Fox CS, Massaro JM, Hoffmann U, Pou KM, Maurovich-Horvat P, Liu CY et al.. Abdominal visceral and subcutaneous adipose tissue compartments: association with metabolic risk factors in the Framingham Heart Study. Circulation 116, 39-48

Division of Mathematics, Boston University, Boston, Massachusetts, United States
Circulation (Impact Factor: 14.43). 08/2007; 116(1):39-48. DOI: 10.1161/CIRCULATIONAHA.106.675355
Source: PubMed


Visceral adipose tissue (VAT) compartments may confer increased metabolic risk. The incremental utility of measuring both visceral and subcutaneous abdominal adipose tissue (SAT) in association with metabolic risk factors and underlying heritability has not been well described in a population-based setting.
Participants (n=3001) were drawn from the Framingham Heart Study (48% women; mean age, 50 years), were free of clinical cardiovascular disease, and underwent multidetector computed tomography assessment of SAT and VAT volumes between 2002 and 2005. Metabolic risk factors were examined in relation to increments of SAT and VAT after multivariable adjustment. Heritability was calculated using variance-components analysis. Among both women and men, SAT and VAT were significantly associated with blood pressure, fasting plasma glucose, triglycerides, and high-density lipoprotein cholesterol and with increased odds of hypertension, impaired fasting glucose, diabetes mellitus, and metabolic syndrome (P range < 0.01). In women, relations between VAT and risk factors were consistently stronger than in men. However, VAT was more strongly correlated with most metabolic risk factors than was SAT. For example, among women and men, both SAT and VAT were associated with increased odds of metabolic syndrome. In women, the odds ratio (OR) of metabolic syndrome per 1-standard deviation increase in VAT (OR, 4.7) was stronger than that for SAT (OR, 3.0; P for difference between SAT and VAT < 0.0001); similar differences were noted for men (OR for VAT, 4.2; OR for SAT, 2.5). Furthermore, VAT but not SAT contributed significantly to risk factor variation after adjustment for body mass index and waist circumference (P < or = 0.01). Among overweight and obese individuals, the prevalence of hypertension, impaired fasting glucose, and metabolic syndrome increased linearly and significantly across increasing VAT quartiles. Heritability values for SAT and VAT were 57% and 36%, respectively.
Although both SAT and VAT are correlated with metabolic risk factors, VAT remains more strongly associated with an adverse metabolic risk profile even after accounting for standard anthropometric indexes. Our findings are consistent with the hypothesized role of visceral fat as a unique, pathogenic fat depot. Measurement of VAT may provide a more complete understanding of metabolic risk associated with variation in fat distribution.

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    • "The larger number of fat cells in the abdominal region increases metabolic complications [8] [9]. This association seems to be due to a higher lipolytic rate in the visceral and deep subcutaneous adipose tissue, promoting an increase of free fatty acids (FA) in the blood circulation [10] [11] [12], and an increase in the hepatic synthesis of triglycerides, which translates into dyslipidemia [13]. Additionally , the adipose tissue plays an important role in the development of a systemic inflammatory state, by secreting several cytokines and chemokines [14] [15]. "

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    • "Excess adipose tissue (i.e., defined with increased body mass index (BMI)) is an independent risk factor for cardiovascular disease (CVD) in both sexes and includes spectrum of overweight (BMI P 25 kg/m 2 ), obese (BMI P 30 kg/m 2 ) and extreme obese (BMI P 40 kg/m 2 ) [2]. Many studies established that visceral adipose tissue (VAT) – 'belly fat' – has stronger association with CVD than subcutaneous adipose tissue (SAT) [3] [4] [5]. VAT is endocrinely more active and most abundant cytokines secreted are interleukin-1 (IL-1), interleukin-6 (IL-6), and tumor necrosis factor-a (TNF-a), and they have an important role in the atherogenesis [6]. "
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    • "measured directly or estimated by body condition index) may be poorly correlated with health or evolutionary fitness due to the health consequences of different lipid storage deposits. For example, in humans, intra-abdominal fat deposits are more strongly correlated with obesity-related health consequences than subcutaneous fat (Fox et al. 2007 "
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