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High Visceral and Low Abdominal Subcutaneous Fat Stores in the Obese Adolescent A Determinant of an Adverse Metabolic Phenotype

Published on Feb 1, 2008in Diabetes 7.20
· DOI :10.2337/db07-0932
Sara E. Taksali19
Estimated H-index: 19
,
Sonia Caprio65
Estimated H-index: 65
+ 10 AuthorsRam Weiss33
Estimated H-index: 33
Cite
Abstract
OBJECTIVE— To explore whether an imbalance between the visceral and subcutaneous fat depots and a corresponding dysregulation of the adipokine milieu is associated with excessive accumulation of fat in the liver and muscle and ultimately with insulin resistance and the metabolic syndrome. RESEARCH DESIGN AND METHODS— We stratified our multi-ethnic cohort of 118 obese adolescents into tertiles based on the proportion of abdominal fat in the visceral depot. Abdominal and liver fat were measured by magnetic resonance imaging and muscle lipid (intramyocellular lipid) by proton magnetic resonance spectroscopy. RESULTS— There were no differences in age, BMI Z score, or fat-free mass across tertiles. However, as the proportion of visceral fat increased across tertiles, BMI and percentage of fat and subcutaneous fat decreased, while hepatic fat increased. In addition, there was an increase in 2-h glucose, insulin, c-peptide, triglyceride levels, and insulin resistance. Notably, both leptin and total adiponectin were significantly lower in tertile 3 than 1, while C-reactive protein and interleukin-6 were not different across tertiles. There was a significant increase in the odds ratio for the metabolic syndrome, with subjects in tertile 3 5.2 times more likely to have the metabolic syndrome than those in tertile 1. CONCLUSIONS— Obese adolescents with a high proportion of visceral fat and relatively low abdominal subcutaneous fat have a phenotype reminiscent of partial lipodystrophy. These adolescents are not necessarily the most severely obese, yet they suffer from severe metabolic complications and are at a high risk of having the metabolic syndrome.
  • References (22)
  • Citations (244)
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References22
Newest
Published on Mar 1, 2008in Magnetic Resonance in Medicine 3.86
Hyeonjin Kim5
Estimated H-index: 5
(Yale University),
Sara E. Taksali19
Estimated H-index: 19
(Yale University)
+ 6 AuthorsR. Todd Constable81
Estimated H-index: 81
(Yale University)
Hepatic fat fraction (HFF) was measured in 28 lean/obese humans by single-voxel proton spectroscopy (MRS), a two-point Dixon (2PD) and a three-point iterative decomposition of water and fat with echo asymmetry and least-squares estimation (IDEAL) method (3PI). For the lean, obese and total subject groups, the range of HFF measured by MRS was 0.3–3.5% (1.1±1.4%), 0.3–41.5% (11.7±12.1), and 0.3–41.5% (10.1±11.6%), respectively For the same groups, the HFF measured by 2PD was −6.3–2.2% (−2.0±3.7%),...
Published on Jun 27, 2007in PLOS ONE 2.78
David Liska1
Estimated H-index: 1
(Yale University),
Sylvie Dufour15
Estimated H-index: 15
(Yale University)
+ 6 AuthorsSonia Caprio65
Estimated H-index: 65
(Yale University)
The prevalence of insulin resistance and type 2 diabetes (T2D) in obese youth is rapidly increasing, especially in Hispanics and African Americans compared to Caucasians. Insulin resistance is known to be associated with increases in intramyocellular (IMCL) and hepatic fat content. We determined if there are ethnic differences in IMCL and hepatic fat content in a multiethnic cohort of 55 obese adolescents. We used 1H magnetic resonance spectroscopy (MRS) to quantify IMCL levels in the soleus mus...
Published on May 3, 2007in Diabetologia 7.11
Xiaolin Yang8
Estimated H-index: 8
(Sahlgrenska University Hospital),
Ulf Smith83
Estimated H-index: 83
(Sahlgrenska University Hospital)
The relative effect of visceral and subcutaneous obesity on the risk of chronic metabolic disease has been a matter of long-term dispute. While ample data support either of the fat depots being causative or associative, valid argument for one depot often automatically belittles the other. Paradigms such as the visceral/portal hypothesis and the acquired lipodystrophy/ectopic fat storage and endocrine hypothesis have been proposed. Nevertheless, neither hypothesis alone explains the entire pathop...
Published on Nov 1, 2006in The Journal of Clinical Endocrinology and Metabolism 5.61
Tania S. Burgert14
Estimated H-index: 14
,
Sara E. Taksali19
Estimated H-index: 19
+ 9 AuthorsMary Savoye24
Estimated H-index: 24
Findings: Elevated ALT (35 U/liter) was found in 14% of adolescents, with a predominance of male gender and white/Hispanic race/ ethnicity. After adjusting for potential confounders, rising ALT was associated with reduced insulin sensitivity and glucose tolerance as well as rising free fatty acids and triglycerides. Worsening of glucose and lipid metabolism was already evident as ALT levels rose into the upper half of the normal range (18–35 U/liter). When hepatic fat fraction was assessed using...
Published on Jan 24, 2006in Annals of the New York Academy of Sciences 4.29
Eric Ravussin16
Estimated H-index: 16
(Pennington Biomedical Research Center),
Steven R. Smith71
Estimated H-index: 71
(Pennington Biomedical Research Center)
Abstract: It is widely accepted that increasing adiposity is associated with insulin resistance and increased risk of type 2 diabetes. The predominant paradigm used to explain this link is the portal/visceral hypothesis. This hypothesis proposes that increased adiposity, particularly in the visceral depots, leads to increased free fatty acid flux and inhibition of insulin action via Randle's effect in insulin-sensitive tissues. Recent data do not entirely support this hypothesis. As such, two ne...
Published on Jan 1, 2006in Annals of Medicine 3.05
Jean-Pierre Després110
Estimated H-index: 110
Despite the fact that controversy remains around the underlying pathophysiological processes leading to the development of the metabolic syndrome (insulin resistance and/or hyperinsulinemia versus abdominal obesity), there is increased recognition that abdominal obesity is the most prevalent form of the metabolic syndrome. Although it has been well established that there is a greater prevalence of chronic metabolic diseases such as diabetes and cardiovascular diseases in obese patients than amon...
Published on Jan 1, 2006in Diabetes 7.20
Cristina Lara-Castro15
Estimated H-index: 15
,
Nanlan Luo13
Estimated H-index: 13
+ 2 AuthorsW. Garvey54
Estimated H-index: 54
Adiponectin circulates in human plasma mainly as a 180-kDa low molecular weight (LMW) hexamer and a high molecular weight (HMW) multimer of ∼360 kDa. We comprehensively examined the relationships between circulating levels of total adiponectin, adiponectin multimers, and the relative distribution (i.e., ratio) of multimeric forms with key features of the metabolic syndrome. Total adiponectin ( r = 0.45), HMW ( r = 0.47), LMW ( r = 0.31), and HMW-to-total adiponectin ratio ( r = 0.29) were signif...
Published on Jan 1, 2005in Gut 17.94
Susanne Kaser30
Estimated H-index: 30
,
Alexander R. Moschen41
Estimated H-index: 41
+ 6 AuthorsHerbert Tilg71
Estimated H-index: 71
Background: Adiponectin, an adipocyte derived polypeptide, has been shown to alleviate steatosis and inflammation in mice with non-alcoholic fatty liver disease. Aim: In the present study, we wished to define liver expression of adiponectin and its receptors in morbidly obese patients undergoing bariatric surgery. Patients with non-alcoholic steatohepatitis (NASH) or simple steatosis were investigated to test whether dysregulation of this system might be involved in these disorders. Patients and...
Published on Jun 3, 2004in The New England Journal of Medicine 70.67
Ram Weiss33
Estimated H-index: 33
,
James Dziura57
Estimated H-index: 57
+ 9 AuthorsJohn H. Morrison109
Estimated H-index: 109
background The prevalence and magnitude of childhood obesity are increasing dramatically. We examined the effect of varying degrees of obesity on the prevalence of the metabolic syndrome and its relation to insulin resistance and to C-reactive protein and adiponectin levels in a large, multiethnic, multiracial cohort of children and adolescents. methods We administered a standard glucose-tolerance test to 439 obese, 31 overweight, and 20 nonobese children and adolescents. Baseline measurements i...
Published on Mar 1, 2004in The Journal of Clinical Endocrinology and Metabolism 5.61
Catherine W. Yeckel13
Estimated H-index: 13
,
Ram Weiss33
Estimated H-index: 33
+ 5 AuthorsSonia Caprio65
Estimated H-index: 65
Given the extreme increase in prediabetes, type 2 diabetes, and the potential for metabolic syndrome in obese youth, identifying simplified indexes for assessing stimulated insulin sensitivity is critical. The purpose of this study was validation of two surrogate indexes of insulin sensitivity determined from the oral glucose tolerance test (OGTT): the composite whole body insulin sensitivity index (WBISI) and the insulin sensitivity index (ISI). An obese population (aged 8–18 yr) of normal and ...
Cited By244
Newest
Published on Jan 1, 2019in Frontiers in Endocrinology 3.63
Ebe D'Adamo8
Estimated H-index: 8
,
Valeria Castorani , Valerio Nobili49
Estimated H-index: 49
(Sapienza University of Rome)
Non-alcoholic fatty liver disease (NAFLD) is recognized as an emerging health risk in obese children and adolescents. NAFLD represents a wide spectrum of liver conditions, ranging from asyntomatic steatosis to steatohepatitis. The growing prevalence of fatty liver disease in children is associated with an increased risk of metabolic and cardiovascular complications. NAFLD is considered the hepatic manifestation of Metabolic Syndrome (MetS) and several lines of evidence have reported that childre...
Sarah Cuschieri5
Estimated H-index: 5
(University of Malta)
Abstract Aim Type 2 diabetes (T2DM) is a complex disease. Interactions between genetic susceptible variants and environmental cues results in the development of this heterogenous disease. Having an understanding of the genetics of T2DM may lead to a better perspective and management of the pathogenesis contributing to T2DM. Materials and methods Published primary and secondary sources were reviewed covering the keywords “genetics + type 2 diabetes” using PubMed and Google Scholar as the main dat...
Published on Jun 1, 2019in Clinical Nutrition 6.40
Kan Sun6
Estimated H-index: 6
(SYSU: Sun Yat-sen University),
Diaozhu Lin7
Estimated H-index: 7
(SYSU: Sun Yat-sen University)
+ 5 AuthorsDan Liu6
Estimated H-index: 6
(SYSU: Sun Yat-sen University)
Summary Background The effects of visceral fat accumulation on the renal damage have drawn much attention. We aimed to investigate the possible relationship between visceral adiposity and albuminuria. Methods We included information from a population-based study in 9473 subjects aged 40 years or older. As a novel and valid indicator for visceral adipose function, visceral adiposity index (VAI) was determined by gender-specific equations and calculated using simple anthropometric and functional p...
Published on Jun 1, 2019in Diabetes 7.20
Jessica Nouws4
Estimated H-index: 4
(Yale University),
Mark Fitch17
Estimated H-index: 17
(University of California, Berkeley)
+ 9 AuthorsGerald I. Shulman142
Estimated H-index: 142
(Yale University)
Patterns of abdominal fat distribution (for example, a high vs. low visceral adipose tissue [VAT]/[VAT + subcutaneous adipose tissue (SAT)] ratio), independent of obesity, during adolescence carry a high risk for insulin resistance and type 2 diabetes. Longitudinal follow-up of a cohort of obese adolescents has recently revealed that a high ratio (high VAT/[VAT + SAT]) is a major determinant of fatty liver and metabolic impairment over time, with these effects being more pronounced in girls than...
Published on Jun 1, 2019in Diabetes Research and Clinical Practice 3.24
Masanori Iwanishi8
Estimated H-index: 8
,
Toru Kusakabe15
Estimated H-index: 15
+ 6 AuthorsKen Ebihara2
Estimated H-index: 2
(Jichi Medical University)
Abstract Aims The present report aimed to clarify the clinical characteristics in a girl at the age of 12 and her mother with partial lipodystrophy and Type A insulin resistance syndrome. Methods We examined fat distribution in the patients using dual-energy X-ray absorptiometry, magnetic resonance imaging, and computed tomography. We performed genetic analysis to examine the causal gene for lipodystrophy and insulin resistance. Results Both patients had partial lipodystrophy and a novel heteroz...
Published on Apr 1, 2019in International Journal of Obesity 4.51
Giuseppina Rosaria Umano4
Estimated H-index: 4
(Yale University),
Veronika Shabanova9
Estimated H-index: 9
(Yale University)
+ 6 AuthorsSonia Caprio65
Estimated H-index: 65
(Yale University)
The relative proportion of visceral fat (VAT) to subcutaneous fat (SAT) has been described as a major determinant of insulin resistance (IR). Our study sought to evaluate the effect of body fat distribution on glucose metabolism and intrahepatic fat content over time in a multiethnic cohort of obese adolescents. We examined markers of glucose metabolism by oral glucose tolerance test, and body fat distribution by abdominal MRI at baseline and after 19.2 ± 11.4 months in a cohort of 151 obese ado...
Published on Feb 1, 2019in European Journal of Clinical Nutrition 3.11
Sochung Chung10
Estimated H-index: 10
(Konkuk University)
The prevalence of obesity is increasing over the world. Especially in Asians compared to Caucasians, there has been a significant increase in the population with major chronic diseases. This has developed over a shorter time period which is associated with socioeconomic changes in recent decades and a greater predisposition to cardiometabolic disorders. Many Asians could be classified has having normal weight but with obesity as evidenced by body composition (BC) and fat distribution. Overweight...
Published on Feb 1, 2019in Acta Diabetologica 3.00
Emilia Hagman6
Estimated H-index: 6
(HUJI: Hebrew University of Jerusalem),
Omri Besor1
Estimated H-index: 1
(Boston Children's Hospital)
+ 5 AuthorsRam Weiss33
Estimated H-index: 33
(Boston Children's Hospital)
Aims In this study, we investigated whether adipose tissue insulin resistance (IR) is affected by the degree of obesity during the fasting and post-prandial state, independent of glucose tolerance among obese children and adolescents. We also tested whether systemic subclinical inflammation is associated with adipose tissue IR.
Published on Jan 1, 2019
Sean Wharton2
Estimated H-index: 2
(UM: University of Michigan),
Christy Costanian (UM: University of Michigan)+ 1 AuthorsRebecca A.G. Christensen2
Estimated H-index: 2
(UPenn: University of Pennsylvania)
The prevalence of obesity has been increasing globally. Due to the negative health effects, obesity has been recognized as a major public health concern. Obesity is defined as a body mass index (BMI) of greater than or equal to 30 kg/m2. The location (i.e., abdominal) and type of excess weight contribute to ill-health; thus methods such as waist circumference and body fat measurements are used in the assessment of obesity. In relation to obesity and type 2 diabetes (T2D), genetics, physical acti...
Paulina Cruz1
Estimated H-index: 1
(WashU: Washington University in St. Louis),
Andrea Granados2
Estimated H-index: 2
(WashU: Washington University in St. Louis)
Latino youth have the highest prevalence of overweight and obesity among all ethnic groups and are disproportionally affected by pre diabetes and type 2 diabetes (T2DM). Interventions that effectively reduce the risk of pre diabetes and T2DM in this population are urgently needed. Studies have shown that without any change, 50% of Latino children and adolescents will develop T2DM. This has important public health implications. Few pharmacologic options are approved for use in the pediatric popul...