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May 3, 2011 -- Liposuction, the popular fat-sucking procedure, can trim problem areas of the body. However, the fat removed returns in a relatively short time, according to a new study.
''All the fat is back by one year," says researcher Robert H. Eckel, MD, professor of medicine, physiology and biophysics at the University of Colorado Anschutz Medical Campus. However, it does not return to the spot that has been operated on. "The fat comes back in different places," Eckel tells WebMD. In his study, the women had liposuction of the lower abdomen, hips, or thighs and were followed for a year. "The reaccumulation of fat was in the upper abdomen and triceps."
The areas that had liposuction did not regain fat, he says. He speculates that the probing of those areas that occurs during liposuction somehow prevents fat from returning there.
The new study is published in the journal Obesity.
More than 203,000 liposuction procedures were done in 2010, up 2% from the year before, says LaSandra Cooper, a spokeswoman for the American Society of Plastic Surgeons. In the procedure, a thin, hollow tube is inserted through incisions to loosen the fat. Next, the dislodged fat is suctioned out.
Two plastic surgeons who reviewed the findings for WebMD say they have not noticed the fat returning in their liposuction patients.
For the study, Eckel and his colleagues evaluated 32 women. The average body mass index (BMI) was below 25 and considered a healthy weight. The range was 22 to 27.
The women had been at a healthy weight for at least three to six months. None had a history of weight loss of more than 10% of their maximum body weight. They had not had liposuction before.
Their average age was 40. The age range was 18 to 50. None had yet gone through menopause.
Of the 32, 14 were assigned to get liposuction. The other 18 served as the comparison group,
The women agreed not to change their lifestyle habits such as exercise and eating habits.
In the liposuction group, doctors removed up to 5 liters of fat from up to three regions: hips, thighs, and lower abdomen.
At six weeks, the percent body fat in the liposuction group declined by 2.1% and by 0.28% in the comparison group.
At six months, the difference between groups declined. By one year, there was no significant difference in body fat between the two groups.
The fat that came back in different areas was not just the fat that lies directly under the skin, known as subcutaneous, but also the deeper visceral fat, linked with heart disease risk.
However, he says, "We did not see an adverse metabolic effect."
Even though the fat reappeared at different sites, he says, most of the women said they were still satisfied with the results of the procedure.
The study was funded partially by a National Institutes of Health grant.
Eckel's advice to those about to undergo liposuction? "Be prepared. Your fat will come back and it may be distributed in your waist or above [if the areas liposuctioned are below that.]"
Eckel cannot explain for sure why the fat returns in different places. However, he speculates, "the brain senses a loss of fat and restores it."
May 2, 2011 -- A new study shows that people with coronary artery disease who carry extra fat around their waists appear to have an increased risk of dying compared to people who store their body fat elsewhere.
The study pooled and reanalyzed data on nearly 16,000 people with coronary artery disease from around the world. It found that those who were centrally obese, as measured by waist-to-hip ratio and waist circumference, had up to twice the risk of dying compared to those who didn’t pack fat around their midsections.
Researchers say the increased risk applies even to people who are otherwise normal weight, but have central obesity.
The study showed that the risk of death could be elevated even in people who don’t look very big.
“The waist might not be too large, but the distribution might still be abnormal,” says study researcher Francisco Lopez-Jimenez, MD, director of the cardiometabolic program at the Mayo Clinic in Rochester, Minn.
About 40% of the people in the study were considered normal weight, with a body mass index (BMI) under 25.
In these normal-weight patients, risks were elevated at waist sizes as small as 33 inches for men and 31 inches for women, if they also stored more fat around their midsections compared to their hips.
“A good chunk of the patients had a waist circumference that would be considered normal by all means, but the waist-to-hip ratio was abnormal,” says Lopez-Jimenez. “People tend to say if the BMI is fine, if the waist circumference is normal, then don’t worry about it. Well, if somebody is very skinny but the distribution of fat is abnormal they are at increased risk.”
A growing body of evidence suggests that fat that’s stored in the abdomen may elevate the risks for heart disease, diabetes, and a host of other metabolic problems, including polycystic ovary syndrome in women, which is a cause of infertility.
“Abdominal fat is known to be more metabolically active than subcutaneous fat, the fat under the skin,” says Lopez-Jimenez.
Belly fat produces inflammatory chemicals and releases free-fatty acids into the blood. It also contributes to insulin resistance.
“That’s a fat that has been linked to high blood pressure, has been linked to diabetes, abnormal cholesterol, triglycerides,” Lopez-Jimenez says. “People with more visceral fat also tend to accumulate more fat in the liver.”
Researchers sifted through the medical literature to find studies that focused on measures of central obesity -- waist circumference and waist-to-hip ratio -- and the risk of premature death in patients with heart disease.
Six studies, representing 15,923 patients from the U.S., France, Denmark, and Korea, were included in the final analysis.
April 14, 2011 -- Breast augmentation involving injections of fat taken from other parts of the body is an increasingly popular alternative to breast implants and traditional lifts. But there are new concerns that the procedure may interfere with mammogram readings.
In a newly published study from China, nearly one in seven women who had the fat injections developed calcifications in their breasts that were considered “highly suspicious” for breast cancer. The findings appear to contradict other research, published just last month, in which researchers concluded that the calcifications resulting from fat injections were unlikely to be mistaken for cancer by radiologists.
Both studies appeared in the journal Plastic and Reconstructive Surgery, published by the American Society of Plastic Surgeons.
Known medically as lipomodeling, lipoinjection, or fat grafting, the practice of reshaping the breasts using a woman’s own fat is still somewhat controversial.
Reconstructive surgeon Kamran Khoobehi, who directs the aesthetic surgery training program at Louisiana State University, has performed more than 200 of the procedures. He says many surgeons with very little experience are now also doing them because they have become so popular with patients.
“A lot of people are jumping on the bandwagon who may or may not know what they are doing, so patients need to be careful,” he says.
In the study, researchers followed 48 women who had fat injections to enlarge or reshape their breasts, performing mammograms 18 months to several years after the injections.
These mammograms showed calcifications that raised the suspicion of breast cancer in eight of the women. Breast biopsy confirmed that none of the women actually had breast cancer.
Researcher Cong-Feng Wang, MD, and colleagues concluded that the calcifications appeared to be caused by injected fat cells that had died and clumped together.
The researchers found the clustered calcifications to be indistinguishable on mammograms from those associated with breast cancer, and they concluded that fat injections should not be used for cosmetic breast augmentation.
But Khoobehi disagrees, calling the Chinese study highly flawed.?
He says the researchers appeared to make no attempt to avoid injecting dead fat cells along with living cells when they performed the procedure, which would have increased the chances for calcification.?
And he says their practice of massaging the breasts following fat injections in an attempt to distribute the fat cells may have had the opposite effect by causing the fat to clump.?
Radiologist Eva Rubin, MD, says fat injections, like any other breast augmentation procedure, can result in fat necrosis and calcifications within the breast, but most of the time these are easily distinguishable from breast cancer.?
Rubin is clinical director of the breast imaging center for Montgomery Radiology Associates in Montgomery, Ala.?
“There are cases with very early calcifications that may mimic breast cancer, but if you know a patient has had a (breast) procedure you are probably not going to jump right in and do a full workup,” she says. “Within a short period of time these calcifications tend to look like more typical fat necrosis.”
March 3, 2011 -- A new way to measure body fat that relies only on measurements of your height and your hip circumference is an improvement on the commonly used measure known as body mass index (BMI), according to the developers of the new method.
"The body mass index (BMI) does not accurately represent the amount of [body] fat," researcher Richard N. Bergman, Keck Professor of Medicine at the University of California's Keck School of Medicine, tells WebMD.
The new measure, called body adiposity index (BAI), does, he says. So far, he has validated the new measurement in Hispanic and African-American populations, and says more research is required to confirm how well it works in whites and other ethnic groups.
With BMI, he says, ''you get a relative number" assessing body fat. With the new BAI, ''you get a number which is the percent fat." The new method, he says, is more accurate.
While an improvement on the BMI method is merited, the new method appears to have its limitations, too, says Fabio Comana, an exercise physiologist at the American Council on Exercise, who reviewed the new research for WebMD.
The new research is published online in the journal Obesity.
Besides considering body weight, BMI is the most common way doctors and others assess whether a person has too much body fat and thus at risk for health problems. It's a measure of fat based on height and weight, used for both men and women.
''The BMI has been around since the 1840s," Bergman says. A BMI of under 25, for instance, is deemed healthy, while those of 30 and above are considered obese. (A person 5 feet 10 inches tall has a BMI of 24.4 at 170 pounds and a BMI of 30.1 at 210 pounds.)
BMI is “OK in general for groups," Bergman says. But on an individual basis, it isn't so accurate in assessing body fat, especially for people who are very muscular.
For instance, he says, ''if you had a BMI of 30, you might have 25% fat [as measured on tests that directly assess body fat] if you are a man, but 35% if you are a woman." Someone very muscular may have a BMI over 25 but have little body fat, he says.
Body fat percentage ''norms" are different for men and women, according to the American Council on Exercise (ACE). For instance, it classifies a body fat percentage of 25% to 31% for women and 18% to 24% for men as ''acceptable'' ranges, with athletes and fit people having lower percentages.
Body fat percentages over 32% for women and over 25% for men are termed obese by the ACE.
Dec. 20, 2010 -- Experts recommend avoiding high-fat dairy products to lower diabetes risk, but a new study suggests this advice may be wrong.
Researchers at the Harvard School of Public Health say they have identified a substance found primarily in dairy fat that appears to lower the risk of type 2 diabetes.
Known as trans-palmitoleic acid, it is present in the fat of ruminant animals such as cows, sheep, and goats.
In the Harvard study, people with the highest levels of the fatty acid in their blood had a threefold lower risk of developing diabetes over time than people with the lowest levels.
They also had healthier HDL, or good, cholesterol levels, lower body fat, and less insulin resistance.
But it is too soon to switch from skimmed milk and low-fat yogurt to higher-fat versions.
The findings must be confirmed, researchers say, and it is not quite clear if trans-palmitoleic acid or a related compound was protective.
The Harvard study was funded by grants from the National Institutes of Health. It appears in the Dec. 21 issue of the Annals of Internal Medicine.
“If nothing else, I think we have confirmed that there is something in dairy that reduces the risk of diabetes,” lead researcher Dariush Mozaffarian, MD, tells WebMD. “Either it is this fatty acid or something associated with it that we have not identified. It would be highly implausible that the relationship we saw is due to something unrelated to dairy.”
The study included 3,736 participants in the National Heart, Lung, and Blood Institute (NHLBI)-run Cardiovascular Health Study.
Throughout the two-decade study, researchers measured metabolic markers of diabetes risk, including circulating blood fatty acid levels.
Higher blood levels of trans-palmitoleic acid at study entry were associated with better cholesterol, less insulin resistance, and less overall inflammation, even after researchers adjusted for other heart disease and diabetes risk factors.
Over 20 years of follow-up, participants with the highest circulating levels of the fatty acid had about a 60% lower risk of developing diabetes than people with the lowest levels.
The finding could explain earlier research suggesting that people who eat more dairy products have a lower risk of developing type 2 diabetes, Mozaffarian says.
In a news release, study co-author Gokhan Hotamisligil, MD, PhD, notes that the next step will be to isolate the fatty acid to test its ability to lower diabetes risk in clinical trials.
“This is an extremely strong protective effect, stronger than other things we know can be beneficial against diabetes,” Hotamisligil says in the release.
The American Diabetes Association (ADA) makes a clear distinction between healthy fats and unhealthy fats, and, not surprisingly, dairy fat falls into the latter category.
Nov. 30, 2010 (Chicago) -- Belly fat may be bad for women's bone health, raising their risk of osteoporosis, researchers report.
In a study of 50 premenopausal women, many of whom were obese, those who had more fat around the waistline were more likely to have low bone mineral density, an osteoporosis risk factor.
"We found that in young women, deep belly fat is bad for the bones," Miriam Bredella, MD, assistant professor of radiology at Massachusetts General Hospital/Harvard Medical School, tells WebMD. "We now know that abdominal obesity needs to be included as a risk factor for osteoporosis and bone loss."
Bredella presented her findings here at the annual meeting of the Radiological Society of North America (RSNA).
Previous research has suggested that excess body fat protects against bone loss and osteoporosis.
But not all fat is the same, Bredella says. Using MRI and CT images, she showed that women with excessive amounts of "bad" visceral or intra-abdominal fat have a more porous bone structure than women without visceral fat. On the other hand, women with excessive subcutaneous fat that lies just below the skin show normal bone structure.
She and colleagues studied women whose BMIs (body mass index) ranged from 19 to 46, with an average BMI of 30. A BMI of 18.5 to 24.9 is considered normal, a BMI of 25 to 29.9 is considered overweight, and a BMI of 30 or more is considered obese.
All underwent a special imaging technique called MRI spectroscopy that allowed the researchers to evaluate different kinds of fat, including fat in the bone marrow. CT scans were used to determine bone mineral density.
The more fat in bones, the lower a woman’s bone mineral density was, the study showed. The more visceral fat -- for example, women with apple-like figures that have fat around the waist -- the more likely a woman was to have lower bone mineral density.
Excessive deep belly fat is also a risk factor for heart disease and diabetes, says RSNA spokesman David Levin, MD, of Thomas Jefferson University Hospital in Philadelphia. He was not involved with the work.
No treatment has been shown to preferentially get rid of belly fat rather than subcutaneous fat, says Mary C. Mahoney, MD, professor of radiology at the University of Cincinnati.
Your best bet: Not gaining fat in the first place or getting rid of as much body fat as possible, she says.
This study was presented at a medical conference. The findings should be considered preliminary as they have not yet undergone the "peer review" process, in which outside experts scrutinize the data prior to publication in a medical journal.
Nov. 19, 2010 -- Children with higher levels of belly fat have higher pulse pressures, which puts them at risk for heart-related disorders, a new study finds.
Gangadarshni Chandramohan, MD, of Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, says doctors should measure children’s waist circumference to judge their level of obesity, rather than the commonly used body mass index, which is a ratio of weight to height.
Chandramohan and colleagues studied data on 4,667 children between 6 and 17, all part of the Third National Health and Nutrition Examination Survey, which is done by the CDC in Atlanta.
“We found the children’s body mass didn’t correlate to higher pulse pressures,” Chandramohan says in a news release. “This study suggests pediatricians add waist measurements to their routine screening of children to help determine the risk of heart-related disorders.”
He says measuring children’s waist circumference is simpler and more cost-effective, but also “a more valid method of screening for the risk of heart-related disorders than the current practice of determining a child’s body mass.”
Previous research, he says, has shown that a high pulse pressure -- the difference between the systolic and diastolic blood pressure readings -- increases a patient’s risk of heart-related disorders, as does high blood pressure.
“It is crucial that new indices for measuring various physiologic parameters such as obesity and associated cardiovascular risk factors be determined using valid, minimally invasive, and cost-effective tools to help patients avoid long-term health concerns,” Chandramohan says.
Chandramohan and colleagues say in an abstract for the meeting that obesity rates have been increasing in children for decades along with various cardiovascular risk factors.
In the study, 48% of the children were males, 74% were white, 36% Hispanic, 36% African-American, 11% obese, and 27% had high waist circumferences.
Pulse pressure was “significantly higher” in children with large waists. The study was presented at the American Society of Nephrology’s Renal Week, which the group bills as the world’s premier meeting in nephrology.
This study was presented at a medical conference. The findings should be considered preliminary as they have not yet undergone the "peer review" process, in which outside experts scrutinize the data prior to publication in a medical journal.
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