Laila Vignati

Relationship between thyroid hormones, resting energy expenditure and cardiometabolic risk factors in euthyroid subjects

BACKGROUND & AIMS Whereas hypothyroid subjects have a decreased resting energy expenditure (REE), it is unknown whether REE is associated with TSH in euthyroid subjects. It is also uncertain whether there is an association between cardiometabolic risk factors and TSH among euthyroid subjects. The primary aim was to test whether REE and TSH are associated in euthyroid subjects. The second aim was to evaluate the association between TSH and cholesterol, HDL-cholesterol, triglycerides, glucose and blood pressure. METHODS 885 Caucasian euthyroid subjects (75% women) aged 18-79 years and with a median body mass index of 28.6 kg/m(2) were consecutively studied at our Research Center. REE was measured using a canopy-equipped indirect calorimeter. Multivariable regression of 25(th), 50(th) and 75(th) percentiles was used to evaluate the association between the outcomes (REE, cholesterol, HDL-cholesterol, triglycerides, glucose and blood pressure) and the predictors (TSH, FT4 and FT3) controlling by gender, age and body mass index. RESULTS REE was not associated with TSH, FT4 and FT3 at any percentile. On the contrary, a positive association between TSH and triglycerides was evident at all percentiles. A positive association between FT3 and HDL-cholesterol was also present but only at the 75(th) percentile. CONCLUSIONS REE is not associated with TSH in euthyroid subjects. It is however positively associated with triglycerides confirming the findings of recent population studies.

Taste sensitivity, nutritional status and metabolic syndrome: Implication in weight loss dietary interventions

AIM We investigated the relationship between taste sensitivity, nutritional status and metabolic syndrome and possible implications on weight loss dietary program. METHODS Sensitivity for bitter, sweet, salty and sour tastes was assessed by the three-Alternative-Forced-Choice method in 41 overweight (OW), 52 obese (OB) patients and 56 normal-weight matched controls. OW and OB were assessed also for body composition (by impedence), resting energy expenditure (by indirect calorimetry) and presence of metabolic syndrome (MetS) and were prescribed a weight loss diet. Compliance to the weight loss dietary program was defined as adherence to control visits and weight loss ≥ 5% in 3 mo. RESULTS Sex and age-adjusted multiple regression models revealed a significant association between body mass index (BMI) and both sour taste (P < 0.05) and global taste acuity score (GTAS) (P < 0.05), with lower sensitivity with increasing BMI. This trend in sensitivity for sour taste was also confirmed by the model refitted on the OW/OB group while the association with GTAS was marginally significant (P = 0.06). MetS+ subjects presented higher thresholds for salty taste when compared to MetS- patients while no significant difference was detected for the other tastes and GTAS. As assessed by multiple regression model, the association between salty taste and MetS appeared to be independent of sex, age and BMI. Patients continuing the program (n = 37) did not show any difference in baseline taste sensitivity when compared to drop-outs (n = 29). Similarly, no significant difference was detected between patients reporting and not reporting a weight loss ≥ 5% of the initial body weight. No significant difference in taste sensitivity was detected even after dividing patients on the basis of nutritional (OW and OB) or metabolic status (MetS+ and MetS-). CONCLUSION There is no cause-effect relationship between overweight and metabolic derangements. Taste thresholds assessment is not useful in predicting the outcome of a diet-induced weight loss program.

Adherence to the Mediterranean diet is inversely associated with visceral abdominal tissue in Caucasian subjects

BACKGROUND & aim: Adherence to the Mediterranean dietary pattern (MDP) is inversely related with abdominal adiposity as detected by waist circumference but the specific association to subcutaneous and visceral abdominal tissue has not been investigated. To this purpose we evaluated the association between MDP, visceral (VAT) and subcutaneous (SAT) abdominal tissue in a large sample of Italian adults. METHODS A cross-sectional study was carried out on 4388 consecutive adults (73.2% women) followed as outpatients at Nutritional Research Centre in Milan, ICANS. VAT and SAT were measured by ultrasonography. MDP was evaluated using a Mediterranean dietary score (MEDscore) obtained from a validated 14-item questionnaire. RESULTS At multiple linear regression adjusted for sex, age, smoking and physical activity, a 1-unit increase in MEDscore was associated with a -0.118 kg/m(2) decrease in BMI (p < 0.01), a -0.292 cm decrease in waist circumference (p < 0.01), a -0.002 cm:cm decrease in waist to height ratio (p < 0.001), a -1.125 mm decrease in the sum of 4 skinfolds (p < 0.001), and with a -0.045 cm decrease in VAT (p < 0.05). MEDscore was, however, not associated with SAT. Finally, the adherence to the MDP was a protective factor for obesity (OR = 0.717, 95%CI: 0.555-0.922) and VAT excess (OR = 0.717, 95%CI: 0.530-0.971). CONCLUSION Our study confirms the inverse association between MDP, BMI and waist circumference and adds that the association with abdominal obesity as detected by waist circumference is due to an association with VAT and not with SAT.

Association of Body Shape Index (ABSI) with cardio-metabolic risk factors: A cross-sectional study of 6081 Caucasian adults

A Body Shape Index (ABSI) was specifically developed as a transformation of waist circumference (WC), statistically independent of BMI to better evaluate the relative contribution of WC to central obesity and clinical outcomes. Previous studies have found ABSI is associated with total mortality and cardiovascular events. However, no study has specifically evaluated the joint contribution of ABSI and BMI to cardio-metabolic outcomes (high triglycerides, low HDL, high fasting glucose and high blood pressure). With this aim, we performed a retrospective study on 6081 Caucasian adults. Subjects underwent a medical interview, anthropometric measurements, blood sampling, measurement of blood pressure, and measurement of visceral abdominal fat thickness (VAT) by ultrasound. Generalized linear models (GLM) were used to evaluate the sex and age adjusted association of ABSI with binary and continuous cardio-metabolic risk factors. Four pre-specified GLM were evaluated for each outcome: M1 = ABSI, BMI and ABSI*BMI interaction, M2 = ABSI and BMI, M3 = ABSI alone and M4 = BMI alone. Bayesian Information Criterion (BIC) was calculated and used to identify the best predictive model. ABSI and BMI contributed independently to all outcomes. Compared to BMI alone, the joint use of BMI and ABSI yielded significantly improved associations for having high triglycerides (BIC = 5261 vs. 5286), low HDL (BIC = 5371 vs. 5381), high fasting glucose (BIC = 6328 vs. 6337) but not high blood pressure (BIC = 6580 vs. 6580). The joint use of BMI and ABSI was also more strongly associated with VAT than BMI alone (BIC = 22930 vs. 23479). In conclusion, ABSI is a useful index for evaluating the independent contribution of WC, in addition to that of BMI, as a surrogate for central obesity on cardio-metabolic risk.

Association of Binge Eating Behavior with Total and Abdominal Adipose Tissue in a Large Sample of Participants Starting a Weight Loss or Maintenance Program

ABSTRACT Objective: It is not clear whether binge eating (BE) behavior is associated with body composition independently of body mass index (BMI). Our aim has been to evaluate the BMI-independent contribution of BE severity and BE status on the total amount of fat mass and abdominal fat distribution in a large sample of participants. Method: We performed a cross-sectional study among 8524 participants followed at a nutritional center. BMI and waist circumference (WC) were measured, body fat (BF) was estimated by skinfold measurement, and abdominal visceral (VAT) and subcutaneous (SAT) adipose tissues were measured by ultrasonography. BE was assessed using the Binge Eating Scale (BES). The association between the continuous BES score (BE severity) and adiposity was assessed in the whole sample after adjustment for BMI and other confounders. The effect of BE status on adiposity was also assessed by matching binge eaters (BES ≥ 18), for sex, age, and BMI, with non-binge eaters (BES < 18). Results: We found that 17.7% of the participants were binge eaters. Continuous BES score was associated with increasing WC (0.03 cm, 95% confidence interval [CI], 0.02 to 0.05 every 1 BES unit, p < 0.001) and decreasing BF (0.01%, 95% CI, −0.02 to −0.00 every 1 BES unit, p = 0.003). No association was found between BE severity and VAT and SAT. After matching, the BF of binge eaters was 0.29% (95% CI, −0.50 to −0.07, p = 0.01) lower than that of non-binge eaters. Conclusions: Given the very small effect size, BE severity and status are not associated in a biologically meaningful manner with BF content and distribution.

Abdominal Subcutaneous and Visceral Adipose Thickness Are Independently Associated with Insulin Resistance

1-OR Gene Expression Changes during the Progression of Diabetic Neuropathy in a Murine Model of Type 2 Diabetes MEEYOUNG PARK, LUCY M. HINDER, BEN MURDOCK, DIANE BENDER, PHILLIPE O’BRIEN, EVA L. FELDMAN, Ann Arbor, MI, St. Louis, MO Diabetic neuropathy (DN) is the most common complication in type 2 diabetes (T2D), affecting up to 50% of diabetic patients. Analysis of microarray and RNA-Seq data has identifi ed genes and pathways associated with DN in murine models; however, these previous transcriptome studies only examined specifi c time-points and longitudinal studies of DN pro gression are lacking. In the current study, we examined genes and path ways related to DN progression over time in dorsal root ganglia (DRG) and sciatic nerve (SCN) of C57BKS db/db mice, a well-characterized murine model of T2D. Peripheral nerve function was assessed at 8 (early neuropathy), 16 (intermediate neuropathy), and 24 (late neuropathy) weeks of age in control db/+ and diabetic db/db mice, and microarray data from each cohort were used to examine gene expression changes throughout the course of DN. Self-Organizing Maps (SOM), an unbiased clustering method, was used to identify genes demonstrating expression changes that coincided with DN progression in DRG and SCN. Functional and pathway enrichment analyses were performed for gene sets with patterns of interest. Results demonstrated that diabetic mice exhibit robust and progressive neuropathy compared to db/+ mice, with signifi cant changes in hindpaw withdrawal latency, intraepidermal nerve fi ber density, and sciatic motor nerve conduction velocity. SOM analysis identifi ed clusters of genes showing expression patterns correlated with the severity of neuropathy, with increasing or decreasing fold-changes as DN progressed. Specifi cally, the genes IL-2, IL-13, IL-17a, and Csf2 were enriched in infl ammation-associated pathways at 8 weeks in DRG and at 24 weeks in SCN. In addition, there was a 2-fold change in expression of genes enriched in cell death at 24 weeks in DRG and SCN. Together, these analyses identifi ed gene and pathway signatures that may play an important role in DN progression in T2D, and suggest potential pharmaceutical targets to prevent DN development. Supported By: American Diabetes Association (1-16-PDF-084 to M.P.); Novo Nordisk Inc.A key United Kingdom policy initiative in the management of diabetes is empowerment through structured education. Nonetheless, motivating attendance in Diabetes Education Centres remain problematic. The central aim of this study was to identify barriers and enabling factors associated with uptake of structured patient education for type 2 diabetes in a Primary Care Trust in South East of England. This three tier mixed methods study used a focus group interview to collect data from (n=10) diabetes educators (Dieticians, podiatrists and diabetes specialist nurses), questionnaire survey of 207 patients (102 attenders and 105 non-attenders), and finally individual face-to-face interviews (n=9) of referring practitioners (practice nurses) in different General Practitioners surgeries. The findings of the qualitative data yielded five key themes: healthcare beliefs, personal circumstances of the patient, ineffective communication, organisation of care and bureaucratic processes. The Chi-square tests run on the quantitative data relating to the health beliefs held by both groups suggested differences between attenders and non-attenders attitudes towards the uptake of Diabetes Education Programmes. Independent T-test, t (165.69) = 12.43, p < .001 results indicated that attenders in this study reported a more positive belief about self-care, importance of the diabetes education session and belief about the seriousness of diabetes as a medical condition in comparison to non-attenders. Logistic regression analysis of key demographic variables on attendance suggested that living arrangements (p < .001), employment (p < .001) and family history of diabetes (p = .05) can be used to predict non-attendance and the odd ratios also supported these findings. Whilst, it may be difficult to completely avoid non-attendance, positive steps to promote attendance include enhanced communication, organisational efficiency and offering adequate support to develop a positive attitude towards diabetes education.

Association between ratio indexes of body composition phenotypes and metabolic risk in Italian adults

The ratio between fat mass (FM) and fat‐free mass (FFM) has been used to discriminate individual differences in body composition and improve prediction of metabolic risk. Here, we evaluated whether the use of a visceral adipose tissue‐to‐fat‐free mass index (VAT:FFMI) ratio was a better predictor of metabolic risk than a fat mass index to fat‐free mass index (FMI:FFMI) ratio. This is a cross‐sectional study including 3441 adult participants (age range 18–81; men/women: 977/2464). FM and FFM were measured by bioelectrical impedance analysis and VAT by ultrasonography. A continuous metabolic risk Z score and harmonised international criteria were used to define cumulative metabolic risk and metabolic syndrome (MetS), respectively. Multivariate logistic and linear regression models were used to test associations between body composition indexes and metabolic risk. In unadjusted models, VAT:FFMI was a better predictor of MetS (OR 8.03, 95%CI 6.69–9.65) compared to FMI:FFMI (OR 2.91, 95%CI 2.45–3.46). However, the strength of association of VAT:FFMI and FMI:FFMI became comparable when models were adjusted for age, gender, clinical and sociodemographic factors (OR 4.06, 95%CI 3.31–4.97; OR 4.25, 95%CI 3.42–5.27, respectively). A similar pattern was observed for the association of the two indexes with the metabolic risk Z score (VAT:FFMI: unadjusted b = 0.69 ± 0.03, adjusted b = 0.36 ± 0.03; FMI:FFMI: unadjusted b = 0.28 ± 0.028, adjusted b = 0.38 ± 0.02). Our results suggest that there is no real advantage in using either VAT:FFMI or FMI:FFMI ratios as a predictor of metabolic risk in adults. However, these results warrant confirmation in longitudinal studies.