a.p.j. houdijk euro weight loss-2015 frankfurt, germany august 18 – 20, 2015
TRANSCRIPT
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A.P.J. Houdijk
Euro Weight Loss-2015Euro Weight Loss-2015FrankfurtFrankfurt, , GermanyGermanyAugustAugust 1 188 –– 2 200, 2015, 2015
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Weight loss
what is the best outcome measure ?
A.P.J. Houdijk MD PhD
Medical Center Alkmaar
Free University Hospital Amsterdam
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The worldwide weight problem
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Overweight worldwide WHO facts
Overweight and obesity: abnormal or excessive fat accumulation that may impair health.
Overweight expressed as BMI ≥ 25; Obese ≥ 30 kg/m2
1.9 billion overweight,13 % of world population
600 million obese
Doubled since 1980
35 years of lifestyle (non) change how is this possible ?
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Weight component of BMI
Weight = fat + lean body mass (LBM) + water
Fat = subcutaneous + intraabdominal + intracellular
LBM = organs +bone + muscle
BMI = LBM + subcut. fat + intraabd. fat + water per M2
Waist circumf. = organs + subcut fat + intraabd fat + air
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Weight loss
Water dehydration
LBM; bone, muscle, organs protein wasting
Fat; subcut fat, intraabd fat wasting or health benefit
BMI reduction measures more than loss of metabolic risky fat
BMI as a sole measure of health monitoring is questionableBut there may be hope for another role for BMI
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Body fat depots
Total adipose tissue
subcutaneousperipheralabdominal
InternalAbdominal (visceral)intra/inter muscularPericardialHepaticPancreatic
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Overweight related metabolic diseasevisceral obesity is the motor
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Visceral obesity induces inflammation and insulin resistance
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Loss of visceral fat reverses inflammation and insulin resistance
i
Kovácˇiková, M. et al. Dietary intervention-induced weight loss decreases macrophage content in adipose tissue of obese women. Int. J. Obes. 2011
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Surrogate marker waist circumference Surrogate marker waist circumference
cardiovascular eventscardiovascular events
Dagenais GR et al, 2005
Ad
jus
ted
rel
ativ
e ri
sk
1 1 1
1.17 1.16 1.14
1.29 1.27
1.35
0.8
1
1.2
1.4
CVD death MI All-cause deaths
Tertile 1
Tertile 2Tertile 3
Men Women<95
95–103>103
<87
87–98>98
Waistcircumference (cm):
The HOPE study
Adjusted for BMI, age, smoking, sex, CVD disease, DM, HDL-cholesterol,
total-C; CVD: cardiovascular disease; MI: myocardial infarction; BMI: body mass index; DM: diabetes mellitus; HDL: high-density lipoprotein
cholesterol
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IAAT= 0.53 l
IAAT= 1.11 l
IAAT= 1.31 l IAAT= 4.2 l
IAAT= 1.15 l IAAT= 4.26 l
Visceral fat and waist circumference ? waist circumference = 84 cm Courtesy: Prof J. Bell
University of Westminster
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IAAT= 0.53 l
IAAT= 1.11 l
IAAT= 1.31 l IAAT= 4.2 l
IAAT= 1.15 l IAAT= 4.26 l
Visceral fat and waist circumference ?waist circumference = 84 cm Courtesy: Prof J. Bell
University of Westminster
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TAT = 13.2 L, IAAT = 1.07
TAT = 21.8 L, IAAT = 3.56 L
TAT = 17.3 L, IAAT = 1.8 L TAT = 21.4 L, IAAT = 2.9 LTAT = 16.8 L, IAAT = 2.2 L
TAT = 24.1 L, IAAT = 3.7 L
TAT = 14.3 L, IAAT= 1.2 LTAT = 12.4 L, IAAT = 0.63 L
TAT = 26.2 L, IAAT = 3.6 L
Visceral fat and BMI ?Umbilical images from subjects with BMI 24 kg/m2
Courtesy: Prof J. Bell University of Westminster
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TAT = 13.2 L, IAAT = 1.07
TAT = 21.8 L, IAAT = 3.56 L
TAT = 17.3 L, IAAT = 1.8 L TAT = 21.4 L, IAAT = 2.9 LTAT = 16.8 L, IAAT = 2.2 L
TAT = 24.1 L, IAAT = 3.7 L
TAT = 14.3 L, IAAT= 1.2 LTAT = 12.4 L, IAAT = 0.63 L
TAT = 26.2 L, IAAT = 3.6 L
Visceral fat and BMI ?Umbilical images from subjects with BMI 24 kg/m2
Courtesy: Prof J. Bell University of Westminster
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Ct scan image for visceral fat
Visceral fat area (cm2) at L3 – L4 levelThreshold for metabolic disease = 100 cm2
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Visceral obesity and BMI in colon cancer
46 % 83 %
Cakir et al. Visceral obesity, BMI and risk of complications after colon cancer resection: a retrospective cohort study. Surgery 2015
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Visceral obesity and BMI in colon cancer
CVD, hypertension and diabetes
Cakir et al. Visceral obesity, BMI and risk of complications after colon cancer resection: a retrospective cohort study. Surgery 2015
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Visceral obesity and BMI in colon cancer
CVD, hypertension and diabetes
Cakir et al. Visceral obesity, BMI and risk of complications after colon cancer resection: a retrospective cohort study. Surgery 2015
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Visceral obesity and BMI in colon cancer
Postoperative complications
Cakir et al. Visceral obesity, BMI and risk of complications after colon cancer resection: a retrospective cohort study. Surgery 2015
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Visceral obesity and BMI in colon cancer
Postoperative complications
Cakir et al. Visceral obesity, BMI and risk of complications after colon cancer resection: a retrospective cohort study. Surgery 2015
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Visceral obesity, BMI and complications
29 %
Cakir et al. Visceral obesity, BMI and risk of complications after colon cancer resection: a retrospective cohort study. Surgery 2015
38 %
17 % 14 %
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Visceral obesity – BMI phenotypes
Cakir et al. Visceral obesity, BMI and risk of complications after colon cancer resection: a retrospective cohort study. Surgery 2015
Slim unfit
Slim fit
Fat unfit
Fat fit
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Slim fit
Slim unfit
Fat fit
Fat unfit
O'Donovan et al
Fit versus unfit phenotypes
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Visceral obesity in relation to BMIA new marker for risk phenotyping ?
Visceral fat in oncological patients CT MRI
Visceral fat measurement in the general population
DEXA
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Summary and conclusions
Visceral fat measurement in relation to BMI identifies risk phenotypes for metabolic syndrome and postoperative complications
Visceral obesity in BMI < 25 higher risk of complications than in BMI> 25 kg/m2 ??
A larger study n=3500 colon cancer patients is including
BMI has a new role
Visceral fat and BMI risk phenotypes may focus lifestyle programs to the highest risk phenotypes
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Summary and conclusions
Stop weighing people measure visceral fat and BMI
Further research needed on the effects of lifestyle programs in the different phenotypes
Thank you
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Questions
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Fat-Fit: Sumo WrestlingFat-Fit: Sumo Wrestling
• Sumo wrestlers bulk (>20,000 kcal/day)(as the heavier the fighter, the lower his centre of gravity)
• Yokozuna have large BMI:
- Taiho: 43.8
– Konishki: 58.2
– Akibono: 56.8
• Elevated % body fat, but low insulin resistance: – low TG
– low T-chol and LDL-chol
– low Fasting glucose
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Euro Weight Loss – 2016 Website: http://weightloss.global-summit.com/europe/
Meet the eminent gathering once again atMeet the eminent gathering once again at
Euro Weight Loss-2016Euro Weight Loss-2016Vienna, AustriaVienna, Austria
September 19-20, 2016September 19-20, 2016