Abdominal Obesity and CVD

Body Fat Distribution: The Importance of Intra-abdominal Adipose Tissue

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Fujioka et al. (43) were the first to propose that a preferential accumulation of intra-abdominal adipose tissue could explain the deterioration in glucose and lipid metabolism observed in obese patients. In their study, subjects with a preferential accumulation of intra-abdominal adipose tissue had higher fasting plasma triglyceride levels and higher plasma glucose responses following an oral glucose tolerance test (OGTT) than subjects with the same BMI values but a preferential accumulation of abdominal subcutaneous adipose tissue. The independent contribution of intra-abdominal adipose tissue vs. subcutaneous adipose tissue has also been examined in obese individuals with similar BMI values but either low or high amounts of intra-abdominal adipose tissue (48, 49). While obese subjects with low levels of intra-abdominal adipose tissue had a basically normal plasma lipoprotein-lipid profile, the subgroup of obese individuals with elevated intra-abdominal fat had the worst metabolic profile: fasting hypertriglyceridemia, low HDL cholesterol concentrations, glucose intolerance, hyperinsulinemia, and a prothrombotic and inflammatory state. Additional studies by Ross et al. (50, 51) further explored the relationship between intra-abdominal adipose tissue and metabolic risk in men and women. When individuals who were matched for similar abdominal subcutaneous adipose tissue but had different levels of intra-abdominal adipose tissue were compared, it was revealed that subjects with high intra-abdominal adipose tissue had higher glucose values following an OGTT and lower glucose disposal values compared to subjects with low intra-abdominal adipose tissue. This means that obese individuals with a preferential accumulation of intra-abdominal adipose tissue may form an obese subgroup at highest risk of CVD. These findings indicate that overall obesity is associated with moderate metabolic complications, but that excess intra-abdominal adipose tissue is associated with a cluster of metabolic abnormalities that increase CVD risk. Therefore, for the same amount of total body fat, individuals with more intra-abdominal adipose tissue are at significantly greater risk of also having features of the metabolic syndrome  (48-52).

Reference

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43. Fujioka S, Matsuzawa Y, Tokunaga K, et al. Contribution of intra-abdominal fat accumulation to the impairment of glucose and lipid metabolism in human obesity. Metabolism 1987; 36: 54-9.

48. Després JP, Moorjani S, Lupien PJ, et al. Regional distribution of body fat, plasma lipoproteins, and cardiovascular disease. Arteriosclerosis 1990; 10: 497-511.

49. Pouliot MC, Després JP, Nadeau A, et al. Visceral obesity in men. Associations with glucose tolerance, plasma insulin, and lipoprotein levels. Diabetes 1992; 41: 826-34.

50. Ross R, Freeman J, Hudson R, et al. Abdominal obesity, muscle composition, and insulin resistance in premenopausal women. J Clin Endocrinol Metab 2002; 87: 5044-51.

51. Ross R, Aru J, Freeman J, et al. Abdominal adiposity and insulin resistance in obese men. Am J Physiol Endocrinol Metab 2002; 282: E657-63.

52. Després JP. Is visceral obesity the cause of the metabolic syndrome? Ann Med 2006; 38: 52-63.

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