Overweight, Obesity, and CVD Risk: a Focus on Visceral/Ectopic Fat (original) (raw)

• Blüher M. Obesity: global epidemiology and pathogenesis. Nat Rev Endocrinol. 2019;15(5):288–98. https://doi.org/10.1038/s41574-019-0176-8.
  Article PubMed Google Scholar
• Statistics Canada: Overweight and obese adults, 2018. https://www150.statcan.gc.ca/n1/pub/82-625-x/2019001/article/00005-eng.htm#n1 (2018). Accessed September 6 2021.
• Centers for Disease Control and Prevention: Adult Obesity Prevalence Maps. https://www.cdc.gov/obesity/data/prevalence-maps.html (2020). Accessed September 24 2021.
• Janssen F, Bardoutsos A, Vidra N. Obesity prevalence in the long-term future in 18 European countries and in the USA. Obes Facts. 2020;13(5):514–27. https://doi.org/10.1159/000511023.
  Article PubMed PubMed Central Google Scholar
• Ward ZJ, Bleich SN, Cradock AL, Barrett JL, Giles CM, Flax C, et al. Projected U.S. state-level prevalence of adult obesity and severe obesity. N Engl J Med. 2019;381(25):2440–50. https://doi.org/10.1056/NEJMsa1909301.
  Article PubMed Google Scholar
• Finkelstein EA, Khavjou OA, Thompson H, Trogdon JG, Pan L, Sherry B, et al. Obesity and severe obesity forecasts through 2030. Am J Prev Med. 2012;42(6):563–70. https://doi.org/10.1016/j.amepre.2011.10.026.
  Article PubMed Google Scholar
• Saeedi P, Petersohn I, Salpea P, Malanda B, Karuranga S, Unwin N, et al. Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: Results from the International Diabetes Federation Diabetes Atlas, 9(th) edition. Diabetes Res Clin Pract. 2019;157:107843. https://doi.org/10.1016/j.diabres.2019.107843.
  Article PubMed Google Scholar
• Wildman RP, Muntner P, Reynolds K, McGinn AP, Rajpathak S, Wylie-Rosett J, et al. The obese without cardiometabolic risk factor clustering and the normal weight with cardiometabolic risk factor clustering: prevalence and correlates of 2 phenotypes among the US population (NHANES 1999–2004). Arch Intern Med. 2008;168(15):1617–24. https://doi.org/10.1001/archinte.168.15.1617.
  Article PubMed Google Scholar
• Lavie CJ, Laddu D, Arena R, Ortega FB, Alpert MA, Kushner RF. Healthy weight and obesity prevention: JACC Health Promotion Series. J Am Coll Cardiol. 2018;72(13):1506–31. https://doi.org/10.1016/j.jacc.2018.08.1037.
  Article PubMed Google Scholar
• Horwich TB, Fonarow GC, Hamilton MA, MacLellan WR, Woo MA, Tillisch JH. The relationship between obesity and mortality in patients with heart failure. J Am Coll Cardiol. 2001;38(3):789–95. https://doi.org/10.1016/s0735-1097(01)01448-6.
  Article CAS PubMed Google Scholar
• Romero-Corral A, Montori VM, Somers VK, Korinek J, Thomas RJ, Allison TG, et al. Association of bodyweight with total mortality and with cardiovascular events in coronary artery disease: a systematic review of cohort studies. Lancet. 2006;368(9536):666–78. https://doi.org/10.1016/S0140-6736(06)69251-9.
  Article PubMed Google Scholar
• Buettner HJ, Mueller C, Gick M, Ferenc M, Allgeier J, Comberg T, et al. The impact of obesity on mortality in UA/non-ST-segment elevation myocardial infarction. Eur Heart J. 2007;28(14):1694–701. https://doi.org/10.1093/eurheartj/ehm220.
  Article PubMed Google Scholar
• Lavie CJ, Osman AF, Milani RV, Mehra MR. Body composition and prognosis in chronic systolic heart failure: the obesity paradox. Am J Cardiol. 2003;91(7):891–4. https://doi.org/10.1016/s0002-9149(03)00031-6.
  Article PubMed Google Scholar
• Uretsky S, Messerli FH, Bangalore S, Champion A, Cooper-Dehoff RM, Zhou Q, et al. Obesity paradox in patients with hypertension and coronary artery disease. Am J Med. 2007;120(10):863–70. https://doi.org/10.1016/j.amjmed.2007.05.011.
  Article PubMed Google Scholar
• •• Neeland IJ, Ross R, Després JP, Matsuzawa Y, Yamashita S, Shai I, et al. Visceral and ectopic fat, atherosclerosis, and cardiometabolic disease: a position statement. Lancet Diabetes Endocrinol. 2019;7(9):715–25. https://doi.org/10.1016/S2213-8587(19)30084-1. (This paper provided a comprehensive overview of the current knowledge surrounding the heterogeneity of obesity while emphasizing the need to monitor changes in visceral and ectopic fat in clinical practice.)
  Article PubMed Google Scholar
• Després JP. Body fat distribution and risk of cardiovascular disease: an update. Circulation. 2012;126(10):1301–13. https://doi.org/10.1161/CIRCULATIONAHA.111.067264.
  Article PubMed Google Scholar
• Emerging Risk Factors Collaboration, Wormser D, Kaptoge S, Di Angelantonio E, Wood AM, Pennells L, et al. Separate and combined associations of body-mass index and abdominal adiposity with cardiovascular disease: collaborative analysis of 58 prospective studies. Lancet. 2011;377(9771):1085–95. https://doi.org/10.1016/S0140-6736(11)60105-0.
  Article Google Scholar
• Bogers RP, Bemelmans WJ, Hoogenveen RT, Boshuizen HC, Woodward M, Knekt P, et al. Association of overweight with increased risk of coronary heart disease partly independent of blood pressure and cholesterol levels: a meta-analysis of 21 cohort studies including more than 300 000 persons. Arch Intern Med. 2007;167(16):1720–8. https://doi.org/10.1001/archinte.167.16.1720.
  Article PubMed Google Scholar
• Powell-Wiley TM, Poirier P, Burke LE, Després JP, Gordon-Larsen P, Lavie CJ, et al. Obesity and cardiovascular disease: a scientific statement from the American Heart Association. Circulation. 2021;143(21):e984–1010. https://doi.org/10.1161/CIR.0000000000000973.
  Article PubMed PubMed Central Google Scholar
• Salas-Salvado J, Diaz-Lopez A, Ruiz-Canela M, Basora J, Fito M, Corella D, et al. Effect of a lifestyle intervention program with energy-restricted Mediterranean diet and exercise on weight loss and cardiovascular risk factors: one-year results of the PREDIMED-Plus trial. Diabetes Care. 2019;42(5):777–88. https://doi.org/10.2337/dc18-0836.
  Article CAS PubMed Google Scholar
• Zomer E, Gurusamy K, Leach R, Trimmer C, Lobstein T, Morris S, et al. Interventions that cause weight loss and the impact on cardiovascular risk factors: a systematic review and meta-analysis. Obes Rev. 2016;17(10):1001–11. https://doi.org/10.1111/obr.12433.
  Article CAS PubMed Google Scholar
• Piché ME, Tchernof A, Després JP. Obesity phenotypes, diabetes, and cardiovascular diseases. Circ Res. 2020;126(11):1477–500. https://doi.org/10.1161/CIRCRESAHA.120.316101.
  Article CAS PubMed Google Scholar
• Tokunaga K, Matsuzawa Y, Ishikawa K, Tarui S. A novel technique for the determination of body fat by computed tomography. Int J Obes. 1983;7(5):437–45.
  CAS PubMed Google Scholar
• Fujioka S, Matsuzawa Y, Tokunaga K, Tarui S. Contribution of intra-abdominal fat accumulation to the impairment of glucose and lipid metabolism in human obesity. Metabolism. 1987;36(1):54–9. https://doi.org/10.1016/0026-0495(87)90063-1.
  Article CAS PubMed Google Scholar
• Matsuzawa Y, Shimomura I, Nakamura T, Keno Y, Kotani K, Tokunaga K. Pathophysiology and pathogenesis of visceral fat obesity. Obes Res. 1995;3(Suppl 2):187S-S194. https://doi.org/10.1002/j.1550-8528.1995.tb00462.x.
  Article PubMed Google Scholar
• Fox CS, Massaro JM, Hoffmann U, Pou KM, Maurovich-Horvat P, Liu CY, et al. Abdominal visceral and subcutaneous adipose tissue compartments: association with metabolic risk factors in the Framingham Heart Study. Circulation. 2007;116(1):39–48. https://doi.org/10.1161/CIRCULATIONAHA.106.675355.
  Article PubMed Google Scholar
• Neeland IJ, Ayers CR, Rohatgi AK, Turer AT, Berry JD, Das SR, et al. Associations of visceral and abdominal subcutaneous adipose tissue with markers of cardiac and metabolic risk in obese adults. Obesity. 2013;21(9):E439–47. https://doi.org/10.1002/oby.20135.
  Article CAS PubMed Google Scholar
• Vague J. La différenciation sexuelle; facteur déterminant des formes de l’obésité. Presse Med. 1947;55(30):339.
  CAS Google Scholar
• Després JP, Lemieux I. Abdominal obesity and metabolic syndrome. Nature. 2006;444(7121):881–7. https://doi.org/10.1038/nature05488.
  Article CAS PubMed Google Scholar
• Tchernof A, Després JP. Pathophysiology of human visceral obesity: an update. Physiol Rev. 2013;93(1):359–404. https://doi.org/10.1152/physrev.00033.2011.
  Article CAS PubMed Google Scholar
• Després JP, Carpentier AC, Tchernof A, Neeland IJ, Poirier P. Management of obesity in cardiovascular practice: JACC Focus Seminar. J Am Coll Cardiol. 2021;78(5):513–31. https://doi.org/10.1016/j.jacc.2021.05.035.
  Article PubMed Google Scholar
• Després JP, Lemieux I, Bergeron J, Pibarot P, Mathieu P, Larose E, et al. Abdominal obesity and the metabolic syndrome: contribution to global cardiometabolic risk. Arterioscler Thromb Vasc Biol. 2008;28(6):1039–49. https://doi.org/10.1161/ATVBAHA.107.159228.
  Article CAS PubMed Google Scholar
• Danforth E Jr. Failure of adipocyte differentiation causes type II diabetes mellitus? Nat Genet. 2000;26(1):13. https://doi.org/10.1038/79111.
  Article CAS PubMed Google Scholar
• Karpe F, Pinnick KE. Biology of upper-body and lower-body adipose tissue–link to whole-body phenotypes. Nat Rev Endocrinol. 2015;11(2):90–100. https://doi.org/10.1038/nrendo.2014.185.
  Article CAS PubMed Google Scholar
• Neeland IJ, Turer AT, Ayers CR, Powell-Wiley TM, Vega GL, Farzaneh-Far R, et al. Dysfunctional adiposity and the risk of prediabetes and type 2 diabetes in obese adults. JAMA. 2012;308(11):1150–9. https://doi.org/10.1001/2012.jama.11132.
  Article CAS PubMed PubMed Central Google Scholar
• Britton KA, Fox CS. Ectopic fat depots and cardiovascular disease. Circulation. 2011;124(24):e837–41. https://doi.org/10.1161/CIRCULATIONAHA.111.077602.
  Article PubMed Google Scholar
• Piché ME, Poirier P. Obesity, ectopic fat and cardiac metabolism. Expert Rev Endocrinol Metab. 2018;13(4):213–21. https://doi.org/10.1080/17446651.2018.1500894.
  Article CAS PubMed Google Scholar
• Rosito GA, Massaro JM, Hoffmann U, Ruberg FL, Mahabadi AA, Vasan RS, et al. Pericardial fat, visceral abdominal fat, cardiovascular disease risk factors, and vascular calcification in a community-based sample: the Framingham Heart Study. Circulation. 2008;117(5):605–13. https://doi.org/10.1161/CIRCULATIONAHA.107.743062.
  Article PubMed Google Scholar
• Britton KA, Massaro JM, Murabito JM, Kreger BE, Hoffmann U, Fox CS. Body fat distribution, incident cardiovascular disease, cancer, and all-cause mortality. J Am Coll Cardiol. 2013;62(10):921–5. https://doi.org/10.1016/j.jacc.2013.06.027.
  Article PubMed PubMed Central Google Scholar
• Kotronen A, Yki-Järvinen H. Fatty liver: a novel component of the metabolic syndrome. Arterioscler Thromb Vasc Biol. 2008;28(1):27–38. https://doi.org/10.1161/atvbaha.107.147538.
  Article CAS PubMed Google Scholar
• Kotronen A, Westerbacka J, Bergholm R, Pietilainen KH, Yki-Jarvinen H. Liver fat in the metabolic syndrome. J Clin Endocrinol Metab. 2007;92(9):3490–7. https://doi.org/10.1210/jc.2007-0482.
  Article CAS PubMed Google Scholar
• Stahl EP, Dhindsa DS, Lee SK, Sandesara PB, Chalasani NP, Sperling LS. Nonalcoholic fatty liver disease and the heart: JACC State-of-the-Art Review. J Am Coll Cardiol. 2019;73(8):948–63. https://doi.org/10.1016/j.jacc.2018.11.050.
  Article PubMed Google Scholar
• •• Stefan N, Häring H-U, Cusi K. Non-alcoholic fatty liver disease: causes, diagnosis, cardiometabolic consequences, and treatment strategies. Lancet Diabetes Endocrinol. 2019;7(4):313–24. https://doi.org/10.1016/S2213-8587(18)30154-2. (This paper provided a comprehensive overview of the current knowledge surrounding non-alcoholic fatty liver disease with a focus on cardiometabolic health.)
  Article PubMed Google Scholar
• • Mantovani A, Petracca G, Beatrice G, Tilg H, Byrne CD, Targher G. Non-alcoholic fatty liver disease and risk of incident diabetes mellitus: an updated meta-analysis of 501 022 adult individuals. Gut. 2021;70(5):962–9. https://doi.org/10.1136/gutjnl-2020-322572. (This meta-analysis revealed that the risk of incident type 2 diabetes increases with non-alcoholic fatty liver disease severity.)
  Article CAS PubMed Google Scholar
• •• Lauridsen BK, Stender S, Kristensen TS, Kofoed KF, Kober L, Nordestgaard BG, et al. Liver fat content, non-alcoholic fatty liver disease, and ischaemic heart disease: Mendelian randomization and meta-analysis of 279 013 individuals. Eur Heart J. 2018;39(5):385–93. https://doi.org/10.1093/eurheartj/ehx662. (This meta-analysis revealed that confounding factors such as excess visceral adiposity are most likely responsible for the known association between liver fat content and ischaemic heart disease.)
  Article CAS PubMed Google Scholar
• Targher G, Byrne CD. Non-alcoholic fatty liver disease: an emerging driving force in chronic kidney disease. Nat Rev Nephrol. 2017;13(5):297–310. https://doi.org/10.1038/nrneph.2017.16.
  Article CAS PubMed Google Scholar
• Tejani S, McCoy C, Ayers CR, Powell-Wiley TM, Després JP, Linge J, et al. Cardiometabolic health outcomes associated with discordant visceral and liver fat phenotypes: insights from the Dallas Heart Study and UK Biobank. Mayo Clin Proc. 2022;97(2):225–37. https://doi.org/10.1016/j.mayocp.2021.08.021. (This study provided evidence of the distinct cardiometabolic consequences of heterogenous ectopic adiposity phenotypes.)
• Chait A, den Hartigh LJ. Adipose tissue distribution, inflammation and its metabolic consequences, including diabetes and cardiovascular disease. Front Cardiovasc Med. 2020;7:22. https://doi.org/10.3389/fcvm.2020.00022.
  Article CAS PubMed PubMed Central Google Scholar
• Addison O, Marcus RL, Lastayo PC, Ryan AS. Intermuscular fat: a review of the consequences and causes. Int J Endocrinol. 2014;2014: 309570. https://doi.org/10.1155/2014/309570.
  Article CAS PubMed PubMed Central Google Scholar
• Maltais A, Alméras N, Lemieux I, Tremblay A, Bergeron J, Poirier P, et al. Trunk muscle quality assessed by computed tomography: association with adiposity indices and glucose tolerance in men. Metabolism. 2018;85:205–12. https://doi.org/10.1016/j.metabol.2018.04.003.
  Article CAS PubMed Google Scholar
• Kelley DE, Goodpaster BH. Skeletal muscle triglyceride. An aspect of regional adiposity and insulin resistance. Diabetes Care. 2001;24(5):933–41. https://doi.org/10.2337/diacare.24.5.933.
  Article CAS PubMed Google Scholar
• Therkelsen KE, Pedley A, Speliotes EK, Massaro JM, Murabito J, Hoffmann U, et al. Intramuscular fat and associations with metabolic risk factors in the Framingham Heart Study. Arterioscler Thromb Vasc Biol. 2013;33(4):863–70. https://doi.org/10.1161/ATVBAHA.112.301009.
  Article CAS PubMed PubMed Central Google Scholar
• Dubé MC, Lemieux S, Piché ME, Corneau L, Bergeron J, Riou ME, et al. The contribution of visceral adiposity and mid-thigh fat-rich muscle to the metabolic profile in postmenopausal women. Obesity (Silver Spring). 2011;19(5):953–9. https://doi.org/10.1038/oby.2010.348.
  Article Google Scholar
• Goodpaster BH, Krishnaswami S, Resnick H, Kelley DE, Haggerty C, Harris TB, et al. Association between regional adipose tissue distribution and both type 2 diabetes and impaired glucose tolerance in elderly men and women. Diabetes Care. 2003;26(2):372–9. https://doi.org/10.2337/diacare.26.2.372.
  Article PubMed Google Scholar
• • Ballin M, Nordstrom P, Niklasson J, Nordstrom A. Associations of visceral adipose tissue and skeletal muscle density with incident stroke, myocardial infarction, and all-cause mortality in community-dwelling 70-year-old individuals: a prospective cohort study. J Am Heart Assoc. 2021;10(9):e020065. https://doi.org/10.1161/JAHA.120.020065. (This study suggested that excess muscle fat might not be associated with an increased cardiovascular risk after controling for visceral obesity.)
  Article PubMed PubMed Central Google Scholar
• Foster MC, Hwang SJ, Porter SA, Massaro JM, Hoffmann U, Fox CS. Fatty kidney, hypertension, and chronic kidney disease: the Framingham Heart Study. Hypertension. 2011;58(5):784–90. https://doi.org/10.1161/HYPERTENSIONAHA.111.175315.
  Article CAS PubMed Google Scholar
• de Vries AP, Ruggenenti P, Ruan XZ, Praga M, Cruzado JM, Bajema IM, et al. Fatty kidney: emerging role of ectopic lipid in obesity-related renal disease. Lancet Diabetes Endocrinol. 2014;2(5):417–26. https://doi.org/10.1016/S2213-8587(14)70065-8.
  Article CAS PubMed Google Scholar
• Noels H, Lehrke M, Vanholder R, Jankowski J. Lipoproteins and fatty acids in chronic kidney disease: molecular and metabolic alterations. Nat Rev Nephrol. 2021;17(8):528–42. https://doi.org/10.1038/s41581-021-00423-5.
  Article CAS PubMed Google Scholar
• Steven S, Hollingsworth KG, Small PK, Woodcock SA, Pucci A, Aribisala B, et al. Weight loss decreases excess pancreatic triacylglycerol specifically in type 2 diabetes. Diabetes Care. 2016;39(1):158–65. https://doi.org/10.2337/dc15-0750.
  Article CAS PubMed Google Scholar
• Wong VW, Wong GL, Yeung DK, Abrigo JM, Kong AP, Chan RS, et al. Fatty pancreas, insulin resistance, and β-cell function: a population study using fat-water magnetic resonance imaging. Am J Gastroenterol. 2014;109(4):589–97. https://doi.org/10.1038/ajg.2014.1.
  Article CAS PubMed Google Scholar
• Kozawa J, Shimomura I. Ectopic fat accumulation in pancreas and heart. J Clin Med. 2021;10(6):1326. https://doi.org/10.3390/jcm10061326.
  Article CAS PubMed PubMed Central Google Scholar
• Unger RH. Lipotoxicity in the pathogenesis of obesity-dependent NIDD. Genetic and clinical implications. Diabetes. 1995;44(8):863–70. https://doi.org/10.2337/diab.44.8.863.
  Article CAS PubMed Google Scholar
• Piché ME, Poirier P, Lemieux I, Després JP. Overview of epidemiology and contribution of obesity and body fat distribution to cardiovascular disease: an update. Prog Cardiovasc Dis. 2018;61(2):103–13. https://doi.org/10.1016/j.pcad.2018.06.004.
  Article PubMed Google Scholar
• Neeland IJ, Poirier P, Després JP. Cardiovascular and metabolic heterogeneity of obesity: clinical challenges and implications for management. Circulation. 2018;137(13):1391–406. https://doi.org/10.1161/CIRCULATIONAHA.117.029617.
  Article PubMed PubMed Central Google Scholar
• Chaston TB, Dixon JB. Factors associated with percent change in visceral versus subcutaneous abdominal fat during weight loss: findings from a systematic review. Int J Obes (Lond). 2008;32(4):619–28. https://doi.org/10.1038/sj.ijo.0803761.
  Article CAS Google Scholar
• Kay SJ, Fiatarone Singh MA. The influence of physical activity on abdominal fat: a systematic review of the literature. Obes Rev. 2006;7(2):183–200. https://doi.org/10.1111/j.1467-789X.2006.00250.x.
  Article CAS PubMed Google Scholar
• Merlotti C, Ceriani V, Morabito A, Pontiroli AE. Subcutaneous fat loss is greater than visceral fat loss with diet and exercise, weight-loss promoting drugs and bariatric surgery: a critical review and meta-analysis. Int J Obes (Lond). 2017;41(5):672–82. https://doi.org/10.1038/ijo.2017.31.
  Article CAS Google Scholar
• Ohkawara K, Tanaka S, Miyachi M, Ishikawa-Takata K, Tabata I. A dose-response relation between aerobic exercise and visceral fat reduction: systematic review of clinical trials. Int J Obes (Lond). 2007;31(12):1786–97. https://doi.org/10.1038/sj.ijo.0803683.
  Article CAS Google Scholar
• Sabag A, Way KL, Keating SE, Sultana RN, O’Connor HT, Baker MK, et al. Exercise and ectopic fat in type 2 diabetes: a systematic review and meta-analysis. Diabetes Metab. 2017;43(3):195–210. https://doi.org/10.1016/j.diabet.2016.12.006.
  Article CAS PubMed Google Scholar
• Verheggen RJ, Maessen MF, Green DJ, Hermus AR, Hopman MT, Thijssen DH. A systematic review and meta-analysis on the effects of exercise training versus hypocaloric diet: distinct effects on body weight and visceral adipose tissue. Obes Rev. 2016;17(8):664–90. https://doi.org/10.1111/obr.12406.
  Article CAS PubMed Google Scholar
• Hammond BP, Brennan AM, Ross R. Exercise and adipose tissue redistribution in overweight and obese adults. In: Lukaski HC, editor. Body composition: health and performance in exercise and sport. Boca Raton: CRC Press; 2017. p. 109–28.
  Chapter Google Scholar
• O’Neill T, Shalev-Goldman E, Ross R. Caloric restriction and/or increasing exercise in the management of obesity. In: Hansen D, editor. Exercise therapy in adult individuals with obesity. Hauppauge: Nova Science Publishers; 2013. p. 43–72.
  Google Scholar
• Lee S, Kuk JL, Davidson LE, Hudson R, Kilpatrick K, Graham TE, et al. Exercise without weight loss is an effective strategy for obesity reduction in obese individuals with and without type 2 diabetes. J Appl Physiol. 2005;99(3):1220–5. https://doi.org/10.1152/japplphysiol.00053.2005.
  Article PubMed Google Scholar
• Ross R, Dagnone D, Jones PJ, Smith H, Paddags A, Hudson R, et al. Reduction in obesity and related comorbid conditions after diet-induced weight loss or exercise-induced weight loss in men. A randomized, controlled trial. Ann Intern Med. 2000;133(2):92–103. https://doi.org/10.7326/0003-4819-133-2-200007180-00008.
  Article CAS PubMed Google Scholar
• Borel AL, Nazare JA, Smith J, Alméras N, Tremblay A, Bergeron J, et al. Visceral and not subcutaneous abdominal adiposity reduction drives the benefits of a 1-year lifestyle modification program. Obesity (Silver Spring). 2012;20(6):1223–33. https://doi.org/10.1038/oby.2011.396.
  Article CAS Google Scholar
• • Rao S, Pandey A, Garg S, Park B, Mayo H, Després JP, et al. Effect of exercise and pharmacological interventions on visceral adiposity: a systematic review and meta-analysis of long-term randomized controlled trials. Mayo Clin Proc. 2019;94(2):211–24. https://doi.org/10.1016/j.mayocp.2018.09.019. (This study added to the evidence that weight loss is a misleading outcome in assessing the effectiveness of exercise interventions in the management of visceral obesity.)
  Article CAS PubMed Google Scholar
• Ross R, Soni S, Houle SA. Negative energy balance induced by exercise or diet: effects on visceral adipose tissue and liver fat. Nutrients. 2020;12(4):891. https://doi.org/10.3390/nu12040891.
  Article CAS PubMed Central Google Scholar
• Yaskolka Meir A, Rinott E, Tsaban G, Zelicha H, Kaplan A, Rosen P, et al. Effect of green-Mediterranean diet on intrahepatic fat: the DIRECT PLUS randomised controlled trial. Gut. 2021;70(11):2085–95. https://doi.org/10.1136/gutjnl-2020-323106.
  Article CAS PubMed Google Scholar
• Pirlet C, Poirier P, Cieza T, Piché ME, Biertho L, Maes F, et al. Clinical impact of weight-loss pharmacotherapy in patients with atherosclerotic cardiovascular disease. Am J Cardiovasc Drugs. 2021;21(3):271–81. https://doi.org/10.1007/s40256-020-00428-8.
  Article PubMed Google Scholar
• Di Marzo V, Després JP. CB1 antagonists for obesity–what lessons have we learned from rimonabant? Nat Rev Endocrinol. 2009;5(11):633–8. https://doi.org/10.1038/nrendo.2009.197.
  Article CAS PubMed Google Scholar
• Ghosh RK, Ghosh GC, Gupta M, Bandyopadhyay D, Akhtar T, Deedwania P, et al. Sodium glucose co-transporter 2 inhibitors and heart failure. Am J Cardiol. 2019;124(11):1790–6. https://doi.org/10.1016/j.amjcard.2019.08.038.
  Article CAS PubMed Google Scholar
• Marso SP, Bain SC, Consoli A, Eliaschewitz FG, Jodar E, Leiter LA, et al. Semaglutide and cardiovascular outcomes in patients with type 2 diabetes. N Engl J Med. 2016;375(19):1834–44. https://doi.org/10.1056/NEJMoa1607141.
  Article CAS PubMed Google Scholar
• Zelniker TA, Wiviott SD, Raz I, Im K, Goodrich EL, Bonaca MP, et al. SGLT2 inhibitors for primary and secondary prevention of cardiovascular and renal outcomes in type 2 diabetes: a systematic review and meta-analysis of cardiovascular outcome trials. Lancet. 2019;393(10166):31–9. https://doi.org/10.1016/S0140-6736(18)32590-X.
  Article CAS PubMed Google Scholar
• Bethel MA, Patel RA, Merrill P, Lokhnygina Y, Buse JB, Mentz RJ, et al. Cardiovascular outcomes with glucagon-like peptide-1 receptor agonists in patients with type 2 diabetes: a meta-analysis. Lancet Diabetes Endocrinol. 2018;6(2):105–13. https://doi.org/10.1016/S2213-8587(17)30412-6.
  Article PubMed Google Scholar
• Després JP. Predicting longevity using metabolomics: a novel tool for precision lifestyle medicine? Nat Rev Cardiol. 2020;17(2):67–8. https://doi.org/10.1038/s41569-019-0310-2.
  Article CAS PubMed Google Scholar
• Lévesque V, Poirier P, Després JP, Alméras N. Relation between a simple lifestyle risk score and established biological risk factors for cardiovascular disease. Am J Cardiol. 2017;120(11):1939–46. https://doi.org/10.1016/j.amjcard.2017.08.008.
  Article CAS PubMed Google Scholar
• Cerhan JR, Moore SC, Jacobs EJ, Kitahara CM, Rosenberg PS, Adami H-O, et al. A pooled analysis of waist circumference and mortality in 650,000 adults. Mayo Clin Proc. 2014;89(3):335–45. https://doi.org/10.1016/j.mayocp.2013.11.011.
  Article PubMed Google Scholar
• Nazare JA, Smith J, Borel AL, Aschner P, Barter P, Van Gaal L, et al. Usefulness of measuring both body mass index and waist circumference for the estimation of visceral adiposity and related cardiometabolic risk profile (from the INSPIRE ME IAA study). Am J Cardiol. 2015;115(3):307–15. https://doi.org/10.1016/j.amjcard.2014.10.039.
  Article PubMed Google Scholar
• •• Ross R, Neeland IJ, Yamashita S, Shai I, Seidell J, Magni P, et al. Waist circumference as a vital sign in clinical practice: a consensus statement from the IAS and ICCR Working Group on Visceral Obesity. Nat Rev Endocrinol. 2020;16(3):177–89. https://doi.org/10.1038/s41574-019-0310-7. (This consensus statement stressed the importance of measuring waist circumference in clinical practice in order to improve cardiometabolic risk assessment and management.)
  Article PubMed PubMed Central Google Scholar
• Lemieux I, Pascot A, Couillard C, Lamarche B, Tchernof A, Alméras N, et al. Hypertriglyceridemic waist: a marker of the atherogenic metabolic triad (hyperinsulinemia; hyperapolipoprotein B; small, dense LDL) in men? Circulation. 2000;102(2):179–84. https://doi.org/10.1161/01.cir.102.2.179.
  Article CAS PubMed Google Scholar
• Ross R, Blair SN, Arena R, Church TS, Després JP, Franklin BA, et al. Importance of assessing cardiorespiratory fitness in clinical practice: a case for fitness as a clinical vital sign: a Scientific Statement from the American Heart Association. Circulation. 2016;134(24):e653–99. https://doi.org/10.1161/CIR.0000000000000461.
  Article PubMed Google Scholar
• Mandsager K, Harb S, Cremer P, Phelan D, Nissen SE, Jaber W. Association of cardiorespiratory fitness with long-term mortality among adults undergoing exercise treadmill testing. JAMA Netw Open. 2018;1(6):e183605. https://doi.org/10.1001/jamanetworkopen.2018.3605.
  Article PubMed PubMed Central Google Scholar
• Lavie CJ, De Schutter A, Milani RV. Healthy obese versus unhealthy lean: the obesity paradox. Nat Rev Endocrinol. 2015;11(1):55–62. https://doi.org/10.1038/nrendo.2014.165.
  Article PubMed Google Scholar
• Borel AL, Nazare JA, Baillot A, Alméras N, Tremblay A, Bergeron J, et al. Cardiometabolic risk improvement in response to a 3-yr lifestyle modification program in men: contribution of improved cardiorespiratory fitness vs. weight loss. Am J Physiol Endocrinol Metab. 2017;312(4):E273–81. https://doi.org/10.1152/ajpendo.00278.2016.
  Article PubMed Google Scholar
• Chartrand DJ, Larose E, Poirier P, Mathieu P, Alméras N, Pibarot P, et al. Visceral adiposity and liver fat as mediators of the association between cardiorespiratory fitness and plasma glucose-insulin homeostasis. Am J Physiol Endocrinol Metab. 2020;319(3):E548–56. https://doi.org/10.1152/ajpendo.00251.2020.
  Article CAS PubMed Google Scholar
• Ross R, Katzmarzyk PT. Cardiorespiratory fitness is associated with diminished total and abdominal obesity independent of body mass index. Int J Obes Relat Metab Disord. 2003;27(2):204–10. https://doi.org/10.1038/sj.ijo.802222.
  Article CAS PubMed Google Scholar
• Janssen I, Katzmarzyk PT, Ross R, Leon AS, Skinner JS, Rao DC, et al. Fitness alters the associations of BMI and waist circumference with total and abdominal fat. Obes Res. 2004;12(3):525–37. https://doi.org/10.1038/oby.2004.60.
  Article PubMed Google Scholar
• Church TS, Kuk JL, Ross R, Priest EL, Biltoft E, Blair SN. Association of cardiorespiratory fitness, body mass index, and waist circumference to nonalcoholic fatty liver disease. Gastroenterology. 2006;130(7):2023–30. https://doi.org/10.1053/j.gastro.2006.03.019.
  Article CAS PubMed Google Scholar
• Kantartzis K, Thamer C, Peter A, Machann J, Schick F, Schraml C, et al. High cardiorespiratory fitness is an independent predictor of the reduction in liver fat during a lifestyle intervention in non-alcoholic fatty liver disease. Gut. 2009;58(9):1281–8. https://doi.org/10.1136/gut.2008.151977.
  Article CAS PubMed Google Scholar
• Grundy SM, Stone NJ, Bailey AL, Beam C, Birtcher KK, Blumenthal RS, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the management of blood cholesterol: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2019;73(24):e285–350. https://doi.org/10.1016/j.jacc.2018.11.003.
  Article PubMed Google Scholar
• Mach F, Baigent C, Catapano AL, Koskinas KC, Casula M, Badimon L, et al. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Eur Heart J. 2020;41(1):111–88. https://doi.org/10.1093/eurheartj/ehz455.
  Article PubMed Google Scholar
• Mozaffarian D. Dietary and policy priorities for cardiovascular disease, diabetes, and obesity: a comprehensive review. Circulation. 2016;133(2):187–225. https://doi.org/10.1161/CIRCULATIONAHA.115.018585.
  Article CAS PubMed PubMed Central Google Scholar
• Liu AG, Ford NA, Hu FB, Zelman KM, Mozaffarian D, Kris-Etherton PM. A healthy approach to dietary fats: understanding the science and taking action to reduce consumer confusion. Nutr J. 2017;16(1):53. https://doi.org/10.1186/s12937-017-0271-4.
  Article CAS PubMed PubMed Central Google Scholar
• Lichtenstein AH, Appel LJ, Vadiveloo M, Hu FB, Kris-Etherton PM, Rebholz CM, et al. Dietary guidance to improve cardiovascular health: a scientific statement from the American Heart Association. Circulation. 2021;2021:CIR0000000000001031. https://doi.org/10.1161/CIR.0000000000001031.
  Article Google Scholar
• Sotos-Prieto M, Bhupathiraju SN, Mattei J, Fung TT, Li Y, Pan A, et al. Association of changes in diet quality with total and cause-specific mortality. N Engl J Med. 2017;377(2):143–53. https://doi.org/10.1056/NEJMoa1613502.
  Article PubMed PubMed Central Google Scholar
• Kirkpatrick CF, Maki KC. Dietary influences on atherosclerotic cardiovascular disease risk. Curr Atheroscler Rep. 2021;23(10):62. https://doi.org/10.1007/s11883-021-00954-z.
  Article PubMed Google Scholar
• Vadiveloo M, Lichtenstein AH, Anderson C, Aspry K, Foraker R, Griggs S, et al. Rapid diet assessment screening tools for cardiovascular disease risk reduction across healthcare settings: a scientific statement from the American Heart Association. Circ Cardiovasc Qual Outcomes. 2020;13(9):e000094. https://doi.org/10.1161/HCQ.0000000000000094.
  Article PubMed Google Scholar
• •• Estruch R, Ros E, Salas-Salvado J, Covas MI, Corella D, Aros F, et al. Primary prevention of cardiovascular disease with a Mediterranean diet supplemented with extra-virgin olive oil or nuts. N Engl J Med. 2018;378(25): e34. https://doi.org/10.1056/NEJMoa1800389. (This landmark study demonstrated the importance of diet quality in the management of cardiometabolic risk in high-risk individuals with overweight/obesity.)
  Article CAS PubMed Google Scholar
• Buteau-Poulin D, Poirier P, Després JP, Alméras N. Assessing nutritional quality as a “vital sign” of cardiometabolic health. Br J Nutr. 2019;122(2):195–205. https://doi.org/10.1017/S0007114519001016.
  Article CAS PubMed Google Scholar
• Amil S, Lemieux I, Poirier P, Lamarche B, Després JP, Alméras N. Targeting diet quality at the workplace: influence on cardiometabolic risk. Nutrients. 2021;13(7):2283. https://doi.org/10.3390/nu13072283.
  Article CAS PubMed PubMed Central Google Scholar
• Fletcher GF, Landolfo C, Niebauer J, Ozemek C, Arena R, Lavie CJ. Promoting physical activity and exercise: JACC Health Promotion Series. J Am Coll Cardiol. 2018;72(14):1622–39. https://doi.org/10.1016/j.jacc.2018.08.2141.
  Article PubMed Google Scholar
• Myers J, McAuley P, Lavie CJ, Després JP, Arena R, Kokkinos P. Physical activity and cardiorespiratory fitness as major markers of cardiovascular risk: their independent and interwoven importance to health status. Prog Cardiovasc Dis. 2015;57(4):306–14. https://doi.org/10.1016/j.pcad.2014.09.011.
  Article PubMed Google Scholar
• Silsbury Z, Goldsmith R, Rushton A. Systematic review of the measurement properties of self-report physical activity questionnaires in healthy adult populations. BMJ Open. 2015;5(9):e008430. https://doi.org/10.1136/bmjopen-2015-008430.
  Article PubMed PubMed Central Google Scholar
• Lobelo F, Rohm Young D, Sallis R, Garber MD, Billinger SA, Duperly J, et al. Routine assessment and promotion of physical activity in healthcare settings: a scientific statement from the American Heart Association. Circulation. 2018;137(18):e495–522. https://doi.org/10.1161/CIR.0000000000000559.
  Article PubMed Google Scholar
• Ekelund U, Tarp J, Steene-Johannessen J, Hansen BH, Jefferis B, Fagerland MW, et al. Dose-response associations between accelerometry measured physical activity and sedentary time and all cause mortality: systematic review and harmonised meta-analysis. BMJ. 2019;366:l4570. https://doi.org/10.1136/bmj.l4570.
  Article PubMed PubMed Central Google Scholar
• Saint-Maurice PF, Troiano RP, Berrigan D, Kraus WE, Matthews CE. Volume of light versus moderate-to-vigorous physical activity: similar benefits for all-cause mortality? J Am Heart Assoc. 2018;7(7):e008815. https://doi.org/10.1161/JAHA.118.008815.
  Article PubMed PubMed Central Google Scholar