Pathophysiology of Human Visceral Obesity: An Update
01 Jan 2013-Physiological Reviews (American Physiological Society Bethesda, MD)-Vol. 93, Iss: 1, pp 359-404
TL;DR: In clinical practice, measuring waist circumference in addition to the body mass index could be helpful for the identification and management of a subgroup of overweight or obese patients at high cardiometabolic risk.
Abstract: Excess intra-abdominal adipose tissue accumulation, often termed visceral obesity, is part of a phenotype including dysfunctional subcutaneous adipose tissue expansion and ectopic triglyceride storage closely related to clustering cardiometabolic risk factors. Hypertriglyceridemia; increased free fatty acid availability; adipose tissue release of proinflammatory cytokines; liver insulin resistance and inflammation; increased liver VLDL synthesis and secretion; reduced clearance of triglyceride-rich lipoproteins; presence of small, dense LDL particles; and reduced HDL cholesterol levels are among the many metabolic alterations closely related to this condition. Age, gender, genetics, and ethnicity are broad etiological factors contributing to variation in visceral adipose tissue accumulation. Specific mechanisms responsible for proportionally increased visceral fat storage when facing positive energy balance and weight gain may involve sex hormones, local cortisol production in abdominal adipose tissues, endocannabinoids, growth hormone, and dietary fructose. Physiological characteristics of abdominal adipose tissues such as adipocyte size and number, lipolytic responsiveness, lipid storage capacity, and inflammatory cytokine production are significant correlates and even possible determinants of the increased cardiometabolic risk associated with visceral obesity. Thiazolidinediones, estrogen replacement in postmenopausal women, and testosterone replacement in androgen-deficient men have been shown to favorably modulate body fat distribution and cardiometabolic risk to various degrees. However, some of these therapies must now be considered in the context of their serious side effects. Lifestyle interventions leading to weight loss generally induce preferential mobilization of visceral fat. In clinical practice, measuring waist circumference in addition to the body mass index could be helpful for the identification and management of a subgroup of overweight or obese patients at high cardiometabolic risk.
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TL;DR: The Task Force for the Management of Dyslipidaemias of the European Society of Cardiology and European Atherosclerosis Society and EAS and ABI : ankle-brachial index are formed.
Abstract: The Task Force for the Management of Dyslipidaemias of the European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS)
Developed with the special contribution of the European Assocciation for Cardiovascular Prevention & Rehabilitation (EACPR)
ABI
: ankle-brachial index
2,358 citations
Lawrence Berkeley National Laboratory1, Buck Institute for Research on Aging2, Lund University3, University of California, San Francisco4, National Institutes of Health5, University College London6, Harvard University7, Columbia University Medical Center8, Emory University9, Queen Mary University of London10, University of Milan11, Humanitas University12, Stanford University13, Albert Einstein College of Medicine14, Veterans Health Administration15, University of California, Los Angeles16, European University of Madrid17
TL;DR: The multi-level mechanisms underlying SCI and several risk factors that promote this health-damaging phenotype, including infections, physical inactivity, poor diet, environmental and industrial toxicants and psychological stress are described.
Abstract: Although intermittent increases in inflammation are critical for survival during physical injury and infection, recent research has revealed that certain social, environmental and lifestyle factors can promote systemic chronic inflammation (SCI) that can, in turn, lead to several diseases that collectively represent the leading causes of disability and mortality worldwide, such as cardiovascular disease, cancer, diabetes mellitus, chronic kidney disease, non-alcoholic fatty liver disease and autoimmune and neurodegenerative disorders. In the present Perspective we describe the multi-level mechanisms underlying SCI and several risk factors that promote this health-damaging phenotype, including infections, physical inactivity, poor diet, environmental and industrial toxicants and psychological stress. Furthermore, we suggest potential strategies for advancing the early diagnosis, prevention and treatment of SCI.
1,708 citations
TL;DR: The objectives of this review are to expose recent data supporting the role of the immune system in the pathogenesis of insulin resistance and type 2 diabetes and to examine various mechanisms underlying this relationship.
1,416 citations
Cites background from "Pathophysiology of Human Visceral O..."
...Furthermore, it is associated with ectopic lipid accumulation in the liver and skeletal muscle, which participates to local insulin resistance and contributes to associated metabolic complications [43]....
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...Subcutaneous and visceral adipose tissues differ by phenotypic, physiological and functional characteristics [43]....
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TL;DR: The evidence reviewed in this paper suggests that adipose tissue quality/function is as important, if not more so, than its amount in determining the overall health and CV risks of overweight/obesity.
919 citations
Cites background from "Pathophysiology of Human Visceral O..."
...Asmentioned earlier, depending on their location, fat depots present distinct metabolic properties, different states of inflammation or adipo(cyto)kines excretion, leading to major individual differences regarding the impact of obesity on cardiometabolic risk (from protective to neutral to increased risk) (Fig 3).(40,89) A important distinction should therefore be made between the...
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TL;DR: NAFLD might be a more direct predictor of type 2 diabetes, cardiovascular disease, non-alcoholic steatohepatitis (NASH), and hepatocellular carcinoma than metabolic syndrome because it is associated with high liver fat content.
891 citations
References
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TL;DR: Dairy therapy remains the first line of treatment of high blood cholesterol, and drug therapy is reserved for patients who are considered to be at high risk for CHD, and the fundamental approach to treatment is comparable.
Abstract: THE SECOND report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel II, or ATP II) presents the National Cholesterol Education Program's updated recommendations for cholesterol management. It is similar to the first in general outline, and the fundamental approach to treatment of high blood cholesterol is comparable. This report continues to identify low-density lipoproteins (LDL) as the primary target of cholesterol-lowering therapy. As in the first report, the second report emphasizes the role of the clinical approach in primary prevention of coronary heart disease (CHD). Dietary therapy remains the first line of treatment of high blood cholesterol, and drug therapy is reserved for patients who are considered to be at high risk for CHD. However, the second report contains new features that distinguish it from the first. These include the following: Increased emphasis on See also pp 3002 and 3009.
28,495 citations
01 Jan 2009
15,111 citations
TL;DR: It was agreed that there should not be an obligatory component, but that waist measurement would continue to be a useful preliminary screening tool, and a single set of cut points would be used for all components except waist circumference, for which further work is required.
Abstract: A cluster of risk factors for cardiovascular disease and type 2 diabetes mellitus, which occur together more often than by chance alone, have become known as the metabolic syndrome. The risk factors include raised blood pressure, dyslipidemia (raised triglycerides and lowered high-density lipoprotein cholesterol), raised fasting glucose, and central obesity. Various diagnostic criteria have been proposed by different organizations over the past decade. Most recently, these have come from the International Diabetes Federation and the American Heart Association/National Heart, Lung, and Blood Institute. The main difference concerns the measure for central obesity, with this being an obligatory component in the International Diabetes Federation definition, lower than in the American Heart Association/National Heart, Lung, and Blood Institute criteria, and ethnic specific. The present article represents the outcome of a meeting between several major organizations in an attempt to unify criteria. It was agreed that there should not be an obligatory component, but that waist measurement would continue to be a useful preliminary screening tool. Three abnormal findings out of 5 would qualify a person for the metabolic syndrome. A single set of cut points would be used for all components except waist circumference, for which further work is required. In the interim, national or regional cut points for waist circumference can be used.
11,737 citations
"Pathophysiology of Human Visceral O..." refers background in this paper
...Although waist circumference was initially identified as one of the five clinical criteria to diagnose the metabolic syndrome by the National Cholesterol Education Program-Adult Treatment Panel III (1), there has been a debate as to whether this feature should be a mandatory clinical criterion as initially proposed by the International Diabetes Federation guidelines (7, 8)....
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TL;DR: This statement from the American Heart Association and the National Heart, Lung, and Blood Institute is intended to provide up-to-date guidance for professionals on the diagnosis and management of the metabolic syndrome in adults.
Abstract: The metabolic syndrome has received increased attention in the past few years. This statement from the American Heart Association (AHA) and the National Heart, Lung, and Blood Institute (NHLBI) is intended to provide up-to-date guidance for professionals on the diagnosis and management of the metabolic syndrome in adults.
The metabolic syndrome is a constellation of interrelated risk factors of metabolic origin— metabolic risk factors —that appear to directly promote the development of atherosclerotic cardiovascular disease (ASCVD).1 Patients with the metabolic syndrome also are at increased risk for developing type 2 diabetes mellitus. Another set of conditions, the underlying risk factors , give rise to the metabolic risk factors. In the past few years, several expert groups have attempted to set forth simple diagnostic criteria to be used in clinical practice to identify patients who manifest the multiple components of the metabolic syndrome. These criteria have varied somewhat in specific elements, but in general they include a combination of both underlying and metabolic risk factors.
The most widely recognized of the metabolic risk factors are atherogenic dyslipidemia, elevated blood pressure, and elevated plasma glucose. Individuals with these characteristics commonly manifest a prothrombotic state and a pro-inflammatory state as well. Atherogenic dyslipidemia consists of an aggregation of lipoprotein abnormalities including elevated serum triglyceride and apolipoprotein B (apoB), increased small LDL particles, and a reduced level of HDL cholesterol (HDL-C). The metabolic syndrome is often referred to as if it were a discrete entity with a single cause. Available data suggest that it truly is a syndrome, ie, a grouping of ASCVD risk factors, but one that probably has more than one cause. Regardless of cause, the syndrome identifies individuals at an elevated risk for ASCVD. The magnitude of the increased risk can vary according to which components of the syndrome are …
9,982 citations
TL;DR: The proportion of Asian people with a high risk of type 2 diabetes and cardiovascular disease is substantial at BMIs lower than the existing WHO cut-off point for overweight (> or =25 kg/m2), but available data do not necessarily indicate a clear BMI cut-offs point for all Asians for overweight or obesity.
9,536 citations
"Pathophysiology of Human Visceral O..." refers background in this paper
...A national United States study of 9,179 individuals with over sampling of minority ethnic groups showed significant ethnic differences in body weight, with African-American and Hispanic populations at highest risk of obesity compared with Caucasian populations (367)....
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...A large number of studies have assessed visceral adiposity in various ethnic groups such as Caucasian, Asian, Indian, and Aboriginal populations (9, 110, 174, 302, 304, 332)....
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...In the past years, discoveries on the regulation of body weight and food intake by endogenous agonists of the en- 1.00 0.75 0.50 0.25 0.00 1.00 0.75 0.50 0.25 0.00 Vi sc er al /s ub cu ta ne ou s ad ip os e tis su e ar ea Vi sc er al /s ub cu ta ne ou s ad ip os e tis su e ar ea African Caucasian Asian African Caucasian Asian Studies in female patients (n=184) Studies in male patients (n=156) 1 1,2 1 1,2 FIGURE 5....
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...In Asian populations, a higher body fat content was reported at lower BMI values compared with Caucasians (119)....
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...Obesity onset occurred 2.1 and 1.5 times earlier for African-American and Hispanic women, respectively, compared with Caucasian women....
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