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Karen L. Herbst - One of the best experts on this subject based on the ideXlab platform.
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a young woman with excessive fat in lower extremities develops disordered eating and is subsequently diagnosed with anorexia nervosa Lipedema and hypermobile ehlers danlos syndrome
American Journal of Case Reports, 2021Co-Authors: Thomas Wright, Karen L. HerbstAbstract:BACKGROUND Lipedema is a loose connective tissue disease that causes disproportionate subcutaneous fat accumulation on the extremities. As a result of the increased subcutaneous tissue accumulation, Lipedema is often confused with obesity by both physicians and patients. Poor awareness and limited diagnosis of Lipedema contribute to the confusion of Lipedema with obesity and can lead to decreased body image acceptance. Patients with Lipedema may have anorexia nervosa, an eating disorder characterized by a distortion of body image, incorrect self-identification of being overweight, restricted eating behavior, and a relentless pursuit of weight loss. CASE REPORT A young woman with disproportionate fat accumulation on the lower half of her body self-identified as having obesity. She developed restrictive eating behavior and became obsessed with weight loss, resulting in anorexia nervosa. Her disproportionate subcutaneous tissue persisted despite losing weight to reach a nadir BMI of 15 kg/m². After a decade-long struggle, her eating disorder resolved, and she maintained a healthy weight and BMI of 21.5 kg/m² but disproportionate fat remained in her lower body. She experienced increasing leg tenderness, pain, and easy bruising and was diagnosed with Lipedema. CONCLUSIONS Lack of recognition of Lipedema by medical professionals and the public as a weight loss-resistant disease can affect body image acceptance. Lipedema was mistaken for obesity by the young woman in this case and likely played a role in her development of an eating disorder. Eating disorders, such as anorexia nervosa, are not rare and may be more common in women with Lipedema.
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a 41 year old woman with excessive fat of the lower body since puberty with progression to swollen ankles and feet despite caloric restriction due to Lipedema and protein calorie malnutrition a case of stage 3 Lipedema
American Journal of Case Reports, 2021Co-Authors: Thomas Wright, Karen L. HerbstAbstract:BACKGROUND Lipedema is a common condition that presents as excessive fat deposition in the extremities, initially sparing the trunk, ankles, and feet, and is found mainly in women, usually occurring after puberty or pregnancy. Lipedema can progress to include lipo-lymphedema of the ankles and feet. This report is of a 41-year old woman with Stage 3 Lipedema and lipo-lymphedema with excessive fat of the lower body since puberty, with progression to swollen ankles and feet despite dietary caloric restriction. CASE REPORT A 41-year-old woman noticed increased fat in her legs since age 12. Her weight and leg size increased until age 21, when she reached a maximum weight of 165 kg, and underwent a Roux-En-Y gastric bypass. Over 12 months, she lost 74.8 kg. Her trunk significantly reduced in weight, but her legs did not. Fifteen years later, during recovery from hysterectomy surgery, she became progressively weaker and swollen over her entire body. Laboratory test results showed hypoalbuminemia (2.0 g/dL), lymphopenia, and hypolipoproteinemia. She was diagnosed with protein and calorie malnutrition with marked gut edema requiring prolonged parenteral nutrition. After restoration of normal protein, her health returned and her pitting edema resolved, but her extremities remained enlarged. She was subsequently diagnosed with Lipedema. CONCLUSIONS This report demonstrates that early and correct diagnosis of Lipedema is important, as women who believe the condition is due to obesity may suffer the consequences of calorie or protein-calorie deficiency in an attempt to lose weight.
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survey outcomes of Lipedema reduction surgery in the united states
Plastic and reconstructive surgery. Global open, 2021Co-Authors: Karen L. Herbst, Emily A Hansen, Leopoldo Cobos M Salinas, Thomas Wright, Ethan Larson, Jaime SchwartzAbstract:Background Lipedema is a loose connective tissue disease affecting the limbs of women, that is difficult to lose by diet, exercise, or bariatric surgery. Publications from Europe demonstrate that Lipedema reduction surgery improves quality of life for women with Lipedema. There are no comparable studies in the United States (USA). The aim of this study was to collect data from women with Lipedema in the USA who have undergone Lipedema reduction surgery in the USA to determine if quality of life, pain, and other measures improved after Lipedema reduction surgery. Methods Subjects were recruited and consented online for a 166-item questionnaire in REDCap. In total, 148 women answered the questionnaire after undergoing Lipedema reduction surgery in the USA. Significance set at P < 0.05 was determined by ANOVA, Tukey's multiple comparison test, or paired t-test. Results Quality of life improved in 84% and pain improved in 86% of patients. Ambulation improved most in Lipedema Stage 3 (96%). Weight loss occurred in all stages by 3 months after surgery. Complications included growth of loose connective tissue within and outside treated areas, tissue fibrosis, anemia, blood clots, and lymphedema. Conclusions Women with Lipedema noticed significant benefits after Lipedema reduction surgery in the USA. Prospective studies are needed to assess benefits and complications after Lipedema reduction surgery in the USA.
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3d spheroids derived from human Lipedema ascs demonstrated similar adipogenic differentiation potential and ecm remodeling to non Lipedema ascs in vitro
International Journal of Molecular Sciences, 2020Co-Authors: Sara Alghadban, Karen L. Herbst, Zaidmara T Diaz, Bruce A Bunnell, India PursellAbstract:The growth and differentiation of adipose tissue-derived stem cells (ASCs) is stimulated and regulated by the adipose tissue (AT) microenvironment. In Lipedema, both inflammation and hypoxia influence the expansion and differentiation of ASCs, resulting in hypertrophic adipocytes and deposition of collagen, a primary component of the extracellular matrix (ECM). The goal of this study was to characterize the adipogenic differentiation potential and assess the levels of expression of ECM-remodeling markers in 3D spheroids derived from ASCs isolated from both Lipedema and healthy individuals. The data showed an increase in the expression of the adipogenic genes (ADIPOQ, LPL, PPAR-γ and Glut4), a decrease in matrix metalloproteinases (MMP2, 9 and 11), with no significant changes in the expression of ECM markers (collagen and fibronectin), or integrin A5 in 3D differentiated Lipedema spheroids as compared to healthy spheroids. In addition, no statistically significant changes in the levels of expression of inflammatory genes were detected in any of the samples. However, immunofluorescence staining showed a decrease in fibronectin and increase in laminin and Collagen VI expression in the 3D differentiated spheroids in both groups. The use of 3D ASC spheroids provide a functional model to study the cellular and molecular characteristics of Lipedema AT.
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Interstitial Fluid in Lipedema and Control Skin
Women's health reports (New Rochelle N.Y.), 2020Co-Authors: Marisol Allen, Michael S. Schwartz, Karen L. HerbstAbstract:Background: Fluid in lymphedema tissue appears histologically as spaces around vessels and between dermal skin fibers. Lipedema is a painful disease of excess loose connective tissue (fat) in limbs...
Epameinondas Gousopoulos - One of the best experts on this subject based on the ideXlab platform.
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a distinct cytokine profile and stromal vascular fraction metabolic status without significant changes in the lipid composition characterizes Lipedema
International Journal of Molecular Sciences, 2021Co-Authors: Stefan Wolf, Gunther Felmerer, Maija Hollmen, Bongsung Kim, Pietro Giovanoli, Nicole Lindenblatt, Jeremy W Deuel, Mauro Vasella, Lisanne Grunherz, Epameinondas GousopoulosAbstract:Lipedema is an adipose tissue disorder characterized by the disproportionate increase of subcutaneous fat tissue in the lower and/or upper extremities. The underlying pathomechanism remains unclear and no molecular biomarkers to distinguish the disease exist, leading to a large number of undiagnosed and misdiagnosed patients. To unravel the distinct molecular characteristic of Lipedema we performed lipidomic analysis of the adipose tissue and serum of Lipedema versus anatomically- and body mass index (BMI)-matched control patients. Both tissue groups showed no significant changes regarding lipid composition. As hyperplastic adipose tissue represents low-grade inflammation, the potential systemic effects on circulating cytokines were evaluated in Lipedema and control patients using the Multiplex immunoassay system. Interestingly, increased systemic levels of interleukin 11 (p = 0.03), interleukin 28A (p = 0.04) and interleukin 29 (p = 0.04) were observed. As cytokines can influence metabolic activity, the metabolic phenotype of the stromal vascular fraction was examined, revealing significantly increased mitochondrial respiration in Lipedema. In conclusion, despite sharing a comparable lipid profile with healthy adipose tissue, Lipedema is characterized by a distinct systemic cytokine profile and metabolic activity of the stromal vascular fraction.
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adipose tissue hypertrophy an aberrant biochemical profile and distinct gene expression in Lipedema
Journal of Surgical Research, 2020Co-Authors: Gunther Felmerer, Aikaterini Stylianaki, Maija Hollmen, Philipp Strobel, Anna Wang, Nicole Lindenblatt, Epameinondas Gousopoulos, Rene HagerlingAbstract:Abstract Background Lipedema is a common adipose tissue disorder affecting women, characterized by a symmetric subcutaneous adipose tissue deposition, particularly of the lower extremities. Lipedema is usually underdiagnosed, thus remaining an undertreated disease. Importantly, no histopathologic or molecular hallmarks exist to clearly diagnose the disease, which is often misinterpreted as obesity or lymphedema. Materials and methods The aim of the present study is to characterize in detail morphologic and molecular alterations in the adipose tissue composition of Lipedema patients compared with healthy controls. Detailed histopathologic and molecular characterization was performed using lipid and cytokine quantification as well as gene expression arrays. The analysis was conducted on anatomically matched skin and fat tissue biopsies as well as fasting serum probes obtained from 10 Lipedema and 11 gender and body mass index–matched control patients. Results Histologic evaluation of the adipose tissue showed increased intercellular fibrosis and adipocyte hypertrophy. Serum analysis showed an aberrant lipid metabolism without changes in the circulating adipokines. In an adipogenesis gene array, a distinct gene expression profile associated with macrophages was observed. Histologic assessment of the immune cell infiltrate confirmed the increased presence of macrophages, without changes in the T-cell compartment. Conclusions Lipedema presents a distinguishable disease with typical tissue architecture and aberrant lipid metabolism, different to obesity or lymphedema. The differentially expressed genes and immune cell infiltration profile in Lipedema patients further support these findings.
Győző Szolnoky - One of the best experts on this subject based on the ideXlab platform.
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update in the management of Lipedema
International Angiology, 2021Co-Authors: Isabel Fornercordero, Angeles Fornercordero, Győző SzolnokyAbstract:Lipedema is a chronic feminine disease that causes abnormal fat deposition in lower limbs and occasionally upper limbs. Easy bruising and pain are common. Lipedema patients suffer from both physical and psychological disability. Despite the relatively high prevalence and the impact on the quality of life, little is known about the disease. The majority of patients are misdiagnosed as lymphedema or obesity. The objective was to perform a non-systematic review on Lipedema literature, related to diagnosis and therapy. Regarding pathophysiology, alterations are not exclusively confined to adipose tissue. Lymphatic dysfunction, cardiovascular variations, blood capillary fragility and increased permeability are common. Patients often present with neurological alterations and hormonal malfunction. Elevated cutaneous sodium has been documented. Due to the absence of a defined etiology, evidence-based research is difficult in the management of Lipedema. The setting of realistic expectations is important for both patient and medical care provider. The major aims of the management are multimodal for improvements in the quality of life; reduction in heaviness and pain, reshaping the affected limbs, weight control, improvements in mobility. Compression garments, physical therapy, exercise regimens, diet and psychological counseling are necessities. For selected patients, surgical treatment is an added option.
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the impact of lower body compression garment on left ventricular rotational mechanics in patients with Lipedema insights from the three dimensional speckle tracking echocardiographic magyar path study
Clinical obesity, 2020Co-Authors: Attila Nemes, Arpad Kormanyos, Peter Domsik, Anita Kalapos, Lajos Kemeny, Győző SzolnokyAbstract:Lipedema is a lymphedema-masquerading symmetrical, bilateral and disproportional obesity. Its conservative maintenance treatment comprises the use of flat-knitted compression pantyhoses. Lipedema is known to be associated with left ventricular morphological and functional alterations. The present study aimed to assess the effects of graduated compression stockings on left ventricular (LV) rotational mechanics measured by three-dimensional speckle-tracking echocardiography (3DSTE) in Lipedema patients. The present study comprised twenty Lipedema patients (mean age: 45.8 ± 11.0 years, all females) undergoing 3DSTE who were also compared to 51 age- and gender-matched healthy controls (mean age: 39.8 ± 14.1 years, all females). 3DSTE analysis was performed at rest, and subsequent to 1 hour application of compression class 2 made-to-measure flat-knitted pantyhose. Six Lipedema patients showed significant LV rotational abnormalities. Of the remaining fourteen Lipedema patients LV basal rotation rotation showed significant reduction, while LV apical rotation showed significant increase with unchanged LV twist after a 60-minute use of compression garment. Significant changes in LV rotational mechanics could be detected among 14 women with Lipedema after the use of compression garment however six probands have special LV rotational abnormalities at baseline and/or after compression.
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are increased left ventricular strains compensatory effects in Lipedema detailed analysis from the three dimensional speckle tracking echocardiographic magyar path study
Journal of Clinical Ultrasound, 2020Co-Authors: Attila Nemes, Arpad Kormanyos, Peter Domsik, Anita Kalapos, Lajos Kemeny, Nandor Gyenes, Győző SzolnokyAbstract:Purpose Lipedema is a chronic, common but underdiagnosed disease masquerading obesity, with female predominance, characterized by disproportional abnormal adipose tissue distribution of the lower and also upper extremities. The present study was designed to determine whether Lipedema is associated with three-dimensional (3D) speckle-tracking echocardiography (3DSTE)-derived left ventricular (LV) deformation abnormalities, and to assess the effects of 1-hour use of medical compression stockings (MCS). Methods The present study comprised 19 female patients with Lipedema (mean age: 42.2 ± 12.4 years), compared to 28 age-matched healthy female controls (mean age: 42.0 ± 9.8 years). Results Lipedema patients showed larger left atrial and LV dimensions and greater LV ejection fraction than controls, without significant difference in other echocardiography variables. Lipedema patients had greater 3DSTE-derived global and mean segmental LV circumferential and area strains than controls. Following 1-hour use of wearing MCS, neither global and nor mean segmental LV strains showed significant impairment or improvement. Conclusions Increased LV strains could be compensatory effects maintaining LV pumping function in Lipedema. Short-term wearing of MCS has no global effect on LV strains.
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the mitral annulus in Lipedema insights from the three dimensional speckle tracking echocardiographic magyar path study
Echocardiography-a Journal of Cardiovascular Ultrasound and Allied Techniques, 2019Co-Authors: Attila Nemes, Arpad Kormanyos, Peter Domsik, Anita Kalapos, Lajos Kemeny, Zsolt Kovacs, Gyorgyike Agnes Piros, Tamas Forster, Győző SzolnokyAbstract:INTRODUCTION Lipedema is a barely recognized and poorly diagnosed, but common disease affecting almost exclusively female patients. The pathomechanism of Lipedema is not known, and clinically, it is a bilateral, symmetrical, disproportional fatty enlargement of the lower half of the body, the disease does not affect the feet, and the upper extremities are often involved. Since Lipedema is associated with increased aortic stiffness and altered left ventricular (LV) rotational mechanics, the present study was designed to compare the size and function of the mitral annulus (MA) between Lipedema patients and controls by three-dimensional speckle-tracking echocardiography (3DSTE). METHODS Twenty-four patients with stage 2 Lipedema and 48 age-, gender-, and body mass index-matched healthy control patients were included in the study. Each person from the Lipedema and the control groups underwent two-dimensional Doppler echocardiography and 3DSTE. RESULTS Significantly enlarged left atrial diameter, LV end-diastolic diameter and volume, and LV end-systolic volume could be detected in Lipedema patients as compared to controls. None of the Lipedema patients and controls showed ≥grade 1 mitral or tricuspid regurgitation. Dilated end-systolic and end-diastolic MA diameter, area, and perimeter could be demonstrated in Lipedema patients as compared to controls, and these changes were accompanied by impaired MA fractional area change at rest. Following 1-hour use of compression stockings, no significant improvement was seen in these parameters. CONCLUSIONS Lipedema is associated with MA enlargement and functional impairment. The use of compression stockings does not improve these alterations.
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mecanica rotacional ventricular izquierda invertida en un paciente con Lipedema del estudio de magyar path
Revista Colombiana de Cardiología, 2019Co-Authors: Attila Nemes, Arpad Kormanyos, Peter Domsik, Lajos Kemeny, Isabel Fornercordero, Győző SzolnokyAbstract:Resumen El Lipedema es un trastorno cronico que se caracteriza por una hiperplasia del tejido adiposo subcutaneo simetrico, deformante, asociado a hematomas y dolor, que afecta fundamentalmente a mujeres tras la pubertad, que suele ser familiar y tiene influencia hormonal. Sin tratamiento, el Lipedema puede progresar a linfedema, y se ha asociado al aumento en la rigidez de la aorta. La mecanica rotacional del ventriculo izquierdo (VI) tiene un papel significativo en la circulacion normal. En circunstancias normales, la base del VI rota en el sentido de las agujas del reloj, mientras que el apex del VI rota en sentido contrario, provocando un movimiento como de retorcer una toalla llamado torsion del VI. En el presente caso, mediante ecocardiografia speckle-tracking tridimensional se revelo una torsion del VI demostrando un apex VI en el sentido de las agujas del reloj y la rotacion antihoraria de la base del VI en un paciente con caracteristicas clinicas de Lipedema.
Manus J Donahue - One of the best experts on this subject based on the ideXlab platform.
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neuroimaging of cerebral blood flow and sodium in women with Lipedema
Obesity, 2020Co-Authors: Kalen J Petersen, Adriana Marton, Paula M C Donahue, Manus J Donahue, Jens Titze, Maria Garza, Kevin D Harkins, Rachelle CrescenziAbstract:OBJECTIVE Lipedema is characterized by pain, fatigue, and excessive adipose tissue and sodium accumulation of the lower extremities. This case-control study aims to determine whether sodium or vascular dysfunction is present in the central nervous system. METHODS Brain magnetic resonance imaging was performed at 3 T in patients with Lipedema (n = 15) and control (n = 18) participants matched for sex, age, race, and BMI. Standard anatomical imaging and intracranial angiography were applied to evaluate brain volume and vasculopathy, respectively; arterial spin labeling and sodium magnetic resonance imaging were applied to quantify cerebral blood flow (CBF) (milliliters per 100 grams of tissue/minute) and brain tissue sodium content (millimoles per liter), respectively. A Mann-Whitney U test (significance criteria P < 0.05) was applied to evaluate group differences. RESULTS No differences in tissue volume, white matter hyperintensities, intracranial vasculopathy, or tissue sodium content were observed between groups. Gray matter CBF was elevated (P = 0.03) in patients with Lipedema (57.2 ± 9.6 mL per 100 g/min) versus control participants (49.8 ± 9.1 mL per 100 g/min). CONCLUSIONS Findings provide evidence that brain sodium and tissue fractions are similar between patients with Lipedema and control participants and that patients with Lipedema do not exhibit abnormal radiological indicators of intracranial vasculopathy or ischemic injury. Potential explanations for elevated CBF are discussed in the context of the growing literature on Lipedema symptomatology and vascular dysfunction.
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upper and lower extremity measurement of tissue sodium and fat content in patients with Lipedema
Obesity, 2020Co-Authors: Rachelle Crescenzi, Paula M C Donahue, Joshua A Beckman, Kalen J Petersen, Maria Garza, Niral J Patel, Chelsea A Lee, Manus J DonahueAbstract:OBJECTIVE The aim of this study is to compare tissue sodium and fat content in the upper and lower extremities of participants with Lipedema versus controls using magnetic resonance imaging (MRI). METHODS MRI was performed at 3.0 T in females with Lipedema (n = 15, age = 43.2 ± 10.0 years, BMI = 30.3 ± 4.4 kg/m2 ) and controls without Lipedema (n = 14, age = 42.8 ± 13.2 years, BMI = 28.8 ± 4.4 kg/m2 ). Participants were assessed for pain and disease stage. Sodium MRI was performed in the forearm and calf to quantify regional tissue sodium content (TSC, mmol/L). Chemical-shift-encoded water-fat MRI was performed in identical regions for measurement of fat/water (ratio). RESULTS In the calf, skin TSC (16.3 ± 2.6 vs. 14.4 ± 2.2 mmol/L, P = 0.04), muscle TSC (20.3 ± 3.0 vs. 18.3 ± 1.7 mmol/L, P = 0.03), and fat/water (1.03 ± 0.37 vs. 0.56 ± 0.21 ratio, P < 0.001) were significantly higher in participants with Lipedema versus control participants. In the forearm, skin TSC (13.4 ± 3.3 vs. 12.0 ± 2.3 mmol/L, P = 0.2, Cohen's d = 0.50) and fat/water (0.65 ± 0.24 vs. 0.48 ± 0.24 ratio, P = 0.07, Cohen's d = 0.68) demonstrated moderate effect sizes in participants with Lipedema versus control participants. Calf skin TSC was significantly correlated with pain (Spearman's rho = 0.55, P = 0.03) and disease stage (Spearman's rho = 0.82, P < 0.001) among participants with Lipedema. CONCLUSIONS MRI-measured tissue sodium and fat content are significantly higher in the lower extremities, but not upper extremities, of patients with Lipedema compared with BMI-matched controls.
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Lipedema and dercum s disease a new application of bioimpedance
Lymphatic Research and Biology, 2019Co-Authors: Rachelle Crescenzi, Paula M C Donahue, Manus J Donahue, Maria Garza, Sandra Weakley, Karen L. HerbstAbstract:Background: Lipedema and Dercum's disease (DD) are incompletely characterized adipose tissue diseases, and objective measures of disease profiles are needed to aid in differential diagnosis. We hyp...
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tissue sodium content is elevated in the skin and subcutaneous adipose tissue in women with Lipedema
Obesity, 2018Co-Authors: Rachelle Crescenzi, Adriana Marton, Paula M C Donahue, Helen Mahany, Sarah K Lants, Ping Wang, Joshua A Beckman, Manus J Donahue, Jens TitzeAbstract:OBJECTIVE To test the hypothesis that tissue sodium and adipose content are elevated in patients with Lipedema; if confirmed, this could establish precedence for tissue sodium and adipose content representing a discriminatory biomarker for Lipedema. METHODS Participants with Lipedema (n = 10) and control (n = 11) volunteers matched for biological sex, age, BMI, and calf circumference were scanned with 3.0-T sodium and conventional proton magnetic resonance imaging (MRI). Standardized tissue sodium content was quantified in the calf skin, subcutaneous adipose tissue (SAT), and muscle. Dixon MRI was employed to quantify tissue fat and water volumes of the calf. Nonparametric statistical tests were applied to compare regional sodium content and fat-to-water volume between groups (significance: two-sided P ≤ 0.05). RESULTS Skin (P = 0.01) and SAT (P = 0.04) sodium content were elevated in Lipedema (skin: 14.9 ± 2.9 mmol/L; SAT: 11.9 ± 3.1 mmol/L) relative to control participants (skin: 11.9 ± 2.0 mmol/L; SAT: 9.4 ± 1.6 mmol/L). Relative fat-to-water volume in the calf was elevated in Lipedema (1.2 ± 0.48 ratio) relative to control participants (0.63 ± 0.26 ratio; P < 0.001). Skin sodium content was directly correlated with fat-to-water volume (Spearman's rho = 0.54; P = 0.01). CONCLUSIONS Internal metrics of tissue sodium and adipose content are elevated in patients with Lipedema, potentially providing objective imaging-based biomarkers for differentially diagnosing the under-recognized condition of Lipedema from obesity.
Rachelle Crescenzi - One of the best experts on this subject based on the ideXlab platform.
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neuroimaging of cerebral blood flow and sodium in women with Lipedema
Obesity, 2020Co-Authors: Kalen J Petersen, Adriana Marton, Paula M C Donahue, Manus J Donahue, Jens Titze, Maria Garza, Kevin D Harkins, Rachelle CrescenziAbstract:OBJECTIVE Lipedema is characterized by pain, fatigue, and excessive adipose tissue and sodium accumulation of the lower extremities. This case-control study aims to determine whether sodium or vascular dysfunction is present in the central nervous system. METHODS Brain magnetic resonance imaging was performed at 3 T in patients with Lipedema (n = 15) and control (n = 18) participants matched for sex, age, race, and BMI. Standard anatomical imaging and intracranial angiography were applied to evaluate brain volume and vasculopathy, respectively; arterial spin labeling and sodium magnetic resonance imaging were applied to quantify cerebral blood flow (CBF) (milliliters per 100 grams of tissue/minute) and brain tissue sodium content (millimoles per liter), respectively. A Mann-Whitney U test (significance criteria P < 0.05) was applied to evaluate group differences. RESULTS No differences in tissue volume, white matter hyperintensities, intracranial vasculopathy, or tissue sodium content were observed between groups. Gray matter CBF was elevated (P = 0.03) in patients with Lipedema (57.2 ± 9.6 mL per 100 g/min) versus control participants (49.8 ± 9.1 mL per 100 g/min). CONCLUSIONS Findings provide evidence that brain sodium and tissue fractions are similar between patients with Lipedema and control participants and that patients with Lipedema do not exhibit abnormal radiological indicators of intracranial vasculopathy or ischemic injury. Potential explanations for elevated CBF are discussed in the context of the growing literature on Lipedema symptomatology and vascular dysfunction.
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upper and lower extremity measurement of tissue sodium and fat content in patients with Lipedema
Obesity, 2020Co-Authors: Rachelle Crescenzi, Paula M C Donahue, Joshua A Beckman, Kalen J Petersen, Maria Garza, Niral J Patel, Chelsea A Lee, Manus J DonahueAbstract:OBJECTIVE The aim of this study is to compare tissue sodium and fat content in the upper and lower extremities of participants with Lipedema versus controls using magnetic resonance imaging (MRI). METHODS MRI was performed at 3.0 T in females with Lipedema (n = 15, age = 43.2 ± 10.0 years, BMI = 30.3 ± 4.4 kg/m2 ) and controls without Lipedema (n = 14, age = 42.8 ± 13.2 years, BMI = 28.8 ± 4.4 kg/m2 ). Participants were assessed for pain and disease stage. Sodium MRI was performed in the forearm and calf to quantify regional tissue sodium content (TSC, mmol/L). Chemical-shift-encoded water-fat MRI was performed in identical regions for measurement of fat/water (ratio). RESULTS In the calf, skin TSC (16.3 ± 2.6 vs. 14.4 ± 2.2 mmol/L, P = 0.04), muscle TSC (20.3 ± 3.0 vs. 18.3 ± 1.7 mmol/L, P = 0.03), and fat/water (1.03 ± 0.37 vs. 0.56 ± 0.21 ratio, P < 0.001) were significantly higher in participants with Lipedema versus control participants. In the forearm, skin TSC (13.4 ± 3.3 vs. 12.0 ± 2.3 mmol/L, P = 0.2, Cohen's d = 0.50) and fat/water (0.65 ± 0.24 vs. 0.48 ± 0.24 ratio, P = 0.07, Cohen's d = 0.68) demonstrated moderate effect sizes in participants with Lipedema versus control participants. Calf skin TSC was significantly correlated with pain (Spearman's rho = 0.55, P = 0.03) and disease stage (Spearman's rho = 0.82, P < 0.001) among participants with Lipedema. CONCLUSIONS MRI-measured tissue sodium and fat content are significantly higher in the lower extremities, but not upper extremities, of patients with Lipedema compared with BMI-matched controls.
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Lipedema and dercum s disease a new application of bioimpedance
Lymphatic Research and Biology, 2019Co-Authors: Rachelle Crescenzi, Paula M C Donahue, Manus J Donahue, Maria Garza, Sandra Weakley, Karen L. HerbstAbstract:Background: Lipedema and Dercum's disease (DD) are incompletely characterized adipose tissue diseases, and objective measures of disease profiles are needed to aid in differential diagnosis. We hyp...
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tissue sodium content is elevated in the skin and subcutaneous adipose tissue in women with Lipedema
Obesity, 2018Co-Authors: Rachelle Crescenzi, Adriana Marton, Paula M C Donahue, Helen Mahany, Sarah K Lants, Ping Wang, Joshua A Beckman, Manus J Donahue, Jens TitzeAbstract:OBJECTIVE To test the hypothesis that tissue sodium and adipose content are elevated in patients with Lipedema; if confirmed, this could establish precedence for tissue sodium and adipose content representing a discriminatory biomarker for Lipedema. METHODS Participants with Lipedema (n = 10) and control (n = 11) volunteers matched for biological sex, age, BMI, and calf circumference were scanned with 3.0-T sodium and conventional proton magnetic resonance imaging (MRI). Standardized tissue sodium content was quantified in the calf skin, subcutaneous adipose tissue (SAT), and muscle. Dixon MRI was employed to quantify tissue fat and water volumes of the calf. Nonparametric statistical tests were applied to compare regional sodium content and fat-to-water volume between groups (significance: two-sided P ≤ 0.05). RESULTS Skin (P = 0.01) and SAT (P = 0.04) sodium content were elevated in Lipedema (skin: 14.9 ± 2.9 mmol/L; SAT: 11.9 ± 3.1 mmol/L) relative to control participants (skin: 11.9 ± 2.0 mmol/L; SAT: 9.4 ± 1.6 mmol/L). Relative fat-to-water volume in the calf was elevated in Lipedema (1.2 ± 0.48 ratio) relative to control participants (0.63 ± 0.26 ratio; P < 0.001). Skin sodium content was directly correlated with fat-to-water volume (Spearman's rho = 0.54; P = 0.01). CONCLUSIONS Internal metrics of tissue sodium and adipose content are elevated in patients with Lipedema, potentially providing objective imaging-based biomarkers for differentially diagnosing the under-recognized condition of Lipedema from obesity.