DOI: https://doi.org/10.22263/2312-4156.2017.1.71
Bondarenko V.M., Pimanov S.I., Makarenko E.V.
Ultrasound diagnosing of visceral adiposity
Vitebsk State Order of Peoples’ Friendship Medical University, Vitebsk, Republic of Belarus
Vestnik VGMU. 2017;16(1):71-79.
Abstract.
Objectives. To assess the limit values of ultrasound parameters of the visceral adipose tissue amount of various localization in patients with metabolic syndrome and in healthy individuals.
Material and methods. To implement the set goal 145 people (100 men and 45 women) aged from 17 to 63 years were examined, the average age of the patients was (M±r) 44,12±12,26 years. 94 surveyed persons out of 145 had metabolic syndrome, including 70 males and 24 females. The determination of visceral adipose tissue was performed by ultrasound using a number of conventional techniques and some of their modifications. The amount of intra-abdominal visceral adipose tissue (VAT) was evaluated by means of three methods: VAT-1 – measured as the distance between the inner surface of the rectus abdominis muscle and the anterior wall of the aorta, VAT-2 – measured as the distance between the inner surface of the rectus abdominis muscle and the posterior wall of the aorta and VAT-3 – measured as the distance between the inner surface of the rectus abdominis muscle and the front surface of the vertebra L4. Perirenal adipose tissue was measured with the use of two methods. We measured the thickness of the adipose tissue, consisting of para- and perinephric fat and the bottom surface area of perinephric (perirenal) visceral fat. The amount of pericardial and epicardial adipose tissue was also measured.
To determine the optimal (sensitivity and specificity ratio) value of a cut-off point, i.e. the cut-off threshold «norm-pathology» for the ultrasound parameters of visceral adipose tissue the ROC-analysis using MedCalc software was made (firm «MedCalc Software», Belgium).
Results. The following limit values for patients with metabolic syndrome have been established: for VAT-1 – more than 54,00 mm, for VAT-2 – more than 64,00 mm; for VAT-3 – more than 64,00 mm; for the thickness of para- and perinephric fat – more than 28,65 mm; for perirenal bottom fat surface area on the right side – more than 19,61 cm2; for perirenal bottom fat surface area on the left side – more than 14,11 cm2; for epicardial VAT – more than 3,13 mm and for pericardial VAT – more than 4,08 mm.
Conclusions. Ultrasound investigation allows to determine the limit values of the visceral adipose tissue amount of different localization in patients with metabolic syndrome. Ultrasound evaluation of visceral fat depots is a good alternative to more complex and expensive visual methods.
Key words: visceral adipose tissue, ultrasound investigation, metabolic syndrome.
References
1. Goyal A, Nimmakayala KR, Zonszein J. Is There a Paradox in Obesity? Cardiol Rev. 2014 Jul-Aug;22(4):163-70. doi: http://dx.doi.org/10.1097/CRD.0000000000000004.
2. Cornier MA, Després JP, Davis N, Grossniklaus DA, Klein S, Lamarche B, et al. Assessing Adiposity: A Scientific Statement From the American Heart Association. Circulation. 2011 Nov;124(18):1996-2019. doi: http://dx.doi.org/10.1161/CIR.0b013e318233bc6a
3. Haslam DW, James WP. Obesity. Lancet. 2005 Oct;366(9492):1197-209. doi: http://dx.doi.org/10.1016/S0140-6736
4. M-vo Zdravookhraneniia Ros Federatsii. References on maintaining patients with a metabolic syndrome: klin rek. Moscow, RF; 2013. 43 р. (In Russ.)
5. Karelis AD, Brochu M, Rabasa-Lhoret R. Can we identify metabolically healthy but obeseindividuals (MHO)? Diabetes Metab. 2004 Dec;30(6):569-72.
6. Wildman RP, Muntner P, Reynolds K, McGinn AP, Rajpathak S, Wylie-Rosett J, et al. The obese without cardiometabolic risk factor clustering and the normal weight with cardiometabolic risk factor clustering: prevalence and correlates of 2 phenotypes among the US population (NHANES 1999–2004). Arch Intern Med. 2008 Aug;168(15):1617-24. doi: http://dx.doi.org/10.1001/archinte.168.15.1617
7. Ruderman NB, Schneider SH, Berchtold P. The “metabolically-obese”, normal-weight individual. Am J Clin Nutri. 1981;34(8):1617-21.
8. Montani JP, Carroll JF, Dwyer TM, Antic V, Yang Z, Dulloo AG. Ectopic fat storage in heart, blood vessels and kidneys in the pathogenesis of cardiovascular diseases. Int J Obes Relat Metab Disord. 2004 Dec;28 Suppl 4:S58-65. doi: http://dx.doi.org/10.1038/sj.ijo.0802858
9. Caballero B The global epidemic of obesity: an overview. Epidemiol Rev. 2007;29:1-5. Epub 2007 Jun 13. doi: http://dx.doi.org/10.1093/epirev/mxm012
10. Cornier MA, Després JP, Davis N, Grossniklaus DA, Klein S, Lamarche B, et al. Assessing Adiposity: A Scientific Statement From the American Heart Association. Circulation. 2011 Nov;124(18):1996-2019. doi: http://dx.doi.org/10.1161/CIR.0b013e318233bc6a
11. Pimanov SI, Bondarenko VM, Marchuk VP, Mikhaylova NA, Sapego AL, Makarenko EV. Assessment of results of measurement of amount of visceral fatty tissue at ultrasonography and a computer tomography. Ul'trazvukovaia Funktsional Diagnostika. 2016;(4):59-72. (In Russ.)
12. Rumyantsev PO, Saenko VA, Rumyantseva UV, Chekin SYu. Statistical methods of the analysis in clinical practice [Elektronnyi resurs]. Moscow, RF; 2011. Rezhim dostupa: http://medstatistic.ru/articles/StatMethodsInClinics.pdf. Data dostupa: 14.02.2017. (In Russ.)
13. Traish AM, Guay A, Feeley R, Saad F. The Dark Side of Testosterone Review Deficiency: I. Metabolic Syndrome and Erectile Dysfunction. J Androl. 2009 Jan-Feb;30(1):10-22. doi: http://dx.doi.org/10.2164/jandrol.108.005215.
14. Rasouli N, Molavi B, Elbein SC, Kern PA. Ectopic fat accumulation and metabolic syndrome. Diabetes Obes Metab. 2007 Jan;9(1):1-10. Doi: http://dx.doi.org/10.1111/j.1463-1326.2006.00590.x
15. Vlachos IS, Hatziioannou A, Perelas A, Perrea DN. Sonographic Assessment of Regional Adiposity. AJR Am J Roentgenol. 2007 Dec;189(6):1545-53. doi: http://dx.doi.org/10.2214/AJR.07.2366
16. Kawasaki S, Aoki K, Hasegawa O, Numata K, Tanaka K, Shibata N, et al. Sonographic Evaluation of Visceral Fat by Measuring Para- and Perirenal Fat. J Clin Ultrasound. 2008 Mar-Apr;36(3):129-33. Doi: http://dx.doi.org/10.1002/jcu.20426
17. Fantuzzi G. Adipose tissue, adipokines, and inflammation. J Allergy Clin Immunol. 2005 May;115(5):911-9. doi: http://dx.doi.org/10.1016/j.jaci.2005.02.023
18. Fitzgibbons TP, Czech MP. Epicardial and perivascular adipose tissues and their influence on cardiovascular disease: basic mechanisms and clinical associations. J Am Heart Assoc. 2014 Mar;3(2):e000582. doi: http://dx.doi.org/10.1161/JAHA.113.000582
19. De Pergola G, Campobasso N, Nardecchia A, Triggiani V, Caccavo D, Gesualdo L, et al. Para- and perirenal ultrasonographic fat thickness is associated with 24-hours mean diastolic blood pressure levels in overweight and obese subjects. BMC Cardiovasc Disord. 2015;15:108. doi: http://dx.doi.org/10.1186/s12872-015-0101-6
Information about authors:
Bondarenko V.M. – senior teacher of the Chair of Hospital Surgery with the courses of Urology & Pediatric Surgery, postgraduate of the Chair of Internal Medicine No.2 of the Faculty for Advanced Training & Retraining, Vitebsk State Order of Peoples’ Friendship Medical University;
Pimanov S.I. – Doctor of Medical Sciences, professor, head of the Chair of Internal Medicine No.2 of the Faculty for Advanced Training & Retraining, Vitebsk State Order of Peoples’ Friendship Medical University;
Makarenko E.V. – Doctor of Medical Sciences, professor of the Chair of Internal Medicine No.2 of the Faculty for Advanced Training & Retraining, Vitebsk State Order of Peoples’ Friendship Medical University.
Correspondence address: Republic of Belarus, 210023, Vitebsk, 27 Frunze ave., Vitebsk State Order of Peoples’ Friendship Medical University, Chair of Internal Medicine No.2 of the Faculty for Advanced Training & Retraining. E-mail: Этот адрес электронной почты защищён от спам-ботов. У вас должен быть включен JavaScript для просмотра. – Vladimir M. Bondarenko.
