PDF version, 2.20 Mb

112 Pages·2010·2.15 MB·English

Table of Contents
Welcome Letter ......................................................................................................................................................................................................4
About the International Chair on Cardiometabolic Risk ..........................................................................................................................................5
Discussed Posters ..................................................................................................................................................................................................7
Session 1: Abdominal obesity: lifestyle correlates .......................................................................................................................................8
Session 2: Abdominal obesity, adipokines, inflammation and ectopic fat ..................................................................................................13
Regular Posters ...................................................................................................................................................................................................19
Poster Session 1........................................................................................................................................................................................20
Poster Session 2........................................................................................................................................................................................62
Index ...................................................................................................................................................................................................................103
3
Welcome Letter
Dear Colleagues,
The 1st International Congress on “Abdominal Obesity: Bridging the Gap Between Cardiology and Diabetology” is organized by the Inter-
national Chair on Cardiometabolic Risk (ICCR) in Hong Kong in January 28-30, 2010. The meeting takes a multidisciplinary approach to the
assessment and management of abdominal obesity as a key risk factor for the development of diabetes and cardiovascular disease.
Evidence suggests that our current worldwide epidemic of abdominal obesity cannot be handled by the current medical model in which compli-
cations such as hypertension, dyslipidemia, type 2 diabetes, cardiovascular disease are often evaluated and managed in isolation without the
proper multidisciplinary resources to improve patients’ nutritional and physical activity habits.
The 1st International Congress on Abdominal Obesity shall raise awareness on abdominal obesity as a new modifiable risk factor which, along
with traditional risk factors, plays a central role in this new concept of global cardiometabolic risk.
A novel approach is required to better understand the various causes of abdominal obesity, which this meeting examines through the review
of original data being translated into new paradigms for assessment and management. In their invited lectures, the top international experts of
the field discuss novel approaches, and share scientific and clinical data to benefit regional healthcare professionals, clinicians and scientists
for the fight against the epidemic of abdominal obesity, diabetes, and cardiovascular disease.
At the same time, questions on abdominal obesity, diabetes, dyslipidemia, and hypertension are reviewed in depth.
Some of the key topics addressed at the congress include:
• Assessment of abdominal obesity, metabolic syndrome and related cardiometabolic risk
• Pathophysiology of abdominal obesity and related cardiometabolic risk
• Drivers of cardiovascular disease risk in abdominal obesity and type 2 diabetes
• Management of abdominal obesity and global cardiometabolic risk: Physical activity/exercise
• Nutritional management of abdominal obesity and type 2 diabetes: From diet to healthy eating and drinking.
We are very grateful to our faculty for making this first event a unique international forum which aims at tackling an important and growing
health problem worldwide.
Sincerely,

Jean-Pierre Després Jean-Claude Coubard
Scientific Director of the ICCR Executive Director of the ICCR

Local Organizing Committee
P. Barter, Australia JP. Després, Canada
B. Brewer, USA F. Hu, USA
J. Chan, Hong Kong, China P. Libby, USA
JC. Coubard, France
4
The International Chair on Cardiometabolic Risk - an academic, independent and multidisciplinary platform - was launched by Université
Laval in March 2006 at a press conference held during the annual meeting of the American College of Cardiology in Atlanta. Since then, the
Chair has organized and participated in an array of activities at international medical congresses while reaching out to both scientific and lay
communities. The Chair’s website, which was launched in the fall 2007, is a key component of its strategy. The website is the most compre-
hensive, up-to-date, and easy-to-use source of information on abdominal obesity and cardiometabolic risk. Intended for both health profes-
sionals and the general public, it uses state-of-the-art technology to help visitors better understand the risk factors and markers that must be
addressed and the lifestyle changes that must be made in order to prevent abdominal obesity, type 2 diabetes and cardiovascular disease.
The Chair’s website is highly interactive and features free slides, webcasts, and videos in which world-renowned experts discuss themes
relevant to cardiometabolic risk. The Chair also publishes the CMReJournal, which is available through its website. The e-journal complements
the Chair’s website and provides up-to-date information on abdominal obesity and related cardiometabolic risk for a range of audiences. It also
features key research findings and messages as well as in-depth papers on issues relevant to abdominal obesity and global cardiometabolic
risk.
By providing a platform for integrated research, developing physician and patient education programs, and working to create new prevention
and treatment strategies, the Chair is committed to stopping and reversing the abdominal obesity pandemic for the benefit of patients and
society alike.
Our website can be found at: www.cardiometabolic-risk.org
5

Discussed
Posters
7
SeSSIon 1: Chongqing Medical University, Chongqing, 6School of Public Health, Xinjiang
Medical University, Xin Jiang, 7National Center for Women and Children’s
Abdominal obesity:
Health, Chinese Center for Disease Control and Prevention, Beijing, China
lifestyle c orrelates
objectives: To explore the optimal threshold values of waist circumference
(WC) for detecting cardiovascular (CV) risk factors for Chinese children and
adolescent.
THe LIPoMeTeR - A neW oPTICAL DeVICe FoR PReCISe
MeASUReMenT oF BoDY FAT DISTRIBUTIon AnD RISK DeTeCTIon Methods: Association of WC and CV risk factors were studied among the
data of 65898 children aged 7-18 years pooled from nine studies in China.
R. Horejsi1, R. Moeller1, A. Adam1, M. Lachmann1, K. Sudi2, E. Tafeit1 CV risk factors in this study included hypertension (blood pressure above
95 percentile levels), dyslipidemia (having one or more of the next three:
1Medical University Graz, Institute of Physiological Chemistry, Graz, Austria, TG≥1.7mmol/L, TC≥5.18mmol/L, and HDLc≤1.04 mmol/L) and elevated
2Private University Liechtenstein, Rektorat, Triesen, Liechtenstein glucose level (fasting plasma glucose≥5.6mmol/L). Receive-operating
characteristic analysis (ROC) and logistic regression were employed to derive
Numerous international studies give evidence for a connection of optimal age- and sex-specific waist circumference references for predicting
typical types of body fat distribution and an increased risk for metabolic, CV risk factors.
cardiovascular, and endocrine disorders.The new optical device, Lipometer,
developed at the Medical University of Graz, Austria, (European Patent Results: A slight increasing trend of CV risk factors was observed starting
EP: 0516251) opens a completely new scope and insight in human from the 75th percentile of waist circumference in the study population,
body composition. This tool permits the quick, non-invasive, and precise while a remarkable increasing trend occurred from the 90th percentile. The
measurement of the thickness of subcutaneous adipose tissue (SAT-) layers optimal waist circumference thresholds for predicting high blood pressures
at any given site of the human body. An individual Lipometer-SAT-Topography were at the 75th percentile for both boys and girls, which was at the 90th
(SAT-Top) represents the result of measurements taken from fifteen percentiles for detecting at least two of the above three CV risk factors.
anatomically well-defined body sites. Based on a dataset of measurements Compared to children with waist circumference below the 75th percentile,
in more than 20.000 individuals aged between 7 and 80 years it is possible the odds of having two CV risk factors doubled among children whose
to describe healthy as well as pathological body fat distribution patterns waist circumference being between the 75th and the 90th percentile, and
of both males and females. In a special two-dimensional factorplot the increased by 5 times among children with waist circumference above the
measurements can be visualized for subjects or/and for groups; the SAT- 90th percentile. The increasing trend of high blood pressure with waist
Tops can be compared, and individual risks for getting certain diseases can circumference remained significant after stratified by BMI category.
be found. To use the SAT-Top for a body fat screening during diets, weight
loss programs and for controlling the success of a treatment is possible. Conclusion: The 75th and the 90th percentile of WC are the optimal cut-off
There are characteristic profile deformations in the case of metabolic and points for predicting an increased and a substantially increased risk of CV
hormonal disorders (type2 diabetes, coronary heart disease, polycystic ovary factors for Chinese children and adolescents.
syndrome). These persons have a more android body fat distributions with an
excess of body fat in the upper part of the body and significantly thinner SAT
layers on the legs. Factor analysis yiels a new perspective on the risk profiles
of the individual SAT-topography: patients with type 2 diabetes, coronary
heart disease and polycystic ovary sydrome are found to be in same square CoST oF ABDoMInAL oVeRWeIGHT AnD oBeSITY In AUSTRALIA
of a two dimensional factor plot. However, thicker subcutaneous adipose
tissue layers on the extremities also may exert as a protective effect on C.M.Y. Lee1, R. Colagiuri2, D. Magliano3, J. Shaw3, P. Zimmet3, I. Caterson1,
coronary heart disease and the fertile capability of a woman. Typical changes S. Colagiuri1, AusDiab Study Group
of body fat distribution correspond to specific disorders; hence, the Lipometry
could provide a useful tool for early diagnosis and thus may be useful in 1Boden Institute of Obesity, Nutrition and Exercise, 2Menzies Centre for
prevention and therapy. Health Policy, University of Sydney, Sydney, NSW, 3Baker IDI Heart and
Diabetes Institute, Melbourne, VIC, Australia
objectives: To estimate the health and non-health cost associated with
abdominal overweight and obesity in Australia.
oPTIMAL WAIST CIRCUMFeRenCe ReFeRenCeS FoR SCReenInG
CARDIoVASCULAR RISK FACToRS FoR CHIneSe CHILDRen AnD Methods: The Australian Diabetes, Obesity and Lifestyle study includes a
ADoLeSCenTS longitudinal component with five year follow-up data collected in 2004/2005.
Data were available on 6,218 participants aged ≥ 25 years at baseline. The
G. Ma1, C. Ji2, J. Ma2, J. Mi3, R. Sung4, F. Xiong5, W. Yan6, X. Hu1, Y. Li1, S. direct health care cost, direct non-health care cost and government subsidies
Du1, H. Fang1, 7 associated with waist circumference defined overweight and obesity were
estimated using the ‘bottom up’ analytical approach.
1National Institute for Nutrition and Food Safety, Chinese Center for Disease
Control and Prevention, 2Institute of Child and Adolescent Health, Peking Result: The annual direct cost per person increased from AU$1,392 for
University Health Science CenterInstitute of Child and Adolescent Health, people with normal waist circumference to AU$1,879 for the abdominally
Peking University Health Science Center, 3Capital Institute of Pediatrics, overweight and AU$2,828 for the abdominally obese. In 2005, the total direct
Beijing, 4Departmentof Paediatrics, The Chinese University of Hong Kong, cost in Australians aged ≥ 30 years was AU$5.7 billion for the overweight
Hong Kong Special Administrative Region, 5The Children’s Hospital of and AU$12.0 billion for the obese. Total direct costs were AU$7.6 billion
8
more in the abdominally overweight and obese than those with normal waist No differences in grip strength in MHO and MONW were observed.
circumference. Furthermore, these individuals received AU$29.7 billion in
government subsidies. Comparing costs by change in waist circumference Conclusions: Fat distribution plays an important role in these phenotypes
status since 1999/2000, those who remained obese in 2004/2005 had the and there is possibly a protective effect of reduced central but increased leg
highest annual total direct cost (AU$2,957). Cost was lower in overweight and fat in maintaining metabolic health in obese females.
obese people who reduced waist circumference (AU$1,603 and AU$2,469,
respectively) compared with those who progressed to obesity (AU$2,555) or
remained obese.

Conclusion: The total direct cost of abdominal overweight and obesity in LonGITUDInAL oUTCoMeS In A CoHoRT STRATIFIeD BY MeTABoLIC
Australia is AU$17.7 billion. The total direct excess cost due to abdominal RISK AnD BoDY MASS InDeX
overweight and obesity was AU$7.6 billion. There is financial incentive at both
individual and societal levels for those who are overweight or obese to reduce S. Appleton1, D. Wilson1, R. Ruffin1, A. Taylor2, R. Adams1, The North West
waist circumference. Adelaide Health Study
1The Health Observatory, Medicine, University of Adelaide, 2Population
Research and Outcomes Study Unit, South Australian Department of Health,
4 Adelaide, SA, Australia
BoDY CoMPoSITIon In MeTABoLICALLY HeALTHY oBeSe AnD
noRMAL WeIGHT BUT MeTABoLICALLY oBeSe PHenoTYPeS In A Aims: Few studies have assessed longitudinal outcomes in metabolically
PoPULATIon SAMPLe healthy obese (MHO) or normal weight individuals with cardiometabolic risk
factors, i.e., “metabolically-obese” normal weight (MONW). Our aims were
S. Appleton1, D. Wilson1, R. Ruffin1, C. Seaborn2, A. Taylor3, R. Adams1, to determine the correlates and longitudinal chronic disease risks associated
The North West Adelaide Health Study with these phenotypes.

1The Health Observatory, Medicine, University of Adelaide, 2Endocrinology, Methods: The North West Adelaide Health Study (mean follow-up time
The Queen Elizabeth Hospital, 3Population Research and Outcomes Study =3.5 years, SD=0.5) is a random population sample recruited in 2000-2003.
Unit, South Australian Department of Health, Adelaide, SA, Australia Participants free of cardiovascular disease and not underweight (n=3743)
were stratified at baseline by body mass index categories and the presence
Aims: Small studies suggest that the metabolic healthy obese (MHO) of metabolic obesity: ≥ two metabolic risk factors [triglyceride ≥1.7mmol/l;
may have less visceral fat compared to insulin resistant obese subjects HDL cholesterol < 1.0mmol/l (men), < 1.3mmol/l (women); blood pressure
despite comparable total body fatness. Normal weight individuals with ≥130/85mmHg; fasting glucose ≥5.6mmol/l or self-reported diabetes; or
cardiometabolic risk factors, i.e., “metabolically-obese” normal weight treatment for these disorders]. Outcome measures were incident diabetes
(MONW) demonstrate higher abdominal adiposity compared to metabolically (self-reported doctor-diagnosed or fasting glucose ≥ 7 mmol/litre; n=70), CVD
healthy normal weight subjects (MHNW). The aim of this study was to (self-reported doctor-diagnosed myocardial infarction, angina, stroke; n=
examine dual energy X-ray absorptiometry (DXA) measures of body 127), and metabolic obesity (n=332). Results are expressed as odds ratios
composition in these subgroups derived from a population sample. (OR), 95% confidence intervals.

Methods: At follow-up (n=3206) of The North West Adelaide Health Study Results: The MHO (12.1%) demonstrated significant cross-sectional
(n=4060 randomly selected adults, aged ≥18 years, recruited in 2000- associations with middle age, neighbourhood disadvantage, former smoking,
2003), 1346 subjects aged ≥ 50 years with DXA measures and free of CVD and low levels of alcohol use, physical activity and lung function when
were stratified by BMI (normal, overweight, obese) and the presence of compared with the metabolically healthy normal weight. However, compared
metabolic obesity/risk: ≥ 2 metabolic risk factors [triglyceride ≥1.7mmol/l; with the metabolically at risk obese, the MHO were significantly younger with
HDL cholesterol males/females < 1.0mmol/l, < 1.3mmol/l respectively; normal and overweight waist circumference, engaged in moderate to high
blood pressure ≥130/85mmHg; fasting glucose ≥5.6mmol/l or self-reported level physical activity and resided in high socioeconomic status (SES) areas.
diabetes; treatment for these disorders]. Clinic assessment included waist Longitudinally, MHO demonstrated increased risks of developing metabolic-
circumference (WC), and grip strength. Age and smoking adjusted means obesity (OR=2.82, 2.0-4.0) and diabetes (OR=2.36, 0.8-7.1) but not CVD.
(SE) are reported. Statistical significance is p< 0.05. Maintenance of metabolic health over time in the MHO was significantly
associated with age ≤40 years (OR=2.83, 1.1-7.6), and at least moderate
Results: In females (n=758), the MONW (n=62) had significantly increased physical activity (OR=2.04, 1.01-4.1).
levels of % total fat [35.5 (0.6) vs 32.9 (0.4)], and % trunk fat [37.4 (0.7)
vs 32.9 (0.4)] but not WC compared with the MHNW (n=167). Despite no The MONW (4.1%) demonstrated significant cross-sectional associations
significant differences in total % fat, MHO (n=86) demonstrated significantly with male gender, older age, central obesity, low household income and area
increased % leg fat [53.2 (0.7) vs 49.9 (0.5)], and reduced WC [101.1cm (0.8) level SES, current smoking, sedentarism, and increased longitudinal risks
vs 104.0 (0.6)] compared with the metabolically obese/at risk obese subjects of incident cardiovascular disease/stroke events (OR=2.48, 1.1-5.4) and
(n=151). diabetes (OR=3.27, 0.9-12.1, p=0.07).

In males (n=588), the MONW (n=38) also demonstrated significantly Conclusion: Both phenotypes experienced poor longitudinal health
increased % total fat [23.8 (0.8) vs 21.0 (0.5)], % trunk fat [29.0 (1.3) vs outcomes over a short time period. “Healthy” obesity was temporary.
25.2 (0.7)] and a trend to lower leg fat free mass index compared with the Identification of people with the MONW phenotype could prevent avoidable
MHNW (n=960). No significant differences between the MHO (n=44) and morbidity which may require less emphasis on BMI and increased
metabolically at risk obese subjects (n=118) were observed. surveillance of central obesity in primary care.

9
CoMPARISon oF THe eFFeCTS oF A 3-YeAR LIFeSTYLe Background: In contrast to that in the middle-aged, higher body mass index
MoDIFICATIon PRoGRAM In VISCeRALLY oBeSe Men WITH (BMI) is a0ssociated with higher survival rates in older people, which has led
IMPAIReD VS. noRMAL GLUCoSe ToLeRAnCe to the postulation that obesity might be less harmful or even protective in old
12 24 36 48 60 72
age. Yet- 1BMI is a measure of overall adiposity, which makes no distinction
e. Pelletier Beaumont1,2, I. Lemieux1, N. Alméras1, J. Bergeron3, between fat elsewhere and abdominal fat, the latter being metabolically more
A. Tremblay1,2, P. Poirier1,4, J.-P. Després1,2 harmful. We hypothesized that overall adiposity might be protective in old
-2
agm)e, but that central fat might offset that benefit and remained harmful as in
1Centre de Recherche de l’Institut Universitaire de Cardiologie et de thee (c middle-aged. We examine the relationship between abdominal adiposity
Pneumologie de Québec, 2Department of Social and Preventive Medicine, ancd mor-t3ality in a cohort of older adults.
n
Université Laval, 3Lipid Research Centre, CHUL Research Centre, 4Faculty of e
er
Pharmacy, Université Laval, Quebec, QC, Canada Memfthods-4: 3978 Chinese elderly ≥65 years were followed for 6 years.
Deumographics, medical conditions, physical activity, and body composition
c
Many studies have shown that impaired glucose tolerance (IGT) is another bycir DXA were recorded at baseline. Abdominal adiposity was measured
metabolic complication often associated with an excess of visceral adipose acst cordin-g5 to specific anatomical landmarks and calculated as a proportion of
ai
tissue. However, not every viscerally obese patient has IGT. whwole body fat mass (relative abdominal fat = abd fat/whole body fat). Deaths
wie in thin 1 -y6ear from baseline were excluded in analysis. Crude, all-cause,
objective: To compare the long term (3 years) effects of a lifestyle cagrdiovascular and cancer mortality were analyzed using Cox regression,
n
modification program in viscerally obese men with vs. without IGT. adajusted for confounders. The lowest quintile of relative abdominal fat (RAF)
h -7
waCs used as the comparison group.
Methods: Glucose tolerance status was assessed by a 75g oral glucose
tolerance test and visceral adiposity was measured by computed tomography. Results-:8 After a mean follow-up of 72.3(11.7) months, 271(13.7%) men
A complete fasting plasma lipoprotein-lipid profile was also obtained in 83 and 90(4.5%) women had died. In men, the upper 4 quintiles of RAF was
viscerally obese men aged 30 to 65 years without diabetes followed for 3 years. associat-e9d with a significantly lower HR for all-cause mortality (both crude
and adjusted: HR(95% CI) in ascendingW qeueinktsiles compared with the lowest
Results: Initially, 45 men were characterized by normal glucose tolerance were 0.62 (0.43-0.89), 0.58 (0.4-0.85), 0.52 (0.36-0.77) and 0.67 (0.47-
(NGT) and 38 by IGT. After the 3-year intervention, men were classified 0.96). No significant relationship between abdominal adiposity and all-cause
Control Intervention
into 4 groups on the basis of their initial and final glucose tolerance status mortality for women was found. Neither was any significant relationship found
[(NGT-NGT, n=32), (NGT-IGT, n=13), (IGT-NGT, n=20) and (IGT-IGT, n=18)]. for cardiovascular and cancer mortality in both genders.
Results showed that independently of their glucose tolerance status, men
from all groups significantly improved their anthropometric and metabolic Conclusion: Higher proportion of abdominal fat was associated with lower
parameters in response to the intervention. However, comparison of these all-cause mortality in men. No such relation was found in women.
four groups revealed that NGT-IGT men were the group with the most
substantial improvements in anthropometric parameters in response to the Crude Mortality Rate
lifestyle modification program. NGT-IGT men represented the group with
the smallest reductions in adiposity indices (Δ BMI: -1.58 ± 1.46 vs. -0.54 (excluded early deaths within 12 months from baseline)
± 2.15 kg/m2, p=0.05, Δ weight: -4.63 ± 4.60 vs -1.49 ± 6.24 kg, p=0.05 and
Δ waist circumference: -6.42 ± 4.49 vs. -3.19 ± 6.22 cm, p=0.05, for NGT- 35 32.4
NGT vs. NGT-IGT groups respectively). Moreover, NGT-NGT men were
also characterized with the most substantial improvements in metabolic 30
parameters such as HDL-cholesterol levels (Δ: +0.20 ± 0.19 vs. +0.05 ± 0.13 s
vs. +0.08 ± 0.16 vs. +0.05 ± 0.15, p< 0.02, for NGT-NGT, IGT-IGT, IGT-NGT ear 25
y 22.4
and NGT-IGT groups respectively). n-
o 20.1
Conclusion: These results suggest that, irrespective of their glucose pers 20 17.8 16.7
tolerance status, viscerally obese men significantly benefited from a 3-year 000 15
lifestyle modification program even when they converted from NGT to IGT. 1
H3-oyweaerv einr,t evrivsecnetriaolnly roebperessee mnteend itnhietia slluyb wgritohu Np GwTh ow bheon reefimteadin tehde NmGoTst afrfotemr the aths / 10 8.2 8.2 7.3 9.2
the intervention. de 6.0
5
0
1 2 3 4 5
ABDoMInAL ADIPoSITY AnD MoRTALITY In 3978 CHIneSe oLDeR
Quintiles of Abd fat / whole boby fat
ADULTS: A 6 YeARS FoLLoW-UP STUDY WITH DXA
J. Lee1,2, T.-W. Auyeung3, T. Kwok2, M. Li4, J. Leung5, P.-C. Leung5, J. Woo2 Male Female
1Department of Medicine & Geriatrics, Shatin Hospital, 2Division of [Crude Mortality vs. relative abd fat quintiles]
Geriatrics, Department of Medicine & Therapeutics, 3School of Public Health,
4Department of Medicine & Therapeutics, The Chinese University of Hong
Kong, 5Jockey Club Centre of Osteoporosis Care and Control, The Chinese
Univerisity of Hong Kong, Hong Kong, Hong Kong S.A.R.
10