Associations of visceral and abdominal subcutaneous adipose tissue with markers of cardiac and metabolic risk in obese adults

Abstract

Visceral (VAT) and abdominal subcutaneous (SAT) adipose tissues contribute to obesity but may have different metabolic and atherosclerosis risk profiles. Among obese participants in the Dallas Heart Study, we examined the cross-sectional associations of abdominal VAT and SAT mass, assessed by magnetic resonance imaging (MRI) and indexed to body surface area (BSA), with circulating biomarkers of insulin resistance, dyslipidemia, and inflammation (n=942); and with aortic plaque and liver fat by MRI and coronary calcium by computed tomography (n=1200). Associations of VAT/BSA and SAT/BSA were examined after adjustment for age, sex, race, menopause, and body mass index. In multivariable models, VAT significantly associated with the homeostasis model assessment of insulin resistance (HOMA-IR), lower adiponectin, smaller LDL and HDL particle size, larger VLDL size, and increased LDL and VLDL particle number (p<0.001 for each). VAT also associated with prevalent diabetes, metabolic syndrome, hepatic steatosis, and aortic plaque (p<0.001 for each). VAT independently associated with C-reactive protein but not with any other inflammatory biomarkers tested. In contrast, SAT associated with leptin and inflammatory biomarkers, but not with dyslipidemia or atherosclerosis. Associations between SAT and HOMA-IR were significant in univariable analyses but attenuated after multivariable adjustment. In conclusion, VAT associated with an adverse metabolic, dyslipidemic, and atherogenic obesity phenotype. In contrast, SAT demonstrated a more benign phenotype, characterized by modest associations with inflammatory biomarkers and leptin, but no independent association with dyslipidemia, insulin resistance, or atherosclerosis in obese individuals. These findings suggest that abdominal fat distribution defines distinct obesity sub-phenotypes with heterogeneous metabolic and atherosclerosis risk.

Dynamic Relation of Changes in Weight and Indices of Fat Distribution With Cardiac Structure and Function: The Dallas Heart Study

“…These mechanisms lead to pathologic LV remodeling,4, 11 and eventually heart failure 2. Variation in body fat distribution may be an important determinant of cardiac remodeling,41 and excess fat storage in the visceral depot may expose the heart to a different inflammatory and metabolic milieu than fat stored in the subcutaneous depot 42. We previously reported that visceral adiposity was independently associated with concentric LV remodeling, whereas lower‐body subcutaneous fat was linked to a more eccentric phenotype 41.…”

“…As mentioned above, in the DHS, the correlation between WC and visceral fat was highly variable: the WC–visceral fat correlation among all DHS participants was 0.73, and among obese participants the WC–visceral fat correlation was lower at 0.46. Furthermore, WC measures include both VAT and abdominal subcutaneous adipose tissue compartments, which are anatomically and physiologically distinct and are associated with a different cardiometabolic risk profile 42. Visceral fat, but not abdominal subcutaneous tissue, has been associated with type 2 diabetes mellitus,44 hypertension,45 and alterations in left ventricular structure and function 41.…”

Proposed cut‐off values of the waist circumference for metabolic syndrome based on visceral fat volume in a Japanese population

“…Although the VFA at the umbilicus has been widely used to identify visceral obesity13, 14, 15, 16, 17, 18, 19, we previously showed that the maximal VFA was not at the umbilicus, but was widely distributed from L1 to L520, 21.…”

“…In contrast, the Japan Society for the Study of Obesity (JASSO) has recommended that the appropriate cut‐off values of WC for detecting visceral obesity are 85 cm in Japanese men and 90 cm in Japanese women from the general population12, and these values are widely used for diagnosis of MetS in Japan. As the JASSO cut‐off value of WC is higher for women than men, unlike the criteria used in other Asian countries, reassessment of the cut‐off values for Japanese persons has been carried out previously, and different values have been proposed13, 14, 15, 16, 17, 18, 19. However, these previous Japanese studies were based on WC and/or the visceral fat area (VFA) at the umbilicus determined by CT scanning.…”

Salivary adiponectin concentration in healthy adult males in relation to anthropometric measures and fat distribution

“…Th e health consequences associated with obesity diff er depending on the place where the adipose tissue is stored; for instance, subcutaneously versus internally (visceral) (Pou et al 2007;Ducluzeau et al 2010;Wildman et al 2011). Although in not all obese individuals of type 2 diabetes or cardiovascular diseases will eventually develop, abdominal adiposity, especially visceral fat, Brought to you by | MIT Libraries Authenticated Download Date | 5/12/18 1:35 AM has been found to be a risk for the developing of the metabolic syndrome, insulin resistance, type 2 diabetes mellitus, and cardiovascular diseases (McLaughlin et al 2011;Neeland et al 2013).…”