Yurdaer Sermez

Correlation of abdominal fat accumulation and liver steatosis: importance of ultrasonographic and anthropometric measurements

PURPOSE This study has two objectives: (1) using ultrasound (US) as a tool for measuring subcutaneous (S) and intra-abdominal; preperitoneal (P) and visceral (V) fat thickness. (2) Assessing the relationship between selected anthropometrical variables and US-measured S, P and V fat also evaluating the contribution of abdominal fat accumulation in development of liver steatosis. METHODS AND MATERIALS Sixty-eight obese patients (aged 43.9+/-9.3 years) and 40 non-obese subjects (aged 34.03+/-9.0 years) were recruited to this study. Height, weight (W), waist (WC) and hip circumferences were measured. Body mass index (BMI) and waist to hip ratio (WHR) were calculated. A linear-array probe (7.5 MHz) was used to measure S and P. A convex-array probe (3.5 MHz) was used for measuring V and assessing liver fatty infiltration. RESULTS In 45 (66%) patients, there were diffuse liver fatty changes. Liver steatosis showed significant correlation with V (r=0.57), P (r=0.38) and S (r=0.37). It also correlated with W (r=0.52), BMI (r=0.6), WC (r=0.45) (P<0.0001). V positively correlated with BMI (r=0.62), W (r=0.55), WC (r=0.52) and WHR (r=0.33). P correlated with WC (r=0.29), WHR (r=0.36) and W (r=0.34), but not with BMI, height and age. A significant correlation was found between S and BMI (r=0.73), W (r=0.65), and WC (r=0.57) (P<0.0001). CONCLUSION Obese patients showed thicker S, P, and V. Liver steatosis correlates significantly with both anthropometrical data; BMI, WHR, WC, and W, and with abdominal V, P, and S fat. V fat can be used as a good predictor for the possibility of different metabolic disorders and liver disturbances as steastosis.

The effects of aerobic and resistance exercises in obese women

Objective: To compare the effects of aerobic and resistance exercise on weight, muscle strength, cardiovascular fitness, blood pressure and mood in obese women who were not on an energy-restricted diet. Design: Randomized, prospective, controlled trial. Setting: Department of Physical Medicine and Rehabilitation, University Hospital. Subjects: Sixty obese women were assigned to one of three groups: aerobic exercise (n=20), resistance exercise (n=20) and control group (n=20). Interventions: The aerobic exercise group performed both walking and leg cycle exercise with increasing duration and frequency. The resistance exercise group performed progressive weight-resistance exercises for the upper and lower body. Main outcome measures: Before and after a 12-week period, all subjects were evaluated by anthropometric measurement, rating of mood, cardiorespiratory capacity and maximum strength of trained muscles. Results: After a 12-week training period, subjects in the resistance group showed significant improvement in one-repetition maximum test of hip abductors (7.95±3.58 kg), quadriceps (14±7.18 kg), biceps (3.37± 2.84 kg) and pectorals (8.75±5.09 kg) compared with those in the control group (P<0.001). VO2 max increased (0.51±0.40) and Beck Depression Scale scores decreased (-5.40±4.27) in the aerobic exercise group compared with the control group, significantly (P<0.001). Only in hip abductor muscle strength was there a significant increase in the resistance exercise group compared with the aerobic exercise group (P <0.05). Conclusion: Both aerobic exercise and resistance exercise resulted in improved performance and exercise capacity in obese women. While aerobic exercise appeared to be beneficial with regard to improving depressive symptoms and maximum oxygen consumption, resistance exercise was beneficial in increasing muscle strength.

Relationship of serum interleukin-6 and tumor necrosis factor α levels with abdominal fat distribution evaluated by ultrasonography in overweight or obese postmenopausal women

Background The objective of this study was to measure associations of circulating interleukin-6 (IL-6) and tumor necrosis factor α (TNF-α) levels with anthropometric and abdominal fat distribution in overweight or obese postmenopausal women. Methods One hundred eight overweight or obese postmenopausal were evaluated. Demographic and anthropometric measurements were done. Serum IL-6, TNF-α, glucose, and insulin levels were measured. Insulin resistance was calculated by using homeostasis model assessment-insulin resistance (HOMA-IR). The assessment of abdominal fat distribution was performed by ultrasonography. Statistical analysis was made with Pearson and partial correlation analysis. Results There was a positive correlation between serum IL-6 and TNF-α (r = .19; p = .047). IL-6 was positively correlated with body mass index (BMI) (r = .43; p = .0001), waist circumference (r = .41; p = .0001), and visceral fat layer (r = .33; p = .0001) measurements and HOMA-IR index (r = .31, p = .001). A positive relationship between HOMA-IR and visceral fat layer thickness was observed (r = .320; p = .0001). TNF-α was positively associated with BMI but not with any measures of central obesity. When adjustment for BMI was performed, there were no significant relationships between the studied parameters. Conclusions There are no significant correlations between abdominal fat distributions measured by ultrasonography and circulating IL-6 and TNF-α levels. BMI may have a stronger association with circulating inflammatory cytokine concentrations than with different measures of central obesity in overweight or obese postmenopausal women.

Determination of risk factors for hypertension through the classification tree method

Most current statistical strategies for determining risk factors for hypertension (HT) among certain populations have proved inconclusive. In this study, the classification tree method, which is more practical and easy to understand than other statistical methods, was used to determine the risk for HT among outpatients in a clinic in Denizli province, western Turkey, between January 2002 and July 2004. The effects of 14 risk factors (body mass index, waist-to-hip ratio, age, serum total cholesterol, serum triglycerides, sex, HT in first-degree relatives, diabetes mellitus, smoking, stress factors, alcohol consumption, dyslipidemia in first-degree relatives, dyslipidemia [previously diagnosed], and saturated fat consumption) on HT were evaluated in this population. In all, 1761 adults at the outpatient clinic were recruited for lipid and HT measurements. The classification tree method revealed 7 main risk factors (body mass index, waist-to-hip ratio, sex, serum triglycerides, serum total cholesterol, HT in first-degree relatives, and saturated fat consumption) for HT. The findings of the present study suggest that the classification tree is a valuable statistical method for evaluating multiple risk factors for HT.

Lower motor neuron disease associated with myelofibrosis

We present a patient who has signs pointing to the involvement of lower motor neurons and myelofibrosis. To our knowledge, unlike lymphoproliferative disorders, co-occurrence of myelofibrosis and lower motor neuron disease (MND) has not been reported so far. A 64-year-old male patient was admitted to our hospital with the complaint of painful cramps in his neck and forearms. On physical examination marked hepatomegaly and splenomegaly were found. On neurologic examination nasal quality of the voice and slight palatal weakness were detected. There were generalised slight weakness and atrophy in both proximal and distal muscle groups. Fasciculations were observed especially in forearm muscles and it was observed that he had been avoiding head movements because of painful muscle cramps. Deep tendon reflexes were hypoactive. Nerve conduction studies were normal. By needle electromyography, giant motor unit action potentials (amplitudes up to 8 mV), fibrillation potentials, positive sharp waves and fasciculation potentials were detected in all muscles which were investigated. A hypercellular bone marrow (100%) was determined by bone marrow biopsy. In addition to increased production of the myeloid and megakaryocytic lines, abnormal aggregation and grouping of megakaryocytes were seen. Reticular fibers were increased. He had some benefit of dyphenilhydantoin treatment given for the painful cramps in his neck and forearm muscles. Hydroxyurea treatment was started for myelofibrosis. Six months later, his general condition was better, and the painful cramps were completely resolved. No marked deterioration has been detected in neurologic examination and electromyography for 1 year.