Elsevier

Ageing Research Reviews

Volume 12, Issue 4, September 2013, Pages 996-1004
Ageing Research Reviews

Review
Should visceral fat be reduced to increase longevity?

https://doi.org/10.1016/j.arr.2013.05.007Get rights and content

Highlights

  • •

    We have tried to answer to some questions on the association of obesity and visceral fat with health risks.

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    We examine studies with an association or correlation between obesity, visceral fat and morbidity.

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    We examine that correlation does not necessarily indicate causality.

  • •

    We have showed a significant positive association between VAT and all-cause mortality.

  • •

    We discussed the need of reducing the visceral fat as a potential treatment strategy to prevent or delay age-related diseases and to increase longevity.

Abstract

Several epidemiologic studies have implicated visceral fat as a major risk factor for insulin resistance, type 2 diabetes mellitus, cardiovascular disease, stroke, metabolic syndrome and death. Utilizing novel models of visceral obesity, numerous studies have demonstrated that the relationship between visceral fat and longevity is causal while the accrual of subcutaneous fat does not appear to play an important role in the etiology of disease risk. Specific recommended intake levels vary based on a number of factors, including current weight, activity levels, and weight loss goals. It is discussed the need of reducing the visceral fat as a potential treatment strategy to prevent or delay age-related diseases and to increase longevity.

Introduction

The prevalence of overweight (body mass index > 25) and obesity (body mass index > 30) has reached epidemic proportions in most of the developed world. Obesity increases the risk for several co-morbidities including type 2 diabetes (T2DM) (Monzillo et al., 2003), stroke (States et al., 2009), cardiovascular disease (CVD) (Tarantino et al., 2012), and metabolic syndrome (MetS) (Tarantino et al., 2009), the further expression of which is hepatic steatosis. The risks associated with obesity have been extended to cancer (Calle et al., 2003, Donohoe et al., 2011) including, prostate (Freedland and Platz, 2007), breast (Protani et al., 2010), liver (Kawai et al., 2011), kidney (Renehan et al., 2008), colon (Dignam et al., 2006), ovarian (Bandera et al., 2009), and endometrial cancers (Chia et al., 2007).

Section snippets

Visceral fat and disease risk

The fundamental cause of obesity is a long-term imbalance in energy intake and expenditure (i.e., positive energy balance) leading to the increased body mass including the accumulation of subcutaneous and visceral fat. Although general obesity is an important risk factor for many diseases, several human studies have demonstrated that visceral fat accrual, which is the fat located in the viscera, as most strongly related to many health conditions, including CVD, insulin resistance and T2DM (Carr

Epidemiologic studies

The ability to prevent or delay the onset of disease is a critical determinant of lifespan. Some diseases are not treatable or preventable and have an inheritable component of risk. However, the leading causes of death and co-morbidities in humans, including CVD, stroke and T2DM are age-related conditions that can be largely prevented or delayed by lifestyle interventions (Selwyn, 2007). Epidemiologic studies have revealed that a common yet preventable risk factor for these diseases is the

Liposuction of subcutaneous fat

Several studies have reported on the metabolic consequences of surgically removing large quantities of subcutaneous fat by liposuction. The general premise of these studies is that absolute fat mass is the most important contributor to obesity-related complications such that large-scale removal of abdominal subcutaneous fat should improve several metabolic parameters including insulin sensitivity. Results from these studies have been contradictory, some of them showing beneficial effects of

Visceral fat and mortality risk

Several studies have reported that obesity, generally defined as a BMI > 30, increases the risk of disease specific and all-cause mortality (Davey Smith et al., 2009, Ryan, 2010, Bender et al., 1999, Wong et al., 2011) and reduces life expectancy (Finkelstein et al., 2010). Obesity has not only been linked to a reduced life expectancy but also to accelerated aging as demonstrated by obese women having telomeres that were 240 bp shorter lean women of a similar age (Valdes et al., 2005).

Since

Visceral fat and global cardiometabolic risk

Excess weight, particularly abdominal obesity, causes or exacerbates cardiovascular and metabolic risk factors, including hypertension, dyslipidemia, and T2DM (Matsuzawa, 2008, Bays et al., 2008, Eglit et al., 2012). These risk factors synergistically increase the likelihood of morbidity and mortality of CVD (Seidell, 2010, Molenaar et al., 2008) which leads to rising healthcare costs (Zheng et al., 2009).

Actions promoting health check-ups for obesity-related conditions and prevention

Weight loss, bariatric surgery and cancer risk reduction

Despite extensive evidence showing a deleterious effect of overweight and obesity on cancer, relatively few data exist on the effects of weight gain or weight loss on altering the risk for cancer. The lack of data on weight loss is likely a function of the small number of individuals able to achieve a sustained weight loss.

The international agency for research on cancer (IARC) evaluated data through 2000 and found limited evidence for an association between weight change and the risk for

The controversy of body fat in caloric restriction-associated longevity

Studies dating back to the early 1900s by Tannenbaum (Tannenbaum, 1942, Tannenbaum and Silverstone, 1953) were the first ones to demonstrate that a reduction in food intake was capable of increasing lifespan and inhibiting tumor formation in rats (Tannenbaum and Silverstone, 1949). Nearly a century later, calorie restriction (CR) remains the only known behavioral intervention capable of delaying the onset of many age-related diseases and extending maximal survival (Trepanowski et al., 2011,

Evidence against a role for body fat in determining lifespan

In 1984 a historic study by Harrison et al. (1984) found that calorie-restricted ob/ob mice were longer lived than ad libitum-fed wild types, despite having nearly twice as much body fat. Indeed, this study made a compelling case against a role for body fat in the determination of lifespan. There has also been controversy regarding the role of body fat in both spontaneous and transgenic long-lived mutants. For instance, several models of growth hormone (GH) deficiency or resistance including

Visceral fat and low-grade inflammation

Since the discovery of leptin in 1994 (Zhang et al., 1994), the view of adipose tissue as an inert storage depot began to change. Indeed, evidence began to mount that obesity and specifically visceral fat is associated with a low-grade inflammation due to the increased secretion of numerous pro-inflammatory cytokines from adipocytes and their associated macrophages (Smith et al., 2010, Macciò and Madeddu, 2011). Many of these cytokines also referred to as “adipokines” including leptin, TNF-α,

Treatment studies

Some group have demonstrated various treatment strategies for visceral fat and/or its complications. In an initial study (Cummings et al., 2011), it is administered leptin with s.c. injections twice daily for 1 mo to rats, since this fat-derived peptide had been shown to play an important role in energy homeostasis.

The enzyme 11β hydroxysteroid dehydrogenase type 1 (11β HSD-1) converts inactive cortisone into active cortisol in cells and excess glucocorticoids promote visceral fat deposition.

Hormone regulation modified by nutrition and exercise

Several studies have shown the importance of acute hormonal elevations and mechanical stimuli for subsequent up- and down-regulation of cytoplasmic steroid receptors needed to mediate the hormonal effects. Some factors such as nutrition, overtraining, detraining and circadian patterns of hormone secretion are critical to examining the hormonal responses and adaptations to resistance training.

Altered nutritional status affects the process of longevity and the health status of the individual in

Visceral fat and strategy for the prevention of systemic inflammation

Mounting evidence supports a role for adipose tissue-derived pro-inflammatory cytokines in the pathogenesis of diabetes and atherosclerotic diseases. Therefore, Ohman et al. (2008) administered pioglitazone, which has been shown to reduce monocyte chemoattractant protein-1 (MCP-1) levels and fat inflammation, to ApoE−/− mice that received a visceral fat transplant or sham-operated controls.

Pioglitazone treatment lowered MCP-1 levels and macrophage content in the visceral fat transplant and

Future directions

Numerous epidemiologic studies have implicated abdominal obesity as a major risk factor for insulin resistance, T2DM, CVD, stroke, MetS, non alcoholic fatty liver disease and death. Utilizing novel models of abdominal obesity, several studies have shown that the relationship between visceral fat and survival is causal while the accumulation of subcutaneous fat does not appear to play an important role in the determinism of disease risk (Finelli and Tarantino, 2012b). Treatment strategies

Author's contribution

All authors gave final approval of the version to be published.

Conflict of interest

The authors declare that there are no conflicts of interest.

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