Aim:We determined the association of lower-body fat mass (LFM) and trunk fat mass (TFM) with cardiometabolic risk factors and adipokines in young, healthy, slim women. Methods: A total of 481 college female students underwent the following: regional body fat distribution as assessed by dual energy X-ray absorptiometry (DXA), a 75g oral glucose tolerance test (OGTT) and fasting blood sampling for measurement of lipids, lipoproteins, apolipoproteins (apo), liver enzymes and adipokines. Results: After adjusting for TFM, LFM was positively associated with HDL cholesterol, adiponectin, pre-heparin lipoprotein lipase and insulin sensitivity, as estimated by the Matsuda index, whereas it was negatively related to triglycerides, apo B, apo B/A1 ratio, small dense LDL, FFA, glucose and insulin at 2h during OGTT, area under the curve of insulin response during OGTT and the white blood cell count. Participants were divided into 9 groups according to tertiles of TFM and LFM. In the middle tertile of TFM, HDL cholesterol and adiponectin increased and triglycerides, apoB/A1 ratio and plasminogen-activator inhibitor-1 decreased from the low to high LFM tertiles. Gammaglutamyltransferase levels in middle and high LFM tertiles were lower than in the lower LFM tertile. Conclusion: For a given level of trunk fat mass, a higher lower-body fat mass is associated with an advantageous profile of not only blood lipoproteins but also serum adipokines, even in healthy, slim women in early adulthood. J Atheroscler Thromb, 2011; 18:365-372.

IntroductionDeterminants and correlates of a novel index of adipose tissue insulin resistance (AT-IR) (the product of fasting insulin and free fatty acid concentrations) were investigated in Japanese women without diabetes and obesity.Research design and methodsCross-sectional associations of AT-IR with fat mass and distribution, and IR-related cardiometabolic variables were examined in 210 young and 148 middle-aged women whose average body mass index (BMI) was <23 kg/m2 and waist was <80 cm. Multivariate linear regression analyses were used to identify most important determinants of AT-IR.ResultsYoung and middle-aged women did not differ in AT-IR (3.5±2.7 and 3.2±2.1, respectively). In both young and middle-aged women, AT-IR was positively associated with trunk/leg fat ratio, a sophisticated measure of abdominal fat accumulation, fasting plasma glucose (FPG), fasting triglycerides (FTG), serum alanine aminotransferase and γ-glutamyl-transpeptidase (all p<0.05). Furthermore, in middle-aged but not in young women, AT-IR showed positive associations with BMI, waist, fat mass index, low-density lipoprotein cholesterol, apolipoprotein B and systolic and diastolic blood pressure (BP) (all p<0.05). AT-IR showed no association with hemoglobin A1c, high-density lipoprotein (HDL) cholesterol and apolipoprotein A1 in two groups of women. On multivariate analysis including waist, FPG, FTG, HDL cholesterol and systolic BP as independent variables, FPG, FTG and HDL cholesterol emerged as independent determinants of AT-IR in young women (cumulative R2=0.141) and waist in middle-aged women (cumulative R2=0.056). In a model which included trunk/leg fat ratio instead of waist, trunk/leg fat ratio and systolic BP were determinants of AT-IR in middle-aged women (cumulative R2=0.093). Results did not alter in young women.ConclusionsAT-IR may be a simple and useful surrogate index of adipose tissue insulin resistance even in populations without diabetes and obesity.

Aim: Although the mean body mass index (BMI) of Japanese patients with type 2 diabetes was within the normal range, we have previously shown that approximately half of all patients classified as normal weight had been formerly obese. The present study examined the clinical features of Japanese type 2 diabetic patients who are currently of normal weight but had formerly been obese (NWFO). Methods: Body weight history with self-reported body weight was obtainable for 108 of 114 type 2 diabetic outpatients who had been regularly attending our department. Common carotid artery intima-media thickness (IMT) was also measured. Results: At the time of the examinations, 5 (5%) and 36 (33%) of 108 type 2 diabetic patients were lean (BMI 18.5 kg/m 2 ) and obese (BMI 25 kg/m 2 ), respectively, whereas normal weight (BMI ≥ 18.5-25 kg/m 2 ) was found in 67 (62%) patients. Among 108 patients, 67 (62%) were normal weight, of which 32 (48%) were formerly obese (NWFO). NWFO patients with a mean age of 65 years old at the clinic visit had reached their lifetime maximum body weight at age 45 and became diabetic at age 51 years. Obese patients aged 62 years at the clinic visit became diabetic at age 50 and had reached their maximum weight at age 51 years. Diabetes duration was 11 years in patients who had never been obese. Thus, NWFO patients had been exposed to obesity-related metabolic abnormalities and/or hyperglycemia for 20 years on average whereas obese and never obese patients had been exposed for 11-12 years. Although obese patients had higher fasting TG and greater BMI than NWFO, both obese and NWFO patients had similarly lower HDL cholesterol levels than those who had never been obese; however, there was no difference among the 3 groups in diabetic treatment, diabetes duration, HbA1c levels, and prevalence of atherosclerotic risk factors, including smokers, users of statins and antihypertensive drugs. Carotid max IMT was thicker in NWFO type 2 diabetic patients (0.86 0.04mm) than either obese patients (0.78 0.03mm, p 0.041) or those who had never been obese (0.78 0.02mm, p 0.046). Conclusion: This report confirms that approximately half of 108 Japanese type 2 diabetic patients who are currently normal weight were formerly obese and shows that these patients had a thicker carotid IMT than either obese patients or those who had never been obese. Formerly obese diabetic patients who have lost weight and are currently normal weight might have been exposed to long-term obesity-related cardiometabolic abnormalities and/or hyperglycemia, resulting in increased common carotid IMT. We therefore suggest that an improved clinical screening tool would include the assessment of body weight history for all Japanese type 2 diabetic patients at their first clinic visit.

Background Child abuse and postnatal depression are two public health problems that often co-occur, with rates of childhood maltreatment highest during the first year of life. Internet-based behavioural activation (iBA) therapy has demonstrated its efficacy for improving postnatal depression. No study has examined whether the iBA program is also effective at preventing child abuse. This study aims to investigate whether iBA improves depressive symptoms among mothers and prevents abusive behaviours towards children in postpartum mothers in a randomized controlled trial, stratifying on depressive mood status. The study also evaluates the implementation aspects of the program, including how users, medical providers, and managers perceive the program in terms of acceptability, appropriateness, feasibility, and harm done. Methods The study is a non-blinded, stratified randomized controlled trial. Based on cut-off scores validated on Japanese mothers, participants will be stratified to either a low Edinburgh Postnatal Depression Scale (EPDS) group, (EPDS 0–8 points) or a high EPDS group (EPDS ≥9 points). A total of 390 postnatal women, 20 years or older, who have given birth within 10 weeks and have regular internet-access will be recruited at two hospitals. Participants will be randomly assigned to either treatment, with treatment as usual (TAU) or through intervention groups. The TAU group receives 12 weekly iBA sessions with online assignments and feedback from trained therapists. Co-primary outcomes are maternal depressive symptoms (EPDS) and psychological aggression toward children (Conflict Tactic Scale 1) at the 24-week follow-up survey. Secondary outcomes include maternal depressive symptoms, parental stress, bonding relationship, quality of life, maternal health care use, and paediatric outcomes such as physical development, preventive care attendance, and health care use. The study will also investigate the implementation outcomes of the program. Discussion The study investigates the effectiveness of the iBA program for maternal depressive symptoms and psychological aggression toward children, as well as implementation outcomes, in a randomized-controlled trial. The iBA may be a potential strategy for improving maternal postnatal depression and preventing child abuse. Trial registration The study protocol (issue date: 2019-Mar-01, original version 2019005NI-00) was registered at the UMIN Clinical Trial Registry (UMIN-CTR: ID UMIN 000036864).