Managing Cardiometabolic Risk

Weight loss and abdominal obesity

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In the 1950s, Jean Vague (1) noted that upper body or android obesity was an important predictor of atherosclerosis, diabetes, gout, and other diseases. While the association between abdominal obesity and metabolic risk may be explained by excess fat accumulation in either of two distinct depots within the abdomen, namely intra-abdominal (visceral) fat and abdominal subcutaneous fat, the literature points to intra-abdominal fat as the depot that carries the greatest health risk. Independent of subcutaneous abdominal fat, intra-abdominal fat is a strong predictor of dyslipidemia (2, 3), glucose intolerance (4, 5), insulin resistance (6), systemic inflammation (7), hypertension (8), cardiovascular disease (9), type 2 diabetes (10), and, most recently, all-cause mortality (11). Accordingly, the ability of exercise and/or diet to significantly reduce body weight and intra-abdominal fat is a key consideration for reducing the health risk among abdominally obese patients.

Reference

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1. Vague J. The degree of masculine differentiation of obesities: a factor determining predisposition to diabetes, atherosclerosis, gout, and uric calculous disease. Am J Clin Nutr 1956; 4: 20-34.

2. Nguyen-Duy TB, Nichaman MZ, Church TS, et al. Visceral fat and liver fat are independent predictors of metabolic risk factors in men. Am J Physiol Endocrinol Metab 2003; 284: E1065-71.

3. Nieves DJ, Cnop M, Retzlaff B, et al. The atherogenic lipoprotein profile associated with obesity and insulin resistance is largely attributable to intra-abdominal fat. Diabetes 2003; 52: 172-9.

4. Brochu M, Starling RD, Tchernof A, et al. Visceral adipose tissue is an independent correlate of glucose disposal in older obese postmenopausal women. J Clin Endocrinol Metab 2000; 85: 2378-84.

5. Janssen I, Fortier A, Hudson R, et al. Effects of an energy-restrictive diet with or without exercise on abdominal fat, intermuscular fat, and metabolic risk factors in obese women. Diabetes Care 2002; 25: 431-8.

6. Ross R, Aru J, Freeman J, et al. Abdominal adiposity and insulin resistance in obese men. Am J Physiol Endocrinol Metab 2002; 282: E657-63.

7. Forouhi NG, Sattar N and McKeigue PM. Relation of C-reactive protein to body fat distribution and features of the metabolic syndrome in Europeans and South Asians. Int J Obes Relat Metab Disord 2001; 25: 1327-31.

8. Hayashi T, Boyko EJ, Leonetti DL, et al. Visceral adiposity is an independent predictor of incident hypertension in Japanese Americans. Ann Intern Med 2004; 140: 992-1000.

9. Fujimoto WY, Bergstrom RW, Boyko EJ, et al. Visceral adiposity and incident coronary heart disease in Japanese-American men. The 10-year follow-up results of the Seattle Japanese-American Community Diabetes Study. Diabetes Care 1999; 22: 1808-12.

10. Boyko EJ, Fujimoto WY, Leonetti DL, et al. Visceral adiposity and risk of type 2 diabetes: a prospective study among Japanese Americans. Diabetes Care 2000; 23: 465-71.

11. Kuk JL, Katzmarzyk PT, Nichaman MZ, et al. Visceral fat is an independent predictor of all-cause mortality in men. Obesity (Silver Spring) 2006; 14: 336-41.

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