Relation of Body Fat Distribution to Metabolic Complications of Obesity*

Abstract

The importance of body fat distribution as a predictor of metabolic aberrations was evaluated in 9 nonobese and 25 obese, apparently healthy women. Plasma glucose and insulin levels during oral glucose loading were significantly higher in women with predominantly upper body segment obesity than in women with lower body segment obesity. Of the former group, 10 of 16 subjects had diabetic glucose tolerance results, while none of the latter group was diabetic. Fasting plasma triglyceride levels were also significantly higher in the upper body segment obese women. The site of adiposity in the upper body segment obese women was comprised of large fat cells, while in the lower body segment obese subjects, it was formed of normal size cells. In both types of obesity, abdominal fat cell size correlated significantly with postprandial plasma glucose and insulin levels. Thigh fat cell size gave no indication as to the presence of metabolic complications. Thigh adipocytes were also resistant to epinephrine-stimulated lipolysis, presumably due to an increase in alpha-adrenergic receptors. Thus, in women, the sites of fat predominance offer an important prognostic marker for glucose intolerance, hyperinsulinemia, and hypertriglyceridemia. This association may be related to the disparate morphology and metabolic behavior of fat cells associated with different body fat distributions.

Fat cell metabolism in different regions in women. Effect of menstrual cycle, pregnancy, and lactation.

“…Obesity in the lower part of the body is less closely associated with the various metabolic complications of obesity as compared with the abdominal type (1,3,20). The metabolic differences between these depots provide a functional basis for these findings and also offer a likely explanation to the observation that the femoral-gluteal fat is difficult to reduce during caloric restriction in obese women (21).…”

Obesity-related hypertension: possible pathophysiological mechanisms

“…He noted that cardiovascular and metabolic complications of obesity were more common in patients with 'android' type of obesity (upper body obesity) when compared with 'gynoid' type (lower body obesity). Later on, several studies demonstrated the association of android (or central) obesity, hypertension, and insulin resistance, which formed the basis for understanding the pathophysiology of obesity-related hypertension (Kissebah et al 1982, Kalkhoff et al 1983, Modan et al 1985, for review see Landsberg et al (2013)). …”

The modulation of corticosteroid metabolism by hydrocortisone therapy in patients with hypopituitarism increases tissue glucocorticoid exposure

“…There is a propensity to central obesity and visceral fat deposition is significantly increased compared to control subjects with similar BMI (6,7). In the general population, visceral adiposity is associated with the metabolic syndrome, insulin resistance/diabetes mellitus, hypercholesterolemia and hypertension (8,9).…”