High visceral fat with low subcutaneous fat accumulation as a determinant of atherosclerosis in patients with type 2 diabetes

Abstract

BackgroundAbdominal visceral obesity has been reported to be associated with cardiovascular risks than body mass index, waist circumference, and abdominal subcutaneous fat. On the other hand, there is evidence that subcutaneous fat has a beneficial role against cardio-metabolic risks such as diabetes or dyslipidemia. However, little is known regarding the association between high visceral fat with low subcutaneous fat accumulation and the risk for atherosclerosis.MethodsThis study was designed to elucidate whether high visceral fat with low subcutaneous fat accumulation enhances the risk for atherosclerosis in patients with type 2 diabetes. This is a cross-sectional study of 148 patients with type 2 diabetes (mean age 65 ± 12 years; 44.5 % female). Visceral fat area (VFA, cm2) and subcutaneous fat area (SFA, cm2) were assessed by abdominal computed tomography. Carotid intima media thickness (CIMT, mm) measured by ultrasonography was used for the assessment of atherosclerosis. Patients were divided into four groups: SFA < 100 cm2 and VFA < 100 cm2 [S(−)V(−)], SFA ≥ 100 cm2 and VFA < 100 cm2 [S(+)V(−)], SFA < 100 cm2 and VFA ≥ 100 cm2 [S(−)V(+)], and SFA ≥ 100 cm2 and VFA ≥ 100 cm2 [S(+)V(+)]. Linear regression analysis with a stepwise procedure was used for the statistical analyses.ResultsAmong the patients examined, 16.3 % were S(−)V(+). Mean (95 % confidence interval) of CIMT adjusting for age and gender were 0.80 (0.69–0.91), 0.86 (0.72–1.01), 1.28 (1.11–1.44) and 0.83 (0.77–0.88) in patients with S(−)V(−), S(+)V(−), S(−)V(+) and S(+)V(+), respectively (p < 0.001). The S(−)V(+) patients exhibited significantly older than S(−)V(−) patients and those with S(+)V(+) and had a highest VFA-SFA ratio (V/S ratio) among the four groups. S(−)V(+) patients were male predominant (100 % male), and S(+)V(−) patients showed female predominance (82 % female). In multivariate linear regression analysis (Adjusted R2 = 0.549), S(−)V(+) was significantly associated with CIMT (Standardized β 0.423, p < 0.001). Notably, S(+)V(+) was inversely associated with CIMT in the multivariate model.ConclusionsThis study provides evidence that high visceral fat with low subcutaneous fat accumulation is an important determinant of carotid atherosclerosis and high subcutaneous fat could be protective against atherosclerosis in patients with type 2 diabetes.

Impact of low‐carbohydrate diet on body composition: meta‐analysis of randomized controlled studies

“…On the other hand, recent studies revealed that not only body weight but also body composition, including body fat mass, is important for cardiovascular risk and mortality . In addition, recent studies revealed a subset of individuals with non‐obese whom the volume of skeletal muscle, and its strength was decreased, so‐called sarcopenia .…”

Ratio of visceral‐to‐subcutaneous fat area predicts cardiovascular events in patients with type 2 diabetes

“…reported in a cross‐sectional study comprising obese participants that the V/S ratio was significantly and positively associated with fasting triglyceride levels and brachial‐ankle pulse wave velocity, a marker of arterial stiffness, but VFA was not associated with brachial‐ankle pulse wave velocity. Additionally, we previously reported that high visceral fat with low subcutaneous fat accumulation is an important determinant of carotid intima‐media thickness, a surrogate marker of atherosclerosis, in patients with type 2 diabetes. However, no data are available on the longitudinal associations of the V/S ratio with incident or recurrent CVD in patients with diabetes.…”

“…proposed that the V/S ratio is a better predictor of the calcium score of the whole aorta, as a marker of atherosclerosis, than SFA or VFA. In addition, we have recently reported in a cross‐sectional study that high VFA with low SFA is an important determinant of carotid atherosclerosis in patients with type 2 diabetes. However, direct evidence is not available as to whether a higher V/S ratio contributes to CVD events in patients with diabetes.…”

Razón entre grasa visceral y subcutánea como predictor de alteraciones cardio-metabólicas

“…La correlación de la razón TAV/TAS y del TAV aislado con el PCC observada en nuestros hallazgos es un resultado que corrobora los resultados presentados por Bouchi y cols. 30 . En esa investigación, realizada con individuos japoneses con DM2, la razón TAV/TAS presentó correlaciones positivas y significativas con aumento del espesor de la capa íntima (ECI).…”

“…Recientemente, se reportó que el TAV podría estar asociado a la formación de placa coronaria en pacientes diabéticos, considerándose un factor de riesgo relevante para el desarrollo de aterosclerosis carotídea. Los individuos con alta razón TAV/TAS presentan una menor capacidad para acumular exceso de energía en el depósito subcutáneo, llevando a una acumulación ectópica dentro del músculo, con consecuente aumento del riesgo de aterosclerosis carotídea 30 .…”