Search Results (148)

Background: Accurate quantification of visceral (VAT) and subcutaneous adipose tissue (SAT) is critical for understanding the cardiometabolic consequences of obstructive sleep apnea (OSA) and other chronic diseases. This study validates a customization framework using pre-trained networks for the development of automated VAT/SAT segmentation models using hybrid positron emission tomography (PET)/magnetic resonance imaging (MRI) data from OSA patients. While the widespread adoption of deep learning models continues to accelerate the automation of repetitive tasks, establishing a customization framework is essential for developing models tailored to specific research questions. Methods: A UNet-ResNet50 model, pre-trained on RadImageNet, was iteratively trained on 59, 157, and 328 annotated scans within a closed-loop system on the Discovery Viewer platform. Model performance was evaluated against manual expert annotations in 10 independent test cases (with 80–100 MR slices per scan) using Dice similarity coefficients, segmentation time, intraclass correlation coefficients (ICC) for volumetric and metabolic agreement (VAT/SAT volume and standardized uptake values [SUVmean]), and Bland–Altman analysis to evaluate the bias. Results: The proposed deep learning pipeline substantially improved segmentation efficiency. Average annotation time per scan was 121.8 min (manual segmentation), 31.8 min (AI-assisted segmentation), and only 1.2 min (fully automated AI segmentation). Segmentation performance, assessed on 10 independent scans, demonstrated high Dice similarity coefficients for masks (0.98 for VAT and SAT), though lower for contours/boundary delineation (0.43 and 0.54). Agreement between AI-derived and manual volumetric and metabolic VAT/SAT measures was excellent, with all ICCs exceeding 0.98 for the best model and with minimal bias. Conclusions: This scalable and accurate pipeline enables efficient abdominal fat quantification using hybrid PET/MRI for simultaneous volumetric and metabolic fat analysis. Our framework streamlines research workflows and supports clinical studies in obesity, OSA, and cardiometabolic diseases through multi-modal imaging integration and AI-based segmentation. This facilitates the quantification of depot-specific adipose metrics that may strongly influence clinical outcomes. Full article

Background: Accurately tracking body-composition changes in endurance field settings remains methodologically challenging. This study aimed to evaluate whether changes in subcutaneous adipose tissue (SAT) across a 7-day ultramarathon are better reflected by anthropometric indices than by body mass (BM) alone. Methods: Twenty ultrarunners were assessed using both anthropometric indices and ultrasound measurements of SAT thickness, applying a novel method that distinguishes layers including (D_I) versus excluding (D_E) embedded fibrous structures. Measurements were obtained before the race and after Stages 4 and 7. Indices included body mass index (BMI), mass index (MI_I), and waist-to-height ratio (WHtR). Results: Total SAT thickness decreased significantly for both D_I (p = 0.001) and D_E (p < 0.001). BM, BMI, MI_I, and WHtR also declined significantly post-race (p < 0.001). SAT reduction was most pronounced at the abdominal and thigh sites. Additionally, ultrarunners with lower D_E values exhibited lower fat at the abdomen and distal triceps. BMI was significantly related to D_E at the upper and lower abdomen and erector spinae; MI_I was significantly associated with D_E at the upper and lower abdomen; and WHtR correlated with both D_E and D_I at abdominal and erector spinae sites. BM showed no significant association with any SAT parameter. Conclusions: Ultrasound-derived SAT thickness, in combination with BMI, MI_I, and WHtR, offers a field-feasible approach to evaluate body-composition change during multistage ultramarathons. In contrast, BM alone does not reliably reflect SAT distribution or loss. Full article

Background: Childhood obesity is a growing global concern associated with early-onset orthopedic complications that may persist into adulthood. Among the anthropometric indicators, abdominal adiposity plays a key role in assessing health risks during pediatric evaluations. However, the relationship between abdominal fat distribution and biomechanical alterations, such as changes in posture and foot support, remains poorly understood. Ultrasonography (US) is a validated, noninvasive imaging method capable of distinguishing preperitoneal and intraperitoneal fat in children. Despite its diagnostic advantages, no study to date has directly examined ultrasound-measured abdominal adiposity-predicted pronated foot posture in children. Objective: We aimed to verify the impact of abdominal adiposity on foot support and its association with obese, overweight, and eutrophic schoolchildren. Methods: This is a cross-sectional study. Sixty-five pupils (aged 6–9 years) from a public school in São Paulo, Brazil, were divided into three groups according to nutritional status: obese (n = 25), overweight (n = 20), and eutrophic (n = 20). Anthropometric measurements and foot posture, assessed using the Foot Posture Index (FPI), were collected during the initial evaluation. Abdominal adiposity was determined by ultrasonography, measuring subcutaneous, preperitoneal, and intraperitoneal fat thickness. Statistical Analysis: Analyses compared group differences and relations between abdominal fat and foot posture, with significance set at p < 0.05. Results: Obese and overweight schoolchildren showed pronated foot posture when compared to eutrophic children, on both sides of the feet. Abdominal adiposity was a good predictor of a more pronated footrest for the right and left feet, showing a high-to-moderate association. Conclusions: Ultrasound-measured abdominal adiposity was identified as a significant predictor of pronated foot posture in schoolchildren. These findings highlight the importance of monitoring abdominal fat accumulation during pediatric evaluations, as excessive adiposity may increase the risk of musculoskeletal dysfunctions and pain in the lower limbs. Early detection of these alterations may help prevent postural and musculoskeletal disorders in overweight and obese children. Full article

Gestational diabetes mellitus (GDM) is a heterogeneous disorder that compromises maternal and offspring health. Conventional medical nutrition therapy focuses on nutrient composition and caloric targets but largely omits timing and individualized biology. This narrative review synthesizes mechanistic, epidemiologic and interventional evidence linking circadian biology and meal timing (chrononutrition) to maternal glycemic control. Observational cohorts associate late eating and breakfast skipping with worse glycemia, while pilot interventions and CGM-based studies indicate that front-loading carbohydrates, restricting evening carbohydrate, extending overnight fasting (≈10–12 h), and simple within-meal sequencing can reduce postprandial excursions and increase time-in-range. We propose a pragmatic, tiered clinical pathway in which routine second-trimester triage (50 g glucose challenge test and ultrasound abdominal subcutaneous fat thickness) identifies higher-risk women for short-term CGM phenotyping and prioritized chrononutrition counseling. Integrating phenotype-matched timing interventions with dietetic support and digital decision tools allows rapid, individualized adjustments informed by real-time glucose patterns and patient chronotype. In principle, this tiered strategy could improve daily glycemic profiles, reduce the need for pharmacotherapy, and translate into better neonatal outcomes if supported by larger randomized trials. Chrononutrition therefore offers a promising extension of standard care: simple, low-cost adjustments to “when” food is eaten, supported by digital tools, could allow nutrition therapy for GDM to become more precise, more responsive, and ultimately more effective for both mother and child. Key priorities include validating bedside and chrono-omic stratifiers, testing scalable delivery platforms, and ensuring equitable access to personalized chrononutrition in pregnancy. Full article

Relevance of the problem and aim of the work: Ankylosis of the temporomandibular joint (TMJ) affects physical, psychological, and social well-being and quality of life. One of the most frequently used surgical interventions for the treatment of temporomandibular joint ankylosis is interpositional arthroplasty, particularly in cases where joint preservation is feasible, with different autologous fats: dermis fat, buccal fat pad, and full thickness skin-subcutaneous fat. The aim of the work was to evaluate the efficiency of using different autologous fats in temporomandibular joint ankylosis treatment with interposition arthroplasty method. Materials and Methods: This systematic literature review was conducted according to PRISMA guidelines and registered in the PROSPERO database (CRD420251038325). A comprehensive search was performed in PubMed, the Cochrane Library, and ScienceDirect databases using combinations of keywords: (temporomandibular joint disorders OR temporomandibular joint) AND (adipose tissue or autologous) AND (ankylosis OR arthroplasty). Inclusion criteria were clinical studies conducted on human subjects, written in English, that evaluated the use of autologous fat in interpositional arthroplasty for TMJ ankylosis. The main outcome measures included postoperative maximum mouth opening (MMO), pain intensity, and relative fat volume contraction. Risk of bias was assessed using the Cochrane RoB 2 tool for randomized controlled trials and the Newcastle–Ottawa Scale for cohort studies. Most included studies were of moderate to high quality. Results: A total of 20 publications were selected, including a total of 369 patients. In a qualitative analysis, the best results for maximal opening of mouth (MOM) at 3, 6, 12, and more than 12 months were obtained with dermal fat. After 3 months, the MOM was 40.0 ± 2.7 mm, after 6 months—40.80 ± 4.26 mm, after 12 months—41.9 ± 4.0 mm, after more than 12 months—43.5 mm. The lowest pain intensity was observed using dermal fat taken from the iliac crest region. The rate of volumetric fat shrinkage was greater using buccal fat pad than dermis fat. Conclusions: The most commonly used types of autologous fat in interposition arthroplasty in ankylosis are the following: dermal fat from the abdominal region (iliac crest, subumbilical area, groin), buccal fat pad and full-thickness subcutaneous fat. The best results after the surgical treatment of TMJ ankylosis with interposition arthroplasty are obtained using dermis fat. Full article

Background/Objectives: Chronic kidney disease (CKD) is a prevalent condition with many cases remaining undiagnosed, although early detection is essential. Adipose tissue distribution—particularly perirenal fat thickness (PrFT)—has recently been linked to renal pathophysiology. This study assessed the association between CT-derived parameters of fat distribution and kidney morphology with CKD. Materials and Methods: This retrospective study included 237 patients (117 subjects, 120 controls) who underwent abdominal CT and had serum creatinine data. The dataset was randomly split (70% training, 30% test) to develop and evaluate a logistic regression model. CKD was defined as estimated Glomerular Filtration Rate (eGFR) < 60 mL/min/1.73 m². PrFT was measured as the distance from the posterior renal capsule to the posterior abdominal wall; renal hilum fat was segmented using a −195 to −45 HU range. Additional parameters (measured using automated segmentation tools) included kidney volume (KV), visceral/subcutaneous fat areas, skeletal muscle area and attenuation, and liver attenuation. Bilateral measurements were averaged. Results: KV (OR = 0.249, 95% CI: 0.146–0.422, p < 0.001) and PrFT (2nd tercile: OR = 7.720, 95% CI: 2.860–20.839; 3rd tercile: OR = 16.892, 95% CI: 5.727–49.822; both p < 0.001) were identified as independent predictors of CKD. These variables were used to construct a simplified model, which demonstrated moderate clinical applicability (AUC = 0.894) when evaluated on the test subset. Conclusions: KV and PrFT emerged as independent predictors of CKD, forming the basis of a simplified model with potential for opportunistic clinical application. This approach may facilitate earlier detection of CKD in patients undergoing CT imaging for unrelated clinical reasons. These imaging parameters are not intended to replace serum creatinine or eGFR but may serve as complementary predictors in specific clinical contexts. Full article

Background: The causation of type 2 diabetes remains under debate, but evidence supports both abdominal lipid and ectopic lipid overspill into tissues including muscle as key. How these depots differentially alter cardiometabolic profile and change during body weight and fat loss is not known. Methods: Women with obesity scheduled to undergo bariatric surgery were assessed at baseline (BL, n = 28) and at 6-month follow-up (6m_FU, n = 26) after weight loss. Fasting plasma (Pla), subcutaneous thigh adipose (STA), subcutaneous abdominal adipose, (SAA), and thigh vastus lateralis muscle (VLM) samples were collected at BL through surgery and at 6m_FU using needle biopsy. An untargeted liquid chromatography mass spectrometry metabolomics platform was used. Pla and tissue-specific lipid and polar metabolite profiles were modelled as changes from BL and 6m_FU. Results: There was significant body weight (−24.5 kg) loss at 6m_FU (p < 0.05). BL vs. 6m_FU tissue metabolomics profiles showed the largest difference in lipid profiles in SAA tissue in response to surgery. Conversely, polar metabolites were more susceptible to change in STA and VLM. In Pla samples, both lipid and polar metabolite profiles showed significant differences between timepoints. Jaccard–Tanimoto coefficient t-tests identified a sub-group of gut microbiome and dietary-derived omega-3-fatty-acid-containing lipid species and core energy metabolism and adipose catabolism-associated polar metabolites that are trafficked between sample types in response to bariatric surgery. Conclusions: In this first report on channelling of lipids and polar metabolites to alternative tissues in bariatric-induced weight loss, adaptive shuttling of small molecules was identified, further promoting adipose processing and highlighting the dynamic and coordinated nature of post-surgical metabolic regulation. Full article

Background/Objectives: Obesity is associated with various skin complications, yet its impact on dermal elastic fibers—key components maintaining skin elasticity—remains unclear, particularly in cases of mild obesity prevalent in East Asian populations. The aim of this study was to investigate whether mild obesity is associated with the early structural deterioration of dermal elastic fibers and alterations in elastin-related gene expression in Japanese individuals. Methods: Abdominal skin samples from 31 Japanese women (the mean body mass index [BMI] 23.9 ± 3.2 kg/m², mean age 49.5 ± 4.8) undergoing breast reconstruction surgery were analyzed. Gene expression levels of elastin-regenerative and -degradative molecules were assessed by quantitative polymerase chain reaction in the epidermis, dermis, and subcutaneous fat. Dermal elastic fiber content was evaluated histologically using Elastica van Gieson staining. Results: No statistically significant correlations between the BMI and elastin-degrading gene expression (NE, MMP2, MMP9, and NEP) were observed. ELN expression in the dermis showed a significant positive correlation with the BMI (ρ = 0.517, p = 0.003), potentially reflecting a compensatory response. Histological analysis revealed a significant inverse correlation between dermal elastic fiber content and the BMI (r = −0.572, p = 0.001), independent of age or smoking history. Conclusions: Even mild obesity is associated with the early degradation of dermal elastic fibers despite limited transcriptional alterations. These findings underscore the need for early skin care interventions to mitigate obesity-related skin fragility, especially in populations with predominantly mild obesity. Full article

Background/Objectives: Childhood obesity represents a growing public health concern. It is closely associated with obstructive sleep apnoea (OSA), which impairs nocturnal breathing and significantly affects neurocognitive and cardiovascular health. This review aims to analyse differences in fat distribution, anthropometric parameters, and instrumental assessments of paediatric OSA compared to adult OSA to improve the diagnostic characterisation of obese children. Methods: narrative review. Results: While adenotonsillar hypertrophy (ATH) remains a primary cause of paediatric OSA, the increasing prevalence of obesity has introduced distinct pathophysiological mechanisms, including fat accumulation around the pharynx, reduced respiratory muscle tone, and systemic inflammation. Children exhibit different fat distribution patterns compared to adults, with a greater proportion of subcutaneous fat relative to visceral fat. Nevertheless, cervical and abdominal adiposity are crucial in increasing upper airway collapsibility. Recent evidence highlights the predictive value of anthropometric and body composition indicators such as neck circumference (NC), neck-to-height ratio (NHR), neck-to-waist ratio (NWR), fat-to-muscle ratio (FMR), and the neck-to-abdominal-fat percentage ratio (NAF%). In addition, ultrasound assessment of lateral pharyngeal wall (LPW) thickness and abdominal fat distribution provides clinically relevant information regarding anatomical contributions to OSA severity. Among imaging modalities, dual-energy X-ray absorptiometry (DXA), bioelectrical impedance analysis (BIA), and air displacement plethysmography (ADP) have proven valuable tools for evaluating body fat distribution. Conclusions: Despite advances in the topic, a validated predictive model that integrates these parameters is still lacking in clinical practice. Polysomnography (PSG) remains the gold standard for diagnosis; however, its limited accessibility underscores the need for complementary tools to prioritise the identification of children at high risk. A multimodal approach integrating clinical, anthropometric, and imaging data could support the early identification and personalised management of paediatric OSA in obesity. Full article

The advent of effective antiretroviral therapy in the mid-1990s, which successfully prevented the progression to AIDS in people living with HIV (PLWH), was associated with the appearance of the so-called HIV-associated lipodystrophy. This condition involved subcutaneous fat atrophy; abdominal fat hypertrophy; and, in some cases, lipomatosis. It was also associated with systemic metabolic disturbances, primarily insulin resistance and dyslipidemia. Following the replacement of certain antiretroviral drugs, particularly the thymidine-analog reverse transcriptase inhibitors stavudine and zidovudine, with less toxic alternatives, the incidences of lipoatrophy and lipomatosis significantly declined. However, lipodystrophy resulting from first-generation antiretroviral therapy does not always resolve after switching to newer agents. Although the widespread use of modern antiretroviral drugs—especially integrase strand transfer inhibitors and non-lipoatrophic reverse transcriptase inhibitors such as tenofovir alafenamide—has reduced the incidences of severe forms of lipodystrophy, these regimens are not entirely free of adipose tissue-related effects. Notably, they are associated with weight gain that resembles common obesity and can have adverse cardiometabolic consequences. Recent evidence also suggests the hypertrophy of specific fat depots, such as epicardial and perivascular adipose tissue, in PLWH on last-generation treatments, potentially contributing to increased cardiovascular risk. This evolving landscape underscores the persistent vulnerability of PLWH to adipose tissue alterations. While these morphological changes may not be as pronounced as those seen in classic HIV-associated lipodystrophy, they can still pose significant health risks. The continued optimization of treatment regimens and the vigilant monitoring of adipose tissue alterations and metabolic status remain essential strategies to improve the health of PLWH. Full article

Background: Obesity is a global health concern linked to an elevated risk of chronic diseases. Abdominal subcutaneous fat (ASF) thickness serves as a key indicator for obesity assessment; however, existing measurement methods often lack simplicity and accessibility. Methods: We developed the ASFmeter, a portable, low-cost A-mode ultrasound device designed for rapid ASF thickness measurement. Forty participants underwent ASF thickness assessment using both the ASFmeter and a conventional B-mode ultrasound system, demonstrating strong agreement (R² = 0.94, SEE = 1.72 mm). Statistical analyses evaluated correlations between ASF thickness and body weight, abdominal circumference, and body mass index (BMI). Results: the ASFmeter exhibited high consistency with B-mode ultrasound measurements, confirming its accuracy. Significant variations in ASF thickness were observed across BMI groups, supporting its utility as a reliable obesity indicator. Conclusions: the ASFmeter offers a user-friendly, portable, and cost-effective solution for ASF measurement, facilitating personal health monitoring and obesity-related risk assessment. This innovation holds promise for widespread application in home-based health management. Full article

Background and objectives: Decompressive craniectomy (DC) is a surgical procedure, useful for relieving the intracranial pressure following trauma. Following reduction in cerebral oedema, the bone is placed back to cover the defect. During the interim period, the bone flap may be preserved using cryopreservation or in subcutaneous tissue. This leads to a need to determine the benefits and risks involved in preservation of bone flap in a subcutaneous pocket or conventional freezer following decompressive craniectomy in traumatic brain injury. Materials and methods: An open randomized controlled trial was conducted at a level one trauma centre from July 2023 to December 2024. Simple randomization was performed in order to allocate patients into the subcutaneous preservation group and the cryogenic preservation group. Patients underwent cranioplasty after 3 months and were followed up post-operatively for complications and Glasgow Outcome Scale assessment. Results: The study initially recruited a total of 158 patients, out of which 104 patients remained eligible for the final analysis. The patients with cryopreserved flaps were found to have a higher rate of surgical site infection (31.3%) as compared to those with subcutaneously preserved flaps (5.6%), with the differences being statistically significant (p < 0.001). Among the 87 patients who had a poorer Glasgow Outcome Scale (GOS) score before the intervention, 55 (63.2%) patients had at least some improvement in GOS over a period of one month. Conclusion: The use of subcutaneous preservation of bone is more beneficial in resource-limited settings as compared to conventional freezer storage. Full article

Background/Objectives: Opinions concerning the role of obesity and changes in muscle mass in individuals with malignancies vary. It is believed that decreased fat tissue leads to a higher complication rate, while decreased muscle mass results in a poorer oncologic outcome. This study aimed to evaluate the impact of fat distribution and skeletal muscle mass on postoperative morbidity and long-term oncological outcomes in patients with non-metastatic colon cancer. Methods: Between 2012 and 2018, a total of 129 patients with stage I-III colon cancer were evaluated. Abdominal CT scans were used to assess muscle mass and fat tissue (subcutaneous and visceral). Differences in postoperative morbidity and long-term oncologic outcome were analyzed and compared. Results: No significant differences occurred concerning complication rate or anastomotic leakage. Individuals with altered body composition parameters had a shorter length of hospital stay (p = 0.046) and an increased duration of surgery (p = 0.029). In patients with an ASA III score, altered fat tissue distribution was associated with improvements in both overall and disease-free survival (p = 0.031 and p = 0.027, respectively) but also resulted in longer hospital stay. Conclusions: Changes in body composition parameters lead to alterations in economic factors as well as changes in oncologic survival, especially in patients with higher ASA scores. No differences in morbidity were observed. Full article

Reducing abdominal subcutaneous fat is a common concern among women, with evidence suggesting that combining aerobic exercise with external shock waves or radiofrequency may enhance fat reduction. This study aimed to assess the effects of six sessions of external shock wave therapy or radiofrequency combined with an aerobic exercise program on abdominal subcutaneous fat and lipid mobilization, compared to the effects of an aerobic exercise program alone. Thirty-one women (aged 18–60) were randomly assigned to three groups: EG1 (shockwave therapy + aerobic exercise), EG2 (radiofrequency + aerobic exercise), and CG (aerobic exercise only). Body composition measures, mean temperature, adipose tissue thickness, lipid profile, and glycerol and interleukin-6 levels were assessed before and after intervention. A significant decrease in the EG groups compared to the CG was observed in the subcutaneous abdominal thickness (p < 0.001, effect size of η²p = 0.446) and waist–hip ratio (p ≤ 0.001, effect size of η²p = 0.408). No significant changes were verified in the levels of lipolytic activity, lipid profile, and interleukine-6. Six sessions of shockwave or radiofrequency therapy combined with aerobic exercise reduced subcutaneous fat thickness and improved hip–waist ratio more effectively than aerobic exercise alone, without affecting lipid mobilization by changes in lipid profile, lipolytic activity, or interleukin-6 levels. Full article

Background: Malnutrition is a prevalent condition associated with adverse health outcomes, requiring the accurate assessment of muscle composition and fat distribution. Methods: This study presents a novel method for the automatic analysis of ultrasound images to estimate subcutaneous and visceral fat, as well as muscle, in patients with suspected malnutrition. The proposed system utilizes computer vision techniques to segment regions of interest (ROIs), calculate relevant variables, and store data for clinical evaluation. Unlike traditional segmentation methods that rely solely on thresholding or pre-defined masks, our method employs an iterative hierarchical approach to refine contour detection and improve localization accuracy. A dataset of abdominal and leg ultrasound images, captured in both longitudinal and transversal planes, was analyzed. Results: Results showed higher precision for longitudinal scans compared to transversal scans, particularly for length-related variables, with the Y-axis Vastus intermediate achieving a precision of 92.87%. However, area-based measurements demonstrated lower precision due to differences between manual adjustments by experts and automatic geometric approximations. Conclusions: These findings highlight the system’s potential for clinical use while emphasizing the need for further algorithmic refinements to improve precision in area calculations. Full article