Re: Obesity Experts Urge Focus on Visceral Adiposity, Fat in Liver

[Guest guest]

BMI in Asians would be an unequal comparison to whites. I didn't have a lot of

Asian women, infants, and children but the ones I saw were consistently lower on

the ht/wt comparisons than other ethnicities. I don't think they are fatter at

23 BMI I think their ht to wt proportion is different and their 23 is not

equivalent to a caucasian 23 - odd way to say it but I think that is what I

mean. Black and partially black children and babies tended to be healthy at a

higher BMI - broader, heavier bones vs smaller frame, slimmer bones. I don't

think excess fat is necessarily accumulating more quickly in the Asians, we just

need to reset the BMI healthy range for the sub-population.

Also statins not helpful to reduce CVD risk !!!

R Vajda, R.D.

________________________________

To: RD-USA <rd-usa >

Sent: Mon, March 7, 2011 7:57:21 PM

Subject: Obesity Experts Urge Focus on Visceral Adiposity, Fat in Liver

Measures of excess visceral adiposity and liver fat are better indicators of

impaired plasma glucose homeostasis and cardiometabolic risk than body mass

index (BMI). And excess fat appears to accumulate more quickly — and with

potentially more dire consequences — in Asians than in other ethnic groups.

These findings, from the largest international study to date on abdominal

obesity, were presented here at the 2nd International Congress on Abdominal

Obesity. The study involved 4504 patients in 29 countries across a wide

range of ethnicities.

" There are millions of people throughout the world who have a BMI above

25 kg/m2 who may already be developing hypertension, dyslipidemia, and

diabetes, " principal investigator Jean-Pierre Després, PhD, FAHA, from Laval

University in Québec City, Quebec, told *Medscape Medical News* in an

interview. " It's clear we need to seriously redefine what it means to be

overweight and obese. "

The study, known as the International Study of Prediction of Intra-Abdominal

Adiposity and its Relationships With Cardiometabolic Risk/Intra-Abdominal

Adiposity (INSPIRE ME IAA), is the first large international study to use

standardized cardiometabolic data and computed tomography (CT) imaging to

assess risk in people with impaired plasma glucose homeostasis but no

diagnosis of type 2 diabetes.

" We found a strong relationship between the presence of visceral fat and

liver fat, regardless of ethnicity, " Dr. Després said. " We also found a

steeper increase in visceral fat, with a concomitant increase in BMI, in

Asians [than in whites]. In other words, Asians tend to have more visceral

fat at lower BMI values. "

When presenting the findings, the investigators did not report the precise

magnitude of that difference, but Dr. Després said anecdotally that

researchers found Asians with a BMI of 23 kg/m2 who had the same amount of

visceral fat as whites with a BMI of 27 to 28 kg/m2.

" The greater susceptibility to visceral fat deposition in Asians also

resulted in a greater accumulation of liver fat, and that led to several

metabolic abnormalities, " he said.

" It's clear that Asians cannot afford to gain weight because they will put

on more visceral fat, more liver fat, and, as a consequence, they will be at

greater risk of developing type 2 diabetes than whites with the same BMI. "

This is not the first time ethnic differences in fat deposition have been

noted, Dr. Després said, but it *is* the first time the differences have

been validated with standardized tests and CT. He noted that the observation

is especially noteworthy because sedentary lifestyles are becoming

increasingly common among Asians as modernization sweeps the world,

especially China. " Given what we saw in terms of ethnic risk factors, " he

said, " the cardiovascular effects of modernization on that population could

be devastating. "

Libby, MD, chief of cardiovascular medicine at Harvard Medical School

in Boston, Massachusetts, said that elucidating ethnic differences is

vitally important.

" This is an important observation, " he said. " Asian people can store

metabolically dangerous [levels of] abdominal fat out of proportion to BMI.

I think clinicians may be underestimating cardiometabolic risk when they're

using BMI alone in people of Asian ancestry. "

Another important finding of the study is that statins do not seem to

significantly blunt the cardiovascular risks for excess visceral fat or fat

in the liver. This was true in patients with and without type 2 diabetes.

" Throughout the developed world, being overweight is increasingly becoming

the norm, " Dr. Després pointed out. " It's abundantly clear that we can't

continue to deal with this epidemic using the current medical model. We need

to rethink our approach. "

Clinicians tend to treat complications of excess fat accumulation in

isolation — including hypertension, dyslipidemia, type 2 diabetes, and

cardiovascular disease — rather than focusing on the root of the problem, he

said. " It is increasing clear that the primary cause of many of those issues

is accumulation of excess body fat stored in the abdominal cavity and in the

liver — even in patients who are only what we think of as 'moderately'

overweight. "

Dr. Després emphasized that primary care physicians should make sure they

measure waist circumference when conducting physical exams and evaluating

patients for diseases associated excess weight.

When high BMIs are coupled with high levels of fasting triglycerides, the

effects on cardiovascular risk are even more elevated, Dr. Després said. " We

know that people with BMIs around 27 kg/m2 who also have elevated fasting

triglycerides have about an 80% chance of harboring excess adipose tissue in

the abdomen, as well as in the liver, " he said, adding that " just measuring

patients' overall weight clearly isn't enough. "

Dr. Després emphasized that much more work needs to be done to determine the

impact of excess body weight. " We don't pretend this is the be all and

end all of studies, " he said. " But being the first international study with

large numbers of people evaluated with standardized tools and CT, we think

it will contribute to our efforts to redefine what we think of as obesity. "

In commenting on the study, Dr. Libby emphasized its importance, but echoed

Dr. Després' caution that a limitation of the study is its use of biomarkers

to measure risk rather than hard end points.

Another limitation, said Dr. Després, is that it failed to include large

numbers of blacks. He noted that a study that did include a sizable cohort

of black subjects clearly demonstrated that blacks carry many of the same

risks as other groups, such as Asians, and in some cases their risks were

greater (*J Am Coll Cardiol*. 2004;44:1011-1017).

Dr. Libby said questions remain about the management of cardiovascular risk

in people who are overweight or obese. " How do we implement the adoption of

sustainable healthy lifestyles on a population basis so that we can stem the

risks associated with abdominal obesity? That's a difficult problem, and we

need much more research on outcomes and interventions to address these

issues. "

To that end, the International Chair on Cardiometabolic Risk is developing a

set of initiatives targeting healthcare professionals and overweight people.

Among those strategies are:

- a new web portal — myhealthywaist.org — that will provide information,

tools, and resources to support healthcare professionals

- a social media campaign aimed at engaging people at risk for the

cardiometabolic consequences of being overweight and explaining the

association between moderate obesity and an excess of visceral adipose

tissue/liver fat

- a new iPad application to help healthcare providers identify at-risk

patients.

*Dr. Després and Dr. Libby have disclosed no relevant financial

relationships.*

2nd International Congress on Abdominal Obesity (ICAO). Presented

February 26, 2011.

www.medscape.com

--

Ortiz, MS, RD

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