The Concept of CMR


Abdominal Obesity and Type 2 Diabetes

Beyond Excess Body Weight

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The strong relationship between obesity and type 2 diabetes does not mean that being overweight or obese will inevitably cause type 2 diabetes. For example, some normal weight individuals may be at high risk of developing type 2 diabetes, whereas many very obese individuals are not insulin resistant (11) and may never develop the disease. Some etiological factors linking excess body fat and type 2 diabetes could explain this phenomenon. Obesity and type 2 diabetes share a number of causative lifestyle factors such as excessive energy intake, a diet high in saturated fat, and a sedentary lifestyle. However, the risk of developing type 2 diabetes may also depend on genetic susceptibility and the distribution of adipose tissue (12).

The possibility of a relationship between body fat distribution and type 2 diabetes was first raised in the mid-forties by French physician Jean Vague (13). He reported that the complications generally found in obese patients depended more on the location of the excess fat rather than obesity per se (13). Following this observation, he described the high-risk form of obesity as “android obesity,” a condition commonly found in men and in which adipose tissue accumulates in the trunk. In opposition, he described the accumulation of body fat in the gluteo-femoral region—the common fat pattern of premenopausal women—as “gynoid obesity.” This type of fat distribution rarely leads to common obesity-related complications (14, 15). Since these pioneering observations, many cross-sectional and prospective studies have linked type 2 diabetes to body fat distribution.

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11. Abbasi F, Brown BW, Jr., Lamendola C, et al. Relationship between obesity, insulin resistance, and coronary heart disease risk. J Am Coll Cardiol 2002; 40: 937-43.
12. Vague J and Vague P. Obesity and diabetes. The Diabetes Annual/4 1988.
13. Vague J. La différenciation sexuelle: facteur déterminant des formes de l'obesité. Presse Med 1947; 339-40.
14. Terry RB, Stefanick ML, Haskell WL, et al. Contributions of regional adipose tissue depots tp plasma lipoprotein concentrations in overweight men and women: possible protective effects of thigh fat. Metabolism 1991; 40: 733-40.
15. Pouliot MC, Després JP, Nadeau A, et al. Associations between regional body fat distribution, fasting plasma free fatty acid levels and glucose tolerance in premenopausal women. Int J Obes 1990; 14: 293-302.