The Concept of CMR
Intra-abdominal Obesity and Cardiometabolic Risk
Excess intra-abdominal (visceral) fat has been linked to the following metabolic complications, irrespective of total body weight:
- Atherogenic dyslipidemia (normal LDL cholesterol levels but increased triglycerides)
- Low HDL cholesterol (good cholesterol)
- Increased apolipoprotein B (a marker of the number of atherogenic lipoproteins) and small, dense LDL particles (especially atherogenic LDL particles)
- A deterioration in plasma glucose-insulin homeostasis (elevated blood glucose and insulin resistance)
- A pro-thrombotic state (tendency to form clots in the blood, which impairs blood flow)
- Increased inflammation markers
This cluster of metabolic abnormalities is commonly referred to as the metabolic syndrome. This syndrome increases the risk of type 2 diabetes and cardiovascular disease (CVD), but it is not entirely clear which of its features are responsible for doing so.
Given the relationship between excess intra-abdominal fat, glucose intolerance, and elevated plasma insulin concentrations, intra-abdominal obesity is acknowledged as an important risk factor for the development of type 2 diabetes. Although not every patient with intra-abdominal obesity will develop type 2 diabetes, this type of obesity often entails other complications that can increase CVD risk. Accordingly, it has been proposed that the information provided by intra-abdominal obesity should be incorporated into current global risk assessment algorithms in order to better assess global CVD risk. This global risk resulting from the presence of traditional risk factors and intra-abdominal obesity is known as global cardiometabolic risk.
The Canadian Trial of Carbohydrates in Diabetes (CCD), a 1-y controlled trial of low-glycemic-index dietary carbohydrate in type 2 diabetes: no effect on glycated hemoglobin but reduction in C-reactive protein. Am J Clin Nutr 2008;87:114-25