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Editorial Comment to Recurrent stone-forming patients have high visceral fat ratio
based on computed tomography images compared to ﬁrst-time stone-forming patients
While the prevalence of metabolic syndrome (MetS) is
spreading worldwide, the increasing number of patients with
urolithiasis associated with MetS will result in a huge burden
for our society both clinically and economically.
is known to be a main facilitator of MetS by increasing insu-
lin resistance and creating a pro-inﬂammatory environment.
Owing to the convenience of carrying out computed tomogra-
phy imaging, visceral fat measurement is useful and practical
for patients with urolithiasis.
The association between visceral fat and clinical outcome
of urolithiasis has been shown by Yamashita et al., who
investigated 300 patients with upper urinary tract calculi that
were surgically removed in their hospital.
In the present
study, they focused on calculating the ratio (%) of visceral
fat area and volume using subcutaneous fat, rather than vis-
ceral fat area (cm
) and volume (cm
). Interestingly, both uni-
variate and multivariate analyses showed that the higher
visceral fat volume ratio was associated with recurrent stone
formation. This ﬁnding might indicate that considering the
body mass index, waist circumference and even visceral fat
area measured at the umbilical slice are not enough to predict
the clinical outcome of stone patients. Although there is still
concern for radiation exposure of multislice computed tomog-
raphy, detailed image examination is necessary for planning
the treatment strategy for stone patients.
In addition to the present study, other earlier studies
showed that visceral fat is associated with uric acid stones
and predicts increases in urinary parameters, such as sodium
As the present study did not include sub-
analysis for the stone component, type and data of urinary
parameters, validation from those aspects might be more use-
ful to better understand their result as to why a high visceral
fat volume ratio results in stone recurrence. Furthermore, the
number of participants in these previous studies was similar
to that in the present study (between 262 and 382); therefore,
a much larger cohort study will be required to determine a
feasible use of visceral fat calculation over our practice.
Department of Nephro-urology, Nagoya City University
Graduate School of Medical Sciences, Nagoya, Aichi, Japan
Conﬂict of interest
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phy images compared to ﬁrst-time stone-forming patients. Int. J. Urol. 2018;
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including visceral fat, subcutaneous fat, body mass index, and waist circumfer-
ence could predict the urinary stone composition most? BMC Urol. 2015; 15:
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dently associated with changes in urine constituent excretion in a stone form-
ing population. Urolithiasis 2015; 43: 213–20.
© 2018 The Japanese Urological Association
Visceral fat ratio and urolithiasis