TOFI/MONW

[LittleGreyCat]

https://en.wikipedia.org/wiki/TOFI
This says, roughly, that there is a very wide variation in the amount of internal body fat for people of the same height, weight and waist measurement.
It talks mainly (for normal weight) of BMI 20-25.

It also says that diagnosing TOFI is very difficult and expensive because it needs an MRI scan.

What it conspicuously doesn't say is if this is still prevalent in those in the lower end of the BMI normal range; that would be 18.5 to 20.

I can suspect that I am MONW because a couple of years ago I had an IR test (privately) which showed that I was producing insulin in the lower part of the normal range but that I still had higher than normal BG level so I was moderately insulin resistant.

This does generate some questions. If you are "normal" BMI and reasonably fit but have IR does that almost certainly mean that you are TOFI/MONW?

If so, how low in weight do you have to go to get rid of that visceral fat? I assume that some visceral fat is a good thing.

There is a suggestion that VO2max measurement might be a cheaper way to diagnose TOFI but there seem to be a lot of assumptions to overcome before a reliable calculation can be made.

 

[Brunneria]

Am I right in assuming that by MONW you mean Metabolically Obese, Normal Weight ?

 

[ianf0ster]

https://en.wikipedia.org/wiki/TOFI
This says, roughly, that there is a very wide variation in the amount of internal body fat for people of the same height, weight and waist measurement.
It talks mainly (for normal weight) of BMI 20-25.

It also says that diagnosing TOFI is very difficult and expensive because it needs an MRI scan.

What it conspicuously doesn't say is if this is still prevalent in those in the lower end of the BMI normal range; that would be 18.5 to 20.

I can suspect that I am MONW because a couple of years ago I had an IR test (privately) which showed that I was producing insulin in the lower part of the normal range but that I still had higher than normal BG level so I was moderately insulin resistant.

This does generate some questions. If you are "normal" BMI and reasonably fit but have IR does that almost certainly mean that you are TOFI/MONW?

If so, how low in weight do you have to go to get rid of that visceral fat? I assume that some visceral fat is a good thing.

There is a suggestion that VO2max measurement might be a cheaper way to diagnose TOFI but there seem to be a lot of assumptions to overcome before a reliable calculation can be made.

Hi LittleGreyCat, I feel the problem is that TOFI/MONW is still a relatively newly discovered phenomenon.
As such it is easiest diagnosed when the subject gets Type 2 Diabetes, or needs a scan of the relevant area for some other reason.

Probably the best known non-diabetic TOFI in the UK is/was Dr Michael Mosely (of the 8 week Blood Sugar diet book), who showed his scan compared to that of a similarly normal weight non-TOFI on the BBC's Trust Me I'm a Doctor several years ago.

A cheap(er) and accurate way of diagnosing TOFI's would be of great benefit to those undiagnosed , because before any diagnosis of TOFI or T2D they are probably feeling that they are in good metabolic shape and have no need to either modify their 'Way Of Eating' or to get more exercise.

I remember being concerned about my life expectancy ( my father died of Heart Attack aged 45yrs). But not feeling very concerned because although I recognised I may have some bad genes, I was neither obese, nor a heavy smoker such as he was.

 

[Member496333]

I was under the impression that a simple ultrasound is sufficient to see ectopic organ fat?

 

[ianf0ster]

I was under the impression that a simple ultrasound is sufficient to see ectopic organ fat?

Hi Jim,
You are correct that it can be seen (though apparently not quantified) by a simple Ultrasound. But it seems to be considered important to be able to quantify it - for which a CT scan or an MRI scan appear to be the standard methods.

 

[ianf0ster]

It is interesting that in this DCUK article sated 15th January 2019, the author mentions waist measurement as an indication of visceral fat. https://www.diabetes.co.uk/body/visceral-fat.html

I thought that the whole point about MONW or TOFI's was that we have weight and waist measurement within the normal healthy range. I certainly did, so did Dr Mosely and also I'm sure @JimLahey.

Further into the artticle, it mentions that calorie restriction, in this case the Newcastle Diet, can reduce levels of visceral fat in T2Ds.
I am disappointed that it didn't also mention the Low Carb 'Way Of Eating'.

 

[DCUKMod]

Hi Jim,
You are correct that it can be seen (though apparently not quantified) by a simple Ultrasound. But it seems to be considered important to be able to quantify it - for which a CT scan or an MRI scan appear to be the standard methods.

Body composition scans can be done via DEXA. Not all DEXA scanners can actually fulfil the body composition task.

Interestingly enough, I had a conversation about body composition scans with a radiographer only last week, as I lay on the scanner. I was there for a bone density scan (not related to diabetes).

Allegedly, many hospitals and clinics have stopped offering body composition services as they didn't find it to be commercially viable. There are a few appropriate machines in NHS facilities, but that'd be GP referral.