Pericardial Adipose Tissue, Atherosclerosis, and Cardiovascular Disease Risk Factors: The Jackson Heart Study Comment on Liu et al.

We read the article by Liu et al. (1) with great interest. The investigators carefully stated that because it is difficult to distinguish pericardial from epicardial fat with computed tomography (CT), they measured pericardial adipose tissue by the combination of pericardial fat and epicardial fat. While they recognized this important misclassification, we also noted that they not only technically but conceptually discussed pericardial and epicardial fat as identical to adipose tissue. This appears to be incorrect and misleading. Epicardial and pericardial adipose tissue are clearly different anatomically, embriologically, physiologically, biomolecularly, and clinically (2,3). Epicardial adipose tissue is the fat located between

LDL receptor expression on T lymphocytes in old patients with Down syndrome

BACKGROUND: In Down syndrome patients several metabolic abnormalities have been reported, some involving the lipid metabolism. The level of LDL in plasma is the major determinant of the risk of vascular disease. There appear to be no studies on the LDL receptor in Down syndrome patients. METHODS: Flow cytometric methods for measuring the LDL receptor in peripheral blood mononuclear cells (PBMC) can identify patients with hypercholesterolemia. We applied this method in 19 old patients with Down syndrome and 23 healthy controls. RESULTS: Down syndrome patients had high levels of triglycerides and low levels of HDL, and high levels of CRP. We also found a down-regulation of LDL receptor expression. CONCLUSIONS: Down syndrome patients show no increase in the frequency of cardiovascular disease. The low incidence in cardiovascular disease despite the low level of HDL, high levels of CRP and reduction of LDL receptor expression lead to the conclusion that either these are not risk factors in these patients or that other risks factors – not yet identified – are considerably lower

Awareness and knowledge about weight status and management: results from the 1 d sensitization campaign 'Obesity Day' in northern Italy.

AbstractObjectiveTo evaluate the awareness and knowledge about weight status and its management.DesignA 1 d cross-sectional survey. Basic anthropometric assessments (weight, height, BMI and waist circumference) and a self-administered questionnaire were considered.SettingNineteen Clinical Nutrition or Endocrinology and Metabolic Disorders Units or Dietetics Services in the Italian region of Lombardy.SubjectsAll adults attending the 'Obesity Day' initiative.ResultsA total of 914 participants (605 female and 309 male) were recruited. Although most of the participants (83·5 %) considered obesity to be a disease, 38·5 % were likely to misperceive their weight status. In particular, 38·8 % of normal-weight adults believed themselves to be overweight, whereas 71·1 % and 37·5 % of classes I and II/III obese adults classified themselves as being overweight and mildly obese, respectively. However, most of the overweight (90·2 %), mildly (96·8 %) and moderately/severely obese adults (99·1 %) recognized the need to lose weight. In all, 37·8 % of the sample underestimated the role of physical activity in weight management. Interestingly, only 17·2 % of dieters (previous or current) declared being advised by their doctor to lose weight. Multivariate models revealed that higher age, low education and higher BMI were important determinants of poor weight control and management. In addition, previous dieting appeared not to provide better knowledge, whereas the role of physical activity was recognized mainly by those practising it.ConclusionsThe present study suggests that in Italy knowledge about weight management should be improved not only in the general population but also among health-care professionals. To confirm this finding, there is now the rationale for a nationally representative survey. New educational programmes can be designed on the basis of the information collected

Amino acids contribute to adaptive thermogenesis. New insights into the mechanisms of action of recent drugs for metabolic disorders are emerging

Adaptive thermogenesis is the heat production by muscle contractions (shivering thermogenesis) or brown adipose tissue (BAT) and beige fat (non-shivering thermogenesis) in response to external stimuli, including cold exposure. BAT and beige fat communicate with peripheral organs and the brain through a variegate secretory and absorption processes − controlling adipokines, microRNAs, extracellular vesicles, and metabolites − and have received much attention as potential therapeutic targets for managing obesity-related disorders. The sympathetic nervous system and norepinephrine-releasing adipose tissue macrophages (ATM) activate uncoupling protein 1 (UCP1), expressed explicitly in brown and beige adipocytes, dissolving the electrochemical gradient and uncoupling tricarboxylic acid cycle and the electron transport chain from ATP production. Mounting evidence has attracted attention to the multiple effects of dietary and endogenously synthesised amino acids in BAT thermogenesis and metabolic phenotype in animals and humans. However, the mechanisms implicated in these processes have yet to be conclusively characterized. In the present review article, we aim to define the principal investigation areas in this context, including intestinal microbiota constitution, adipose autophagy modulation, and secretome and metabolic fluxes control, which lead to increased brown/beige thermogenesis. Finally, also based on our recent epicardial adipose tissue results, we summarise the evidence supporting the notion that the new dual and triple agonists of glucagon-like peptide-1 (GLP-1), glucose-dependent insulinotropic polypeptide (GIP), and glucagon (GCG) receptor − with never before seen weight loss and insulin-sensitizing efficacy − promote thermogenic-like amino acid profiles in BAT with robust heat production and likely trigger sympathetic activation and adaptive thermogenesis by controlling amino acid metabolism and ATM expansion in BAT and beige fat

Natural zeolites chabazite/phillipsite/analcime increase blood levels of antioxidant enzymes

Imbalance between reactive oxygen species generation and antioxidant capacity induces a condition known as oxidative stress which is implicated in numerous pathological processes. In this study we evaluated whether natural zeolites chabazite/phillipsite/analcime may affect the levels of different antioxidant enzymes (gluthatione peroxidase, superoxide dismutase, gluthatione reductase), total antioxidant status and oxidative stress in 25 clinically healthy men, both non-smokers and smokers. Measurements were performed on whole blood or on plasma samples before (T0) and after 4-weeks zeolites intake (T1). At T1, gluthatione peroxidase, superoxide dismutase and gluthatione reductase increased compared to T0 levels, both considering all subjects as joint and after subdivision in non-smokers and smokers. Differently, a reduction in total antioxidant status was observed at T1. Anyway, total antioxidant status resulted higher than the reference values in both groups at each time point. A decrease in lipid peroxidation, a major indicator of oxidative stress assessed by monitoring thiobarbituric acid reactive substances, was also observed in all subjects at T1. Our results suggested that chabazite/phillipsite/analcime may help to counteract oxidative stress in apparently healthy subjects exposed to different oxidative stress risk factors, such as smoking, thus representing a particular kind of food with potential antioxidant properties

Increased visceral adipose tissue rather than BMI as a risk factor for dementia

In addition to the association between overweight/obesity and cardiovascular disorders, with the presence of a vascular burden as a cofactor, recent studies have particularly focused on the association between indicators of adiposity and dementia. Particularly, renewed predictive value has been addressed to body mass index (BMI). A high BMI can increase the risk for dementia when measured before clinical dementia onset. Although the use of BMI in population-based and clinical studies is feasible, this is an index of weight excess and shows limits in its ability to distinguish between fat and fat-free mass or between deep (visceral) abdominal fat and subcutaneous abdominal fat. In this scenario, we suggest that visceral adipose tissue (VAT) rather than BMI should be considered as a concurrent factor in the development of dementia. Several physiopathologic theories (neurochemical, hormonal, atherosclerotic and inflammatory) have been proposed to explain the decline of cognitive functions. Along with this, well known cardiovascular risk factors (dyslipidaernia, insulin resistance, blood pressure, adipocytokine/chemokines, atherosclerosis) contributing to the development of cognitive decline seem more strongly related to body fat distribution, particularly visceral adipose tissue (VAT), rather than to BMI. With this regard, VAT may be reasonably considered to play a predominant role

Relationship between soluble receptor for advanced glycation end products (sRAGE), body composition and fat distribution in healthy women

Purpose: Soluble receptor for advanced glycation end products (sRAGE) is a decoy receptor which sequesters RAGE ligands and acts as a cytoprotective agent. To date, it is unclear whether the lower sRAGE levels observed in obesity are a marker of increased overall adiposity or reflect increases in particular fat depots. Therefore, we evaluated in healthy women the relationship among sRAGE and indicators of adiposity, including abdominal visceral (VAT) and epicardial visceral (EAT) adipose tissues, to explore the potential role of sRAGE as an earlier biomarker of cardiometabolic risk. Methods: Plasma sRAGE levels were quantified by an enzyme-linked immunosorbent assay in 47 healthy women. Total fat mass (FM) and fat-free mass were estimated with bioimpedance analysis. Anthropometric measures and biochemical data were recorded. Subcutaneous adipose tissue, VAT and EAT volumes were measured by magnetic resonance imaging. Results: Obese women had lower sRAGE levels compared to normal-weight women. sRAGE levels were also lower in women with a waist circumference (WC) larger than 80 cm. Correlation analyses indicated an inverse association of sRAGE with body mass index and FM. Concerning adipose tissue distribution, sRAGE inversely correlated with WC, EAT and VAT depots. In a multiple stepwise regression analysis, performed to emphasize the role of fat distribution, EAT volume was the only predictor of sRAGE. Conclusions: Lower sRAGE levels reflect accumulation of visceral fat mainly at the epicardial level and are present in advance of metabolic complications in adult women. sRAGE quantification might be an early marker of cardiometabolic risk

Regulated on activation, normal-T cell expressed and secreted (RANTES/CCL5) levels: an association with epicardial visceral fat thickness

Introduction: Epicardial adipose tissue (EAT), accumulated around the heart, is considered an index of visceral adiposity and a promising indicator of high cardio-metabolic risk. Evidences showing that EAT is a metabolically active organ and a source of inflammatory adipo-chemocytokines suggest a condition of chronic inflammation in this small cardiac fat depot. However, the potential links between cardiac adiposity and circulating levels of inflammatory adipo-chemokines, as markers of subclinical inflammation, are not completely understood. Our aim is to evaluate whether cardiac adiposity, measured as EAT thickness, is related to Regulated on activation, Normal T Cell Expressed and Secreted (RANTES/CCL5) levels, in obese patients. Methods: EAT thickness (meauserd by echocardiography, on the free wall of right ventricle), RANTES/CCL5 and other inflammatory markers (by ELISA kit) were measured in 36 women with uncomplicated obesity (OB) (BMI 41.6\ub15.6 kg/m2) and 15 normal-weight controls. Abdominal visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) were assessed by computed tomography (CT). Results: OB patients had thicker EAT (6.8\ub10.9 vs. 1.3\ub10.3 mm, p<0.0001) (Fig.1) and higher RANTES/CCL5 levels (2468.9\ub1745.5 vs. 1272.1\ub1413.7 pg/ml, p<0.03) than controls (Fig. 2). The EAT thickness positively correlated with RANTES/CCL5 concentrations (r2=0.65, p<0.001) (Fig.3). Moreover, EAT thickness and RANTES/CCL5 concentration were directly correlated with indices of fat distribution (VAT, VAT/SAT and waist, p<0.001 for all). Notably, when using multiple regression analysis, RANTES/CCL5 levels most closely correlated with EAT thickness (t=3.93) and VAT areas (t=3.77), while other indices of fat distribution did not enter the model. Conclusions: EAT thickness, an indicator of cardiac adiposity, may be related to inflammatory adipo-chemokines in visceral-obese patients and might be used as a reliable marker of visceral adiposity. The elevated RANTES/CCL5 levels, contributing to the pro-inflammatory state, may also lead to cardio-metabolic disorders