and self-reported outcomes. Data were collected in 2 study centers: diabetologist practice in Dessau-Roßlau and the University of Dresden.

Between November 2022 and June 2023, a total of 276 patients were screened for eligibility, with 149 randomized to in intervention group (IG; n=73) and a control group (CG; n=76). The majority of participants were male (91/149, 61%). The dropout rate at month 6 was 19% (121/149). While both groups achieved significant HbA1c reduction at 6 months (IG: mean -0.8, SD 0.9%, P<.001; CG: mean -0.3, SD 0.7%, P=.001), the primary confirmatory analysis revealed statistically significant advantage of the IG (adjusted mean difference: -0.53%, SD 0.15, 95% CI -0.24 to -0.82; P<.001; effect size [Cohen d]=0.67, 95% CI 0.33-1). Significant between-group differences in favor of the IG were also observed for weight loss (P=.002), BMI (P=.001) and systolic blood pressure (P<.03). In addition, Vitadio users experienced greater reduction in diabetes-related distress (P<.03) and obtained more pronounced improvements in self-care practices in the areas of general diet (P<.001), specific diet (P<.03), and exercise (P<.03).

This trial provides evidence for the superior efficacy of Vitadio in lowering the HbA1c levels in T2DM patients compared to standard care. In addition, Vitadio contributed to improvements in cardiometabolic health, reduced diabetes-related distress, and enhanced self-management, highlighting its potential as an accessible digital tool for comprehensive diabetes management.

German Clinical Trials Registry DRKS00027405; https://drks.de/search/de/trial/DRKS00027405.

PurposeBariatric surgery is a widely used treatment for obesity; however, it may be associated with certain complications. Effective postoperative management, including lifestyle interventions and exercise training, is essential for optimal outcomes. This study explores the effectiveness of exercise training in postoperative care.MethodsWe searched PubMed, Web of Science, Cochrane, and Embase up to April 3, 2024. Articles were screened and data extracted based on inclusion/exclusion criteria. Risk of bias was assessed using RoB 2.0, and data were analyzed with Stata 15.0.ResultsTwenty-three articles involving 1940 patients were included; 16 were analyzed quantitatively. Exercise training did not significantly reduce body weight compared to routine care (WMD: -0.26; 95% CI, -2.11 to 1.58; I2 = 54%), but it significantly reduced fat mass (WMD: -2.42; 95% CI, -3.50 to -1.34; I2 = 42.9%) and maintained lean mass (WMD: 1.40; 95% CI, 0.32 to 2.48; I2 = 0.0%). Additionally, it reduced waist circumference (WMD: -2.58; 95% CI, -4.43 to -0.73; I2 = 13.4%) and improved exercise capacity (VO₂ max: WMD: 1.88; 95% CI, 0.64 to 3.13; I2 = 0.0%).ConclusionWhile exercise training did not significantly lower body weight post-surgery, it effectively reduced fat mass, maintained lean mass, and improved waist circumference and exercise capacity. Given the limited sample sizes in most studies, further large-scale controlled trials are warranted for more definitive conclusions, along with further consideration of their long-term impact on health metrics.

Although visceral adiposity increases cardiovascular risk in the general population, the obesity paradox has been reported in critically ill patients. However, evidence for its prognostic role in patients undergoing coronary artery bypass grafting (CABG) is limited. This study evaluated the prognostic implications of visceral adiposity in patients who underwent CABG using computed tomography-based measurement of visceral fat.

A total of 2810 patients who underwent CABG from 2007 to 2017 were analyzed. The study population was classified into 3 groups according to visceral fat area index (VFAI) tertiles. VFAI was calculated as visceral fat area (cm2)/height2 (m2) at the L3 level. The primary outcome was all-cause mortality during follow-up.

Patients in the low VFAI group (lowest tertile) were younger and had a lower body mass index and less subcutaneous fat than those in the high VFAI group (highest tertile). During a median 8.7-year follow-up, VFAI was significantly associated with the risk of mortality in restricted cubic spline curve analysis (HR, 0.94 per 10 increases; 95%CI, 0.91-0.97; P<.001). Patients in the low VFAI group had a higher incidence of long-term mortality than those in the intermediate and high VFAI groups (T1 36.1%, T2 27.2%, and T3 29.1%; T1 vs T2; adjusted HR, 1.36; 95%CI, 1.15-1.61; P<.001; T1 vs T3; adjusted HR, 1.37; 95%CI, 1.16-1.62; P<.001). Similar results were obtained after inverse probability treatment-weighting analysis.

Low visceral adiposity was associated with an increased risk of long-term mortality in patients who underwent CABG.

Background/Objectives: Sarcopenia, abdominal obesity, and sarcopenic obesity are prevalent and clinically significant in older adults, each shaped by diverse biopsychosocial factors. However, integrative analyses using nationally representative data remain limited in Korea. Methods: We analyzed 2118 adults aged ≥65 years from the 2022-2023 Korea National Health and Nutrition Examination Survey (KNHANES). Body composition was classified into sarcopenia, abdominal obesity, and sarcopenic obesity. Guided by Engel's Biopsychosocial Model, we examined biological (e.g., sex, chronic disease, nutrition, exercise), psychological (e.g., stress, sleep, self-rated health), and social (e.g., income, education, living status) variables. Complex-sample multinomial logistic regression identified condition-specific associations. Results: Prevalence rates were 18.2% for sarcopenia, 41.0% for abdominal obesity, and 3.4% for sarcopenic obesity. Eating alone and a lack of resistance exercise were common risk factors across all three conditions. Sarcopenia was associated with male sex, insufficient dietary intake, alcohol consumption, poor self-rated health, and low household income. Abdominal obesity was linked to recent weight gain, hypertension, diabetes, prolonged sedentary time, perceived obesity, and low educational attainment. Sarcopenic obesity was associated with male sex, diabetes, elevated hs-CRP, perceived stress, poor self-rated health, and economic inactivity. Conclusions: Body composition abnormalities among older Korean adults are influenced by complex, condition-specific interactions across biological, psychological, and social domains. These findings emphasize the significance of adopting an integrative perspective that considers physical, psychological, and social health components when addressing age-related body composition issues.

Cardiometabolic syndrome (CMS) is a global health issue that is commonly associated with obesity. This study aimed to assess the utility of neck circumference for predicting cardiometabolic risk in the Iranian population. A cross-sectional study with 6789 participants was conducted using face-to-face interviews, clinical evaluations, body composition measurements using Inbody 770 device, laboratory tests and anthropometric measurements. The anthropometric measurements included height, weight, body mass index, neck, waist, hip and wrist circumference, while laboratory measures included complete blood count, fasting blood glucose, lipid profile and lipid accumulation product. The results revealed that 22.4% of the population had CMS, with a higher prevalence in males (29.8%) than in females (16%). Waist circumference was the most prevalent indicator of CMS (75.8%), particularly in males (86%), while low high-density lipoprotein (HDL) levels were the least common (found in only 349 males). Neck circumference was significantly related to all CMS indicators. Univariate logistic regression analysis indicated that every unit increase in neck circumference led to a twofold increase in the probability of CMS (OR (95% CI) = 1.24 (1.21, 1.26), p < 0.001). Neck circumference had a higher predictive value (AUC = 0.7, sensitivity = 0.71, specificity = 0.6, validity = 0.63) for CMS risk than weight and body mass index (BMI). The cut-off points for neck circumference in diagnosing CMS among the males and females were 38.6 and 36.9 cm, respectively. Neck and waist circumference are better predictors of cardiovascular risk factors than BMI or waist-to-hip ratio. Monitoring changes in these measurements can help predict CMS.

Ultra-process foods (UPF) were suspected to induce many diseases and threaten consumers' health. The aim of this study was to examine the association between the consumption of highly processed foods and adiposity indexes in Tehranian adults.

In a cross-sectional design, 850 Tehranian adults were included. NOVA classification was used to assess the intake of UPF in participants. The amount of calorie intake through processed foods was assessed. Adiposity indexes outcomes include body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), visceral adiposity index (VAI), body roundness index (BRI), and body adiposity index (BAI). Lipid accumulation product (LAP) and triglyceride-glucose index (TyG) were also assessed. Binary logistic regression was used to evaluate the association between the intake of UPF and adiposity indexes measurements.

there was a higher intake of UPF in men than women (p < 0.001). The results of logistic regression revealed that there is a significant association between intake of UPF with WHR (odds ratio (OR): 1.09, 95% confidence interval (CI): 0.73-1.61) and BRI (OR: 2.10, 95% CI: 1.38-3.19) in the crude model. Nevertheless, after adjusting for confounders, the results were insignificant (WHR: OR, 0.77, 95% CI, 0.46-1.27, and BRI: OR, 1.70, 95% CI, 1.05-2.73). No significant association was seen for other outcomes (p > 0.001 for all). The results of dose-response analyses revealed a substantial association between UPF intake and BMI, WHrT, WC, VAI, BRI, BAI, LAP, and TyG.

UPF consumption was significantly related to increased risk of high-risk adiposity indexes in the dose-response analysis. More studies are needed to strengthen the results of this study.

Transcatheter Aortic Valve Implantation (TAVI) has revolutionized severe aortic stenosis treatment, but risk stratification remains challenging. This systematic review examined the association between computed tomography (CT)-derived adipose tissue parameters and TAVI outcomes. We searched major databases for studies on visceral (VAT), subcutaneous (SAT), and intramuscular (IMAT) adipose tissue parameters and post-TAVI outcomes. Fourteen studies (9692 patients) were included. Higher SAT area/volume was consistently associated with better survival (5 studies, HR range: 0.83-2.77, p < 0.05). Lower SAT and VAT density also correlated with better survival (5 and 4 studies, respectively, HR range: 1.31-1.46, p < 0.05). VAT area showed mixed results. A VAT:SAT ratio < 1 was associated with better cardiovascular outcomes in one study. Lower IMAT index correlated with shorter hospital stays in a single study. This review reveals complex relationships between adipose tissue parameters and TAVI outcomes. Lower adipose tissue density and higher subcutaneous adiposity were most consistently associated with better outcomes. These findings suggest that detailed analysis of adipose tissue characteristics may enhance risk stratification in TAVI candidates.

We examined associations between body mass index (BMI), waist circumference (WC), and dementia risk, and differences in BMI and WC trajectories before dementia diagnosis. We included 9,739 participants (54% women) aged 70+ from the Trøndelag Health Study (HUNT4 70+). BMI was measured four times (1984-2019) and WC three times (1995-2019). Dementia diagnoses were clinically assessed at HUNT4 70+ . Women and men with dementia had higher midlife BMI and WC than those without dementia. These differences diminished closer to diagnosis, especially in women. Midlife obesity in both sexes and midlife overweight, high WC, and overweight/obesity with high WC in men were linked to higher dementia risk. Lower dementia risk was observed with late-life overweight for both sexes, late-life high WC in women, late-life overweight/obesity with normal WC in men or high WC in women. Adiposity measures and their changes influence dementia risk differently in women and men.

Obesity is a critical risk factor for ischemic heart disease (IHD), affecting 42% of the U.S. population. This study examines trends in obesity-related IHD mortality among U.S. adults aged 25 and older from 1999 to 2020, using the CDC WONDER database.

We analyzed IHD as the primary cause and obesity as a contributing factor, calculating age-adjusted (AAMRs) and crude mortality rates (CMRs) per 100,000 individuals. Joinpoint regression assessed annual percent changes (APC), stratifying by race, sex, age, and region.

From 1999 to 2020, 139,644 obesity-related IHD deaths were recorded. AAMR rose from 1.92 to 4.69 per 100,000. Rates were higher in men (3.79) than women (2.10), with Black Americans showing the highest AAMR (4.07). Older adults (65+) had the highest CMR (5.73). Nonmetropolitan areas exhibited higher AAMRs (3.47) than metropolitan regions (2.78). States with the highest mortality included Vermont, Oklahoma, Wyoming, Wisconsin and Iowa while Alabama, Virginia, Massachusetts, Connecticut and Georgia had the lowest.

The findings indicate a 2.5-fold increase in obesity-related IHD mortality, highlighting the need for targeted public health interventions and further research to address this growing public health concern.

The purpose of this study was to explore the incremental predictive value of liver fat fraction (LFF) in forecasting major adverse cardiovascular events (MACE) among patients with type 2 diabetes mellitus (T2DM).

We prospectively enrolled 265 patients with T2DM who presented to our hospital with symptoms of chest distress and pain suggestive of coronary artery disease (CAD) between August 2021 and August 2022. All participants underwent both coronary computed tomography angiography (CCTA) and upper abdominal dual-layer spectral detector computed tomography (SDCT) examinations within a 7-day interval. Detailed clinical data, CCTA imaging features, and LFF determined by SDCT multi-material decomposition algorithm were meticulously recorded. MACE was defined as the occurrence of cardiac death, acute coronary syndrome (ACS), late-phase coronary revascularization procedures, and hospital admissions due to heart failure.

Among 265 patients (41% male), 51 cases of MACE were documented during a median follow-up of 30 months. The LFF in T2DM patients who experienced MACE was notably higher compared to those without MACE (p < 0.001). The LFF was divided into tertiles using the cutoffs of 4.10 and 8.30. Kaplan-Meier analysis indicated that patients with higher LFF were more likely to develop MACE, regardless of different subgroups in framingham risk score (FRS) or coronary artery calcium score (CACS). The multivariate Cox regression results indicated that, compared with patients in the lowest tertile, those in the second tertile (hazard ratio [HR] = 3.161, 95% confidence interval [CI] 1.163-8.593, P = 0.024) and third tertile (HR = 4.372, 95% CI 1.591-12.014, P = 0.004) had a significantly higher risk of MACE in patients with T2DM. Even after adjusting for early revascularization, both LFF tertile and CACS remained independently associated with MACE. Moreover, compared with the traditional FRS model, the model that included LFF, CACS, and FRS showed stable clinical net benefit and demonstrated better predictive performance, with a C-index of 0.725, a net reclassification improvement (NRI) of 0.397 (95% CI 0.187-0.528, P < 0.01), and an integrated discrimination improvement (IDI) of 0.100 (95% CI 0.043-0.190, P < 0.01).

The elevated LFF emerged as an independent prognostic factor for MACE in patients with T2DM. Incorporating LFF with FRS and CACS provided incremental predictive power for MACE in patients with T2DM.

WHAT IS CURRENTLY KNOWN ABOUT THIS TOPIC?: T2DM is associated with increased MACE rates, underscoring the need for improved risk prediction. CACS is a well-established tool for MACE risk assessment but may not capture all risk factors. Hepatic steatosis is a common comorbidity in metabolic syndrome and T2DM. WHAT IS THE KEY RESEARCH QUESTION?: Does the incorporation of LFF derived from SDCT into existing risk prediction models enhance the accuracy of MACE forecasting in patients with T2DM? WHAT IS NEW?: SDCT-LFF measurement introduces a more accurate method for assessing hepatic steatosis. LFF as an independent predictor of MACE in T2DM patients is a novel finding. The study presents LFF as an additional tool for risk stratification, complementing FRS and CACS. HOW MIGHT THIS STUDY INFLUENCE CLINICAL PRACTICE?: Study findings may guide personalized prevention for T2DM patients at higher MACE risk.

This study aims to investigate the causal relationship between obesity and essential hypertension, and evaluate the mediation effect of visceral adipose tissue (VAT) by Mendelian randomization (MR) analysis. We included body mass index (BMI), waist circumference (WC), waist-hip ratio (WHR), WC adjusted for BMI (WCadjbmi), and WHR adjusted for BMI (WHRadjbmi) as obesity-related anthropometric traits. In the bidirectional MR analyses, we found that higher BMI (OR, 1.638; p = 3.97 × 10-19), WC (OR, 1.702; p = 1.45 × 10-12), and WHR (OR, 1.863; p = 1.84 × 10-8) were significantly associated with increased risk of essential hypertension, while no evidence of reverse causality was observed. Then, in the two-step MR analyses, all five anthropometric traits had a positive and significant association with VAT mass, especially WC (OR, 2.315; p = 1.00 × 10-210). Meanwhile, higher predicted VAT mass was significantly associated with increased risk of essential hypertension (OR, 1.713; p = 1.18 × 10-38). Furthermore, the mediation analyses revealed that VAT had a significant mediation effect on the causal relationship between obesity-related anthropometric traits and essential hypertension, and mediated proportions in BMI, WC, and WHR were 77.8%, 80.1%, and 41.4%, respectively. Finally, the sensitivity analyses using two other datasets showed a similar result. In conclusion, our results showed that BMI, WC, and WHR have a positive and significant association with increased risk of essential hypertension. Moreover, VAT has a significant mediation effect on the causal relationship between obesity-related anthropometric traits and essential hypertension. Our study provided important statistical evidence suggesting that VAT may play a crucial meditation role in the occurrence and development of obesity-related hypertension.

Therapies targeting the LPL (lipoprotein lipase) pathway are under development for cardiometabolic disease. Insights into their efficacy-both alone and in combination with existing lipid-lowering therapies-modes of action, and safety of these agents are essential to inform clinical development. Using Mendelian randomization, we aimed to (1) evaluate efficacy, (2) explore shared mechanisms, (3) assess additive effects with approved lipid-lowering drugs, and (4) identify secondary indications and potential adverse effects.

We selected triglyceride-lowering genetic variants located in the genes encoding ANGPTL3 (angiopoietin-like 3), ANGPTL4 (angiopoietin-like 4), APOC3 (apolipoprotein C3), and LPL and conducted drug target Mendelian randomization on primary outcomes including coronary artery disease and type 2 diabetes, and secondary outcomes, including apolipoprotein B, waist-to-hip ratio, body mass index, and 233 metabolic biomarkers. We conducted interaction Mendelian randomization analyses in 488 139 UK Biobank participants to test the effect of combination therapy targeting the LPL and LDLR (low-density lipoprotein receptor) pathways. Finally, we investigated potential secondary indications and adverse effects by leveraging genetic association data on 1204 disease end points.

Genetically predicted triglyceride lowering through the perturbation of LPL pathway activation targets ANGPTL4, APOC3, and LPL was associated with a lower risk of coronary artery disease and type 2 diabetes and lower apolipoprotein B. Genetically predicted triglyceride lowering through ANGPTL4 was associated with a lower waist-to-hip ratio, suggestive of a favorable body fat distribution. There was no evidence of a multiplicative interaction between genetically proxied perturbation of ANGPTL4, APOC3, and LPL and that of HMGCR (HMG-CoA reductase) and PCSK9 (proprotein convertase subtilisin/kexin type 9) on coronary artery disease and type 2 diabetes, consistent with additive effects. Finally, associations of genetically predicted LPL pathway targeting were supportive of the broad safety of these targets.

Our findings provide genetic evidence supporting the efficacy and safety of LPL pathway activation therapies for the prevention of coronary artery disease and type 2 diabetes, alone or in combination with statins or PCSK9 inhibitors.

Background/Objectives: Few studies have compared the associations of different adiposity markers with cardiometabolic risk factors in individuals without diabetes or cardiovascular disease (CVD), particularly in South America. Moreover, the associations with more severe cardiometabolic risk, defined by the simultaneous presence of altered glycemia, blood pressure, and dyslipidemia, remain unknown. We examined whether the waist-to-height ratio (W-HtR), waist circumference (WC), and BMI were independently associated with cardiometabolic risk in a chronic disease prevention program in Medellín, Colombia. Methods: A cross-sectional study was conducted in 29,236 adults (age: 19-121 years) without diabetes or CVD. Exposures included increased W-HtR (>0.5), increased WC (≥80 cm for women, ≥90 cm for men), and overweight/obesity. The outcomes were dyslipidemia, elevated glycemia, high blood pressure, and full cardiometabolic risk (FCMR), defined as the presence of all three factors. Logistic regressions adjusted for sociodemographic and lifestyle covariates and additional adiposity markers were used. Cubic spline analyses examined the shape of associations. Results: Most individuals were over 40 years old (97.6%), only 40 were ≥100 years, and 16.5% (n = 4821) had FCMR. Increased W-HtR tripled the odds of FCMR compared with normal W-HtR (OR: 3.04, 95%CI: 2.45-3.77, p < 0.001). Increased WC doubled the odds of FCMR (p < 0.001). W-HtR remained the strongest predictor after adjusting for WC (OR: 1.99, 95%CI: 1.59-2.50) and BMI (OR: 2.48, 95%CI: 1.99-3.08). Cubic spline analyses showed a linear association between W-HtR and FCMR, whereas the BMI-FCMR association plateaued at approximately 30 kg/m2. Conclusions: In this cross-sectional study of a large middle-to-older-aged cohort, W-HtR was the strongest adiposity marker correlated with cardiometabolic risk.

The growing prevalence of obesity and related chronic diseases has led to increased interest in interventions targeting ectopic fat reduction to which its accumulation is linked to metabolic dysfunction.

This study aimed to evaluate the effects of combined exercise training combined with dietary interventions compared with dietary interventions alone on ectopic fat [visceral fat area (VFA), liver fat, intramuscular fat (IMF), pancreatic fat, renal sinus fat, and pericardial and epicardial fats] in adults with overweight and obesity, both with and without chronic diseases.

Web of Science, Scopus, and PubMed were searched for original articles up to 1 March, 2024, that included exercise compared with control interventions on body weight and ectopic fat in adults with overweight or obesity. Weighted mean differences (WMD) for body weight, liver fat, pancreatic fat, and renal sinus fat and standardized mean differences (SMD) for VFA, IMF, pericardial and epicardial fats, and 95% confidence intervals were determined using random-effects models.

Thirty-two studies, including 1488 participants and 38 intervention groups, met the inclusion criteria. The combined intervention of exercise and diet did not reduce body weight (WMD = -0.23 kg, P = 0.180), liver fat (WMD = 0.05%, P = 0.730), IMF (SMD = -0.08, P = 0.640), pericardial and epicardial fats (SMD = -0.12, P = 0.280), pancreatic fat (WMD = -0.24%, P = 0.370), and renal sinus fat (WMD = 0.01 cm2, P = 0.170) when compared with a diet-only group. Interestingly, exercise combined with diet significantly reduced VFA in participants with obesity (SMD = -0.12, P = 0.040) and healthy males (SMD = -0.33, P = 0.001) when compared with a diet-only group.

The findings suggest that combined exercise and dietary interventions did not lead to significant reductions in most ectopic fat depots when compared with diet alone. However, a modest reduction in VFA was observed in participants with obesity and healthy males. These results highlight the nuanced impact of exercise in combination with dietary interventions and the need to consider specific fat depots and participant characteristics in obesity management strategies.The trial was registered at PROSPERO as CRD42024546770.

This aimed to quantify the association between dual trajectory patterns combining seven central adiposity (CA) indices and fasting plasma glucose (FPG) with cardiovascular disease (CVD) risk in adults, and to compare their predictive performance.

The Kailuan Study, a prospective study initiated in June 2006, included 39 772 adults without pre-existing CVD as of 2010. Dual trajectories of seven CA indices combined with FPG were recorded from 2006 to 2010 to predict CVD risk from 2010 to 2021. Cox regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for incident CVD.

During a median follow-up of 11.0 years, 2715 incident CVD events were recorded. Four distinct patterns of CA indices (waist circumference, waist-to-height ratio, abdominal volume index, body roundness index) and three distinct patterns of other CA indices (waist-to-hip ratio, conicity index, A body shape index) combined with FPG were identified. Compared with the lowest-risk group, the highest-risk group exhibited a significantly higher CVD risk (adjusted HRs [95% CIs]: 2.41 [2.02-2.86], 2.57 [2.18-3.05], 2.25 [1.92-2.63], 2.35 [2.01-2.73], 2.08 [1.74-2.49], 1.97 [1.72-2.26], 1.81 [1.58-2.07], respectively). Overall, the predictive capabilities were generally similar, with the combination of waist circumference and FPG showing a slightly better predictive performance compared with other patterns.

Distinct patterns of dual trajectories involving seven CA indices combined with FPG were associated with CVD risk. The results suggest that the combination of waist circumference and FPG may have greater clinical significance in predicting CVD risk.

Monitoring body composition through Computed Tomography (CT) scans, including muscle and adipose tissue, plays a key role in the prognosis of various cancers. However, abdominal CT is impractical for patients with breast cancer (BC), making chest CT an essential tool for postoperative surveillance. This study aims to evaluate the effect of subcutaneous fat tissue at the 11th thoracic vertebral plane on the postoperative prognosis of BC patients by analyzing chest CT images, providing evidence for postoperative nutritional and rehabilitation guidance.

We conducted a retrospective analysis of the medical records of 188 BC patients treated and discharged from the Second Affiliated Hospital of Wenzhou Medical University between January 1, 2013, and December 31, 2013. The subcutaneous fat area (SFA) at the 11th thoracic vertebra (T11) was measured using chest CT images, and the subcutaneous fat index (SFI, area/height2) was calculated. Using multivariate Cox proportional hazards models and propensity score matching (PSM), the relationships between the SFI and overall survival (OS), as well as recurrence-free survival (RFS), were assessed. Additionally, Kaplan-Meier survival curves were applied to compare prognostic differences between the groups.

The median follow-up duration was 128 months (range: 27-188 months). Of the 188 patients included in the study, the optimal cutoff value for the SFI was determined to be 49.31 cm²/m². Multivariate analysis indicated that SFI was an independent prognostic factor for both OS (HR 2.50, 95% CI 1.07-5.83, P = 0.034) and RFS (HR 2.04, 95% CI 1.10-3.78, P = 0.024). After PSM, Kaplan-Meier survival curve analysis revealed significant differences in both RFS and OS between the two groups (P = 0.025 and P = 0.018, respectively). All the results showed that the prognosis of BC with more subcutaneous fat was poor.

The findings demonstrated that the SFI at T11 was negatively correlated with patient survival. This offers a new perspective on personalized management for BC patients, suggesting that future research should validate these results and investigate combining imaging assessments with lifestyle interventions, such as exercise, nutrition, and diet, to optimize patient outcomes.

Elevated fasting insulin levels (FI), indicative of altered insulin secretion and sensitivity, may precede type 2 diabetes (T2D) and cardiovascular disease onset. In this study, we group FI-associated genetic variants based on their genetic and phenotypic similarities and identify seven clusters with distinct mechanisms contributing to elevated FI levels. Clusters fall into two types: "non-diabetogenic hyperinsulinemia," where clusters are not associated with increased T2D risk, and "diabetogenic hyperinsulinemia," where T2D associations are driven by body fat distribution, liver function, circulating lipids, or inflammation. In over 1.1 million multi-ancestry individuals, we demonstrated that diabetogenic hyperinsulinemia cluster-specific polygenic scores exhibit varying risks for cardiovascular conditions, including coronary artery disease, myocardial infarction (MI), and stroke. Notably, the visceral adiposity cluster shows sex-specific effects for MI risk in males without T2D. This study underscores processes that decouple elevated FI levels from T2D and cardiovascular risk, offering new avenues for investigating process-specific pathways of disease.

Gender differences in dietary habits, physical activity and body composition are key determinants of health and disease risk. Although these differences are well documented, their variation across age groups remains poorly explored. This study examines gender-specific patterns in eating behaviours, sport preferences and body composition metrics, with the aim of providing evidence for tailored public health interventions.

A cross-sectional study was conducted on 2,276 participants (1,349 females and 927 males) aged 18-75 years. Recruitment combined an online survey and clinical assessments. Body composition was evaluated with bioelectrical impedance analysis (BIA) and eating habits were investigated with detailed weekly food diaries. Gender differences between five age groups were statistically analysed using chi-square and t-tests (p ≤ 0.05). The study protocol was approved by the Lazio Area 5 Ethics Committee.

Significant differences in body composition were observed between genders: men had a higher lean mass and basal metabolic rate, whereas women showed a higher fat mass in all age groups. Eating habits varied significantly: men preferred salty and protein-rich foods, consumed alcohol more frequently and showed a higher prevalence of meal skipping and uncontrolled eating behaviour. Women showed greater meal regularity, a preference for sweet tastes and a higher likelihood of eating alone in the older age groups. Sports participation differs markedly in the age group 30-39 years, in which men were predominantly involved in team sports, while women favoured strength training and skill activities.

This study highlights the strong gender disparities in dietary and lifestyle behaviour, which evolve with age. These findings underline that tailored public health strategies, responding to gender-specific requirements, are needed to promote healthier lifestyles and reduce inequalities. Future studies should use longitudinal designs to explore causal relationships.

The study is registered on ClinicalTrials.gov (NCT06661330; registered 22 October 2024, retrospectively). Available at: https://clinicaltrials.gov/study/NCT06661330 .

Obesity, measured by body mass index, is a risk factor for cardiovascular disease. However, the role of body composition, including body fat percentage and lean body mass (LBM), in cardiovascular outcomes has not been well studied in patients with coronary artery disease (CAD). This study aims to evaluate the association of body composition with cardiovascular outcomes and all-cause mortality in patients with CAD.

Body composition was obtained via bioelectrical impedance analysis from 1291 patients with CAD before starting cardiac rehabilitation. Patients were divided into quintiles by body composition and analyzed in total and after sex stratification. All-cause mortality and a composite of major adverse cardiovascular events, including acute coronary syndrome, coronary revascularization, heart failure hospitalization, and stroke, were primary study outcomes. In the total cohort adjusted analyses, body mass index, body fat percentage, and LBM were not predictors of all-cause mortality or major adverse cardiovascular events. In sex-stratified analyses, among women, the third LBM quintile was associated with decreased risk of all-cause mortality compared with the lowest LBM quintile (adjusted hazard ratio, 0.07 [95% CI, 0.01-0.57]; P=0.01). No other body composition variables were associated with all-cause mortality or major adverse cardiovascular events in either sex.

In women with CAD, moderate LBM was associated with lower mortality when compared with low LBM, whereas body fat percentage and body mass index were not associated with mortality or major adverse cardiovascular events in either sex. Future research studying the implications of changes in body composition on outcomes in men and women with CAD is warranted.

Ectopic fat deposition, involving lipid infiltration within organs and fat accumulating surrounding organs, plays a crucial role in the development of metabolic abnormalities in obesity. Current imaging measurements of obesity primarily focus on lipid infiltration within liver, neglecting fat deposition in other areas. This study aims to explore the methods of measuring and correlating different types of abdominal ectopic fat deposition in obese patients using magnetic resonance imaging (MRI) and ultrasound techniques, and to investigate the relationship between these fat parameters and obesity-related metabolic markers.

Abdominal ectopic fat deposition including liver fat content, mesenteric fat thickness (MFT), perirenal fat thickness (PrFT) and preperitoneal fat thickness (PFT) were measured in 220 overweight/obese patients using both MRI and ultrasound techniques. Correlation analysis validated the concordance of fat parameters at specific sites between the two imaging methods and identified the cutoff values of hepatic attenuation coefficient (AC) for diagnosis of liver steatosis. Additionally, we investigated the correlation between fat parameters by both methods and obesity-related metabolic markers.

Ultrasonic measurement of PrFT and hepatic AC both had high correlation with PrFT (r = 0.829, p < 0.001) and hepatic Proton-density fat fraction (PDFF, r = 0.822, p < 0.001) measured via MR. Hepatic AC cutoff values for diagnosing mild, moderate, and severe fatty liver were 0.705 dB/cm/MHz (AUC = 0.922), 0.755 dB/cm/MHz (AUC = 0.923), and 0.875 dB/cm/MHz (AUC = 0.890) respectively. Hepatic AC correlated significantly with AST and ALT (r = 0.477 ~ 0.533, p < 0.001). MFT measured by ultrasound were positively associated with glycated hemoglobin (r = 0.324 ~ 0.371, p < 0.001) and serum triglyceride levels (r = 0.303 ~ 0.353, p < 0.001). PrFT measured by both methods showed significant positive correlations with serum creatinine levels (r = 0.305 ~ 0.308, p < 0.001).

Both MRI and ultrasound demonstrate metabolic correlations in quantifying mesenteric, hepatic, and perirenal fat. In addition to assessment of liver fat content, the measurements of ectopic fat deposition by MRI or ultrasound are a simple and crucial way for comprehensive fat evaluation in individuals with overweight/obesity.

Background and Objectives: Various adiposity indicators have been used to predict metabolic syndrome (MetS). The aim of the present study was to evaluate the predictive ability of known adiposity indicators, such as abdominal girth, girth/height and fat percentage, as well as less commonly used indicators, such as the conicity index (CI), body roundness index (BRI), visceral adiposity index (VAI) and body shape index (ABSI), to predict MetS. Materials and Methods: A total of 261 participants, including family members and graduates of a flagship school in the city of Trujillo, Peru, participated. Metabolic syndrome was assessed according to the harmonised ATP III criteria. ROC curves were analysed for each of the adiposity indicators using SPSS 26.0 statistical software. Results: The prevalence of MetS was found to be 43.4%, with a higher proportion in men (25.8%). The area under the curve (AUC) for the prediction of MetS exceeded a value of 0.8 for VAI, abdominal circumference, circumference/height and relative fat mass in both men and women, with VAI showing the highest values of 0.858 and 0.875 in women and men, with cut-off points for MetS of 2.57 and 1.73, respectively. Conclusions: VAI can be used in the diagnosis of metabolic syndrome during lipid profile and anthropometric assessment.

Background: Non-alcoholic fatty liver disease (NAFLD), more recently redefined as metabolic-associated fatty liver disease (MAFLD), is now recognized as the most prevalent cause of chronic liver disease. Its strong association with cardiovascular disease (CVD) underscores its emerging role in global morbidity and mortality. Objective: This review critically examines the pathophysiological mechanisms that link NAFLD/MAFLD with CVD. It focuses on shared metabolic disturbances, inflammatory pathways, and alterations in the gut microbiota that contribute to hepatic and cardiovascular pathology. Review and Gaps: Current evidence highlights insulin resistance, dyslipidemia, systemic inflammation, and gut dysbiosis as pivotal factors connecting NAFLD/MAFLD to CVD. Despite these insights, inconsistencies in diagnostic criteria and a lack of validated non-invasive biomarkers hinder a clear understanding of the causal relationship between liver and cardiovascular diseases. Conclusions: Addressing these knowledge gaps through standardized diagnostic protocols and large-scale longitudinal studies is essential. Improved biomarker validation and clearer delineation of the underlying mechanisms will improve cardiovascular risk stratification and enable more personalized therapeutic strategies for patients with NAFLD/MAFLD.

Metabolic dysfunction-associated steatotic liver disease (MASLD) progression exhibits significant sex differences, with males generally developing more severe disease. This study used an endothelial nitric oxide synthase knockout (eNOS KO) murine model to investigate sex-specific MASLD progression under a Western diet intervention. Magnetic resonance imaging (MRI) assessed body composition and liver and skeletal muscle fat fraction, revealing greater visceral fat, liver volume, and liver-to-muscle fat ratios in males. Dimensionality reduction and clustering analyses identified distinct sex-specific MASLD phenotypes and progression patterns. Histological evaluations confirmed greater liver damage in males, evidenced by higher MAFLD Activity Scores. These findings highlight the critical role of sex as a biological variable in MASLD pathology and emphasize the influence of body composition and fat distribution on disease progression. The study underscores the utility of advanced imaging and analytical techniques for refining non-invasive diagnostics and guiding sex-specific interventions, paving the way for personalized MASLD management strategies.

Overweight patients with cardiovascular disease (CVD) tend to survive longer than normal-weight patients, a phenomenon known as the "obesity paradox". The phenotypic characteristics of adipose distribution in these patients (who survive longer) often reveal a larger proportion of subcutaneous white adipose tissue (scWAT), suggesting that the presence of scWAT is negatively associated with all-cause mortality and that scWAT appears to provide protective benefits in patients facing unhealthy states. Exercise-mediated browning is a crucial aspect of the benign remodeling process of adipose tissue (AT). Reduced accumulation, reduced inflammation, and associated adipokine secretion are directly related to the reduction in CVD mortality. This paper summarized the pathogenetic factors associated with AT accumulation in patients with CVD and analyzed the possible role and pathway of exercise-mediated adipose browning in reducing the risk of CVD and CVD-related mortality. It is suggested that exercise-mediated browning may provide a new perspective on the "obesity paradox"; that is, overweight CVD patients who have more scWAT may gain greater cardiovascular health benefits through exercise.

Although the epidemic of atherosclerosis has slowed down in industrialized nations, it has increased in speed and severity in developing countries. The worldwide expanding incidence and prevalence of obesity, insulin resistance, and diabetes mellitus may be among the most important drivers of this trend, and the role of visceral adipose tissue as a promoter of atherosclerosis has come under intense scrutiny. Epicardial adipose tissue (EAT) is embryologically similar to the visceral fat in the intraperitoneal space. Both adipose compartments are capable of secreting numerous pro-atherosclerotic cytokines and have been shown to promote inflammation in patients with dysmetabolic syndromes and in patients with established coronary artery disease. The adverse cardiovascular effects of EAT extend to influencing the development of atrial fibrillation and heart failure, mostly with preserved ejection fraction, through a combination of inflammatory, pro-fibrotic, and pro-arrhythmogenic pathways. In this work we provide an overview of the current understanding of the role of EAT in the development of several cardiovascular conditions as well as some of the therapeutic advances in the field.

Visceral adipose tissue (VAT) has been related to coronary artery disease (CAD), but its association with recurrent major adverse cardiovascular events (MACE) in premature CAD (pCAD) has not been fully explored. Thus, we aimed to investigate the impact of VAT on recurrent MACE in patients with pCAD.

This was a retrospective sub-analysis of 853 patients with pCAD from the GEA cohort study. VAT was measured by computed tomography at baseline. The primary outcome was the recurrence of MACE over 5 years of follow-up. Likewise, the association of VAT with non-fatal and fatal MACE was analyzed as a secondary outcome. Cox regression models were fitted and adjusted by confounders obtained at baseline to estimate adjusted hazard ratios (aHR).

The median age of the patients was 53 years, and 80% were male, with a median follow-up of 4.9 years. Overall, 10% of the patients had recurrent MACE (6.5% non-fatal and 3.6% fatal) with an incidence rate of 18.5 (95% CI: 18.0-19.0) events per 1,000 person-years. VAT was positively associated with MACE. Those in the upper tertile (VAT ≥ 194 cm²) had the highest risk for total (aHR: 2.71; 95% CI: 1.37-5.35; p=0.004) and non-fatal (aHR: 3.58; 95% CI: 1.49-8.61; p=0.004) MACE. Fatal MACE was not statistically associated (aHR: 2.13; 95% CI: 0.72-6.35; p=0.174).

Among patients with pCAD, VAT increased the risk of recurrent MACE despite adequate pharmacological treatment. These results suggest that VAT could be considered an emergent risk factor and a promising target for residual cardiovascular risk reduction.

Cardiac autonomic neuropathy (CAN) is a life-threatening complication of diabetes. While obesity is a well-known risk factor of dysautonomia, the association between CAN and body fat distribution has not been fully clarified, especially in autoimmune diabetes (AD).

To evaluate if the association between CAN and body fat distribution differs between AD and type 2 diabetes (T2D).

Body fat distribution was evaluated by Dual X-Ray Absorptiometry in 143 people with diabetes (44 with ADand 99 with T2D) undergoing clinical screening for CAN. The association of CAN with markers of ectopic fat distribution was evaluated in multivariate regression models adjusting for confounders and testing for the interaction between diabetes type and CAN.

A significant interaction between CAN and diabetes type was found with respect to markers of ectopic fat distribution. Specifically, people with CAN had significantly higher amount of visceral adipose tissue (530 [376-665]g versus 251[189-360]g, p = 0.001), total fat mass (22708[20200-27845]g versus 15434[12981-21879]g, p = 0,016), and trunk-to-leg ratio (0.88 [0.75-1.04] versus 0.70 [0.56-0.78], p = 0,023) compared to those without CAN only in participants with AD, but not in T2D (p-values for interaction < 0.05 for all comparisons).

Ectopic fat distribution is more strongly associated with CAN in AD than in T2D. This highlights the distinct role of fat distribution in the cardiometabolic health of people with AD, suggesting the need for further studies to better understand the pathophysiology and implications of overweight in this population.

The population with cardiovascular-kidney-metabolic (CKM) syndrome has a higher risk of cardiovascular events. Chinese visceral adiposity index (CVAI), an index of both visceral obesity and surrogate insulin resistance, has been linked to cardiovascular events. However, the nature of this relationship remains unclear in individuals with CKM syndrome.

All data came from the China Health and Retirement Longitudinal Study (CHARLS). The association between CVAI and cardiovascular events risk was explored using Cox regression models, restricted cubic spline (RCS) curves, and multiple sensitivity analyses. To compare the predictive abilities of various indices, receiver operating characteristic (ROC) analyses were employed.

7744 participants were in final analysis. During 9 year follow-up, 1679 cases of cardiovascular disease (CVD), 1,255 cases of heart disease, and 604 cases of stroke were recorded. Cox regression analyses revealed that per-SD (standard deviation) increase in CVAI, the risk of CVD, heart disease, and stroke increased by 22% (95% CI 1.13-1.32), 22% (95% CI 1.13-1.32), and 32% (95% CI 1.19-1.47). In participants at CKM stage 3 with CVD, a J-shaped curve was observed in the RCS analyses (P non-linearity = 0.036). Subgroup analysis revealed an interaction between age and each 10-unit increase in CVAI in CVD (P interaction = 0.0173) and stroke risk (P interaction = 0.028). The AUC (area under curve) value for CVAI was highest compared to other indicators (all DeLong Test P values < 0.05).

This research demonstrates a higher CVAI was linked to increased cardiovascular risk in individuals with CKM syndrome stage 0-3. Monitoring CVAI can help identify high-risk individuals early and improve the effectiveness of disease management.

Less than 50% of patients treated for hypertension reach a target office systolic blood pressure (SBP). We aimed to evaluate the role of adiposity on antihypertensive drug responses in newly diagnosed hypertensive patients.

Estimated glomerular filtration rates, body mass index (BMI), skinfold thickness (SFT), body surface areas and waist circumferences of 150 hypertensive patients naïve to treatment were measured. Treatment protocols were started as combination of angiotensin converting enzyme inhibitor (ACE-I) plus calcium channel blocker (CCB), angiotensin receptor blocker plus CCB or ACE-I plus diuretic. Pre-treatment and change in blood pressure (ΔBP) after 4 weeks treatment were determined. Multiple linear regression analysis was used to find independent predictors of Δblood pressure changes, and multivariable binary logistic regression analysis to find independent predictors of target SBP < 140 mmHg at 4 weeks.

A total of 104 patients reached the target systolic pressure of <140 mmHg at 4 weeks. Triceps, mid-abdomen and subscapular SFT were significantly thicker in the uncontrolled blood pressure group (P = .011, P = .006 and P = .016, respectively). Pretreatment SBP (r = 0.644), pretreatment diastolic blood pressure (DBP) (r = 0.188), subscapular SFT (r = -0.318), suprailiac SFT (r = -0.211) and ΔDBP (r = 0.433) were correlated with ΔSBP in correlation analysis. Pretreatment SBP (β = 0.644, 95% CI = 0.697-0.993, P < .001), subscapular SFT (β = -0.253, 95% CI = -0.886--0.329, P < .001), pretreatment DBP (β = -0.380, 95% CI = -0.1001- -0.453, P = .001) and ΔDBP (β = 0.401, 95% CI = 0.377-0.796, P < .001) were independent predictors of ΔSBP in multivariable linear regression analysis. Subscapular SFT was an independent predictor of target SBP < 140 mmHg in multivariable logistic regression analysis (OR = 0.895, 95% CI = 0.832-0.963, P = .003).

Subscapular SFT may be a valuable marker for prediction of response to antihypertensive drugs.

In polycystic ovary syndrome (PCOS), ectopic fat accumulation remains debatable. Therefore, intra-abdominal, hepatic, and epicardial fat were compared between PCOS women and body mass index (BMI)-matched controls and their associations with metabolic and hormonal parameters were explored. Furthermore, the performance of echocardiographic epicardial adipose tissue thickness (EATT) and hepatic steatosis measurement using transient elastography-based controlled attenuation parameter (TE-CAP) in screening abdominal visceral adipose tissue (VAT) was originally evaluated.

Women aged 18-39 years with BMI < 35 kg/m² were recruited. PCOS was defined by the Rotterdam criteria. All participants underwent clinical and laboratory exams, dual-energy X-ray absorptiometry (DXA), TE-CAP, and echocardiography. A receiver operating characteristic curve was applied to evaluate the accuracy and optimal cutoff values of TE-CAP and EATT in predicting DXA-measured VAT.

The study included 35 women with PCOS and 37 controls. PCOS women exhibited higher levels of androgens, insulin resistance (IR) parameters, LDL-cholesterol, triglycerides, VAT, and EATT. VAT correlated with IR and triglycerides, whereas EATT correlated with HDL-cholesterol. In PCOS women aged 18-29, the cutoff values of CAP and EATT for VAT were 198.0 and 3.07, respectively, with CAP showing higher area under the curves (AUC). In PCOS women aged 30-39, the cutoff values were 209.5 and 3.36, respectively, with EATT showing higher AUC.

VAT correlates with more metabolic parameters in PCOS than TE-CAP or EATT. TE-CAP is useful for VAT screening in PCOS patients aged 18-39 years, whereas EATT is effective and outperforms CAP in those aged 30-39 years.

Obesity directly contributes to the progression of cardiovascular disease, but little is known about the association and risk attribution of normal-weight obesity subtypes with the incidence of major vascular events (MVEs) and their subtypes.

This is a prospective cohort study based on the China Kadoorie Biobank (CKB). A total of 308,071 individuals with no prior vascular diseases or cancer were included at baseline. The incidence of MVEs and their subtypes were recorded during follow-up. Adjusted hazard ratios (HRs) for each disease were yielded by Cox regression.

During a median follow-up of 10.3 years, 62,040 MVEs occurred, with the adjusted HRs (95 % confidence intervals) were 1.11 (1.09-1.13) for normal-weight general obesity (NWGO), 1.27 (1.23-1.31) for normal-weight central obesity (NWCO), and 1.30 (1.27-1.33) for normal-weight central and general obesity (NWCGO). For subtypes of MVEs, increased waist circumference (WC) was associated with excess risk of ischaemic heart disease (IHD) independent of body fat percent (BF%) levels (HR range: 1.30-1.69 in men; 1.36-1.55 in women), while the risk plateaued with rising BF% within each WC quartile. However, even in men with lower WC (≤78 cm [median]), the risks of cerebrovascular disease (CeVD), particularly ischaemic stroke (IS), were increased with higher BF% (all P < 0.01). Conversely, in women, independent dose-response associations were primarily observed between increasing WC and CeVD, with the highest risk observed for IS (HR 1.38, 1.31-1.47).

This study provided novel, sex-specific evidence that normal-weight obesity subtypes were associated with distinct risks of subtypes of MVEs, with elevated risks predominantly attributable to WC in women and both WC and BF% in men.

The worldwide prevalence of obesity is a key factor involved in the epidemic proportions reached by chronic societal diseases. A revolution in the study of obesity has been the development of imaging techniques for the measurement of its regional distribution. These imaging studies have consistently reported that individuals with an excess of visceral adipose tissue (VAT) were those characterized by the highest cardiometabolic risk. Excess VAT has also been found to be accompanied by ectopic fat deposition. It is proposed that subcutaneous versus visceral obesity can be considered as two extremes of a continuum of adiposity phenotypes with cardiometabolic risk ranging from low to high. The heterogeneity of obesity phenotypes represents a clinical challenge to the evaluation of cardiometabolic risk associated with a given body mass index (BMI). Simple tools can be used to better appreciate its heterogeneity. Measuring waist circumference is a relevant step to characterize fat distribution. Another important modulator of cardiometabolic risk is cardiorespiratory fitness. Individuals with a high level of cardiorespiratory fitness are characterized by a lower accumulation of VAT compared to those with poor fitness. Diet quality and level of physical activity are also key behaviors that substantially modulate cardiometabolic risk. It is proposed that it is no longer acceptable to assess the health risk of obesity using the BMI alone. In the context of personalized medicine, precision lifestyle medicine should be applied to the field of obesity, which should rather be referred to as 'obesities.'

(1) Background/Objectives: Cardiovascular diseases (CVD) are the leading cause of morbidity and mortality globally, necessitating effective risk prediction strategies. This study was aimed at developing and validating a multivariate predictive model integrating body composition and lipid profile to assess cardiovascular risk in an adult population. (2) Methods: A cross-sectional analysis of 90 participants from the general Spanish population was conducted. Participants were classified into cardiovascular risk groups (low, medium, high) based on systolic blood pressure. (3) Results: Descriptive and multinomial logistic regression analyses revealed significant associations between cardiovascular risk and specific parameters, such as visceral fat, glucose levels, and waist-to-hip ratio. Visceral adiposity emerged as a strong predictor of high cardiovascular risk, highlighting its critical role in cardiovascular health. Glucose levels were also significantly associated with increased risk, underscoring the importance of metabolic health in cardiovascular outcomes. Contrary to expectations, lipid markers like cholesterol and triglycerides did not show significant variations across risk categories, suggesting that traditional lipid profiles may not fully capture cardiovascular risk in the study group. Waist-to-hip ratio showed significant associations with cardiovascular risk transitions, particularly between low and medium risk, emphasizing the importance of fat distribution patterns. (4) Conclusions: These findings suggest that body composition, particularly visceral fat, is a crucial determinant of cardiovascular risk, necessitating more personalized risk assessment approaches that move beyond traditional lipid markers.

Adults living with overweight or obesity do not represent a single homogenous group in terms of mortality and disease risks. The aim of our study was to evaluate how the associations of adulthood overweight and obesity with mortality and incident disease are modified by (i.e., differ according to) self-reported childhood body weight categories.

The sample comprised 191,181 men and 242,806 women aged 40-69 years (in 2006-2010) in the UK Biobank. The outcomes were all-cause mortality, incident cardiovascular disease (CVD), and incident obesity-related cancer. Cox proportional hazards regression models were used to estimate how the associations with the outcomes of adulthood weight status (normal weight, overweight, obesity) differed according to perceived body weight at age 10 years (about average, thinner, plumper). To triangulate results using an approach that better accounts for confounding, analyses were repeated using previously developed and validated polygenic risk scores (PRSs) for childhood body weight and adulthood BMI, categorised into three-tier variables using the same proportions as in the observational variables.

In both sexes, adulthood obesity was associated with higher hazards of all outcomes. However, the associations of obesity with all-cause mortality and incident CVD were stronger in adults who reported being thinner at 10 years. For example, obesity was associated with a 1.28 (1.21, 1.35) times higher hazard of all-cause mortality in men who reported being an average weight child, but among men who reported being a thinner child this estimate was 1.63 (1.53, 1.75). The ratio between these two estimates was 1.28 (1.17, 1.40). There was also some evidence that the associations of obesity with all-cause mortality and incident CVD were stronger in adults who reported being plumper at 10 years. In genetic analyses, however, there was no evidence that the association of obesity (according to the adult PRS) with mortality or incident CVD differed according to childhood body size (according to the child PRS). For incident obesity-related cancer, the evidence for effect modification was limited and inconsistent between the observational and genetic analyses.

Greater risks for all-cause mortality and incident CVD in adults with obesity who perceive themselves to have been a thinner or plumper than average child may be due to confounding and/or recall bias.

The essential cause of menopause is ovarian failure, which can cause decline in sex hormones (especially estrogen) that can increase the risk of metabolic diseases, such as cardiovascular disease and osteoporosis. This study screened 1511 eligible patients from 2148 perimenopausal and postmenopausal women, measuring various physiological and biochemical indicators to analyze differences among age groups (40-44, 45-49, and 50-54 years) with laboratory techniques. The study found no significant difference in the incidence of cardiovascular disease betweenperimenopausal and postmenopausal women. But the incidence of osteoporosis was higher in postmenopausal women and was associated with age (p < 0.05). Additionally, follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), total cholesterol (TC), lumbar spine bone mineral density (BMD) (T1), right femoral BMD (T2) and femoral neck BMD were significantly correlated in both groups. Significant differences were observed in FSH, LH, E2, TC, low-density lipoprotein (LDL), L2-L4, T1, femoral neck reduction and T2 among women in different age groups. Correlation analysis indicated that age increased the risk of cardiovascular disease and osteoporosis in bothperimenopausal and postmenopausal women. This study contributes to a deeper understanding of the pathogenesis of cardiovascular disease and osteoporosis in perimenopausal and menopausal women.