The Atherogenic Lipoprotein Profile Associated With Obesity and Insulin Resistance Is Largely Attributable to Intra-Abdominal Fat

Abstract

Obesity and insulin resistance are both associated with an atherogenic lipoprotein profile. We examined the effect of insulin sensitivity and central adiposity on lipoproteins in 196 individuals (75 men and 121 women) with an average age of 52.7 years. Subjects were subdivided into three groups based on BMI and their insulin sensitivity index (S I ): lean insulin sensitive (n ‫؍‬ 65), lean insulin resistant (n ‫؍‬ 73), and obese insulin resistant (n ‫؍‬ 58). This categorization revealed that both obesity and insulin resistance determined the lipoprotein profile. In addition, the insulin-resistant groups had increased central adiposity. Increasing intra-abdominal fat (IAF) area, quantified by computed tomography scan and decreasing S I , were important determinants of an atherogenic profile, marked by increased triglycerides, LDL cholesterol, and apolipoprotein B and decreased HDL cholesterol and LDL buoyancy (Rf). Density gradient ultracentrifugation (DGUC) revealed that in subjects who had more IAF and were more insulin resistant, the cholesterol content was increased in VLDL, intermediate-density lipoprotein (IDL), and dense LDL fractions whereas it was reduced in HDL fractions. Multiple linear regression analysis of the relation between the cholesterol content of each DGUC fraction as the dependent variable and IAF and S I as independent variables revealed that the cholesterol concentration in the fractions corresponding to VLDL, IDL, dense LDL, and HDL was associated with IAF, and that S I additionally contributed independently to VLDL, but not to IDL, LDL, or HDL. Thus an atherogenic lipoprotein profile appears to be the result primarily of an increase in IAF, perhaps via insulin resistance.

Is weight loss the optimal target for obesity-related cardiovascular disease risk reduction?

“…Indeed, independent of subcutaneous fat, visceral fat is a strong predictor of dyslipidemia (20,21), glucose tolerance (22,23), insulin resistance (24) and systemic inflammation (25), as well as incidence of hypertension (26), CVD (7), type 2 diabetes (27) and all-cause mortality (28). These observations underscore the notion that both WC and visceral fat should be primary targets for strategies designed to reduce obesity and related CVD risk.…”

Lifecourse predictors of normal metabolic parameters in overweight and obese adults

“…[18][19][20] There is evidence that intraabdominal fat, in particular, is associated with insulin resistance. 21 The women in this study were mainly perimenopausal; only a small number had early menopause. We were unable to examine the impact of menopausal status in this study.…”

Influência do excesso de peso corporal e da adiposidade central na glicemia e no perfil lipídico de pacientes portadores de diabetes mellitus tipo 2

“…Vários estudos têm sugerido que a variação anatômica da distribuição da gordura corporal é um indicador mais importante de complicações metabólicas do que a massa corporal total (7)(8)(9)(10). A obesidade visceral resulta em inúmeras modificações fisiopatológicas, que podem resultar em diferentes graus de resistência à insulina.…”

“…Dentre elas, podem ser citadas a menor extração de insulina pelo fígado, o aumento na produção hepáti-ca de glicose e a diminuição da captação de glicose pelos tecidos periféricos, como o tecido muscular (11). Além da resistência à insulina, a gordura abdominal está relacionada à hipertensão e alterações desfavoráveis no perfil das lipoproteínas plasmáticas, caracterizando o quadro de síndrome metabólica e levando a um aumento no risco de doença cardiovascular (7)(8)(9)(10).…”