title: Frailty Syndrome: Visceral Adipose Tissue and Frailty in Patients with Symptomatic Severe Aortic Stenosis.
abstract: In patients with severe aortic stenosis (AS), frailty is a clinically relevant measure of increased vulnerability that should be included in the preoperative risk assessment. Bioelectrical impedance analysis (BIA) derived phase angle (PA) reflects cell membrane integrity and function. Few studies are available on the relative contribution of adiposity distribution on frailty, and about the influences of frailty and visceral obesity in PA value. Therefore, we aimed to evaluate associations among frailty, visceral fat depots and PA in patients with symptomatic severe AS.
  
  
  
  In a cohort of patients with symptomatic severe AS and preserved ejection fraction, we examined the associations between frailty, visceral fat depots and bioelectrical impedance analysis (BIA) derived phase angle (PA); and between visceral fat and PA. Frailty was defined according the Fried et al. scale criteria and the body fat distribution was determined by multidetector computed tomography and by BIA.
  
  
  
  Of the fifty-five included patients, 26 were frail (47%). Adjusting for age and gender, frailty was associated with indexed epicardial adipose tissue volume (EATVi) (the odds of frailty increased 4.1-fold per additional 100 cm3/m2 of EAT [95% confidence interval (CI) of 1.03 to 16.40, p=0.04] and with PA (OR of 0.50, 95% CI, 0.26 to 0.97, p=0.04), but not with body mass index (BMI), waist circumference (WC), indexed total, visceral and subcutaneous abdominal fat areas (TAFAi, VAFAi and SAFAi) nor with indexed mediastinal adipose tissue volume (MATVi). In an age and gender adjusted linear model, PA was inversely correlated with EATVi (β=-0.008, 95% CI, -0.016 to -0.001, p=0.03), but not with BMI, WC, nor with MATVi, VAFAi, SAFAi and TAFAi.
  
  
  
  In patients with symptomatic severe AS, EATVi is associated with frailty, independently of age and gender, but not with MAFVi or VAFAi. Moreover, frailty and EATVi are associated with impaired cell membrane integrity and function assessed by PA.
authors.affiliation: Marília Pinheiro, Faculty of Nutrition and Food Sciences, Portugal, E-mail: mariliapinheiroo@gmail.com, Phone (0351) 918197460.
authors.forename: M
authors.initials: M
authors.lastname: Pinheiro
authors.forename: J
authors.initials: J
authors.lastname: Mancio
authors.forename: G
authors.initials: G
authors.lastname: Conceição
authors.forename: W
authors.initials: W
authors.lastname: Ferreira
authors.forename: M
authors.initials: M
authors.lastname: Carvalho
authors.forename: A
authors.initials: A
authors.lastname: Santos
authors.forename: L
authors.initials: L
authors.lastname: Vouga
authors.forename: V
authors.initials: V
authors.lastname: Gama Ribeiro
authors.forename: A
authors.initials: A
authors.lastname: Leite-Moreira
authors.forename: I
authors.initials: I
authors.lastname: Falcão-Pires
authors.forename: N
authors.initials: N
authors.lastname: Bettencourt
mesh_terms: D050154:Adiposity; D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000503:physiopathology*; D015992:Body Mass Index; D003430:Cross-Sectional Studies; D017097:Electric Impedance; D005260:Female; D016330:Frail Elderly; D006801:Humans; D050152:Intra-Abdominal Fat; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015596:Nutrition Assessment; D018570:Risk Assessment; D055105:Waist Circumference