Results: Waist circumference, waist-to-hip ratio (WHR), and US-determined visceral fat values showed the best correlation coefficients with visceral fat determined by CT (r ϭ 0.55, 0.54, and 0.71, respectively; p Ͻ 0.01). Fat mass determined by DXA was inversely correlated with visceralto-subcutaneous-fat ratio (r ϭ Ϫ0.47, p Ͻ 0.01). Bioimpedance-determined fat mass and skinfolds were correlated with only subcutaneous abdominal fat quantified by CT. Linear regression indicated US visceral-fat distance and WHR as the main predictors of CT-determined visceral fat (adjusted r 2 ϭ 0.51, p Ͻ 0.01). A waist measurement of 107 cm (82.7% specificity, 60.6% sensitivity) and WHR of 0.97 (78.8% specificity, 63.8% sensitivity) were chosen as discriminator values corresponding with visceral obesity diagnosed by CT. A value of 6.90 cm for visceral fat USdetermined diagnosed visceral obesity with a specificity of 82.8%, a sensitivity of 69.2%, and a diagnostic concordance of 74% with CT.Discussion: US seemed to be the best alternative method for the assessment of intra-abdominal fat in obese women. Its diagnostic value could be optimized by an anthropometric measurement. Prospective studies are needed to establish CT and US cutoffs for defining visceral-fat levels related to elevated cardiovascular risk.

Abstract-Visceral fat accumulation is associated with increased cardiovascular risk. Clinical evaluation of visceral fat is limited because of the lack of reliable and low-cost methods. To assess the correlation between ultrasonography and computed tomography (CT) for the evaluation of visceral fat, 101 obese women, age 50.5Ϯ7.7 years with a body mass index of 39.2Ϯ5.4 kg/m 2 , were submitted to ultrasonograph and CT scans. Visceral fat measured by ultrasonography, 1 cm above the umbilical knot, showed a high correlation with CT-determined visceral fat (rϭ0.67, PϽ0.0001). The ultrasonograph method showed good reproducibility with an intra-observer variation coefficient of Ͻ2%. Both ultrasonograph and CT visceral fat values were correlated with fasting insulin (rϭ0.29 and rϭ0.27, PϽ0.01) and plasma glucose 2 hours after oral glucose load (rϭ0.22 and rϭ0.34, PϽ0.05), indicating that ultrasonography is a useful method to evaluate cardiovascular risk. A significant correlation was also found between visceral fat by CT and serum sodium (rϭ0.18, PϽ0.05). A ultrasonograph-determined visceral-to-subcutaneous fat ratio of 2.50 was established as a cutoff value to define patients with abdominal visceral obesity. This value also identified patients with higher levels of plasma glucose, serum insulin and triglycerides and lower levels of HDL-cholesterol, which are metabolic abnormalities characteristic of the metabolic syndrome. Our data demonstrate that ultrasonography is a precise and reliable method for evaluation of visceral fat and identification of patients with adverse metabolic profile.

Our data reinforce the association between obesity and high cardiovascular risk. In addition, our findings suggested a role for body fat distribution in the development of hypertension in obese patients.

NUNES FARIA, ALESSANDRA, FERNANDO FLEXA RIBEIRO FILHO, SANDRA ROBERTA GOUVEIA FERREIRA, AND MARIA TERESA ZANELLA. Impact of visceral fat on blood pressure and insulin sensitivity in hypertensive obese women. Obes Res. 2002;10:1203-1206. Objective: The relationship among body fat distribution, blood pressure, serum leptin levels, and insulin resistance was investigated in hypertensive obese women with central distribution of fat. Research Methods and Procedures:We studied 74 hypertensive women (age, 49.8 Ϯ 7.5 years; body mass index, 39.1 Ϯ 5.5 kg/m 2 ; waist-to-hip ratio, 0.96 Ϯ 0.08). All patients were submitted to 24-hour blood pressure ambulatory monitoring (24h-ABPM). Abdominal ultrasonography was used to estimate the amount of visceral fat (VF). Fasting blood samples were obtained for serum leptin and insulin determinations. Insulin resistance was estimated by homeostasis model assessment insulin resistance index (HOMA-r index). Results: Sixty-four percent of the women were postmenopausal, and all patients showed central distribution of fat (waist-to-hip ratio Ͼ 0.85). The VF correlated with systolic 24h-ABPM values (r ϭ 0.28, p ϭ 0.01) and with HOMA-r index (r ϭ 0.27; p ϭ 0.01). VF measurement (7.5 Ϯ 2.3 vs. 5.9 Ϯ 2.2 cm, p Ͻ 0.001) and the systolic 24h-ABPM (133 Ϯ 14.5 vs. 126 Ϯ 9.8 mm Hg, p ϭ 0.04), but not HOMA-r index, were significantly higher in the postmenopausal group (n ϭ 48) than in the premenopausal group (n ϭ 26). No correlations were observed between blood pressure levels and HOMA-r index, leptin, or insulin levels. In the multiple regression analysis, visceral fat, but not age, body fat mass, or HOMA-r index, correlated with the 24h-ABPM (p ϭ 0.003). Discussion: In centrally obese hypertensive women, the accumulation of VF, more often after menopause, is associated with higher levels of blood pressure and insulin resistance. The mechanism through which VF contributes to higher blood pressure levels seems to be independent of leptin or insulin levels.

INTRODUCTION: The objective of this study was to assess the frequency of Binge Eating Disorder (BED) or Binge Eating episodes (BINGE), anxiety, depression and body image disturbances in severely obese patients seeking treatment for obesity. METHOD: We assessed 50 patients (10M and 40F) with Body Mass Index (BMI) between 40 and 81.7 Kg/m² (mean 52.2±9.2 Kg/m²) and aging from 18 to 56 years (mean 38.5±9.7). Used instruments: Questionnaire on Eating and Weight Patterns <FONT FACE=Symbol>¾</FONT> Revised (QEWP-R) for BED or BINGE assessment, Beck Depression Inventory (BDI) for depressive symptoms, State - Trait Anxiety Inventory (STAI-TRAIT and STAI-STATE) for anxiety and Body Shape Questionnaire (BSQ) for body image assessments. RESULTS: In this population BED and BINGE frequencies were 36% and 54%, respectively. Symptoms of depression were detected in 100% while severe symptomatology was found in 84% of the cases. The frequency of anxiety as a trait was 70%, as a state, 54% and 76% of all patients reported discomfort regarding body image. The frequency of BED was higher in patients with higher anxiety scores as a personality trait (>40) but not as a state (46% vs. 13%; p<0,05). A high frequency of BINGE was found in those with higher scores (>140) in the BSQ assessment. CONCLUSION: Our results indicate a high frequency of binge eating episodes, severe depressive symptoms, anxiety and concern with body image in grade III obesity patients.

OBJECTIVE -Visceral obesity is shown to be a predictor of morbidity and mortality. We evaluated the association of measurements of generalized adiposity and visceral fat area (VFA), with abnormalities of metabolic syndrome (MS).RESEARCH DESIGN AND METHODS -Seventy-six women (47.9 Ϯ 9.2 years) with BMI of 38.7 Ϯ 5.4 kg/m 2 underwent anthropometric measurements, laboratory procedures, bioeletrical impedance, and abdominal computed tomography (CT) scan. Diagnosis of MS was based on the presence of abdominal obesity and at least two of the following components: hypertension, dyslipidemia, and glucose intolerance and/or hyperinsulinemia.RESULTS -BMI was correlated with both components of adipose tissue-subcutaneous (r ϭ 0.66, P Ͻ 0.01) and VFA (r ϭ 0.33, P Ͻ 0.02)-and leptin levels (r ϭ 0.38, P Ͻ 0.01). In contrast, VFA was correlated with 2-h glucose and insulin levels (r ϭ 0.32 and 0.35, P Ͻ 0.05, respectively), triglyceride, HDL cholesterol, and uric acid (r ϭ 0.33, -0.34 and 0.24, P Ͻ 0.05, respectively). Subjects with high VFA, matched for BMI, showed greater plasma glucose area under the curve (621 Ϯ 127 vs. 558 Ϯ 129 mg ⅐ h Ϫ1 ⅐ dl Ϫ1 , P Ͻ 0.05), 2-h insulin (804 Ϯ 599 vs. 579 Ϯ 347 pmol/l, P Ͻ 0.05), and uric acid levels (0.33 Ϯ 0.07 vs. 0.26 Ϯ 0.06 mmol/l, P Ͻ 0.05) than subjects with low VFA. In logistic regression analysis, waist circumference, VFA, and 2-h insulin were identified as independent predictors of MS. Receiver operating characteristic curve analysis pointed out the values of 104 cm for waist circumference (58.1% specificity, 84.1% sensitivity), 158.5 cm 2 for VFA (78.1% specificity, 52.3% sensitivity), and 559.8 pmol/l for 2-h insulin (71.9% specificity, 69.8% sensitivity); the presence of at least two of the three variables resulted in a degree of concordance of 76%.CONCLUSIONS -While BMI was unable to differentiate between obese people and those at higher risk for MS, abdominal fat was shown to be associated with its metabolic abnormalities. The usefulness of abdominal fat in the identification of high-risk subjects may be improved when combined with 2-h insulin determination. Diabetes Care 26:1725-1730, 2003O besity is considered a major public health problem due to its increasing prevalence and high morbidity and mortality, mainly attributed to abnormalities included in the spectrum of the metabolic syndrome (MS) (1-3). Particularly, upper-body obesity has been shown to be an important predictor of cardiovascular disease (4). The search for markers able to identify subjects at high risk to develop MS is motivated by the potential benefits of early interventions.The simplicity of BMI assessment has made this widely used to classify subjects' risk of morbidity and mortality (1,5). However, BMI is not accurate to quantify body fat excess or the distribution of fatness. Recent studies have reported populations with low prevalence of obesity but high incidence of typical disturbances of MS (6,7), thereby raising the question of whether BMI plays a role in the identification of patients at high ...

Objective - Effects of Sibutramine on the Treatment of Obesity in Patients with Arterial Hypertension Artigo OriginalThe prevalence of obesity and its associated morbidities has increased in several countries worldwide, including Brazil 1,2 . The increase in body mass index has proved to be a determinant factor for elevation of blood pressure, both for obese and nonobese children and adults 3,4 . In addition, the presence of obesity is related to a 2.5 higher risk of arterial hypertension, mainly in patients with central body fat distribution 5 . Several hypotheses exist for the pathophysiology of arterial hypertension in this obese population. The first and more accepted hypothesis proposes that hyperinsulinemia secondary to insulin resistance existing in these patients leads to greater sympathetic activity and to renal sodium retention, which would account for the increase in pressure levels [6][7][8] . The second hypothesis associates the arterial hypertension existing in these patients with the mechanical compression of renal parenchyma by visceral fat. This leads to hyperactivation of the renin-angiotensinaldosterone system (RAAS), higher sodium reabsorption, and a subsequent elevation in blood pressure by a mechanism independent from insulinemia 9,10 .Even though we have not reached a consensus about the causes of arterial hypertension in the obese, several clinical studies confirm the importance of weight loss to better control blood pressure levels 11,12 .The great challenge has been to find effective clinical treatments, which do not impair blood pressure control, to induce weight loss in hypertensive patients. Of the several treatments available for weight control, we can count on appetite suppressing drugs, which comprise a generic class of drugs derived from amphetamines that act through adrenergic receptors, and, therefore, may aggravate hypertension. More recently, other options include orlistat that inhibits gastrointestinal fat absorption, and sibutramine, an appetite suppressant that blocks serotonin, dopamine, and noradrenaline reuptake 13 .The use of sibutramine is associated with an increase in satiety scores and a lack of decline in 24-hour energy

Sibutramine therapy induced greater body weight loss than placebo in hypertensive obese patients. This was associated with WHR reduction, decreases in VF and insulin resistance. The maintenance of leptin levels during sibutramine therapy may be important to avoid weight recovery, although this finding must be confirmed by other prospective studies.