Abdominal Subcutaneous and Visceral Adipose Tissue and Insulin Resistance in the Framingham Heart Study

Abstract

Insulin resistance is associated with central obesity and an increased risk of cardiovascular disease. Our objective is to examine the association between abdominal subcutaneous (SAT) and visceral adipose tissue (VAT) and insulin resistance, to determine which fat depot is a stronger correlate of insulin resistance, and to assess whether there was an interaction between SAT, VAT, and age, sex, or BMI. Participants without diabetes from the Framingham Heart Study (FHS), who underwent multidetector computed tomography to assess SAT and VAT (n = 3,093; 48% women; mean age 50.4 years; mean BMI 27.6 kg/m2), were evaluated. Insulin resistance was measured using the homeostasis model and defined as HOMAIR ≥75th percentile. Logistic regression models, adjusted for age, sex, smoking, alcohol, menopausal status, and hormone replacement therapy use, were used to assess the association between fat measures and insulin resistance. The odds ratio (OR) for insulin resistance per standard deviation increase in SAT was 2.5 (95% confidence interval (CI): 2.2–2.7; P < 0.0001), whereas the OR for insulin resistance per standard deviation increase in VAT was 3.5 (95% CI: 3.1–3.9; P < 0.0001). Overall, VAT was a stronger correlate of insulin resistance than SAT (P < 0.0001 for SAT vs. VAT comparison). After adjustment for BMI, the OR of insulin resistance for VAT was 2.2 (95% CI: 1.9–2.5; P < 0.0001). We observed an interaction between VAT and BMI for insulin (P interaction = 0.0004), proinsulin (P interaction = 0.003), and HOMAIR (P interaction = 0.003), where VAT had a stronger association in obese individuals. In conclusion, SAT and VAT are both correlates of insulin resistance; however, VAT is a stronger correlate of insulin resistance than SAT.

Androgenic sex steroids contribute to metabolic risk beyond intra‐abdominal fat in overweight/obese black and white women

“…Thus, it is not surprising that VAT more so than SAT was positively associated with a constellation of metabolic variables characteristic of the metabolic syndrome and CVD risk. Although SAT does have some of the same metabolic effects as VAT, it is not as strongly correlated with proinflammatory, hyperinsulinemic markers (29,30). Of the metabolic variables examined, SAT had a significant relationship with SBP only.…”

Independent tissue contributors to obesity-associated insulin resistance

“…Also, this study was carried out in men only. Nevertheless, studies have shown similar (bivariate) associations between VAT, SAT, IHL, and MVR and insulin resistance in women, as well as improvements in these variables with weight loss (2,(25)(26)(27)(28). Amounts of IHL and VAT are, however, typically greater in men, whereas the amount of SAT is greater in women (2, 10); this might affect the relative contribution of each mediator in women in the multiple mediator models.…”

“…SAT's effect on insulin resistance is controversial; the increased lipolysis and adipokine dysregulation in SAT is considered to contribute to insulin resistance (2), yet a fat distribution pattern with high SAT and low VAT volumes is considered a metabolically healthy phenotype (7). The involvement of IHL, on the other hand, is also debated, as IHL has been postulated to be both a cause and a consequence of insulin resistance.…”

Endurance training improves insulin sensitivity and body composition in prostate cancer patients treated with androgen deprivation therapy

“…In particular, the reduction in the amount of VAT is of great importance, since the accumulation of adipose tissue in this compartment is more strongly associated with insulin resistance and type 2 diabetes compared with SAT (Bray et al 2008, Preis et al 2010. The reasons for this are multiple.…”