A.P.J. Houdijk Euro Weight Loss-2015 Frankfurt, Germany August 18 – 20, 2015.
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Transcript of A.P.J. Houdijk Euro Weight Loss-2015 Frankfurt, Germany August 18 – 20, 2015.
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
Euro Weight Loss-2016Euro Weight Loss-2016Vienna, AustriaVienna, Austria
September 19-20, 2016September 19-20, 2016