Managing Cardiometabolic Risk

Targeting Abdominal Obesity to Manage the Metabolic Syndrome

There is a wealth of evidence suggesting that intra-abdominal (visceral) adipose tissue, insulin resistance, and the development of the metabolic syndrome and/or type 2 diabetes are closely linked (1, 2). In addition to its ties to abdominal obesity, the metabolic syndrome has also been linked to blood lipid disorders, an inflammatory and pro-thrombotic state, hypertension, and insulin resistance. In this regard, Palaniappan et al. (3) found that the best predictors of incident metabolic syndrome over a 5 year follow-up were waist circumference, HDL cholesterol, and proinsulin levels. They examined a sample of 714 men aged 54.4 ± 8.5 years at the beginning of follow-up who participated in the Insulin Resistance Atherosclerosis (IRAS) Study. The authors suggested that steps should be taken to address components of the metabolic syndrome, such as waist circumference, in order to reduce the risk of developing the syndrome and related complications such as type 2 diabetes and cardiovascular disease. This study also showed that waist circumference was a better predictor of metabolic syndrome than directly measuring insulin sensitivity with an oral glucose tolerance test. The contribution of various lifestyle and therapeutic interventions to reducing body weight, abdominal fat in particular, and preventing insulin resistance and type 2 diabetes is examined below.