A.P.J. Houdijk

Euro Weight Loss-2015Euro Weight Loss-2015FrankfurtFrankfurt, , GermanyGermanyAugustAugust 1 188 –– 2 200, 2015, 2015

Weight loss

what is the best outcome measure ?

A.P.J. Houdijk MD PhD

Medical Center Alkmaar

Free University Hospital Amsterdam

The worldwide weight problem

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 ?

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

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

Body fat depots

Total adipose tissue

subcutaneousperipheralabdominal

InternalAbdominal (visceral)intra/inter muscularPericardialHepaticPancreatic

Overweight related metabolic diseasevisceral obesity is the motor

Visceral obesity induces inflammation and insulin resistance

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

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

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

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

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

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

Ct scan image for visceral fat

Visceral fat area (cm2) at L3 – L4 levelThreshold for metabolic disease = 100 cm2

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

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

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

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

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

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 %

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

Slim fit

Slim unfit

Fat fit

Fat unfit

O'Donovan et al

Fit versus unfit phenotypes

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

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

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

Questions

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

Euro Weight Loss – 2016 Website: http://weightloss.global-summit.com/europe/

Meet the eminent gathering once again atMeet the eminent gathering once again at

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September 19-20, 2016September 19-20, 2016