Visceral adiposity syndrome and cardiometabolism
Abstract
The distribution of fat in the human body is related to hemodynamic and metabolic homeostasis. Brown fat is inversely related to body mass index and is associated with a lower probability of developing diabetes. Beige adipose tissue shares some functional characteristics with brown adipose tissue. White adipose tissue constitutes the majority of the fatty tissue and is mainly distributed in the subcutaneous and abdominal cavity. Intra-abdominal white fat has gained prominence in recent years for its association with cardiovascular risk factors and higher cardiovascular mortality. This review article discusses the human adaptation in the environment, a sympathovagal and hypothalamic-pituitary-adrenal imbalance as a possible cause of increased visceral adiposity and its consequences on cardiometabolism.
References
Cannon WB, De La Paz D. Emotional stimulation of adrenal secretion. Am J Physiol 1911;28:64-70.
Cameron AJ, Shaw JE, Zimmet PZ. The metabolic syndrome: prevalence in worldwide populations. Endocrinol Metab Clin North Am 2004 Jun;33(2):351-75.
Lopes HF, Correa‑Giannella ML, Consolim‑Colombo FM, Egan BM. Visceral adiposity syndrome. Diabetol Metab Syndr 2016;8:1-8.
Leitnera BP, Huanga S, Brychtaa RJ, Duckwortha CJ, Baskina AS, McGeheea S, et al. Mapping of human brown adipose tissue in lean and obese young men. PNAS 2017;114:8649–54.
Cypess AM, Lehman S, Williams G, Tal I, Rodman D, Goldfine AB, et al. Identification and importance of brown adipose tissue in adult humans. N Engl J Med 2009;360:1509-17.
Vijgen GHEJ, Bouvy ND, Teule GJJ, Brans B, Hoeks J, Schrauwen P, et al. Increase in brown adipose tissue activity after weight loss in morbidly obese subjects. J Clin Endocrinol Metab 2012 Jul;97(7):E1229-33.
Lidell ME, Betz MJ, Enerback S. Brown adipose tissue and its therapeutic potential. J Intern Med 2014;276:364–77.
Petrovic N, Walden TB, Shabalina IG, Timmons JA, Cannon B, Nedergaard J. Chronic peroxisome proliferator-activated receptor gamma (PPARgamma) activation of epididymally derived white adipocyte cultures reveals a population of thermogenically competent, UCP1-containing adipocytes molecularly distinct from classic brown adipocytes. J Biol Chem 2010;285:7153–64.
Wu J, Cohen P, Spiegelman BM. Adaptive thermogenesis in adipocytes: is beige the new brown? Genes Dev 2013 Feb 1;27(3):234-50.
Shao M, Wang QA, Song A, Vishvanath L, Busbuso NC, Scherer PE, et al. Cellular origins of beige fat cells revisited. Diabetes 2019;68:1874–85.
Shao M, Gupta RK. Transcriptional brakes on the road to adipocyte thermogenesis. Biochim Biophys Acta Mol Cell Biol Lipids 2019;1864:20–8.
Deprès J-P, Moorjani S, Ferland M, Tremblay A, Lupien PJ, Nadeau A, et al. Adipose tissue distribution and plasma lipoprotein levels in obese women: importance of intra-abdominal fat. Arterioscler Thromb Vasc Biol 1989;9:203-10.
Ibrahim MM. Subcutaneous and visceral adipose tissue: structural and functional differences. Obes Rev 2010;11:11-8.
Dusserre E, Moulin P, Vidal H. Differences in mRNA expression of the proteins secreted by the adipocytes in human subcutaneous and visceral adipose tissues. Biochim Biophys Acta 2000 Jan 3;1500(1):88-96.
Linder K, Arner P, Flores-Morales A, Tollet-Egnell P, Norstedt G. Differentially expressed genes in visceral or subcutaneous adipose tissue of obese men and women. J Lipid Res 2004 Jan;45(1):148-54.
Reaven GM. Banting lecture 1988. Role of insulin resistance in human disease. Diabetes 1988 Dec;37(12):1595-607.
Enzi G, Busetto L, Inelmen EM, Coin A, Sergi G. Historical perspective: visceral obesity and related comorbidity in Joannes Baptista Morgagni’s De sedibus et causis morborum per anatomen indagata. Int J Obes Relat Metab Disord 2003;27:534–5.
Preble WE. Obesity: observations on one thousand cases. Boston Med Surg J 1923;188:617–21.
Vague J. The degree of masculine differentiation of obesities: a factor determining predisposition to diabetes, atherosclerosis, gout, and uric calculous disease. Am J Clin Nutr 1956;4:20–34.
Alberti KG, Zimmet PZ. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus: provisional report of a WHO consultation. Diabet Med 1998;15:539–53.
Balkau B, Charles MA. Comment on the provisional report from the WHO consultation: European group for the study of insulin resistance (EGIR). Diabet Med 1999;16:442–3.
Expert panel on detection, evaluation, and treatment of high blood cholesterol in adults. Executive summary of The third report of the national cholesterol education program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). JAMA 2001 May 16;285(19):2486-97.
Alberti KG, Zimmet P, Shaw J. The metabolic syndrome—a new worldwide definition. IDF epidemiology task force consensus group. Lancet 2005;366:1059–62.
Ishizaka N, Ishizaka Y, Toda E-I, Nagai R, Yamakado M. Association between serum uric acid, metabolic syndrome, and carotid atherosclerosis in Japanese individuals. Arterioscler Thromb Vasc Biol 2005;25:1038-44.
Ryo M, Nakamura T, Kihara S, Kumada M, Shibazaki S, Takahashi M, et al. Adiponectin as a biomarker of the metabolic syndrome. Circ J 2004;68:975-81.
Matsuzawa Y, Funahashi T, Kihara S, Shimomura I. Adiponectin and metabolic syndrome. Arterioscler Thromb Vasc Biol 2004;24:29-33.
Whitehead JP, Richards AA, Hickman IJ, Macdonald GA, Prins JB. Adiponectin-a key adipokine in the metabolic syndrome. Diabetes Obes Metab 2006 May;8(3):264-80.
Lambert EA, Straznicky NE, Dixon JB, Lambert GW. Should the sympathetic nervous system be a target to improve cardiometabolic risk in obesity? Am J Physiol Heart Circ Physiol 2015;309: H244-H258.
Grassi G, Biffi A, Seravalle G, Trevano FQ, Dell’Oro R, Corrao G, et al. Sympathetic neural overdrive in the obese and overweight state meta-analysis of published studies. Hypertension 2019;74:349-58.
Björntorp P. Do stress reactions cause abdominal obesity and comorbidities? Obes Rev 2001 May;2(2):73-86.
Tentolouris N, Liatis S, Katsilambros N. Sympathetic system activity in obesity and metabolic syndrome. Ann N Y Acad Sci 2006 Nov;1083:129-52.
Lopes HF, Bortolotto LA, Szlejf C, Kamitsuji CS, Krieger EM. Hemodynamic and metabolic profile in offspring of malignant hypertensive parents. Hypertension 2001;38:616-20.
Feber J, Ruzicka M, Geier P, Litwin M. Autonomic nervous system dysregulation in pediatric hypertension. Curr Hypertens Rep 2014;16:426.
Thorp AA, Schlaich MP. Relevance of sympathetic nervous system activation in obesity and metabolic syndrome. J Diabetes Res 2015;2015:341583. doi: 10.1155/2015/341583.
Julius S, Gudbrandsson T, Jamerson K, Andersson O. The interconnection between sympathetics, microcirculation, and insulin resistance in hypertension. Blood Press 1992 May;1(1):9-19.
Pollare T, Lithell H, Selinus I, Berne C. Application of prazosin is associated with an increase of insulin sensitivity in obese patients with hypertension. Diabetologia 1988 Jul;31(7):415-20.
Grassi G, Dell'Oro R, Quarti-Trevano F, Scopelliti F, Seravalle G, Paleari F, et al. Neuroadrenergic and reflex abnormalities in patients with metabolic syndrome. Diabetologia 2005 Jul;48(7):1359-65.
Gil JS, Drager LF, Guerra-Riccio GM, Mostarda C, Irigoyen MC, Costa-Hong V, et al. The impact of metabolic syndrome on metabolic, pro-inflammatory and prothrombotic markers according to the presence of high blood pressure criterion. Clinics (Sao Paulo) 2013 Dec;68(12):1495-501.
Lopes HF, Consolim-Colombo FM, Barreto-Filho JAS, Riccio GMG, Negrão CE, Krieger EM. Increased sympathetic activity in normotensive offspring of malignant hypertensive parents compared to offspring of normotensive parents. Braz J Med Biol Res 2008;41:849-53.
Noll G, Wenzel RR, Schneider M, Oesch V, Binggeli C, Shaw S, et al. Increased activation of sympathetic nervous system and endothelin by mental stress in normotensive offspring of hypertensive parents. Circulation 1996 Mar 1;93(5):866-9.
Grassi G, Ram VS. Evidence for a critical role of the sympathetic nervous system in hypertension. J Am Soc Hypertens 2016;10(5):457-66.
Gamboa A, Figueroa R, Paranjape SY, Farley G, Diedrich A, Biaggioni I. Autonomic blockade reverses endothelial dysfunction in obesity-associated hypertension. Hypertension 2016;68:1004-10.
Schlaich MP, Kaye DM, Lambert E, Sommerville M, Socratous F, Esler MD. Relation between cardiac sympathetic activity and hypertensive left ventricular hypertrophy. Circulation 2003 Aug 5;108(5):560-5.
Head RJ. Hypernoradrenergic innervation: its relationship to functional and hyperplastic changes in the vasculature of the spontaneously hypertensive rat. Blood Vessels 1989;26(1):1-20.
Stephens N, Heagert AM. The sympathetic nervous system and small artery neuroeffector function in hypertension. Vascular Medicine Review 1994;5:73-91.
Griendling KK, Ushio-Fukai M, Lassègue B, Alexander RW. Angiotensin II signaling in vascular smooth muscle. New concepts. Hypertension 1997 Jan;29(1 Pt 2):366-73.
Luke A, Adeyemo A, Kramer H, Forrester T, Cooper RS. Association between blood pressure and resting energy expenditure independent of body size. Hypertension 2004;43:555-60.
Ali N, Mahmood S, Manirujjaman M, Perveen R, Al Nahid A, Ahmed S, et al. Hypertension prevalence and influence of basal metabolic rate on blood pressure among adult students in Bangladesh. BMC Public Health 2017 Jul 25;18(1):58.
Simonson E, Brozek J. Russian research on arterial hypertension. Ann Intern Med 1959;50:129-93.
Ibrahim MM. Subcutaneous and visceral adipose tissue: structural and functional differences. Obes Rev 2010;11:11-8.
Melzer K. Carbohydrate and fat utilization during rest and physical activity. e-SPEN, the European e-Journal of Clinical Nutrition and Metabolism 6 2011;e45-e52.
Luke A, Adeyemo A, Kramer H, Forrester T, Cooper RS. Association between blood pressure and resting energy expenditure independent of body size. Hypertension 2004;43:555-60.
Ali N, Mahmood S, Manirujjaman M, Perveen R, Al Nahid A, Ahmed S, et al. Hypertension prevalence and influence of basal metabolic rate on blood pressure among adult students in Bangladesh. BMC Public Health 2017 Jul 25;18(1):58.
Motta E Motta J, Souza LN, Vieira BB, Delle H, Consolim-Colombo FM, Egan BM, et al. Acute physical and mental stress resulted in an increase in fatty acids, norepinephrine, and hemodynamic changes in normal individuals: A possible pathophysiological mechanism for hypertension-Pilot study. J Clin Hypertens (Greenwich) 2021 Apr;23(4):888-94.
Boden G. Role of fatty acids in the pathogenesis of insulin resistance and NIDDM. Diabetes 1997 Jan;46(1):3-10.
Chueire VB, Muscelli E. Effect of free fatty acids on insulin secretion, insulin sensitivity and incretin effect - a narrative review. Arch Endocrinol Metab 2020 Dec 15:2359-3997000000313.
Randle PJ, Garland PB, Hales CN, Newsholme EA. The glucose fatty-acid cycle. Its role in insulin sensitivity and the metabolic disturbances of diabetes mellitus. Lancet 1963;1:785–9.
Soroosh GP, Dzaye O, Reiter-Brennan C, Blaha MJ. Cardiometabolic medicine: a review of the current proposed approaches to revamped training in the United States. Cardiovascular Endocrinology & Metabolism 2021; Volume publish ahead of print. doi:10.1097/XCE.0000000000000243.
Alvarez GE, Beske SD, Ballard TP, Davy KP. Sympathetic neural activation in visceral obesity. Circulation 2002 Nov 12;106(20):2533-6.
Hillebrand S, Mutsert R, Christen T, Maan AC, Jukema JW, Lamb HJ, et al. Body fat, especially visceral fat, is associated with electrocardiographic measures of sympathetic activation. Obesity 2014;22:1553–9.
31. Tentolouris N, Liatis S, Katsilambros N. Sympathetic system activity in obesity and metabolic syndrome. Ann N Y Acad Sci 2006 Nov;1083:129-52.
Bjorntorp P. Body fat distribution, insulin resistance, and metabolic diseases. Nutrition 1997;13:795-803.
Hucking K, Hamilton-Wessler M, Ellmerer M, Bergman RN. Burst-like control of lipolysis by the sympathetic nervous system in vivo. J Clin Invest 2003;111:257–64.
Kreier F, Fliers E, Voshol PJ, Van Eden CG, Havekes LM, Kalsbeek A, et al. Selective parasympathetic innervation of subcutaneous and intra-abdominal fat--functional implications. J Clin Invest 2002 Nov;110(9):1243-50.
Romijn JA, Fliers E. Sympathetic and parasympathetic innervation of adipose tissue: metabolic implications. Curr Opin Clin Nutr Metab Care 2005 Jul;8(4):440-4.
Trayhurn P, Wood IS. Adipokines: inflammation and pleiotropic role of white adipose tissue. Br J Nutr 2004;92:347-55.
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).