{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T15:51:08Z","timestamp":1773676268645,"version":"3.50.1"},"reference-count":51,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2022,11,19]],"date-time":"2022-11-19T00:00:00Z","timestamp":1668816000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2022,11,19]],"date-time":"2022-11-19T00:00:00Z","timestamp":1668816000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sci Rep"],"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Increasing evidence supports a role for local fat depots in cancer outcomes. Despite the robust positive association of obesity with renal cell carcinoma (RCCa) diagnosis, increased adiposity is inversely related to RCCa oncological outcomes. Here, we sought to ascertain whether imagiologically assessed local fat depots associate with RCCa progression and survival and account for this apparent paradox. A retrospective cohort of renal carcinoma patients elective for nephrectomy (n\u2009=\u2009137) were included. Beyond baseline clinicopathological characteristics, computed tomography (CT)-scans at the level of renal hilum evaluated areas and densities of different adipose tissue depots (perirenal, subcutaneous, visceral) and skeletal muscle (<jats:italic>erector spinae, psoas<\/jats:italic> and <jats:italic>quadratus lumborum<\/jats:italic> muscles) were analyzed. Univariate and multivariable Cox proportional hazards models were estimated following empirical analysis using stepwise Cox regression. Age, visceral adipose tissue (VAT) area and body mass index (BMI) predicted tumour-sided perirenal fat area (<jats:italic>R<\/jats:italic><jats:sup><jats:italic>2<\/jats:italic><\/jats:sup>\u2009=\u20090.584), which presented upregulated <jats:italic>UCP1<\/jats:italic> expression by 27-fold (<jats:italic>P<\/jats:italic>\u2009=\u20090.026) and smaller adipocyte areas, compared with subcutaneous depot. Multivariate analyses revealed that increased area of perirenal adipose tissue (PRAT) on the contralateral and tumour side associate with improved progression-free survival (HR\u2009=\u20090.3, 95CI\u2009=\u20090.1\u20130.8, <jats:italic>P<\/jats:italic>\u2009=\u20090.019) and overall survival (HR\u2009=\u20090.3, 95CI\u2009=\u20090.1\u20130.7, <jats:italic>P<\/jats:italic>\u2009=\u20090.009). PRAT measurements using CT, might become a possible tool, well correlated with other measures of obesity such as VAT and BMI, that will improve determination of obesity and contribute to assess the risk for disease progression and mortality in renal cancer patients. Present data supports the obesity paradox in RCCa, assumed that larger PRAT areas seem to protect from disease progression and death.<\/jats:p>","DOI":"10.1038\/s41598-022-24418-9","type":"journal-article","created":{"date-parts":[[2022,11,19]],"date-time":"2022-11-19T16:05:40Z","timestamp":1668873940000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["A hint for the obesity paradox and the link between obesity, perirenal adipose tissue and Renal Cell Carcinoma progression"],"prefix":"10.1038","volume":"12","author":[{"given":"Jos\u00e9","family":"Preza-Fernandes","sequence":"first","affiliation":[]},{"given":"Pedro","family":"Passos","sequence":"additional","affiliation":[]},{"given":"Miguel","family":"Mendes-Ferreira","sequence":"additional","affiliation":[]},{"given":"Adriana R.","family":"Rodrigues","sequence":"additional","affiliation":[]},{"given":"Alexandra","family":"Gouveia","sequence":"additional","affiliation":[]},{"given":"Avelino","family":"Fraga","sequence":"additional","affiliation":[]},{"given":"Rui","family":"Medeiros","sequence":"additional","affiliation":[]},{"given":"Ricardo","family":"Ribeiro","sequence":"additional","affiliation":[]}],"member":"297","published-online":{"date-parts":[[2022,11,19]]},"reference":[{"key":"24418_CR1","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1111\/nyas.12416","volume":"1311","author":"NA Berger","year":"2014","unstructured":"Berger, N. A. Obesity and cancer pathogenesis. Ann. N. Y. Acad. Sci. 1311, 57\u201376. https:\/\/doi.org\/10.1111\/nyas.12416 (2014).","journal-title":"Ann. N. Y. Acad. Sci."},{"key":"24418_CR2","doi-asserted-by":"publisher","first-page":"984","DOI":"10.1054\/bjoc.2001.2040","volume":"85","author":"A Bergstrom","year":"2001","unstructured":"Bergstrom, A. et al. Obesity and renal cell cancer\u2013a quantitative review. Br. J. Cancer 85, 984\u2013990. https:\/\/doi.org\/10.1054\/bjoc.2001.2040 (2001).","journal-title":"Br. J. Cancer"},{"key":"24418_CR3","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1111\/j.1464-410X.2009.08706.x","volume":"105","author":"WT Lowrance","year":"2010","unstructured":"Lowrance, W. T. et al. Obesity is associated with a higher risk of clear-cell renal cell carcinoma than with other histologies. BJU Int. 105, 16\u201320. https:\/\/doi.org\/10.1111\/j.1464-410X.2009.08706.x (2010).","journal-title":"BJU Int."},{"key":"24418_CR4","doi-asserted-by":"publisher","first-page":"1862","DOI":"10.1093\/jnci\/djt310","volume":"105","author":"AA Hakimi","year":"2013","unstructured":"Hakimi, A. A. et al. An epidemiologic and genomic investigation into the obesity paradox in renal cell carcinoma. J. Natl. Cancer Inst. 105, 1862\u20131870. https:\/\/doi.org\/10.1093\/jnci\/djt310 (2013).","journal-title":"J. Natl. Cancer Inst."},{"key":"24418_CR5","doi-asserted-by":"publisher","first-page":"1298","DOI":"10.1038\/ejcn.2013.203","volume":"67","author":"X Song","year":"2013","unstructured":"Song, X. et al. Comparison of various surrogate obesity indicators as predictors of cardiovascular mortality in four European populations. Eur. J. Clin. Nutr. 67, 1298\u20131302. https:\/\/doi.org\/10.1038\/ejcn.2013.203 (2013).","journal-title":"Eur. J. Clin. Nutr."},{"issue":"Suppl 3","key":"24418_CR6","doi-asserted-by":"publisher","first-page":"S56","DOI":"10.1038\/ijo.2008.87","volume":"32","author":"KJ Rothman","year":"2008","unstructured":"Rothman, K. J. BMI-related errors in the measurement of obesity. Int. J. Obes. (Lond) 32(Suppl 3), S56-59. https:\/\/doi.org\/10.1038\/ijo.2008.87 (2008).","journal-title":"Int. J. Obes. (Lond)"},{"key":"24418_CR7","doi-asserted-by":"publisher","first-page":"489","DOI":"10.1111\/apha.12224","volume":"210","author":"J Aubrey","year":"2014","unstructured":"Aubrey, J. et al. Measurement of skeletal muscle radiation attenuation and basis of its biological variation. Acta. Physiol. (Oxf.) 210, 489\u2013497. https:\/\/doi.org\/10.1111\/apha.12224 (2014).","journal-title":"Acta. Physiol. (Oxf.)"},{"key":"24418_CR8","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0175561","volume":"12","author":"G Favre","year":"2017","unstructured":"Favre, G. et al. Perirenal fat thickness measured with computed tomography is a reliable estimate of perirenal fat mass. PLoS ONE 12, e0175561. https:\/\/doi.org\/10.1371\/journal.pone.0175561 (2017).","journal-title":"PLoS ONE"},{"key":"24418_CR9","doi-asserted-by":"publisher","first-page":"246","DOI":"10.2967\/jnumed.109.068775","volume":"51","author":"S Baba","year":"2010","unstructured":"Baba, S., Jacene, H. A., Engles, J. M., Honda, H. & Wahl, R. L. CT Hounsfield units of brown adipose tissue increase with activation: preclinical and clinical studies. J. Nucl. Med. 51, 246\u2013250. https:\/\/doi.org\/10.2967\/jnumed.109.068775 (2010).","journal-title":"J. Nucl. Med."},{"key":"24418_CR10","doi-asserted-by":"publisher","first-page":"157","DOI":"10.1016\/j.urolonc.2017.12.011","volume":"36","author":"H Huang","year":"2018","unstructured":"Huang, H., Chen, S., Li, W., Wu, X. & Xing, J. High perirenal fat thickness predicts a poor progression-free survival in patients with localized clear cell renal cell carcinoma. Urol. Oncol. 36, 157. https:\/\/doi.org\/10.1016\/j.urolonc.2017.12.011 (2018).","journal-title":"Urol. Oncol."},{"key":"24418_CR11","doi-asserted-by":"publisher","first-page":"990S","DOI":"10.1093\/jn\/127.5.990S","volume":"127","author":"IH Rosenberg","year":"1997","unstructured":"Rosenberg, I. H. Sarcopenia: origins and clinical relevance. J. Nutr. 127, 990S-991S. https:\/\/doi.org\/10.1093\/jn\/127.5.990S (1997).","journal-title":"J. Nutr."},{"key":"24418_CR12","doi-asserted-by":"publisher","first-page":"455","DOI":"10.1080\/14737140.2017.1301209","volume":"17","author":"H Fukushima","year":"2017","unstructured":"Fukushima, H. & Koga, F. Impact of sarcopenia in the management of urological cancer patients. Expert Rev. Anticancer Ther. 17, 455\u2013466. https:\/\/doi.org\/10.1080\/14737140.2017.1301209 (2017).","journal-title":"Expert Rev. Anticancer Ther."},{"key":"24418_CR13","doi-asserted-by":"publisher","first-page":"646","DOI":"10.1016\/j.cell.2011.02.013","volume":"144","author":"D Hanahan","year":"2011","unstructured":"Hanahan, D. & Weinberg, R. A. Hallmarks of cancer: The next generation. Cell 144, 646\u2013674. https:\/\/doi.org\/10.1016\/j.cell.2011.02.013 (2011).","journal-title":"Cell"},{"key":"24418_CR14","doi-asserted-by":"publisher","first-page":"108","DOI":"10.1186\/1741-7015-10-108","volume":"10","author":"R Ribeiro","year":"2012","unstructured":"Ribeiro, R. et al. Obesity and prostate cancer: gene expression signature of human periprostatic adipose tissue. BMC Med. 10, 108. https:\/\/doi.org\/10.1186\/1741-7015-10-108 (2012).","journal-title":"BMC Med."},{"key":"24418_CR15","doi-asserted-by":"publisher","first-page":"5225","DOI":"10.1210\/jc.2019-00461","volume":"104","author":"M Haffa","year":"2019","unstructured":"Haffa, M. et al. Transcriptome profiling of adipose tissue reveals depot-specific metabolic alterations among patients with colorectal cancer. J. Clin. Endocrinol. Metab. 104, 5225\u20135237. https:\/\/doi.org\/10.1210\/jc.2019-00461 (2019).","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"24418_CR16","doi-asserted-by":"publisher","first-page":"9246","DOI":"10.18632\/oncotarget.24226","volume":"9","author":"NN Wijayatunga","year":"2018","unstructured":"Wijayatunga, N. N. et al. An integrative transcriptomic approach to identify depot differences in genes and microRNAs in adipose tissues from high fat fed mice. Oncotarget 9, 9246\u20139261. https:\/\/doi.org\/10.18632\/oncotarget.24226 (2018).","journal-title":"Oncotarget"},{"key":"24418_CR17","doi-asserted-by":"publisher","first-page":"1830","DOI":"10.1002\/oby.20765","volume":"22","author":"PA Svensson","year":"2014","unstructured":"Svensson, P. A. et al. Characterization of brown adipose tissue in the human perirenal depot. Obesity (Silver Spring) 22, 1830\u20131837. https:\/\/doi.org\/10.1002\/oby.20765 (2014).","journal-title":"Obesity (Silver Spring)"},{"key":"24418_CR18","doi-asserted-by":"publisher","first-page":"5454","DOI":"10.18632\/oncotarget.27157","volume":"10","author":"FA Bruna","year":"2019","unstructured":"Bruna, F. A. et al. Human renal adipose tissue from normal and tumor kidney: Its influence on renal cell carcinoma. Oncotarget 10, 5454\u20135467. https:\/\/doi.org\/10.18632\/oncotarget.27157 (2019).","journal-title":"Oncotarget"},{"key":"24418_CR19","doi-asserted-by":"publisher","first-page":"283","DOI":"10.1016\/S1470-2045(19)30797-1","volume":"21","author":"A Sanchez","year":"2020","unstructured":"Sanchez, A. et al. Transcriptomic signatures related to the obesity paradox in patients with clear cell renal cell carcinoma: a cohort study. Lancet Oncol. 21, 283\u2013293. https:\/\/doi.org\/10.1016\/S1470-2045(19)30797-1 (2020).","journal-title":"Lancet Oncol."},{"key":"24418_CR20","doi-asserted-by":"publisher","first-page":"94223","DOI":"10.18632\/oncotarget.21666","volume":"8","author":"F Campo-Verde-Arbocco","year":"2017","unstructured":"Campo-Verde-Arbocco, F. et al. Human renal adipose tissue induces the invasion and progression of renal cell carcinoma. Oncotarget 8, 94223\u201394234. https:\/\/doi.org\/10.18632\/oncotarget.21666 (2017).","journal-title":"Oncotarget"},{"key":"24418_CR21","unstructured":"Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser 894, i-xii, 1\u2013253 (2000)."},{"key":"24418_CR22","doi-asserted-by":"publisher","first-page":"625","DOI":"10.1002\/ijc.27639","volume":"132","author":"Y Choi","year":"2013","unstructured":"Choi, Y. et al. Body mass index and survival in patients with renal cell carcinoma: a clinical-based cohort and meta-analysis. Int. J. Cancer 132, 625\u2013634. https:\/\/doi.org\/10.1002\/ijc.27639 (2013).","journal-title":"Int. J. Cancer"},{"key":"24418_CR23","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1161\/CIRCULATIONAHA.106.675355","volume":"116","author":"CS Fox","year":"2007","unstructured":"Fox, C. S. et al. Abdominal visceral and subcutaneous adipose tissue compartments: association with metabolic risk factors in the Framingham Heart Study. Circulation 116, 39\u201348. https:\/\/doi.org\/10.1161\/CIRCULATIONAHA.106.675355 (2007).","journal-title":"Circulation"},{"key":"24418_CR24","doi-asserted-by":"publisher","first-page":"16330","DOI":"10.18632\/oncotarget.24667","volume":"9","author":"J Nattenmuller","year":"2018","unstructured":"Nattenmuller, J. et al. Visceral abdominal fat measured by computer tomography as a prognostic factor for gynecological malignancies?. Oncotarget 9, 16330\u201316342. https:\/\/doi.org\/10.18632\/oncotarget.24667 (2018).","journal-title":"Oncotarget"},{"key":"24418_CR25","doi-asserted-by":"publisher","first-page":"1530","DOI":"10.1172\/JCI22028","volume":"113","author":"S Klein","year":"2004","unstructured":"Klein, S. The case of visceral fat: argument for the defense. J. Clin. Invest. 113, 1530\u20131532. https:\/\/doi.org\/10.1172\/JCI22028 (2004).","journal-title":"J. Clin. Invest."},{"key":"24418_CR26","doi-asserted-by":"publisher","first-page":"455","DOI":"10.1111\/iju.12716","volume":"22","author":"HW Lee","year":"2015","unstructured":"Lee, H. W. et al. Prognostic significance of visceral obesity in patients with advanced renal cell carcinoma undergoing nephrectomy. Int. J. Urol. 22, 455\u2013461. https:\/\/doi.org\/10.1111\/iju.12716 (2015).","journal-title":"Int. J. Urol."},{"key":"24418_CR27","doi-asserted-by":"publisher","first-page":"210","DOI":"10.1093\/jjco\/hyu193","volume":"45","author":"G Kaneko","year":"2015","unstructured":"Kaneko, G. et al. Visceral obesity is associated with better recurrence-free survival after curative surgery for Japanese patients with localized clear cell renal cell carcinoma. Jpn. J. Clin. Oncol. 45, 210\u2013216. https:\/\/doi.org\/10.1093\/jjco\/hyu193 (2015).","journal-title":"Jpn. J. Clin. Oncol."},{"key":"24418_CR28","doi-asserted-by":"publisher","first-page":"2137","DOI":"10.1016\/j.juro.2009.07.065","volume":"182","author":"HG Jeon","year":"2009","unstructured":"Jeon, H. G. et al. Reevaluation of renal cell carcinoma and perirenal fat invasion only. J. Urol. 182, 2137\u20132143. https:\/\/doi.org\/10.1016\/j.juro.2009.07.065 (2009).","journal-title":"J. Urol."},{"key":"24418_CR29","doi-asserted-by":"publisher","first-page":"1622","DOI":"10.1111\/j.1464-410X.2008.08239.x","volume":"103","author":"SA Poon","year":"2009","unstructured":"Poon, S. A., Gonzalez, J. R., Benson, M. C. & McKiernan, J. M. Invasion of renal sinus fat is not an independent predictor of survival in pT3a renal cell carcinoma. BJU Int. 103, 1622\u20131625. https:\/\/doi.org\/10.1111\/j.1464-410X.2008.08239.x (2009).","journal-title":"BJU Int."},{"key":"24418_CR30","doi-asserted-by":"publisher","first-page":"51","DOI":"10.1111\/iju.13237","volume":"24","author":"K Chen","year":"2017","unstructured":"Chen, K. et al. Tumor size and Fuhrman grade further enhance the prognostic impact of perinephric fat invasion and renal vein extension in T3a staging of renal cell carcinoma. Int. J. Urol. 24, 51\u201358. https:\/\/doi.org\/10.1111\/iju.13237 (2017).","journal-title":"Int. J. Urol."},{"key":"24418_CR31","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1158\/1055-9965.EPI-16-0559","volume":"26","author":"ER Mayeda","year":"2017","unstructured":"Mayeda, E. R. & Glymour, M. M. The obesity paradox in survival after cancer diagnosis: tools for evaluation of potential bias. Cancer Epidemiol. Biomark. Prev. 26, 17\u201320. https:\/\/doi.org\/10.1158\/1055-9965.EPI-16-0559 (2017).","journal-title":"Cancer Epidemiol. Biomark. Prev."},{"key":"24418_CR32","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1016\/j.molmet.2019.03.005","volume":"24","author":"NZ Jespersen","year":"2019","unstructured":"Jespersen, N. Z. et al. Heterogeneity in the perirenal region of humans suggests presence of dormant brown adipose tissue that contains brown fat precursor cells. Mol. Metab. 24, 30\u201343. https:\/\/doi.org\/10.1016\/j.molmet.2019.03.005 (2019).","journal-title":"Mol. Metab."},{"key":"24418_CR33","doi-asserted-by":"publisher","first-page":"1972","DOI":"10.3892\/or.2019.7306","volume":"42","author":"X Li","year":"2019","unstructured":"Li, X., Wang, G., Liu, J. & Ding, G. Increased UCP1 expression in the perirenal adipose tissue of patients with renal cell carcinoma. Oncol. Rep. 42, 1972\u20131980. https:\/\/doi.org\/10.3892\/or.2019.7306 (2019).","journal-title":"Oncol. Rep."},{"key":"24418_CR34","doi-asserted-by":"publisher","first-page":"8687","DOI":"10.1038\/s41598-022-12746-9","volume":"12","author":"M Ferrando","year":"2022","unstructured":"Ferrando, M. et al. Renal peritumoral adipose tissue undergoes a browning process and stimulates the expression of epithelial-mesenchymal transition markers in human renal cells. Sci. Rep. 12, 8687. https:\/\/doi.org\/10.1038\/s41598-022-12746-9 (2022).","journal-title":"Sci. Rep."},{"key":"24418_CR35","doi-asserted-by":"publisher","first-page":"421","DOI":"10.1038\/s41586-022-05030-3","volume":"608","author":"T Seki","year":"2022","unstructured":"Seki, T. et al. Brown-fat-mediated tumour suppression by cold-altered global metabolism. Nature 608, 421\u2013428. https:\/\/doi.org\/10.1038\/s41586-022-05030-3 (2022).","journal-title":"Nature"},{"key":"24418_CR36","doi-asserted-by":"publisher","first-page":"272","DOI":"10.3892\/ol.2020.12135","volume":"20","author":"J Shi","year":"2020","unstructured":"Shi, J. et al. Impact of inflammation and immunotherapy in renal cell carcinoma. Oncol. Lett. 20, 272. https:\/\/doi.org\/10.3892\/ol.2020.12135 (2020).","journal-title":"Oncol. Lett."},{"key":"24418_CR37","doi-asserted-by":"publisher","first-page":"707126","DOI":"10.3389\/fendo.2021.707126","volume":"12","author":"SH Hammoud","year":"2021","unstructured":"Hammoud, S. H., AlZaim, I., Al-Dhaheri, Y., Eid, A. H. & El-Yazbi, A. F. Perirenal adipose tissue inflammation: Novel insights linking metabolic dysfunction to renal diseases. Front. Endocrinol. (Lausanne) 12, 707126. https:\/\/doi.org\/10.3389\/fendo.2021.707126 (2021).","journal-title":"Front. Endocrinol. (Lausanne)"},{"key":"24418_CR38","doi-asserted-by":"publisher","first-page":"285","DOI":"10.1097\/IGC.0000000000001165","volume":"28","author":"Y Zhang","year":"2018","unstructured":"Zhang, Y. et al. Perirenal adiposity is associated with lower progression-free survival from ovarian cancer. Int. J. Gynecol. Cancer 28, 285\u2013292. https:\/\/doi.org\/10.1097\/IGC.0000000000001165 (2018).","journal-title":"Int. J. Gynecol. Cancer"},{"key":"24418_CR39","doi-asserted-by":"publisher","first-page":"865","DOI":"10.1002\/bjs5.50338","volume":"4","author":"K Eto","year":"2020","unstructured":"Eto, K. et al. Perirenal fat thickness as a predictor of postoperative complications after laparoscopic distal gastrectomy for gastric cancer. BJS Open 4, 865\u2013872. https:\/\/doi.org\/10.1002\/bjs5.50338 (2020).","journal-title":"BJS Open"},{"key":"24418_CR40","doi-asserted-by":"publisher","first-page":"171","DOI":"10.1097\/DCR.0000000000001746","volume":"64","author":"SE Eckberg","year":"2021","unstructured":"Eckberg, S. E. et al. Perirenal fat surface area and oncologic outcome in elective colon cancer surgery. Dis. Colon. Rectum. 64, 171\u2013180. https:\/\/doi.org\/10.1097\/DCR.0000000000001746 (2021).","journal-title":"Dis. Colon. Rectum."},{"key":"24418_CR41","doi-asserted-by":"publisher","first-page":"1817","DOI":"10.1038\/ijo.2016.171","volume":"40","author":"M Bagheri","year":"2016","unstructured":"Bagheri, M., Speakman, J. R., Shemirani, F. & Djafarian, K. Renal cell carcinoma survival and body mass index: a dose-response meta-analysis reveals another potential paradox within a paradox. Int. J. Obes. (Lond) 40, 1817\u20131822. https:\/\/doi.org\/10.1038\/ijo.2016.171 (2016).","journal-title":"Int. J. Obes. (Lond)"},{"key":"24418_CR42","doi-asserted-by":"publisher","unstructured":"M, U. D. et al. Human brown fat radiodensity indicates underlying tissue composition and systemic metabolic health. J. Clin. Endocrinol. Metab. 102, 2258\u20132267, doi:https:\/\/doi.org\/10.1210\/jc.2016-2698 (2017).","DOI":"10.1210\/jc.2016-2698"},{"key":"24418_CR43","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.115.002545","volume":"5","author":"JJ Lee","year":"2016","unstructured":"Lee, J. J. et al. Cross-sectional associations of computed tomography (CT)-derived adipose tissue density and adipokines: The framingham heart study. J. Am. Heart Assoc. 5, e002545. https:\/\/doi.org\/10.1161\/JAHA.115.002545 (2016).","journal-title":"J. Am. Heart Assoc."},{"key":"24418_CR44","doi-asserted-by":"publisher","first-page":"420","DOI":"10.1016\/j.euf.2016.11.009","volume":"4","author":"A Vrieling","year":"2018","unstructured":"Vrieling, A. et al. Body composition in relation to clinical outcomes in renal cell cancer: A systematic review and meta-analysis. Eur. Urol. Focus 4, 420\u2013434. https:\/\/doi.org\/10.1016\/j.euf.2016.11.009 (2018).","journal-title":"Eur. Urol. Focus"},{"key":"24418_CR45","doi-asserted-by":"publisher","first-page":"1905","DOI":"10.1007\/s10552-010-9618-2","volume":"21","author":"S Waalkes","year":"2010","unstructured":"Waalkes, S. et al. Obesity is associated with improved survival in patients with organ-confined clear-cell kidney cancer. Cancer Causes Control 21, 1905\u20131910. https:\/\/doi.org\/10.1007\/s10552-010-9618-2 (2010).","journal-title":"Cancer Causes Control"},{"key":"24418_CR46","doi-asserted-by":"publisher","first-page":"348","DOI":"10.3109\/00365599.2012.678382","volume":"46","author":"AJ Rogde","year":"2012","unstructured":"Rogde, A. J. et al. Obesity is associated with an improved cancer-specific survival, but an increased rate of postoperative complications after surgery for renal cell carcinoma. Scand. J. Urol. Nephrol. 46, 348\u2013357. https:\/\/doi.org\/10.3109\/00365599.2012.678382 (2012).","journal-title":"Scand. J. Urol. Nephrol."},{"key":"24418_CR47","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1002\/jso.20139","volume":"88","author":"L Schips","year":"2004","unstructured":"Schips, L. et al. Does overweight impact on the prognosis of patients with renal cell carcinoma? A single center experience of 683 patients. J. Surg. Oncol. 88, 57\u201361. https:\/\/doi.org\/10.1002\/jso.20139 (2004).","journal-title":"J. Surg. Oncol."},{"key":"24418_CR48","doi-asserted-by":"publisher","first-page":"584","DOI":"10.1177\/0003319718799967","volume":"70","author":"BX Liu","year":"2019","unstructured":"Liu, B. X., Sun, W. & Kong, X. Q. Perirenal fat: A unique fat pad and potential target for cardiovascular disease. Angiology 70, 584\u2013593. https:\/\/doi.org\/10.1177\/0003319718799967 (2019).","journal-title":"Angiology"},{"key":"24418_CR49","doi-asserted-by":"publisher","first-page":"108","DOI":"10.1186\/s12872-015-0101-6","volume":"15","author":"G De Pergola","year":"2015","unstructured":"De Pergola, G. et al. Para- and perirenal ultrasonographic fat thickness is associated with 24-hours mean diastolic blood pressure levels in overweight and obese subjects. BMC Cardiovasc. Disord. 15, 108. https:\/\/doi.org\/10.1186\/s12872-015-0101-6 (2015).","journal-title":"BMC Cardiovasc. Disord."},{"key":"24418_CR50","doi-asserted-by":"publisher","first-page":"468","DOI":"10.1111\/apha.12182","volume":"210","author":"XQ Xiong","year":"2014","unstructured":"Xiong, X. Q., Chen, W. W. & Zhu, G. Q. Adipose afferent reflex: Sympathetic activation and obesity hypertension. Acta Physiol. (Oxf.) 210, 468\u2013478. https:\/\/doi.org\/10.1111\/apha.12182 (2014).","journal-title":"Acta Physiol. (Oxf.)"},{"key":"24418_CR51","doi-asserted-by":"publisher","first-page":"1430","DOI":"10.1111\/jch.13370","volume":"20","author":"MA Ricci","year":"2018","unstructured":"Ricci, M. A. et al. Morbid obesity and hypertension: The role of perirenal fat. J. Clin. Hypertens. (Greenwich) 20, 1430\u20131437. https:\/\/doi.org\/10.1111\/jch.13370 (2018).","journal-title":"J. Clin. Hypertens. (Greenwich)"}],"container-title":["Scientific Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41598-022-24418-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-022-24418-9","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-022-24418-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,11,21]],"date-time":"2022-11-21T08:06:40Z","timestamp":1669018000000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41598-022-24418-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,11,19]]},"references-count":51,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2022,12]]}},"alternative-id":["24418"],"URL":"https:\/\/doi.org\/10.1038\/s41598-022-24418-9","relation":{},"ISSN":["2045-2322"],"issn-type":[{"value":"2045-2322","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,11,19]]},"assertion":[{"value":"4 February 2022","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"15 November 2022","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 November 2022","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing interests.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"19956"}}