Ultrasonographic visceral fat thickness in the first trimester can predict metabolic syndrome and gestational diabetes mellitus

Gür, Esra Bahar; İnce, Özlem; Turan, Gülüzar Arzu; Karadeniz, Muammer; Tatar, Sumeyra; Çelik, Esin; Yalçın, Murat; Güçlü, Serkan

doi:10.1007/s12020-013-0154-1

Cited by 71 publications

(84 citation statements)

References 20 publications

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“…Interpretation of previous data was largely hindered by the cross-sectional design of central obesity measurement at the time of GDM diagnosis and also limited data on WHR (40). Our findings are consistent with a few small-scale studies including 10–45 GDM cases, which linked ultrasonography measured visceral fat in early pregnancy to impaired glucose tolerance or GDM in the third trimester (12, 41). However, these studies were not able to examine the joint association and incremental predictive value of visceral fat beyond a combination of established risk factors for GDM.…”

Section: Discussionsupporting

confidence: 92%

“…However, evidence has been largely confined to non-pregnant individuals. Data on the association between central obesity in early pregnancy and risk of GDM beyond established risk factors including overall obesity as measured by BMI are limited, mostly in small-scale studies including 10–80 women with GDM (11, 12, 13, 14). In particular, waist-to-hip ratio (WHR) and waist circumference (WC) have been established as simple and less expensive surrogate measures of central obesity with high correlations with intra-abdominal or visceral fat mass (15, 16), whereas data on WHR or WC in early pregnancy in relation to GDM risk are scant.…”

Section: Introductionmentioning

confidence: 99%

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Central Obesity Increases the Risk of Gestational Diabetes Partially Through Increasing Insulin Resistance

Zhu

Hedderson

Quesenberry

et al. 2018

Obesity

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Objective This study examined the associations of central obesity measures, waist to hip ratio (WHR) and waist circumference (WC), in early pregnancy with subsequent risk of gestational diabetes mellitus (GDM) and evaluated the potential mediating role of insulin resistance markers. Methods Within the prospective Pregnancy Environment and Lifestyle Study cohort of 1,750 women, WC and hip circumference were measured at gestational weeks 10 to 13. In a nested case‐control study within the cohort, 115 GDM cases and 230 controls had fasting serum insulin, homeostatic model assessment of insulin resistance (HOMA‐IR), and adiponectin measurements at gestational weeks 16 to 19. Poisson and conditional logistic regression models were used, adjusting for established risk factors for GDM, including prepregnancy overweight or obesity. Results For women with WHR < 0.85, one or more established risk factors increased GDM risk 1.99‐fold (95% CI: 0.99‐4.02). For women with WHR ≥ 0.85 but no established risk factors, GDM risk increased 2.41‐fold (95% CI: 1.14‐5.06), and in those with established risk factors it increased 6.22‐fold (95% CI: 3.49‐11.10). Similar but attenuated results were observed for WC ≥ 88 cm. Insulin, HOMA‐IR, and adiponectin levels mediated the WHR–GDM association by 9% to 11%; corresponding mediation proportions for the WC–GDM association were 35% to 41% (all P < 0.04). Conclusions Central obesity in early pregnancy represented a high‐risk phenotype for GDM independent of other risk factors, including overweight or obesity, and may inform early screening and prevention strategies.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Central Obesity Increases the Risk of Gestational Diabetes Partially Through Increasing Insulin Resistance

Zhu

Hedderson

Quesenberry

et al. 2018

Obesity

View full text Add to dashboard Cite

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“…Importantly, this has been shown to occur even independent of the BMI, which is so far the only adipogenic indicator/marker clinically considered in GDM screening/treatment but, on the other hand, hardly serves as a marker for visceral type of obesity. Reports have purposed that ultrasound could be a potential way of estimating the VAT and SAT risk factors in pregnancy [40][41][42]. In confirmation of the aforementioned observations, our data may point to a particular role visceral obesity might play in the etiopathogenesis of GDM, through altered/increased expression of inflammatory factors and/or further factors increasing insulin resistance through altered action in VAT.…”

Section: Discussionsupporting

confidence: 82%

Visceral Adipose Tissue Inflammatory Factors (TNF-Alpha, SOCS3) in Gestational Diabetes (GDM): Epigenetics as a Clue in GDM Pathophysiology

Rancourt

Ott

Ziska

et al. 2020

IJMS

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Gestational diabetes (GDM) is among the most challenging diseases in westernized countries, affecting mother and child, immediately and in later life. Obesity is a major risk factor for GDM. However, the impact visceral obesity and related epigenetics play for GDM etiopathogenesis have hardly been considered so far. Our recent findings within the prospective ‘EaCH’ cohort study of women with GDM or normal glucose tolerance (NGT), showed the role, critical factors of insulin resistance (i.e., adiponectin, insulin receptor) may have for GDM pathophysiology with epigenetically modified expression in subcutaneous (SAT) and visceral (VAT) adipose tissues. Here we investigated the expression and promoter methylation of key inflammatory candidates, tumor necrosis factor-alpha (TNF-α) and suppressor of cytokine signaling 3 (SOCS3) in maternal adipose tissues collected during caesarian section (GDM, n = 19; NGT, n = 22). The mRNA expression of TNF-α and SOCS3 was significantly increased in VAT, but not in SAT, of GDM patients vs. NGT, accompanied by specific alterations of respective promoter methylation patterns. In conclusion, we propose a critical role of VAT and visceral obesity for the pathogenesis of GDM, with epigenetic alterations of the expression of inflammatory factors as a potential factor.

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“…They found that visceral adipose tissue depth above the upper quartile was associated with a positive GCT, whereas subcutaneous fat was not correlated. Similar results were reported by Gur et al ., who also noted that sonographic visceral fat was superior to waist circumference and BMI in predicting gestational diabetes.…”

supporting

confidence: 90%

Ultrasound in the management of obesity in pregnancy

Mongelli

Condous

2016

Australas J Ultrasound Med

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T he prevalence of obesity in women is increasing on a world-wide basis, not only in developed countries but now also in developing countries. Here in Australia, about 40-50% of the population are either overweight or obese. 1,2 This has been linked to an increased risk of pregnancy complications including fetal growth disorders, pre-eclampsia and gestational diabetes. [3][4][5] In the post-natal period, maternal haemorrhage and infections are more common. The neonate is also at risk of low Apgar scores, jaundice and hypoglycaemia. [6][7][8][9] The underlying pathophysiology in obesity is a chronic inflammatory state resulting from cytokines released by excess adipose tissue. In pregnancy, there is a natural increase in inflammation, and in combination with obesity, deranged metabolic homeostasis may occur with subsequent pathology. [3][4][5]10 Traditionally, obesity has been quantified in terms of the body mass index (BMI), calculated as the weight in kg divided by the square of height in metres. This was originally invented by Adolphe Quetelet, a Belgian astronomer and social scientist, around 1840. There are several limitations to this index. It does not reflect the actual distribution of body fat, 11,12 and this is a major issue since it is well known that central (abdominal) fat distribution is more closely correlated with adverse outcomes such as hypertension, diabetes and cardiovascular disease, than peripheral fat. 13 It does not differentiate between muscle mass and fat mass, and hence there may be ethnic differences in reference standards. 14 This measurement is somewhat biased in that tall people tend to have BMI that are unduly high for the amount of fat that they carry.Accurate measurements of central adiposity can be obtained by computed tomography, magnetic resonance imaging or body densitometry. Apart from cost, these methods may not be suitable for pregnant women in routine clinical practice. An alternative index of central adiposity is the subcutaneous fat thickness (SFT). Abdominal SFT has no correlation with age, number of pregnancies, or history of laparotomy, 15 but it becomes thinner as pregnancy progresses due to the increase in abdominal volume and pressure. The techniques for the sonographic measurement of the SFT and other measures of intra-abdominal fat were first described by Armellini et al. in non-pregnant women in 1991. 16 They found these measurements reliable and superior to skinfold measurement with callipers.The first clinical correlations of ultrasonic assessment of adiposity were reported in a small study by Martin et al. 17 Subcutaneous and visceral fat was measured in pregnant women at around 12 weeks' gestation. A glucose challenge test (GCT) was carried out at around 26 weeks' gestation. They found that visceral adipose tissue depth above the upper quartile was associated with a positive GCT, whereas subcutaneous fat was not correlated. Similar results were reported by Gur et al., 18 who also noted that sonographic visceral fat was superior to waist circumference and BMI ...

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Ultrasonographic visceral fat thickness in the first trimester can predict metabolic syndrome and gestational diabetes mellitus

Cited by 71 publications

References 20 publications

Central Obesity Increases the Risk of Gestational Diabetes Partially Through Increasing Insulin Resistance

Central Obesity Increases the Risk of Gestational Diabetes Partially Through Increasing Insulin Resistance

Visceral Adipose Tissue Inflammatory Factors (TNF-Alpha, SOCS3) in Gestational Diabetes (GDM): Epigenetics as a Clue in GDM Pathophysiology

Ultrasound in the management of obesity in pregnancy

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