Managing CMR

Preventing Type 2 Diabetes

Targeting Abdominal Obesity

Lifestyle Interventions

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Although each component of the metabolic syndrome can be targeted separately through pharmacotherapy, it is also possible to take a more global therapeutic approach to treating the metabolic syndrome and/or type 2 diabetes by focusing on reducing excess atherogenic/diabetogenic intra-abdominal adipose tissue, which is often present in patients with the clustering abnormalities of this syndrome. The causes of this preferential adipose tissue accumulation include an obesogenic and diabetogenic diet, a low level of physical activity leading to a positive energy balance, and genetic susceptibility. These causes should all be targeted to reduce the risk of developing the metabolic syndrome and type 2 diabetes (4). As depicted in Figure 1, abdominally obese individuals should be encouraged to increase their daily energy expenditure in order to decrease intra-abdominal adipose tissue and improve their plasma lipoprotein-lipid profile and indices of plasma glucose-insulin homeostasis. Typically, this loss of intra-abdominal adipose tissue reduces free fatty acid flux to the liver, which slows hepatic VLDL production, lowers plasma triglyceride and apolipoprotein B levels, and increases HDL cholesterol concentrations (5). It also changes the pattern of adipose tissue secretory products, causing interleukin-6 levels to fall and adiponectin concentrations to rise, which improves insulin sensitivity (6, 7). The end product of abdominal fat loss is a reduction in CRP levels.

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5. Lamarche B, Després JP, Pouliot MC, et al. Is body fat loss a determinant factor in the improvement of carbohydrate and lipid metabolism following aerobic exercise training in obese women? Metabolism 1992; 41: 1249-56.
6. Bruun JM, Verdich C, Toubro S, et al. Association between measures of insulin sensitivity and circulating levels of interleukin-8, interleukin-6 and tumor necrosis factor-alpha. Effect of weight loss in obese men. Eur J Endocrinol 2003; 148: 535-42.
7. Kopp HP, Kopp CW, Festa A, et al. Impact of weight loss on inflammatory proteins and their association with the insulin resistance syndrome in morbidly obese patients. Arterioscler Thromb Vasc Biol 2003; 23: 1042-7.