Reciprocal Relations of Subcutaneous and Visceral Fat to Bone Structure and Strength

Abstract

Information is lacking from prospective studies on the incidence and risk factors for postoperative nerve injury after routine gynecologic surgery. In 2 retrospective studies, the reported risk of nerve injury from major gynecologic oncologic procedures was estimated to be between 1.1% and 1.9%. This prospective cohort study evaluated the overall incidence and time course of pelvic nerve injury in a population of 616 female patients undergoing elective gynecologic surgery for benign and malignant conditions. The study was conducted between 2007 and 2008 at a single academic medical center.Before surgery, neurologic evaluation found preexisting lower extremity neuropathies in 12 (1.9%) participants. After surgery, 14 new peripheral nerve injuries were observed in 11 patients; the overall incidence of postoperative neuropathy was 1.8% (11/616), with a 95% confidence interval of (1.0-3.2). The neuropathies detected included 1 ilioinguinal/ iliohypogastric, 1 saphenous, 1 genitofemoral, 1 common fibular, 5 lateral femoral cutaneous, and 5 femoral. There was a complete resolution of neuropathic symptoms in 91% (10/11) of the patients at a median time of 31.5 days (range: 1 day to 6 months).These findings are consistent with other studies suggesting a low risk of new onset neurologic injury after gynecologic surgery. GYNECOLOGYVolume 65, Number 2 OBSTETRICAL AND GYNECOLOGICAL SURVEY ABSTRACT Hypoestrogenism in postmenopausal women results in skin atrophy with a decrease in both elasticity and skin thickness. The fragility of the skin in aging women may be responsible for the reported 50% or more increase in major laparoscopic complications during the initial entry into the female abdomen. Several first-entry techniques in laparoscopy have been investigated to minimize entry-related complications. The Veress needle approach is the standard method used by most gynecologists. A promising new method is the direct optical access (DOA) which uses optically-guided trocars to provide visual guidance during entry. These 2 techniques have not been compared.The aim of this prospective randomized study was to evaluate the efficacy and safety of these 2 methods in postmenopausal women. The study was conducted at multiple European gynecology centers between 2004 and 2008. A total of 186 postmenopausal women scheduled to undergo laparoscopy for simple, persistent postmenopausal ovarian cysts were randomized to 2 groups: group I (n ϭ 89) was assigned to surgical entry using DOA, and group 2 (n ϭ 97) was assigned to entry using the Veress needle method. The 2 procedures were compared for the following parameters: the time needed for achieve adequate abdominal access, the occurrence of major and minor vascular and bowel injuries, and blood loss during laparoscopic access. Operative Gynecology 91 92Obstetrical and Gynecological Survey ABSTRACTMajor risk factors in the general surgical population for morbidity and mortality have been identified using a number of risk scoring systems. Such risk factors include older age, length of surgery,...

Relationships of percent body fat and percent trunk fat with bone mineral density among Chinese, black, and white subjects

“…Recent studies showed a strong relationship between BMD and abdominal fat distribution; however, these results are inconsistent [13,14,32], and how abdominal fat influences bone metabolism is not clear. An effect of abdominal fat distribution on BMD may be caused by the secretions from the abdominal adipocyte and, additionally, obesity-related metabolic diseases also associated with BMD [32].…”

“…The ethnic difference in the relationship between %TF and BMD may be due to the reciprocal effect of visceral and subcutaneous fat masses on BMD [14]. With the same increment of BF, Chinese people were reported to have more subcutaneous fat accumulated compared with their European counterparts [21], and the positive correlation between subcutaneous fat and BMD was found to be slightly stronger than the negative correlation between visceral fat and BMD [14]. The opposite associations between subcutaneous fat and visceral fat with BMD are mainly due to the different expressions of biochemical factors.…”

“…A recent epidemiologic study using waist circumference as the index of abdominal fat showed a negative association between abdominal fat accumulation and BMD [13]. Furthermore, a newly published study divided abdominal fat into visceral and subcutaneous adiposity and found a negative correlation between visceral adiposity and BMD [14]. However, the evidence of the association between BMD and abdominal fat distribution was still limited.…”

Fat mass is negatively associated with bone mineral content in Koreans

“…Although we have not evaluated the composition of visceral vs. subcutaneous fat in this study, previous studies have demonstrated that visceral fat has been shown to be distinct from subcutaneous fat in its effect on bone metabolism [29,30]. Indeed, Gilsanz et al [19] found that the visceral fat exerts negative effects on femoral bone mass and strength, while the subcutaneous fat has positive effects. In another study conducted in 461 healthy Korean subjects, the visceral fat area on abdominal computed tomography scan was inversely associated with BMD, whereas the subcutaneous fat area showed no significant association [28].…”

“…A number of studies have shown that both fat mass and lean mass can contribute to an increase in bone mass, thereby reducing the risk of fractures [10,15,16]; others have demonstrated a detrimental effect of fat mass on bone mass after controlling for body weight [12,17,18]. Additionally, when considering total fat mass, subcutaneous fat was beneficial to bone mass, whereas visceral fat was deleterious [19].…”