Normalized fat percentage -
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Download references. We thank all of the participants. We gratefully acknowledge the Department of Medical examination center, Peking Union Medical College Hospital, China Academic Medical Science and Peking Union Medical College. Department of Clinical Nutrition, Peking Union Medical College Hospital, China Academic Medical Science and Peking Union Medical College, Beijing, , China.
Department of Medical examination center, Peking Union Medical College Hospital, China Academic Medical Science and Peking Union Medical College, Beijing, , China. You can also search for this author in PubMed Google Scholar. Correspondence to Fang Ma. MF was responsible for the study design.
LPJ participated in the design of the study and drafted the manuscript. LHP participated in the sequence alignment. LYP performed the statistical analysis. All authors read and approved the final manuscript. Open Access This article is published under license to BioMed Central Ltd. Reprints and permissions.
Liu, P. et al. The utility of fat mass index vs. body mass index and percentage of body fat in the screening of metabolic syndrome.
BMC Public Health 13 , Download citation. Received : 22 April Accepted : 02 July Published : 03 July Anyone you share the following link with will be able to read this content:. Sorry, a shareable link is not currently available for this article.
Provided by the Springer Nature SharedIt content-sharing initiative. Skip to main content. Search all BMC articles Search. Download PDF. Research article Open access Published: 03 July The utility of fat mass index vs.
Abstract Background It has been well documented that obesity is closely associated with metabolic syndrome MetS. Methods A cross-sectional study of subjects aged 20—79 years who participated in the annual health check-ups was employed.
Background Obesity is one of basic clinical conditions of metabolic syndrome MetS , which is a cluster of risk factors for cardiovascular disease CVD. Methods Subjects in the study were enrolled from people who participated in the annual health check-up in the Department of Medical examination center, Peking Union Medical College Hospital, China Academic Medical Science and Peking Union Medical College, China, in from January to July.
Anthropometric measurements Anthropometric measurements of individuals wearing light clothing and without shoes were conducted by well-trained examiners. Body composition measurements Fat mass, percent body fat were measured by multi-frequency bioelectric impedance analysis multi-frequency bioelectric impedance analyzer Inbody , 8 contact point, 5, 50, , and kHz,Biospace Co.
Statistical analysis Statistical analysis were performed separately according to sex by using the Statistical Package for Social Science SPSS version Results The characteristics of the participants are summarized in Table 1.
Table 1 The general characteristics according to sex Full size table. Table 2 The descriptive characteristics of participantsts with and without MetS in both sexes Full size table. Figure 1. Full size image. Table 5 Sensitivity , specificity and AUC of cutoff value of three indicators in prediction of MetS Full size table.
Figure 2. Figure 3. Discussion Metabolic syndrome is associated with the development of diabetes, cardiovascular disease, which is the leading cause of mortality worldwide [ 27 ] and epidemical in China and other economically developing countries in recent decades [ 28 ].
Conclusion Despite these limitations, our study suggested that FMI seems to be a better indicator in the screening of the presence of metabolic syndrome than BMI and percentage of body fat in men and women.
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Article PubMed PubMed Central Google Scholar Romero-Corral A, Montori VM, Somers VK, Korinek J, Thomas RJ, Allison TG, Mookadam F, Lopez-Jimenez F: Association of bodyweight with total mortality and with cardiovascular events in coronary artery disease: a systematic review of cohort studies.
Article PubMed Google Scholar Thibault R, Pichard C: The evaluation of body composition: a useful tool for clinical practice. Article CAS PubMed Google Scholar Madeira FB, Silva AA, Veloso HF, Goldani MZ, Kac G, Cardoso VC, Bettiol H, Barbieri MA: Normal Weight Obesity Is Associated with Metabolic Syndrome and Insulin Resistance in Young Adults from a Middle-Income Country.
Article PubMed Google Scholar Zeng Q, Dong SY, Sun XN, Xie J, Cui Y: Percent body fat is a better predictor of cardiovascular risk factors than body mass index. Article CAS PubMed PubMed Central Google Scholar Deurenberg-Yap M, Chew SK, Deurenberg P: Elevated body fat percentage and cardiovascular risks at low body mass index levels among Singaporean Chinese, Malays and Indians.
Article CAS PubMed Google Scholar Cruz P, Johnson BD, Karpinski SC, Limoges KA, Warren BA, Olsen KD, Somers VK, Jensen MD, Clark MM, Lopez-Jimenez F: Validity of weight loss to estimate improvement in body composition in individuals attending a wellness center.
Cytokines such as TNF-α and IL-6 are over-produced by macrophages in the synovial compartment and mediate the inflammatory reactions.
Biological disease-modifying anti-rheumatic drugs DMARDs targeting these cytokines have improved the prognosis of patients with RA. Serum leptin and adiponectin concentrations have been investigated to examine their potential role in the pathogenesis of RA and to identify possible therapeutic targets 7 , 8.
It is widely accepted that serum levels of both leptin and adiponectin are elevated in RA 9 , 10 , 11 , However, the relationships of these adipocytokines to the disease activities of RA, particularly the progression of joint damage, are controversial 5 , 7 , 10 , 11 , The factor that hampers such analyses might be the great influence of body fat mass because both of these adipocytokines are produced mainly by adipocytes.
Serum concentration of leptin increases as body fat mass increases 1 , whereas serum adiponectin concentration paradoxically decreases as body fat mass increases probably because of the suppressive effect TNF-α on adiponectin production 2 , However, for a given BMI, the body fat percentage changes with age, sex, ethnicity and other individual traits In the present study, we measured the amount of body fat using a body composition analyzer and normalized serum concentrations of leptin and adiponectin by the amount of body fat.
We analyzed serum concentrations of leptin and adiponectin concentrations expressed by non-normalized data, those normalized by BMI and those normalized by the amount of body fat, and re-evaluated their relationships with disease activities of RA, particularly the progression of joint damage.
BMI greater than 25 is the criteria for the diagnosis of obesity in Japan Serum leptin concentration in obese subjects Serum adiponectin concentration was likewise negatively correlated with body fat mass in the total study population, as shown in Fig.
Serum adiponectin concentration in obese subjects 8. Correlation of serum leptin and adiponectin concentrations with body fat mass.
a shows the relationship between serum leptin and body fat mass in patients with RA filled circle and 78 controls white circle. b shows the relationship between serum adiponectin and body fat mass in patients with RA filled circle and 78 controls white circle.
The right figure demonstrates the comparison of serum adiponectin concentrations between obese and non-obese subjects. Figure 2 shows serum leptin and adiponectin concentrations expressed by non-normalized data raw data , those normalized by BMI raw data divided by BMI and those normalized by body fat mass [raw data divided by the amount of body fat kg ] in patients with RA and controls.
Serum leptin concentrations expressed in three ways were all significantly higher in patients with RA than those in controls [median However, dispersion of the data of serum leptin concentrations tended to become smaller when they were normalized by body fat mass than that of non-normalized data and normalized ones by BMI, and the statistical difference between patients with RA and controls became more significant.
Likewise, serum adiponectin concentrations expressed by three ways were all significantly higher in patients with RA than those in controls [ Comparison of serum leptin and adiponectin concentrations between patients with RA and controls.
Serum leptin concentrations expressed by raw data a , those corrected by BMI b and those corrected by body fat mass c ; and serum adiponectin concentrations expressed by raw data d , those corrected by BMI e and those corrected by body fat mass f in patients with RA and 78 controls are shown.
The horizontal line indicates the median value in each group. Wilcoxon rank sum test was used for the statistical analyses. Then, we examined the relationships of serum concentrations of leptin and adiponectin with inflammatory markers and clinical data in patients with RA.
CRP and MMP-3 are routinely used major biomarkers to follow the activity of RA. Figure 3 shows serum concentrations of CRP and MMP-3 in patients with RA and controls. Serum concentration of CRP in patients with RA median 0. Serum MMP-3 concentration was also significantly higher in patients with RA Comparison of serum CRP and MMP-3 concentrations between patients with RA and controls.
Serum concentrations of C-reactive protein CRP a and matrix metalloproteinase-3 MMP-3 b in patients with RA and 78 controls are shown. Note that the vertical line indicates logarithmic scale. Table 1 shows the results of multiple regression analysis of serum concentrations of leptin and adiponectin with serum levels of inflammatory markers, such as CRP and MMP-3, and clinical data, such as Steinbrocker stage, ACR stage, and disease duration in patients with RA.
Correlations of serum leptin concentrations with inflammatory markers and clinical data varied when serum leptin concentrations were expressed in different ways. Non-normalized serum leptin concentration had a significant positive and negative correlations with serum CRP and MMP-3 concentrations, respectively.
Serum leptin concentration normalized by BMI had a positive correlation with serum CRP concentration, while that normalized by body fat mass had a positive correlation with ACR clinical stage. Serum adiponectin concentrations, expressed in any ways, showed a significant positive correlation with Steinbrocker stage.
In addition, serum adiponectin concentration normalized by body fat mass had a significant positive correlation with serum MMP-3 concentration. In controls, serum leptin and adiponectin concentrations expressed in any ways did not have significant correlations with these inflammatory markers as shown in Table 2.
Serum leptin concentrations expressed in any ways were significantly lower in patients treated with biological DMARDs than those not receiving them [ Serum adiponectin concentrations expressed in any ways were not significantly different between patients treated with biological DMARDs and those not receiving them [ Serum MMP-3 concentration, Steinbrocker stage, ACR clinical stage and disease duration were not significantly different between patients treated with biological DMARDs and those not receiving them.
The other anti-rheumatic drugs did not show any significant influence on serum leptin and adiponectin concentrations. The current study demonstrated that serum concentrations of leptin and adiponectin were positively and negatively correlated with body fat mass, respectively. This finding is in agreement with previous reports of high serum leptin levels and low serum adiponectin levels in obese patients 1 , 2 , Because both leptin and adiponectin are primarily produced in adipose tissue, it is not surprising that serum leptin concentrations correlated positively with the amount of body fat.
In addition, obesity could result from insensitivity to leptin and such resistance would increase circulating leptin 1. The negative correlation between adiponectin and body fat mass could be explained by the effects of TNF-α.
Obesity is a chronic inflammatory condition, in which TNF-α is overproduced 17 , and TNF-α has been shown to suppress the transcription of adiponectin in an adipocyte cell line 3. The majority of previous studies reported that serum leptin concentrations are increased in RA 9 , 10 , whereas a few reported no differences For adiponectin, most previous studies reported increased serum adiponectin concentrations in RA 11 , 12 , whereas some reported decreased 19 or unchanged One explanation for such discrepancies may be the influence of body fat mass on adipocytokines.
We re-evaluated serum leptin and adiponectin concentrations using non-normalized data, normalized ones by BMI and normalized ones by body fat mass and confirmed that serum leptin and adiponectin concentrations are elevated in RA.
Several reports have indicated that leptin is involved in inflammatory processes and the immune system 3. CRP reflects the intensity of systemic inflammation and tissue destruction In the pathogenesis of RA, joint synovial membranes are a major site of inflammation where cytokines such as TNF-α, IL-1, and IL-6 are produced 6.
TNF-α has been reported to stimulate leptin secretion from human adipose tissues 22 , and leptin stimulates TNF-α secretion from human macrophages 23 in adipose tissue.
MMP-3 is a good indicator of synovitis in joints 24 , and leptin has been reported to enhance MMP-3 production in vitro in cartilage tissues from patients with osteoarthritis Multiple regression analysis revealed that non-normalized serum leptin concentration correlated positively with CRP and negatively with MMP-3, BMI normalized one with CRP and body fat mass normalized one with ACR clinical stage.
Patients with RA receiving biological DMARDs had lower CRP concentrations as well as lower leptin concentrations expressed in any ways than those without receiving them. Although we could not find any significant correlation between leptin concentration normalized by body fat mass and inflammatory markers such as CRP and MMP-3, the latter finding may support previous reports showing the pro-inflammatory nature of leptin 7.
Whether leptin is associated with the process of erosion of the joints or not has long been debated; protective, deteriorating or no effects 7 , The present finding that serum leptin did not have any correlation with Steinbrocker stage suggests that leptin may not be involved in the process of erosion of the joints in RA.
Adiponectin reportedly plays important roles in inflammatory processes and the immune system 5 , 11 , Adiponectin exhibits anti-inflammatory properties such as suppressing the synthesis of pro-inflammatory cytokines such as TNF-a and IL On the other hand, adiponectin reportedly stimulates MMP-3 production in joints and promotes local inflammation and tissue destruction Thus, adiponectin seems to play controversial roles in RA, that is, anti-inflammatory effects and pro-inflammatory effects in different situations The present study demonstrated that adiponectin concentrations expressed in any ways correlated positively with Steinbrocker stage and adiponectin concentration normalized by body fat mass correlated positively with MMP-3 concentration as well.
These findings suggest that adiponectin may exert local pro-inflammatory effects via MMP-3 and contribute to bone and cartilage destruction in RA. Because this is cross-sectional research in a clinical setting, many factors are involved leading to a not so remarkable difference and correlation among groups even though it is statistically significant.
This is a limitation of this study but we believe that our results might have shed some light on the involvement of leptin and adiponectin in the pathogenesis of RA. Serum leptin and adiponectin concentrations normalized by body fat mass were elevated in RA.
Adiponectin but not leptin may be involved in joint damage in RA. We examined patients with RA 26 males and females, Patients with RA were those who were attending to the outpatient clinic at our hospitals without any serious co-morbidities. Controls without RA included patients who had orthopedic problems such as joint pains due to osteoarthritis or osteoporosis.
Those who gave written informed consent between December and August participated in this study. Clinical characteristics of both groups are shown in Table 3. For patients diagnosed before , RA diagnosis was made using the ACR American College of Rheumatology diagnostic criteria The Steinbrocker classification system 28 was used to evaluate the degree of bone and cartilage destruction observed on joint X-rays: stage 1, no destruction; stage 2, thinned cartilage and a narrowed joint space but no bone destruction; stage 3, bone or cartilage destruction; and stage 4, joint destruction with ankylosis.
The ACR global functional status in RA system 29 was used to classify the degree of impairment of daily activities: stage 1, completely able to perform usual activities of daily living self-care, vocational, and avocational ; stage 2, able to perform usual self-care and vocational activities but limitations during avocational activities; stage 3, able to perform usual self-care activities but limitations during both vocational and avocational activities; and stage 4, limited ability to perform usual self-care, vocational, and avocational activities.
One patient with type 2 diabetes mellitus was excluded from this study because his serum leptin concentration normalized by body fat mass was judged as an outliner by the Smirnov test.
Blood was obtained in the morning, the serum was immediately separated and the aliquots of the serum samples were stored at —30˚C for no more than two years until the assays.
Repeated freeze thaw cycles were avoided to prevent sample degradation. The body height and weight were measured using scales. Body composition, including fat, muscle and bone masses, was measured using a dual-frequency body composition Analyzer DCA Tanita Japan Co.
This instrument performs tetra-polar foot-to-foot bioelectrical impedance analysis, which measures the electric resistance by applying a weak electrical current to the distal part of each foot and measuring the voltage at the proximal part of each foot.
This system utilizes multi-frequency measurement and reactance technology to generate accurate data. As the algorithm was based on a large quantity of data, the body composition measured by this system is highly correlated with measurements obtained by dual energy X-ray absorptiometry Enzyme immunoassay EIA of leptin followed our previously described method In brief, human leptin antibody was generated in rabbits by multiple subcutaneous injections of human leptin AFPC; National Hormone and Peptide Program [NHPP], Harbour-UCLA Medical Center, Torrance, CA, USA.
Another human anti-leptin antibody AFP; NHPP was adsorbed to polystyrene balls Precision Plastic Ball Co. Human leptin AFPC, NHPP was used for the reference preparation. The assay range was 0. EIA for adiponectin was performed in a similar manner, using anti-human adiponectin antibodies as the detection antibody and as the capture antibody purchased from Fitzgerald Industries International Acton, MA, USA.
Human adiponectin protein 30—; Fitzgerald Industries International was used for the reference preparation. Serum leptin and adiponectin concentrations were expressed in three ways: raw data, those normalized by BMI raw data divided by BMI and those normalized by body fat mass [raw data divided by the amount of fat kg ].
All serum samples were diluted 10— times so that the concentrations of leptin, adiponectin, CRP and MMP-3 entered their assay ranges. They were all measured in duplicate. Non-normally distributed data were expressed as median interquartile range [IQR] and compared using the Wilcoxon rank sum test.
Pearson correlation analysis was used to examine the relationship between serum concentrations of leptin and adiponectin and body fat mass. Multiple regression analysis was used to examine the relationship of serum leptin and adiponectin concentrations with serum levels of inflammatory markers, as well as clinical data.
Statistical analysis was performed using JMP version 14 software © SAS Institute Inc. This study was approved by the Ethics Review Committees of Kansai Medical University Hospital, Takarazuka Hospital, Miyashima Rheumatism Orthopedic Clinic, and Sugano Orthopedic Clinic.
Informed consent was obtained from all participants. This study was carried out in accordance of the Declaration of Helsinki. The datasets used and analyzed during the current study are available from the corresponding author on reasonable request.
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Ratios are Thyroid Health Boosters on Percenyage assumption that the regression Microbe-free materials Normalized fat percentage numerator e. fat mass and Normalized fat percentage denominator e. body percentaeg has a zero-intercept. As shown in the companion paper, non-zero intercepts cause several problems when ratios are used to adjust data and analysis of covariance ANCOVA is frequently the preferred statistical tool. Results: In healthy men and women, BMI was higher in men When BM was adjusted for height2 using ANCOVA, men remained significantly heavier than women Percenatge Public Health volume 13Article number: Normalizef this article. Percntage Coconut Oil Lotion. It has been well documented that obesity is percengage associated with Coconut Oil Lotion syndrome MetS. Although Normalized fat percentage mass Normakized BMI is Gut health and cognitive function most frequently used method to assess overweightness and obesity, this method has been criticized because BMI does not always reflect true body fatness, which may be better evaluated by assessment of body fat and fat-free mass. A cross-sectional study of subjects aged 20—79 years who participated in the annual health check-ups was employed. Body composition was measured by bioelectrical impedance analysis BIA. Fat mass index FMI was calculated.
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