The Concept of CMR
Slides, videos and moreThe Concept of CMR
Epidemiology
Abdominal Obesity and Type 2 Diabetes
- 1Key Points (1 page)
- 2The “Diabesity” Epidemic (1 page)
- 3Beyond Excess Body Weight (1 page)
- 4Abdominal Obesity: the Diabetogenic Obesity (3 pages)
- 5Upper Body Fat Distribution: the Importance of Intra-abdominal Adipose Tissue (2 pages)
- 6References (1 page)
Abdominal Obesity: the Diabetogenic Obesity
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Several prospective studies have shown that abdominal obesity increases the risk of type 2 diabetes (16, 17). This is due largely to the fact that large amounts of abdominal fat can cause metabolic complications such as glucose intolerance, hyperinsulinemia, and insulin resistance, all of which increase the risk of type 2 diabetes (18, 19). Indeed, individuals with abdominal obesity often have impaired plasma glucose-insulin homeostasis (13, 18, 20, 21). Excess abdominal adipose tissue has been linked to hyperinsulinemia during the fasting state as well as following an oral glucose load (18, 19). The increased insulin secretion, insulin resistance, and decreased hepatic insulin extraction that are common metabolic complications of abdominal obesity could explain the hyperinsulinemia also found in abdominally obese individuals. Moreover, obese patients with abdominal adipose tissue accumulation are often glucose intolerant despite their hyperinsulinemia, which suggests these subjects are insulin resistant (18, 19). It has been suggested that the relationship between excess abdominal adipose tissue and diabetogenic abnormalities is in part related to the direct release of free fatty acids into the portal vein (22). These free fatty acids could decrease hepatic clearance of insulin and worsen systemic hyperinsulinemia (23), a precursor to type 2 diabetes. However, other factors such as the many adipokines (interleukin-6, tumour necrosis factor-α, adiponectin) released by adipose tissue might also contribute to the insulin-resistant state observed among individuals with abdominal obesity (24).
Although the mechanism linking abdominal obesity and type 2 diabetes is not fully understood, several studies using anthropometric measurements have reported that upper body obesity—also known as “android obesity”—was more common in diabetic patients than in non-diabetic patients (25, 26). In 1969, Feldman et al. (26) demonstrated in a study of over 7,000 subjects that type 2 diabetic subjects had more total fat mass and that this mass was distributed in the upper body. Another study of some 15,000 women (25) showed that obese women who accumulated body fat in the abdominal area had a tenfold increase in their risk of diabetes compared to non-obese women who accumulated body fat in the gluteo-femoral region.
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