High Visceral and Low Abdominal Subcutaneous Fat Stores in the Obese Adolescent

Abstract

OBJECTIVE-To explore whether an imbalance between the visceral and subcutaneous fat depots and a corresponding dysregulation of the adipokine milieu is associated with excessive accumulation of fat in the liver and muscle and ultimately with insulin resistance and the metabolic syndrome.RESEARCH DESIGN AND METHODS-We stratified our multi-ethnic cohort of 118 obese adolescents into tertiles based on the proportion of abdominal fat in the visceral depot. Abdominal and liver fat were measured by magnetic resonance imaging and muscle lipid (intramyocellular lipid) by proton magnetic resonance spectroscopy.RESULTS-There were no differences in age, BMI Z score, or fat-free mass across tertiles. However, as the proportion of visceral fat increased across tertiles, BMI and percentage of fat and subcutaneous fat decreased, while hepatic fat increased. In addition, there was an increase in 2-h glucose, insulin, c-peptide, triglyceride levels, and insulin resistance. Notably, both leptin and total adiponectin were significantly lower in tertile 3 than 1, while C-reactive protein and interleukin-6 were not different across tertiles. There was a significant increase in the odds ratio for the metabolic syndrome, with subjects in tertile 3 5.2 times more likely to have the metabolic syndrome than those in tertile 1.CONCLUSIONS-Obese adolescents with a high proportion of visceral fat and relatively low abdominal subcutaneous fat have a phenotype reminiscent of partial lipodystrophy. These adolescents are not necessarily the most severely obese, yet they suffer from severe metabolic complications and are at a high risk of having the metabolic syndrome.

High fat stores in ectopic compartments in men with newly diagnosed type 2 diabetes: an anthropometric determinant of carotid atherosclerosis and insulin resistance

“…This cross-sectional study offered the finding that altered partitioning of fat in muscle (greater low-density muscle area or lower muscle attenuation) and the liver (lower liver attenuation) was observed relatively early in the development of type 2 diabetes, along with an increased visceral fat mass. Considering that other groups also showed similar results in insulin-resistant obese adolescents, 22 high fat stores at ectopic sites are not a consequence of diabetes, but may be a cause. We preliminarily reported altered fat partitioning in the abdomen and muscle in a small number of subjects.…”

Evaluating the Fat Distribution in Idiopathic Intracranial Hypertension Using Dual-Energy X-ray Absorptiometry Scanning

“…17–19 Importantly, total abdominal fat mass, as measured by waist circumference or DEXA, is determined by the mass of two distinct adipose tissue depots, the subcutaneous and the visceral depot, with the latter particularly contributing to the adverse effects of central obesity. 20,21 Weight loss is associated with overall reductions in total body fat mass, whereby there appears to be gender- and depot-specific differences. 22,23 Our data are in line with previous studies in women, showing reductions in abdominal fat mass following dietary intervention.…”

Assessment methods of body composition

“…Mnoga od istraživanja koja su sprovedena za analizu telesnog sastava su usredsređena na podelu masnog tkiva na subkutano masno tkivo i intraabdominalno odnosno visceralno masno tkivo.Kardiometabolički rizici povezani više sa visceralnim masnim tkivom pa je odnos između visceralnog i subkutanog masnog tkiva važan pokazatelj ovih rizika [42]. Ultrasonografijom je moguće precizno izmeriti i debljinu mišićnog i koštanog tkiva podjednako efikasno kao i debljinu subkutanog i intraabdominalnog masnog tkiva [43].…”

“…Nema jonizujućeg zraćenja kod ultrasonografije koje postoji kod DXA i CT pa se smatra metodom minimalnog zdravstvenog rizika [44]. Ultrazvučna metoda je skuplja od antropometrijske ili jednostavnijih BIA uređaja, međutim nudi nekoliko prednosti u odnosu na ove metode [42]. Nije ograničena debljinom subkutanog masnog tkiva, konzistencijom vezivnog tkiva ili statusom hidracije.…”

“…Iako je snimanje jednostavna procedura, interpretacija je mnogo složenija i subjektivna [45]. Neki artefakti su nerazdvojan deo ultrasonografske metode [44], a interpretacija ultrazvučnih nalaza iziskuje stručnost i iskustvo [42,45].…”