Faculty of Medicine

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    ESTIMATED CENTRAL OBESITY INDEX –WORTHWHILE SCREENING TEST PROCEDURE OF ABDOMINAL OBESITY
    (Institute of Knowledge Management, 2019)
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    Janicevic Ivanovska, Danijela
    Central obesity index (COI) is an indicator of central, abdominal obesity, which is the main characteristic of the metabolic syndrome. Dual-energy x-ray absorptiometric (DXA) assessment of the body fat distribution was performed through the COI values determined with a scan of the entire body in comparison toestimated COI values (eCOI) on spine and hip performed scans. COI was determined as a ratio of android (A) tissue percent fat (A-Tf%) and gynoid (G)-Tf% (COI=A/G-Tf%) as well as eCOI=eA/eG-Tf% in 3 groups of women: 1st group of women with Cushing’s syndrome(CS) (n=14), 2nd group of obese (O) women(n=21), 3rd group of non obese healthy women (C) (n=22). The examinees were not different according to their age, which was 44.32±13.83 years in the 1stgroup, 43.33±12.58 years in the 2ndgroup and 42.56±14.67 years in the 3rdgroup, as well as according to their BMI, which was 30.02±5.02 kg/m2in CS, 29.66±4.88 kg/m2 in O, but it was in normal range 21.76±1.43 kg/m2in non obese control group of healthy women.The values of eA, eG and eA/еG were not significantly different compared to the correspondent values A-Tf%, G-Tf% and A/G-Tf% in all examined groups (p>0.05). The values of eA and A-Tf% in CS were significantly higher compared to O (P<0.05), as well as compared to C and O+C and in O compared to C (p<0.0001). COI value (1.05±0.15) and eCOI (1.04±0.1) in CS were significantly higher compared to O (p<0.006 and p<0.008) and highly significantly higher compared to C, O+C and in O compared to C (p<0.0001). Estimated values eA, eG and eA/eG correlated highly significantly positively with the correspondent values A-Tf%, G-Tf% and A/G-Tf% (p<0.0001) and COI values correlated highly significantly with eCOI, eA and A-Tf% (p<0.0001) and not significantly with G-Tf% and eG (p>0.05) in O confirming COI positive association with central, abdominal fat distribution.Conclusion: DXA indexes COI and eCOI discovered extreme central body fat distribution in CS women,differentiated them significantly and precisely from C and CO, and could be used as diagnostic DXA indexes of extreme central, abdominal obesity in CS and non CS abdominal obese women in DXA body composition and fat distribution assessment. Determination of eCOI is reliable, more practical and faster, with lower radiation and is more acceptable compared to COI, and it can be a routine screening procedure forbody composition and body fat distribution assessment, during regular spine and hip scans for osteoporotic risk assessment instead of COI body fat distribution determination with total body composition measured scans which are used in scientific studies and are not necessary to be performed in clinical body fat distribution examinations.
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    Lipid profile changes relations to body fat distribution changes determined with dual-energy x-ray absorptiometry during the weight loss
    (Institute of Knowledge Management, 2019)
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    Janicevic Ivanovska, Danijela
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    Obesity and central body fat distribution are known risk factors for cardiovascular and metabolic diseases. Dual-energy x-ray absorptiometry (DXA) enables precise, accurate body composition and body fat distribution assessment and it measures and monitors body composition changes in obese patients undergoing weight loss. Obesity is associated with dyslipidemic profile. Low HDL-C levels are frequently associated with raised levels of plasma triglycerides and increased risk of cardiovascular disease and TG/HDL-C ratio may be a better predictor of insulin resistance and cardiovascular disease. LDL-C is one of the major culprits in the development of atherosclerotic heart disease and reduction of LDL-C levels is the primary target of therapy. The effect of weight loss on body fat distribution was examined through android, legs and ndroid/legs tissue and fat mass ratios indexes of central, abdominal obesity determined by DXA and their relationship with lipid profile hanges. The following parameters were determined before and after weight loss: body mass index (BMI), body weight (BW), android (A) and legs (L) tissue mass (TM) and fat mass (FM), their % with DXA, their ratios, indexes of abdominal fat distribution A/L-TM and TM% and A/L-FM and FM%, as well as lipid profile: total cholesterol (C), triglycerides (TG), HDL-C, LDL-C, LDL/HDL-C, C/HDL-C and TG/HDL-C. BW of 62.96±1.2 kg and BMI value of 28.98±0.78 kg/m2 before the weight loss lowered to 49.96±1.3 kg (p<0.012), and normal BMI 22.81±0.62 kg/m2 (p<0.012). A-TMf% value decrease from 50.41±1.7% to 29.55±1.34% after weight loss was significant (p<0.006) and A-FM% 49.92±1.2% decrease to 29.25±1.34% was also highly significant (p<0.005). A-TM 5.43±0.71 kg and A-FM 2.74±0.71 kg lowered to 3.76±0.25 kg and 1.11±0.12 kg after weight loss (p<0.05). L-TMf% 50.31±1.7% lowered to 35.2±2.12% (p<0.018) and L-TM 19.69±0.71 kg lowered to 16.15±0.55 kg (p<0.033). L-FM% 48.51±1.14% lowered to 33.8±1.98% (p<0.009) and L-FM 9.89±0.64 kg lowered to 5.68±0.16 kg (p<0.0002). A/L-TMf% value decrease from 1.01±0.07% to 0.84±0.014% and A/L-FM% value decrease from 1.03±0.04 to 0.87±0.07 were also significant (p<0.05). TG values decrease from 1.21±0.01 mmol/l to 0.83±0.07 mmol/l was significant (p<0.002) and C values decrease from 6.5±0.01 mmol/l to 5.43±0.37 mmol/l was also significant (p<0.05). LDL-C values 4.3±0.1 mmol/l lowered to 3.39±0.34 mmol/l (p<0.026) and TG/HDL-C ratio 0.73±0.01 lowered to 0.52±0.03 (p<0.011). This study showed that A-TMf% and A-FM% lowered highly significantly, indicating significant FM% reduction in android, abdominal TM. Atherogenic lipids TG, C and LDL-C and atherogenic index TG/HDL-C ratio lowered significantly. Also, it was confirmed that DXA indexes of central, abdominal obesity A/L-TM% and A/L-FM% were increased in overweight subjects before the weight loss and lowered highly significantly after the weight loss and increased A/L TM and A/L FM values lowered to normal values, indicating that normal BMI and BW reached after the weight loss were associated with normalized body fat distribution, and significant reduction of the atherogenic lipid profile indicating reduced atherogenic risk.
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    NEW DXA DIAGNOSTIC INDEXES OF ABDOMINAL OBESITY
    (Macedonian Academy of sciences and Arts, 2021-02)
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    Aim: Cushing’s syndrome (CS) is associated with weight gain and extreme central, visceral, abdominal obesity which is confirmed with dual-energy X-rays absorptiometric (DXA) diagnostic cut-off point (CP) values of central obesity indexes (COI), determined as an android to gynoid tissue and fat mass ratios. These best differentiate CS from non-CS obese women matched with CS according to their age and BMI. The aim of this study was to determine the CP values of new DXA indexes of central, abdominal obesity as a ratio of android and trunk to legs as well as trunk and legs to total tissue and fat mass that best differentiate CS and matched non-CS obese women in order to confirm central abdominal obesity, and to determine their normal CP values that best differentiate healthy non-obese women from CS and non-CS obese women, and to exclude abdominal obesity completely. Material and Methods: DXA indexes of abdominal obesity, calculated as а ratio of regional body fat and tissue mass compartments android to legs (A/L), trunk to legs (Tr/L), trunk to total (Tr/To) and legs to total (L/To) values were determined among 4 groups. Each group consisted of 18 women: 1st group of CS, 2nd group of obese women (O1) not different according to their age and BMI from CS, 3rd group of obese women (O2) with higher BMI of 35 ± 1.2 kg and a 4th group of non-obese, healthy women (C) with a normal BMI. Diagnostic accuracy (DG) of CP values of DXA indexes of abdominal obesity and indexes of normal body fat distribution (BFD) were determined. Results: A/L, Tr/L, Tr/To, and L/To DXA indexes were significantly different between CS and O1 as well as between non-CS women O2 compared to O1 and C. These indexes had a highly significant correlation among each other and also in relation to their BMI (p < 0.0001). A/L-Tm CP value of 0.3 best differentiated the CS from group O1, with the highest DG of 100 % and an A/L-Fm CP value of 0.26 differentiated them with a DG of 94.44% and sensitivity of 100 %. An A/L-Tn CP value of 0.23 and an A/L-Fn CP value of 0.25 best differentiated CS and C as well as O2 and C for the highest DG of 100 %. Conclusions: DXA indexes A/L, Tr/L, Tr/To and L/To values were significantly different among the four groups. These values correlated significantly among them and with their BMI in non-CS groups, thus confirming a BMI increase association with a more pronounced abdominal BFD. An A/L-Tm CP value of 0.3 and an A/L-Fm CP value of 0.26 were discovered as the best DXA diagnostic indexes of extreme abdominal obesity in CS and these could also be used in discovering abdominal BFD in non-CS obese women with metabolic syndrome (MS). An A/L-Tn CP value of 0.23 and an A/L-Fn CP value of 0.25 were discovered as the best DXA diagnostic indexes of normal BFD which completely excluded abdominal obesity.
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    DIAGNOSTIC CENTRAL OBESITY INDEXES CUT – OFF POINT VALUES DETERMINED WITH DUAL-ENERGY X-RAY ABSORPTIOMETRY IN CUSHING’S AND OBESE WOMEN
    (Macedonian Academy of Sciences and Arts, 2020)
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    Aim: The aim of this study was to develop quantiative criteria for defining visceral obesity and to establish dual-energy X-ray absorptiometric (DXA) diagnostic cut-off points (CP) for normal and abnormal values of the central obesity indexes (COI) that best differentiate extreme visceral obesity in Cushing’s syndrome (CS) from non CS obese and non obese women. Material and Methods: COI1–4 values calculated as a ratio of android to gynoid tissue mass, fat mass and their % were determined in 4 groups, each consisting of 18 women: 1st group of CS, 2nd group of obese women (O1 ) not different according to their age and BMI from CS, 3rd group of obese women (O2 ) with BMI of 35 ± 1.2 kg and 4th group of non obese healthy women (C) with normal BMI. Diagnostic accuracy (DG) of CP values of COI1m-4m indexes of abdominal obesity and CP values of COI1n-4n indexes of normal body fat distribution (BFD) was determined. Results: COI1-4 indexes values were highly significantly different among the 4 examined groups and were significantly highest in CS patients and lowest in group C (p < 0.0001). COI1m-4m CP values differentiated extreme visceral, abdominal obesity in CS with highest DG as well as COI1n-4n CP values differentiated normal BFD in group C. COI1m CP of 0.55 best differentiated CS from O1 for DG of 100%. COI2n of 0.38 best differentiated C from CS and O2 for highest DG of 100% compared to O1 because of the significantly higher BMI and COI1n-4n values in O2 that were associated with more pronounced abdominal obesity and highly significantly positive correlation with BMI. Conclusions: DXA cut-off point values of indexes COI1m-4m and COI1n-4n were established as diagnostic indexes and criteria useful in discovering extreme abdominal and normal BFD. COI1m CP value of 0.55 was discovered as a diagnostic criterion of extreme abdominal obesity and COI2n of 0.38 as a diagnostic criterion of normal BFD that excluded abdominal obesity. The other indexes COI1m-4m and COI1n-4n CP values had also high DG in discovering abdominal and normal body fat distribution.