Background Visceral and subcutaneous adipose tissue (VAT and SAT) vary in volume and quality. We evaluated whether fat volume or attenuation (indirect measure of quality) predicts metabolic risk factor changes. Methods and Results Framingham Heart Study Multi-detector Computed Tomography Substudy participants (n=1730, 45% women) were followed over a mean of 6.2 years. Baseline VAT and SAT volume (in cm3) and attenuation (in Hounsfield units, HU) were assessed. Outcomes included blood pressure, lipids and glucose. We constructed multivariable regression models predicting change from baseline to follow-up. Baseline VAT was associated with metabolic risk factors at follow-up. Per 500 cm3 increment in baseline VAT, glucose was 2.34 mg/dL higher (95% CI 1.71–2.97) and HDL was 1.62 mg/dL lower (95% CI 0.97–2.28) in women (p<0.0001 for both). These findings remained significant after adjustment for BMI. Results for SAT were similar, although less striking. Lower (more negative) fat attenuation was associated with more adverse metabolic profiles at follow-up. For example, per 5 unit decrease in baseline VAT HU, log triglycerides increased by 0.08 mg/dL (95% CI 0.05–0.12,p=0.005), which remained significant after adjustment for baseline VAT. Among men, VAT and SAT HU were associated with changes in CVD risk factors, but were mostly attenuated after baseline volume adjustment. Conclusions VAT and SAT volume are associated with incident metabolic risk factors beyond their contributions to overall adiposity. Decrements in fat attenuation are also associated with incident risk factors. These findings suggest that both volume and quality of VAT and SAT contribute to metabolic risk.

OBJECTIVETo describe the metabolic profile of individuals with objective binge eating (OBE) and to evaluate whether associations between OBE and metabolic risk factors are mediated by body mass index (BMI).DESIGN AND METHODSParticipants from the Framingham Heart Study, Third Generation and Omni 2 cohorts (n = 3551, 53.1% women, mean age 46.4 years) were screened for binge eating. We used multivariable-adjusted regression models to examine the associations of OBE with metabolic risk factors.RESULTSThe prevalence of OBE was 4.8% in women and 4.9% in men. Compared to non-binge eating, OBE was associated with higher odds of hypertension (OR 1.85, 95% CI 1.32–2.60), hypertriglyceridemia (OR 1.42, 95% CI 1.01–2.01), low HDL (OR 1.70, 95% CI 1.18–2.44), insulin resistance (OR 3.18, 95% CI 2.25–4.50) and metabolic syndrome (OR 2.75, 95% CI 1.94–3.90). Fasting glucose was 7.2 mg/dl higher in those with OBE (p=0.0001). Individuals with OBE had more visceral, subcutaneous and liver fat. Most of these associations were attenuated with adjustment for BMI, with the exception of fasting glucose.CONCLUSIONSBinge eating is associated with a high burden of metabolic risk factors. Much of the associated risk appears to be mediated by BMI, with the exception of fasting glucose.

OBJECTIVEObesity and type 2 diabetes continue to increase in prevalence in the U.S. Whether diabetes incidence continues to increase in recent times is less well documented. We examined trends in diabetes incidence over the previous four decades.RESEARCH DESIGN AND METHODSFramingham Heart Study participants ages 40–55 years and free of diabetes at baseline (n = 4,795; mean age 45.3 years; 51.6% women) were followed for the development of diabetes in the 1970s, 1980s, 1990s, and 2000s. Diabetes was defined as either fasting glucose ≥126 mg/dL or use of antidiabetes medication. Poisson regression was used to calculate sex-specific diabetes incidence rates for a 47-year-old individual in each decade. Rates were also calculated among obese, overweight, and normal weight individuals.RESULTSThe annualized rates of diabetes per 1,000 individuals were 2.6, 3.8, 4.7, and 3.0 (women) and 3.4, 4.5, 7.4, and 7.3 (men) in the 1970s, 1980s, 1990s, and 2000s, respectively. Compared with the 1970s, the age- and sex-adjusted relative risks of diabetes were 1.37 (95% CI 0.87–2.16; P = 0.17), 1.99 (95% CI 1.30–3.03; P = 0.001), and 1.81 (95% CI 1.16–2.82; P = 0.01) in the 1980s, 1990s, and 2000s, respectively. Compared with the 1990s, the relative risk of diabetes in the 2000s was 0.85 (95% CI 0.61–1.20; P = 0.36).CONCLUSIONSIn our community-based sample, the risk of new-onset diabetes continued to be higher in the 2000s compared with the 1970s. In the past decade, diabetes incidence remained steady despite the ongoing trend of rising adiposity.

BackgroundProlactin is an anterior pituitary hormone that may modulate the adverse effects of obesity. Prolactin has been associated with cardiovascular disease mortality, but less is known about whether prolactin predicts incidence of cardiovascular disease risk factors.Methods and ResultsOur sample (n=3232, mean age 40.4 years, 52.1% women) was drawn from Framingham Heart Study participants who attended 2 examinations an average of 6.1 years apart. After excluding those with elevated prolactin (>30 mg/dL for women, >20 mg/dL for men), multivariable‐adjusted regressions modeled the associations between baseline prolactin and changes in cardiovascular disease risk factors. Models were adjusted for age, sex, baseline value of the risk factor, smoking status, hormone replacement therapy, and menopausal status and additionally for body mass index. Mean prolactin levels were 11.9 mg/dL (SD 5.2) in women and 8.0 mg/dL (SD 2.9) in men. No associations were observed for change in weight, body composition, total cholesterol, triglycerides, or fasting glucose. In women, for example, for each 5‐mg/dL increment in prolactin, odds of incident hypercholesterolemia were 1.06, which was not significant (95% CI 0.91–1.23, P=0.46). Some exceptions were of note. In women, for each 5‐mg/dL increment in prolactin, we observed increased odds of low high‐density lipoprotein cholesterol at follow‐up (odds ratio 1.50, 95% CI 1.18–1.91, P=0.001) that persisted after adjustment for body mass index (P=0.001). In men, a 5‐mg/dL increment in prolactin was associated with increased odds of incident hypertension (odds ratio 1.61, 95% CI 1.18–2.20 P=0.002) and incident diabetes (odds ratio 1.70, 95% CI 1.04–2.78, P=0.03).ConclusionsProlactin is not associated with a comprehensive panel of incident cardiovascular disease risk factors. Measurement of circulating prolactin levels in the community likely does not provide substantial insight into cardiometabolic risk.

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Bedside-prepared slides offer improved diagnostic adequacy and specimen cellularity over solution-based samples. The difference may be especially important when using smaller (25-gauge) needles to perform fine-needle aspiration. When solution-based samples are used, larger (21-gauge) needles provide more diagnostic specimens.