Dysfunctional Adiposity and the Risk of Prediabetes and Type 2 Diabetes in Obese Adults

Abstract

MARKED INCREASE IN THEprevalence of overweight and obesity 1 has contributed to a doubling in type 2 diabetes mellitus incidence over the past 3 decades. 2 Increasing rates of diabetes among obese individuals has counterbalanced reductions in other cardiovascular disease (CVD) risk factors and is the primary factor contributing to a slowed decline in CVD event rates in the general population. 3 Prediabetes, an intermediate hyperglycemia phenotype and risk factor for diabetes, 4 is also associated with obesity and carries an excess risk for CVD and death. 5 Although increased body mass index (BMI) is associated with diabetes at the population level, 6 it does not adequately discriminate diabetes risk among obese individuals. 7 Indeed, many obese persons appear resistant to the development of metabolic disease. 8 Because the metabolic disease risks associated with obesity are heterogeneous, there remains an unmet clinical need for tools that differentiate obese persons who will ultimately develop prediabetes and diabetes from those who will remain metabolically healthy.Adipose tissue dysfunction is characterized by ectopic fat deposition in the abdominal viscera and liver, inflammatory and adipokine dysregulation, and insulin resistance and may be a more important mediator of diabetes devel-CME available online at www.jamaarchivescme.com and questions on p 1165.

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

“…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. Moreover, when visceral fat was replaced with WC in a predictive model of type 2 diabetes mellitus, WC was not significantly associated with the outcome 44.…”

“…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. Moreover, when visceral fat was replaced with WC in a predictive model of type 2 diabetes mellitus, WC was not significantly associated with the outcome 44. In summary, although we did not find major differences between the effects of generalized versus central adiposity in this study, more detailed and precise imaging‐based assessments of adipose depots are required to further delineate the independent effects of varying depots on cardiac structure and function over time.…”

Association of Depressive Symptoms with Hippocampal Volume in 1936 Adults

“…The details of the participant selection process and the study design have been previously described (Neeland et al, 2012;Victor et al, 2004).…”

Metabolically healthy and unhealthy obesity: differential effects on myocardial function according to metabolic syndrome, rather than obesity

“…However, there is conflicting evidence that suggests excess visceral fat and insulin resistance, but not general adiposity are associated with incident pre-diabetes and type 2 diabetes in obese individuals 10 . A recent study of almost 30,000 individuals demonstrated that metabolically unhealthy obese individuals have a greater risk of developing diabetes than the metabolically healthy obese 11 .…”