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Abstract Objectives Lipoedema is a chronic fat disorder involving an excessive abnormal deposition of subcutaneous fat in the thighs, legs, hips and buttocks mainly (Wounds UK, 2017). The importance of healthy eating in lipoedema management has been recognised (Wounds UK, 2017), yet dietary guidelines specific for lipoedema are lacking (Bertsch et al., 2020). The study aimed to investigate the self-reported dietary and lifestyle impact on lipoedema management among a representative lipoedema population in the UK. Methods The study used an online questionnaire that consisted of multiple-choice and open-response questions to collect data on symptoms and diagnostic status of lipoedema and self-reported dietary and lifestyle impact on lipoedema management among participants. The questionnaire was constructed using the Survey Monkey software. The active online survey link was sent to Lipoedema UK's members and contacts via e-mail and also made accessible via the study flyer advertised on Lipoedema UK's website and newsletters. Ethical approval was obtained from the De Montfort University Faculty Research Ethics Committee of Health and Life Sciences prior to the study. Participants had given their consents before starting the survey. Data collection was anonymous. Data were analysed using SPSS v26.0. Results The results showed that 165 out of 257 participants (66.3%) had tried diet as a mean to improve their lipoedema symptoms in the past. Anti-inflammatory diet was reported to be one of the three most effective diets that improved their symptoms (either single or multiple). The other two diets were ketogenic diet and rare adipose disorder diet. Noticeably, 95% of the 257 participants were classified as either overweight or obese based on their Body Mass Index (BMI) measure. And 20% of the participants who tried weight loss diets had found improvements in their lipoedema conditions. Conclusions The study results will help inform the development of future research on finding a dietary solution to effective lipoedema management for the UK lipoedema population. Funding Sources De Montfort University funded the recruitment of a Research Assistant to support part of the data analysis work.

Background: Although lipedema is often clinically distinguished from lymphedema, there is considerable overlap between the 2 entities. The purpose of this study was to evaluate lymphoscintigraphic findings in patients with lipedema to better characterize lymphatic flow in this patient population. Methods: This is an updated 4 year experience containing significant new information of patients with lipedema receiving lymphoscintigraphy at our institution between January 2015 and October 2017. Patient demographics, clinical characteristics, and lymphoscintigraphic findings were extracted. Klienhan’s transport index (TI) was utilized to assess lymphatic flow in patient’s lower extremities (LEs). Scores range from 0-45, with values >10 denoting pathologic lymphatic transport. Results: 19 total patients with lipedema underwent lymphoscintigraphic evaluation. Mean age was 54.8 and mean BMI was 35.9 kg/m2. Severity of lipedema was classified as stage 1 in 5 patients (26.3%), stage 2 in 4 patients (21.1%), stage 3 in 4 patients (21.1%), and stage 4 in 6 patients (31.6%). The mean TI for all extremities was 12.5. 24 (63.2%) LEs had a pathologic TI , including 7 LEs with stage 1 (29.2%), 3 LEs with stage 2 (12.5%), 6 LEs with stage 3 (25.0%), and 8 LEs with stage 4 lipedema (33.3%). The mean TI was significantly greater for extremities with severe (stage 3/4) lipedema than those with mild or moderate (stage 1/2) lipedema (15.1 vs. 9.7, p=0.049). Mean difference in TI scores between each LE for individual patients was 6.43 (SD 7.96). Conclusions: Our results suggest that patients with lipedema have impaired lymphatic transport, and more severe lipedema may be associated with greater lymphatic transport abnormalities.

Introduction Lipedema (meaning edema in fat) and Dercum Disease (DD) are fat disorders in which accumulation of painful subcutaneous adipose tissue (SAT) affects more females than males, especially at times of female hormone change. Patients with both fat disorders are often misdiagnosed as obese. The purpose of this study was to determine if estrogen (ER) and progesterone receptors (PR) are different in lipedema versus DD in SAT and skin versus controls. These receptors are on mast cells that produce histamine causing leakage from blood vessels inducing hypoxia and angiogenesis. Progesterone is known to activate histamine release from mast cells. We aim to determine levels of ER and PR in SAT and if blood vessels replicate at a higher rate in lipedema and DD versus controls to help further understand these conditions and work towards finding a cure. Materials and Methods Immunohistochemistry (San Diego Pathology, San Diego, CA) was used to test for the presence of PR, ER, Ki67 (marker of replicating cells), and CD117 (marker of mast cells). Results and Discussion Mast cell numbers were similar in control, DD and lipedema SAT (Figure). ER were not different in control, DD and lipedema SAT. PR were significantly lower in lipedema SAT. There was no difference in Ki67 in lipedema or DD blood vessels compared to controls. Conclusion Lower numbers of PR in our data suggest mast cell secretions (histamine and others) could be higher inducing leakage from vessels and fluid collection in SAT. Fluid in the tissue should induce hypoxia and growth of more blood vessels. Despite higher PR on mast cells, lipedema blood vessels did not appear to be replicating at a higher level. With further research and additional samples, the relevance of elevated PR in lipedema tissue may become apparent. Support or Funding Information Research reported in this poster was supported by the National Institute of General Medical Sciences of the National Institutes of Health under linked Award Numbers RL5GM118969, TL4GM118971, and UL1GM118970. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Special acknowledgement to the Minority Health Disparities summer research program at the University of Arizona, the College of Medicine Tucson Treatment, Research, and Education of Adipose Tissue Program. This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Einleitung: Bei einem Lipödem liegt eine anlagebedingte Fettgewebsvermehrung vor, bei der es zu einer symmetrischen Verdickung der Extremitäten kommt. Klinisch ist für das Lipödem eine Druckschmerzhaftigkeit charakteristisch. Bei länger bestehendem Lipödem kann man beobachten, dass bei einem Teil der Patientinnen zusätzliche Beschwerden auftreten. Die betroffenen Frauen erleben auf Grund der massiven Schwellungen dann, neben einem ausgeprägten Spannungs- und Schweregefühl der Beine, physische und psychische Belastungen, wodurch Sportangebote häufig nicht wahrgenommen werden und die soziale Interaktionen eingeschränkt ist. Studiendesign: Die vorliegende prospektive randomisierte Studie wurde zur Evaluation der Wirksamkeit eines vibrationsgestützten Krafttrainings mit dem Galileo-System im Vergleich zu einem herkömmlichen Training zur Aktivierung der Beinmuskelpumpe bei Patientinnen mit Lipödem durchgeführt. Die Probanden beider Gruppen erhielten 12 Anwendungen in einem Zeitraum von sechs Wochen. Zur Beurteilung des Therapieverlaufs wurde die Druckschmerzschwelle im Beinbereich mithilfe der visuellen Analogskala (VAS) und der Dolorimetrie an definierten Messpunkten erfasst. Nebenzielkriterien waren die Volumenreduktion und die Verbesserung funktioneller Parameter sowie der Lebensqualität. Die Erhebung der Outcomeparameter erfolgte vor der Intervention (U1), vor der letzen Trainingseinheit (U2) und 6 Wochen nach Therapieende (U3). Ergebnisse: Das Vibrationstraining (n=27) und die Venengymnastik (n=17) zeigten bezüglich der Schmerzlinderung signifikante Verbesserungen im Therapieverlauf. Die Druckschmerzschwelle konnte erhöht werden. Die Auswertung der Fragebögen zu Hämatomneigung und Schmerzempfinden ergab in der Interventionsgruppe eine signifikante Beschwerdelinderung im Therapieverlauf. In beiden Gruppen konnte eine subjektive Verbesserung der Mobilität und ein positiver Einfluss auf die Lebensstiländerung verzeichnet werden. Die im Gehtest beurteilte Ausdauerleistung verbesserte sich ebenfalls. Diskussion: Es konnte gezeigt werden, dass sowohl mit herkömmlicher Krankengymnastik als auch durch ein gerätegestütztes Vibrationstraining zwei wesentliche Symptome des Lipödems, nämlich Druckschmerzhaftigkeit und Hämatomneigung, positiv beeinflusst werden können. Somit lässt sich die Notwendigkeit unterstreichen, dass eine Therapie des Lipödems durch eine Bewegungstherapie ergänzt werden sollte.

The challenges of providing effective treatment for patients with lymphoedema-related disorders have never been more prominent. Conservative management of lymphoedema remains of central importance, however, there is increasing evidence that other therapies, such as surgical approaches, may have an important part to play in the arena of treatment. The findings from these proceedings highlight the potential role that surgical approaches, including liposuction, can have in transforming the lives of patients. Conservative approaches, while effective in many patients, do not provide a solution for some of the complex issues patients face, nor do they always provide sustained results even after periods of expensive, intensive treatment. Relatively little attention has been placed on the impact that lymphatic conditions have on the lives of patients and their families. However, research is beginning to show that patients’ health-related quality of life is significantly affected and that previously dismissed symptoms, such as pain, are a feature of the condition. Lymphoedema and lipoedema are both likely to have a deleterious effect on the body image of patients who live day-to-day with distorted limbs. Treatments such as liposuction have the potential to reverse some of the crippling effects of these disorders on the psychosocial health of patients. The indications from these proceedings are that this is an important and encouraging area of practice that must be considered as part of the armoury of treatment. Liposuction has often been viewed negatively by the lymphoedema community, who have been sceptical about its value and concerned for its safety. This document shows that when it is used appropriately, by well trained surgeons, it can be very effective. In fact, the area of liposuction now has a growing evidence base that rivals many of the other conservative areas of lymphoedema management. Management of lymphatic conditions demands that the professional groups begin to work together in a more collaborative way in order to develop treatments that really address the growing number of patients with these types of conditions.

Knowledge of both the morphology/ pathomorphology and physiology/pathophysiology of adipose tissue is limited and the behaviour of fat tissue has not been widely researched. Changes in adipose tissue (hyperplasia, hypertrophy and atrophy) are defined differently and, as a consequence, diagnostic failures frequently occur. Figure 1 shows the complicated regulatory mechanisms which are responsible for lipolysis and lipogenesis. Even if body weight is normal, appearance depends on the distribution of subcutaneous adipose tissue (Figure 2) . The amount of fat we carry and how we look are, in part, subject to fashion. What was still sexy several decades ago, a bigger waist and more on the hips, no longer corresponds to how we see perfection today. Figure 2 shows the different ideals of beauty — ‘Wonderwoman’, for example, where you can detect as little fat as possible. Recently, there has been a mania for slimness. In order to comply with the current trend in fashion, young girls starve or undergo surgical procedures to have the typical female fatty tissue removed.

Lipoedema is a disease characterised by an abnormal, circumscribed accumulation of subcutaneous fat, mainly in the lower extremities, in combination with oedema. This results in an obvious disproportion between the upper and lower half of the body, as well as pain (Figure 1). Although lipoedema was first described in 1940 by Allen and Hines in the United States of America, the discussion still continues today as to whether this disease really is an entity, with some clinicians even doubting that it exists. In the 1940s it was described as a symmetrical subcutaneous deposition of fat in the buttocks and lower legs, together with an accumulation of fluid that begins almost imperceptibly, progressing gradually. Lipoedema was often associated with weight gain and accentuated by orthostatic activity.

Lymphoedema is a debilitating, progressive and incurable pathological condition caused by a chronic imbalance between the production and transport of lymph within the lymphatic system. There are many reasons for this damage or disruption to the lymphatic system. Lymphoedema results in significant physical and psychological morbidity. Approximately 140–250 million people worldwide are affected by this condition, mostly in developing countries as a result of lymphatic filariasis, a parasitic infection transmitted by mosquitoes. In the majority of cases, treatment is non-curative, complex and requires a multidisciplinary clinical approach. Surgery takes place as a last resort when conservative treatment has proven ineffective to restore function, reduce comorbidity or the frequency of erysipelas attacks.

Knowledge of both the morphology/ pathomorphology and physiology/pathophysiology of adipose tissue is limited and the behaviour of fat tissue has not been widely researched. Changes in adipose tissue (hyperplasia, hyper trophy and atrophy) are defined differently and, as a consequence, diagnostic failures frequently occur. Figure 1 shows the complicated regulatory mechanisms which are responsible for lipolysis and lipogenesis. Even if body weight is normal, appearance depends on the distribution of subcutaneous adipose tissue (Figure 2). The amount of fat we carry and how we look are, in part, subject to fashion. What was still sexy several decades ago, a bigger waist and more on the hips, no longer corresponds to how we see perfection today. Figure 2 shows the different ideals of beauty — ‘Wonderwoman’, for example, where you can detect as little fat as possible. Recently, there has been a mania for slimness. In order to comply with the current trend in fashion, young girls starve or undergo surgical procedures to have the typical female fatty tissue removed.

ipoedema is a disease characterised by an abnormal, circumscribed accumulation of subcutaneous fat, mainly in the lower extremities, in combination with oedema. This results in an obvious disproportion between the upper and lower half of the body, as well as pain (Figure 1). Although lipoedema was first described in 1940 by Allen and Hines in the United States of America, the discussion still continues today as to whether this disease really is an entity, with some clinicians even doubting that it exists. In the 1940s it was described as a symmetrical subcutaneous deposition of fat in the buttocks and lower legs, together with an accumulation of fluid that begins almost imperceptibly, progressing gradually. Lipoedema was often associated with weight gain and accentuated by orthostatic activity. There are still aspects of lipoedema that are poorly understood. However, what we do know is that lipocytes, capillaries and venules are involved. An increased number and/or size of lipocytes results in increased fat volume, increased permeability of the capillaries causes oedema, and increased fragility of venules leads to haematoma (Table 1). Oedema is the main and most obvious cause of pain in people with lipoedema, so conservative therapy which reduces oedema can lessen the pain suffered. There are probably other factors causing pain, but oedema seems to be the most obvious. Lipoedema only develops in adult females. Figures 2a and 2b show the same patient at different ages. In most cases, lipoedema starts after puberty, a time when women want to look slim and beautiful. Figures 3a and 3b show the legs of a girl at the age of 17 and then 10 years later. The increase in volume can be seen mainly in the thighs. For some people lipoedema continues to progress until the end of life and is accentuated by pregnancy, birth and other hormonal changes, such as the menopause. In others, it remains at a steady level without progressing. The disease can also develop later in life. Figures 4a and 4b show a patient’s arm at the age of 51 and 10 years later. The forearms have stayed the same, while the upper arms have dramatically increased. It is not known why only the upper part of the arm is affected and the lower part remains unchanged.