Visceral and ectopic fat, atherosclerosis, and cardiometabolic disease: a position statement (original) (raw)
Related papers
Impact of increased visceral and cardiac fat on cardiometabolic risk and disease
Diabetic Medicine, 2012
Objective Previous studies have highlighted the associations between abdominal, cardiac or total fat accumulation and cardiovascular disease. The aim of this study was to investigate the impact of different ectopic fat depots on measurements of metabolic dysfunction and cardiovascular disease risk. Methods Using magnetic resonance imaging in 113 subjects, we measured abdominal (visceral and subcutaneous) and cardiac (epicardial and extra-pericardial) fat depots and examined their association with overall (BMI) and abdominal obesity (waist circumference), dyslipidaemia (triglycerides, total and HDL cholesterol), glucose tolerance (by an oral glucose tolerance test) and insulin sensitivity, blood pressure and 10-year coronary heart disease risk by Framingham score. Results Fat accumulation was proportional to the degree of obesity, with body fat ranging from 14 to 33 kg, visceral fat from 0.8 to 1.8 kg and cardiac fat from 134 to 236 g. Most cardiac fat (70% on average) was extra-pericardial, with a wide variability for both cardiac depots (epicardial: 172-2008 mm 2 ; extra-pericardial: 100-5056 mm 2). Only visceral and extra-pericardial fat, but not epicardial or subcutaneous fat, could discriminate between subjects with three or more factors of the metabolic syndrome or medium-to-high coronary heart disease risk score. Controlling for gender and BMI by multivariable analysis, the best marker of reduced insulin sensitivity was visceral fat (partial r =)0.35); extra-pericardial fat was the closest associate of increased blood pressure (partial r = 0.26) and both extra-pericardial and visceral fat clustered with hypertriglyceridaemia (partial r = 0.29 and 0.24; both P < 0.02). Conclusion Increased epicardial fat per se does not necessarily translate into presence or prediction of disease. In contrast, increased deposition of visceral abdominal and extra-pericardial mediastinal fat are both associated with an enhanced cardiovascular disease risk profile.
Ectopic fat deposition and global cardiometabolic risk: New paradigm in cardiovascular medicine
The Journal of Medical Investigation, 2013
The obesity epidemic is a global public health concern that increases the likelihood of morbidity and mortality of metabolic and cardiovascular disease (CVD) and threatens to reduce life expectancy around the world. The concept of the metabolic syndrome (MetS) takes into account that visceral fat plays an essential role in the development of metabolic and cardiovascular diseases. However, MetS cannot be used to assess global CVD risk but is at best one more modifiable CVD risk factor. Thus, global cardiometabolic risk (the global risk of cardiovascular disease resulting from traditional risk factors combined with the additional contribution of the metabolic syndrome and/or insulin resistance) should be considered individually. There is solid evidence supporting the notion that excess abdominal fat is predictive of insulin resistance and the presence of related metabolic abnormalities currently referred to as MetS. Despite the fact that abdominal obesity is a highly prevalent feature of MetS, the mechanisms by which abdominal obesity is causally related to MetS are not fully elucidated. Besides visceral fat accumulation, ectopic lipid deposition, especially in liver and skeletal muscle, has been implicated in the pathophysiology of diabetes, insulin resistance and obesity-related disorders. Also, ectopic fat deposition could be deteriorated in the heart components such as (1) circulatory and locally recruited fat, (2) intra-and extra-myocellular fat, (3) perivascular fat, and (4) pericardial fat. In this review, the contribution of ectopic lipid deposition to global cardiometabolic risk is reviewed and also discussed are potential underlying mechanisms including adipocytokine, insulin resistance and lipotoxicity.
Ectopic fat assessment focusing on cardiometabolic and renal risk
Endocrinology and metabolism (Seoul, Korea), 2014
It is well known that people with high levels of body fat are at higher risk for developing diabetes mellitus, kidney disease, and cardiovascular disorders. Since individuals who are slightly overweight, or even individuals of normal weight, can vary in body fat distribution, their metabolic profiles and the degree of association of these profiles with cardiometabolic risk factors may differ. Fat distribution might be more of a predictive factor for cardiorenometabolic risk than obesity itself, which has led researchers to investigate whether ectopic fat accumulation may partially account for the development of cardiorenometabolic disorders. In addition to visceral obesity, fat can accumulate in the liver and muscle, and these intrahepatic and intramuscular lipid stores are associated with insulin resistance and adverse metabolic phenotypes. More recently, pericardial fat, perivascular fat, and perirenal fat were found to be associated with coronary atherosclerosis, cardiovascular d...
Ectopic fat: the true culprit linking obesity and cardiovascular disease?
Thrombosis and Haemostasis, 2013
SummaryObesity is a major risk factor for cardiovascular disease and its complications. However, not all fat depots share the same characteristics. Recent studies have found that ectopic rather than subcutaneous fat accumulation is associated with increased cardiometabolic risk. However, ectopic fat accumulation can be seen initially as a protective mechanism against lipotoxicity. Subsequently the adipose tissue becomes dysfunctional, thus inducing systemic metabolic alterations (through release of cytokines) or specific organ dysfunctions. The purpose of this review is to summarise the current available data on the impact of excess adiposity vs ectopic fat in the development of cardiometabolic diseases.
Predictors of Ectopic Fat Accumulation in Liver and Pancreas in Obese Men and Women
Obesity, 2011
The aim of the present study was to determine the relationship between body fat distribution, adipocytokines, inflammatory markers, fat intake and ectopic fat content of liver and pancreas in obese men and women. A total of 12 lean subjects (mean age 47.25 ± 14.88 years and mean BMI 22.85 ± 2), 38 obese subjects (18 men and 20 women) with mean age 49.1 ± 13.0 years and mean BMI 34.96 ± 4.21 kg/m 2 were studied. Measurements: weight, height, BMI, waist circumference, as well as glucose, insulin, HOMA (homeostasis model assessment of insulin resistance), cholesterol, triglycerides, high-density lipoprotein cholesterol, high sensitivity C-reactive protein, daily energy intake, leptin, and adiponectin. Magnetic resonance was used to evaluate visceral, subcutaneous adipose tissue (SCAT) as well as liver and pancreas lipid content using in-phase and out-of-phase magnetic resonance imaging (MRI) sequence. Obese subjects had significantly higher weight, waist circumference, SCAT, deep SCAT, visceral adipose tissue (VAT), liver and pancreatic lipid content than lean subjects. Obese women had significantly lower VAT, liver and pancreas lipid content regardless of same BMI. In multiple regression analyses, the variance of liver lipid content explained by gender and VAT was 46%. When HOMA was added into a multiple regression, a small increase in the proportion of variance explained was observed. A 59.2% of the variance of pancreas lipid content was explained by gender and VAT. In conclusion, obese men show higher VAT and ectopic fat deposition in liver and pancreas than obese women despite same BMI. Independent of overall adiposity, insulin resistance, adiponectin and fat intake, VAT, measured with MRI, is the main predictor of ectopic fat deposition in both liver and pancreas.
The Missing Risk: MRI and MRS Phenotyping of Abdominal Adiposity and Ectopic Fat
Obesity, 2012
Individual compartments of abdominal adiposity and lipid content within the liver and muscle are differentially associated with metabolic risk factors, obesity and insulin resistance. Subjects with greater intra-abdominal adipose tissue (IAAT) and hepatic fat than predicted by clinical indices of obesity may be at increased risk of metabolic diseases despite their “normal” size. There is a need for accurate quantification
Revista espanola de cardiologia (English ed.), 2016
Obesity is an important cardiovascular risk factor and the location of fat deposits seems to be an important determinant of its metabolic impact. Visceral adipose tissue (VAT) exerts a harmful effect on metabolic homeostasis, but few longitudinal studies have evaluated the prognostic impact of the ratio of VAT to subcutaneous adipose tissue (SAT). This study aimed to evaluate whether the VAT/SAT ratio was associated with all-cause mortality and cardiac events. Registry-based retrospective cohort study. Eligible patients consisted of those without known heart disease referred to cardiac computed tomography (CT) angiography to evaluate suspected coronary artery disease (CAD). We included all patients with available information on VAT and SAT areas and coronary artery calcium (CAC) score. We assessed the combined endpoint of all-cause mortality, myocardial infarction or revascularization procedure at least 1 month after cardiac CT. The final population consisted of 713 participants (61...
The Journal of Clinical Endocrinology & Metabolism, 2009
Context: Epicardial adipose tissue (EAT) is a metabolically active visceral fat depot. Its distribution is asymmetrical and primarily concentrated in the grooves. To date, it remains unclear which measurement of EAT best reflects its metabolic risk. Objective: We aimed to examine the correlations between various multidetector computed tomographic measurements of EAT, metabolic syndrome components, and plasma levels of highsensitivity C-reactive protein and adipokines. Design, Setting, and Participants: This study included 148 consecutive patients undergoing multidetector computed tomography prior to diagnostic coronary angiography. Thickness in the grooved segments, cross-sectional areas, and total volume of EAT were measured. The cross-sectional areas of sc and visceral abdominal fat depots were additionally measured in 70 randomly selected patients. Results: Thickness of EAT in the left atrioventricular groove was the only EAT measurement significantly correlated with all three metabolic syndrome components (blood pressure, lipid, and glucose components) and plasma levels of resistin and high-sensitivity C-reactive protein after age and gender adjustments. The association between left atrioventricular groove thickness and increasing number of metabolic syndrome components remained significant after additional adjustments for body mass index, waist circumference, and intraabdominal visceral fat area. By using the receiver operating characteristic analysis, the optimal cutoff point for left atrioventricular groove thickness to predict the presence of at least two metabolic syndrome components was 12.4 mm. Conclusions: A simple measurement of EAT thickness in the left atrioventricular groove may provide a more accurate assessment of metabolic risk associated with EAT, which could not be accounted for by anthropometric indexes and intraabdominal visceral fat. (J Clin Endocrinol Metab 94: 662-669, 2009) O besity often coexists with several metabolic risk factors, including hypertension, atherogenic dyslipidemia, and impaired glucose tolerance, which together are referred to as the metabolic syndrome (1, 2). The metabolic syndrome confers an increased risk of major cardiovascular events not only in individuals without known heart disease, but also in those with established atherosclerotic cardiovascular diseases (3-5). Adipocytes and surrounding adipose tissue are known to mediate the
Atherosclerosis, 2010
Visceral abdominal fat has been associated to cardiovascular risk factors and coronary artery disease (CAD). Computed tomography (CT) coronary angiography is an emerging technology allowing detection of both obstructive and nonobstructive CAD adding information to clinical risk stratification. The aim of this study was to evaluate the association between CAD and adiposity measurements assessed clinically and by CT. We prospectively evaluated 125 consecutive subjects (57% men, age 56.0 ± 12 years) referred to perform CT angiography. Clinical and laboratory variables were determined and CT angiography and abdominal CT were performed in a 64-slice scanner. CAD was defined as any plaque calcified or not detected by CT angiography. Visceral and subcutaneous adiposity areas were determined at different intervertebral levels. CT angiography detected CAD in 70 (56%) subjects, and no association was found with usual anthropometric adiposity measurements (waist and hip circumferences and body mass index). Otherwise, CT visceral fat areas (VFA) were significantly related to CAD. VFA T12-L1 values ≥145 cm 2 had an odds ratio of 2.85 (95% CI 1.30-6.26) and VFA L4-L5 ≥150 cm 2 had a 2.87-fold (95% CI 1.31-6.30) CAD risk. The multivariate analysis determined age and VFA T12-L1 as the only independent variables associated to CAD. Visceral fat assessed by CT is an independent marker of CAD determined by CT angiography.