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"Role of abdominal fat distribution in determining insulin sensitivity and other features of the metabolic syndrome"

Prof. Steven Kahn (biography)
English - 2002-04-27 - 35 minutes
(52 slides)

Summary :
It is well recognized that insulin resistance is a feature of a number of conditions and forms a basis for the metabolic syndrome, sometimes referred to as the insulin resistance syndrome. Obesity is also associated with insulin resistance as well as a number of other features of the metabolic syndrome. The relationship of body size and a number of measures of abdominal fat distribution with insulin sensitivity were examined in a large cohort of subjects. This analysis revealed that intra-abdominal fat is a major determinant of insulin sensitivity while body mass index and the waist:hip ratio are less so. In contrast to intra-abdominal fat, subcutaneous fat is the major determinant of leptin levels. As both obesity and insulin resistance have been associated with an atherogenic lipid profile, the contribution of these two parameters to plasma lipoproteins was also looked at. While there is strong co-linearity between intra-abdominal fat and insulin sensitivity, intra-abdominal fat is the more important determinant of the atherogenic lipid profile observed by density gradient ultracentrifugation. In summary, body fat distribution is a major determinant of a number of features related to the metabolic syndrome. When considering abdominal fat, intra-abdominal fat plays a critical role in determining insulin sensitivity and an atherogenic lipid profile, while subcutaneous fat is the major determinant of leptin levels.

Learning objectives :
Data is presented showing how body fat distribution is a major determinant of a number of features related to the metabolic syndrome. Focus on intra-abdominal fat and its role in determining insulin sensitivity.

Bibliographic references :
Insulin resistance and fat patterning with aging: relationship to metabolic risk factors for cardiovascular disease.

Cefalu WT, Werbel S, Bell-Farrow AD, Terry JG, Wang ZQ, Opara EC, Morgan T, Hinson WH, Crouse JR 3rd.

Department of Internal Medicine, Bowman Gray School of Medicine, Wake Forest University, Winston-Salem, NC 27157-1047, USA.

Both insulin resistance and abdominal fat patterning are related to aging, and have been related to cardiovascular disease (CVD) risk factors such as dyslipidemia and hypertension. However, previous studies have not used direct methods to quantify the independent strength of the association of each of these two putative primary factors with metabolic outcomes. We quantified overall obesity by the body mass index (BMI) and used a previously validated magnetic resonance imaging (MRI) method to quantify abdominal fat in 63 healthy nondiabetic individuals aged 22 to 83 years. We also measured the glucose and insulin response to an oral glucose tolerance test and the insulin sensitivity ([SI] by modified minimal model analysis). Body fat patterning was evaluated by the waist to hip ratio (WHR) and by MRI, which allowed direct measurement of subcutaneous (SCF) and intraabdominal (IAF) fat depots at the umbilicus in these subjects. These independent parameters were related to risk factors for CVD (blood pressure, lipids, and lipoproteins) and to plasma concentrations of free fatty acids (FFAs). Measures of overall obesity (BMI), total fat [TF], and/or SCF measured at the abdomen by MRI), glucose/insulin metabolism and SI, and central fat patterning (WHR or IAF measured by MRI) were correlated with mean arterial pressure (MAP), triglyceride (TG), and high-density lipoprotein cholesterol (HDL-C) levels in univariate analysis and after controlling for age and gender. An index of central fat patterning (WHR) added to the informativeness of the insulin area under the curve (IAUC) in explaining 24% of the variability in plasma TG concentration, but measures of overall obesity were not independently related. Both the BMI and TF contributed to the IAUC in explaining 32% to 34% of the variability in MAP, but central fat patterning was not independently related. No index of overall obesity, fat patterning, glucose/insulin metabolism, and/or SI, was independently related to the plasma concentration of HDL-C after controlling for any one of the other two. Direct measurement of glucose/insulin metabolism and SI, as well as fat patterning, provides information on their relative associations with CVD risk factors. The measures of glucose/insulin metabolism and SI were more consistently related to dyslipidemia and hypertension than were the overall obesity and fat patterning in this healthy population.

Metabolism 1998 Apr;47(4):401-8


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