Nowadays, obesity is seriously increasing in most of the populations all over the world, and is associated with the development and progression of high-mortality diseases such as type-2 diabetes mellitus (T2DM) and its subsequent cardiovascular pathologies. Recent data suggest that both body fat distribution and adipocyte phenotype, can be more determinant for fatal outcomes in obese patients than increased general adiposity. In particular, visceral adiposity is significantly linked to long term alterations on different cardiac structures, and in developed forms of myocardial diseases such as hypertensive and ischaemic heart diseases, and diabetic cardiomyopathy. Interestingly, this depot may be also related to epicardial fat accumulation through secretion of lipids, adipokines, and pro-inflammatory and oxidative factors from adipocytes. Thus, visceral adiposity and its white single-lipid-like adipocytes, are risk factors for different forms of heart disease and heart failure, mainly in higher degree obese subjects. However, under specific stimuli, some of these adipocytes can transdifferentiate to brown multi-mitochondrial-like adipocytes with anti-inflammatory and anti-apoptotic proprieties. Accordingly, in order to improve potential cardiovascular abnormalities in obese and T2DM patients, several therapeutic strategies have been addressed to modulate the visceral and epicardial fat volume and phenotypes. In addition to lifestyle modifications, specific genetic manipulations in adipose tissue and administration of PPARγ agonists or statins, have improved fat volume and phenotype, and cardiovascular failures. Furthermore, incretin stimulation reduced visceral and epicardial fat thickness whereas increased formation of brown adipocytes, alleviating insulin resistance and associated cardiovascular pathologies.
Bibiloni MDM, Pons A, Tur JA. Prevalence of overweight and obesity in adolescents: a systematic review. ISRN Obes. 2013;2013:392747. PubMedCentral
Auclair A, Martin J, Bastien M, Bonneville N, Biertho L, Marceau S, Hould FS, Biron S, Lebel S, Lescelleur O, Després JP, Poirier P. Is there a role for visceral adiposity in inducing type 2 diabetes remission in severely obese patients following biliopancreatic diversion with duodenal switch surgery? Obes Surg. 2016;26(8):1717–27.
Skårn SN, Eggesbø HB, Flaa A, Kjeldsen SE, Rostrup M, Brunborg C, Reims HM, Aksnes TA. Predictors of abdominal adipose tissue compartments: 18-year follow-up of young men with and without family history of diabetes. Eur J Intern Med. 2016;29:26–31.
Wang Y, Rimm EB, Stampfer MJ, Willett WC, Hu FB. Comparison of abdominal adiposity and overall obesity in predicting risk of type 2 diabetes among men. Am J Clin Nutr. 2005;81:555–63. PubMed
Meisinger C, Döring A, Thorand B, Heier M, Löwel H. Body fat distribution and risk of type 2 diabetes in the general population: are there differences between men and women? The MONICA/KORA Augsburg cohort study. Am J Clin Nutr. 2006;84:483–9. PubMed
Goldani H, Adami FS, Antunes MT, Rosa LH, Fassina P, Quevedo Grave MT, et al. Applicatility of the visceral adiposity index (VAI) in the prediction of the components of the metabolic syndrome in elderly. Nutr Hosp. 2015;32:1609–15. PubMed
Henderson DC, Fan X, Sharma B, Copeland PM, Borba CPC, Freudenreich O, et al. Waist circumference is the best anthropometric predictor for insulin resistance in nondiabetic patients with schizophrenia treated with clozapine but not olanzapine. J Psychiatr Pract. 2009;15:251–61. PubMedPubMedCentralCrossRef
Xiao L, Yang X, Lin Y, Li S, Jiang J, Qian S, et al. Large adipocytes function as antigen-presenting cells to activate CD4+ T cells via upregulating MHCII in obesity. Int J Obes. 2016;40:112–20. CrossRef
Kwon H, Pessin JE. Adipokines mediate inflammation and insulin resistance. Front Endocrinol. 2013;4:71. CrossRef
López-Jaramillo P, Gómez-Arbeláez D, López-López J, López-López C, Martínez-Ortega J, Gómez-Rodríguez A, et al. The role of leptin/adiponectin ratio in metabolic syndrome and diabetes. Horm Mol Biol Clin Investig. 2014;18:37–45. PubMed
Fandiño-Vaquero R, Fernández-Trasancos A, Alvarez E, Ahmad S, Batista-Oliveira AL, Adrio B, et al. Orosomucoid secretion levels by epicardial adipose tissue as possible indicator of endothelial dysfunction in diabetes mellitus or inflammation in coronary artery disease. Atherosclerosis. 2014;235:281–8. PubMedCrossRef
Festuccia WT, Blanchard P-G, Deshaies Y. Control of brown adipose tissue glucose and lipid metabolism by PPARγ. Front Endocrinol. 2011;2:84. CrossRef
Kim M-K, Tomita T, Kim M-J, Sasai H, Maeda S, Tanaka K. Aerobic exercise training reduces epicardial fat in obese men. J Appl Physiol. 1985;2009(106):5–11.
Hernández-Gil DL, Nieves-Rivera JJ, Mora L, Corretjer L, Altieri PI, Suárez A, et al. Metabolic changes after roux-N-Y bariatric surgery in hispanics. Bol Asoc Médica P R. 2015;107:66–9.
Rabkin SW, Campbell H. Comparison of reducing epicardial fat by exercise, diet or bariatric surgery weight loss strategies: a systematic review and meta-analysis. Obes Rev Off J Int Assoc Study Obes. 2015;16:406–15. CrossRef
Korner J, Inabnet W, Febres G, Conwell IM, McMahon DJ, Salas R, et al. Prospective study of gut hormone and metabolic changes after adjustable gastric banding and Roux-en-Y gastric bypass. Int J Obes. 2005;2009(33):786–95.
García-Ruiz E, Reynés B, Díaz-Rúa R, Ceresi E, Oliver P, Palou A. The intake of high-fat diets induces the acquisition of brown adipocyte gene expression features in white adipose tissue. Int J Obes. 2005;2015(39):1619–29.
Vosselman MJ, Hoeks J, Brans B, Pallubinsky H, Nascimento EBM, van der Lans AA, et al. Low brown adipose tissue activity in endurance-trained compared with lean sedentary men. Int J Obes. 2005;2015(39):1696–702.
Rothwell NJ, Stock MJ. Luxuskonsumption, diet-induced thermogenesis and brown fat: the case in favour. Clin Sci Lond Engl. 1979;1983(64):19–23.
Quintero-Castillo D, Luz-Araujo H, Guerra-Velázquez M, Reyna-Villasmil E, Santos Bolívar J, Torres-Cepeda D, et al. Lipid profile in obese and non-obese women with polycystic ovary syndrome treated with metformin. Endocrinol Nutr Organo Soc Espanola Endocrinol Nutr. 2010;57:262–7.
Wooltorton E. Obesity drug sibutramine (Meridia): hypertension and cardiac arrhythmias. Can Med Assoc J. 2002;166:1307–8.
Hernandez AV, Usmani A, Rajamanickam A, Moheet A. Thiazolidinediones and risk of heart failure in patients with or at high risk of type 2 diabetes mellitus: a meta-analysis and meta-regression analysis of placebo-controlled randomized clinical trials. Am J Cardiovasc Drugs. 2011;11:115–28. PubMedCrossRef
Dicker D, Herskovitz P, Katz M, Atar E, Bachar GN. Computed tomography study of the effect of orlistat on visceral adipose tissue volume in obese subjects. Isr Med Assoc J. 2010;12:199–202. PubMed
Park J-H, Park YS, Kim YJ, Lee IS, Kim JH, Lee J-H, et al. Effects of statins on the epicardial fat thickness in patients with coronary artery stenosis underwent percutaneous coronary intervention: comparison of atorvastatin with simvastatin/ezetimibe. J Cardiovasc Ultrasound. 2010;18:121–6. PubMedPubMedCentralCrossRef
Alexopoulos N, Melek BH, Arepalli CD, Hartlage G-R, Chen Z, Kim S, et al. Effect of intensive versus moderate lipid-lowering therapy on epicardial adipose tissue in hyperlipidemic post-menopausal women: a substudy of the BELLES trial (Beyond Endorsed Lipid Lowering with EBT Scanning). J Am Coll Cardiol. 2013;61:1956–61. PubMedCrossRef
Hong JY, Park KY, Kim BJ, Hwang WM, Kim DH, Lim DM. Effects of short-term exenatide treatment on regional fat distribution, glycated hemoglobin levels, and aortic pulse wave velocity of obese type 2 Diabetes mellitus patients. Endocrinol Metab. 2016;31:80–5. CrossRef
Lima-Martínez MM, Paoli M, Rodney M, Balladares N, Contreras M, D’Marco L, Iacobellis G. Effect of sitagliptin on epicardial fat thickness in subjects with type 2 diabetes and obesity: a pilot study. Endocrine. 2016;51(3):448–55.
Yang J, Ren J, Song J, Liu F, Wu C, Wang X, et al. Glucagon-like peptide 1 regulates adipogenesis in 3T3-L1 preadipocytes. Int J Mol Med. 2013;31:1429–35. PubMed
- Regulation of visceral and epicardial adipose tissue for preventing cardiovascular injuries associated to obesity and diabetes
- BioMed Central
Neu im Fachgebiet Innere Medizin
Meistgelesene Bücher aus der Inneren Medizin
Mail Icon II