Point: visceral adiposity is causally related to insulin resistance.
نویسندگان
چکیده
Related to Insulin Resistance The relationship between obesity and insulin resistance, while well recognized for many years, has nonetheless been confusing since not all obese individuals have insulin resistance (1) and because insulin resistance occurs in individuals who have BMIs that are within the normal or mildly overweight categories (2). Early attempts to understand the relationships between obesity, type 2 diabetes, and cardiovascular disease focused on the waist-to-hip ratio as a means of distinguishing those individuals who were at increased risk from those who were not (3,4). A high waist-to-hip ratio is a surrogate for masculine distribution of obesity (central obesity). Cross-sectional studies by Kissebah et al. (5) and Krotkiewski et al. (6) in the 1980s demonstrated that hypertension, hypertriglyceridemia, hyperinsulinemia, and glucose intolerance were increased in subjects with a high waist-to-hip ratio. Long-term longitudinal population-based studies of men (13.5 years) and women (12 years) in Gothenburg, Sweden, showed that the waist-to-hip ratio was a predictor of the future development of diabetes, myocardial infarction, angina pectoris, stroke, and death independent of BMI (3,4). Technology developed in the 1990s, including computer tomography scans and MRI, made it possible to precisely measure specific adipose tissue depots such as total body adipose tissue mass, abdominal subcutaneous adipose tissue mass, visceral adipose tissue mass, and hepatic and intramuscular triglyceride content (7,8). Utilizing those techniques, many studies have examined the relationship between total adipose tissue, abdominal subcutaneous adipose tissue, and visceral adipose tissue mass and insulin resistance, the components of the metabolic syndrome, and the development of type 2 diabetes or clinical cardiovascular events (9–21). Despite the much smaller size of the visceral adipose tissue depot compared with the total subcutaneous adipose tissue depot or total adiposity, many investigations demonstrated that the visceral adipose tissue mass and not the subcutaneous or total adipose tissue mass was significantly correlated in multivariate analyses with insulin resistance, type 2 diabetes, and cardiovascular events (9 – 11,13,14,16,19,20). The hypothesis that visceral adiposity and not total adiposity was the cause of the components and clinical consequences of the metabolic syndrome has been challenged by several studies that found either that abdominal subcutaneous adipose tissue mass and not visceral adipose tissue mass was independently correlated with insulin resistance or that they were both equally correlated (8,12,17,18,21). Studies using isotopic techniques have calculated that the majority of circulating free fatty acids are derived from peripheral adipose tissue (22) and that if free fatty acids are postulated to be responsible for the insulin resistance associated with obesity, then total adiposity rather than visceral adiposity should be responsible for insulin resistance. Several lines of evidence support the hypothesis that visceral adipose tissue and not subcutaneous adipose tissue is the major contributor in causing insulin resistance and the metabolic syndrome. They are discussed in the below sections.
منابع مشابه
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Background: Considering the limited population-based studies and lack of a general consensus on the most sensitive and precise predictor of insulin resistance and metabolic syndrome in the women with polycystic ovary syndrome (PCOS), the present study was performed with the aim of comparing the validity of various available adiposity markers in these patients. Methods: In the national and popul...
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Obesity, especially visceral adiposity, is a major determinant of the development of type 2 diabetes. Both visceral adiposity and insulin resistance are strongly related to cardiovascular risk factors in diabetic and non-diabetic subjects. One of the areas where the correlation between visceral fat (upper body adiposity) and cardiovascular risk is most apparent is the prediabetic state. We have...
متن کاملCounterpoint: visceral adiposity is not causally related to insulin resistance.
Causally Related to Insulin Resistance I t has been known for over half a century that accumulation of fat in the upper body is associated with metabolic complications of obesity. The mechanism responsible for this association is widely believed to be insulin resistance, which is frequently present in individuals with upper-body obesity (1) and is associated with increased cardiovascular risk (...
متن کاملAdiposity markers and insulin resistance in type 1 diabetes patients
Background Obesity is associated with risk of clinical and metabolic complications such as dyslipidemia, hypertension and diabetes. Previous studies have demonstrated that visceral obesity is related to type 2 diabetes, cardiovascular disease and insulin resistance (IR). This study aims to evaluate the relationship between different markers of body adiposity and IR in adults with type 1 diabete...
متن کاملVisceral adiposity, not abdominal subcutaneous fat area, is associated with an increase in future insulin resistance in Japanese Americans.
OBJECTIVE Visceral adiposity is generally considered to play a key role in the metabolic syndrome. We sought to determine whether greater visceral adiposity directly measured by computed tomography (CT) is associated with increased future insulin resistance independent of other adipose depots. RESEARCH DESIGN AND METHODS We followed 306 nondiabetic Japanese Americans over 10-11 years. Baselin...
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ورودعنوان ژورنال:
- Diabetes care
دوره 28 9 شماره
صفحات -
تاریخ انتشار 2005