Visceral fat resection in humans: Effect on insulin sensitivity, beta‐cell function, adipokines, and inflammatory markers

Abstract

Objective: The visceral fat is linked to insulin resistance, the metabolic syndrome, type 2 diabetes and an increased cardiovascular risk, but it is not clear whether it has a causative role. Design and Methods: Surgical resection of this fat depot is a research model to address this issue. Twenty premenopausal women with metabolic syndrome and grade III obesity were randomized to undergo Roux-en-Y gastric bypass (RYGBP) either alone or combined with omentectomy. Insulin sensitivity (IS; euglycemic-hyperinsulinemic clamp), acute insulin response to glucose (AIR; intravenous glucose tolerance test), disposition index (DI ¼ AIR Â IS measured by clamp), lipid profile, adipokine profile (leptin, adiponectin, resistin, visfatin, interleukin-6, TNF-a, MCP-1), ultra-sensitive C-reactive protein (CRP), body composition, and abdominal fat echography were assessed prior to surgery and 1, 6, and 12 months post-surgery. Results: Omentectomy was associated with greater weight loss at all time points. IS improved similarly in both groups. Omentectomy was associated to lower CRP after 12 months, but it did not influence adipokines and other metabolic parameters. Among non-diabetic subjects, omentectomy was associated with a preservation of baseline AIR after 12 months (as opposed to deterioration in the control group) and a greater DI after 6 and 12 months. Conclusion: Although omentectomy did not enhance the effect of RYGBP on insulin sensitivity and adipokines, it was associated with a preservation of insulin secretion, a greater weight loss, and lower CRP.

Heterogeneity of adipose tissue in development and metabolic function

“…Thus, functional alterations in VAT would directly impact on hepatic function and contribute to overall higher (cardio)-metabolic risk (Wajchenberg et al, 2002). However, the observed improvement of glucose metabolism after a combination of VAT removal and bariatric surgery (Thörne et al, 2002) was predominantly caused by bariatric surgery rather than VAT removal (Andersson et al, 2014;Lima et al, 2013). In addition, removal of SAT also showed little effects on metabolism (Mohammed et al, 2008;Seretis et al, 2015).…”

Obese with higher FNDC5/Irisin levels have a better metabolic profile, lower lipopolysaccharide levels and type 2 diabetes risk

“…We evaluated cardiorespiratory fitness, muscle strength, resting metabolic rate (RMR), anthropometric parameters, body composition, feeding behavior, measurements of FNDC5/irisin, inflammatory markers and total cholesterol (TC), HDL-cholesterol (HDL), LDL-cholesterol (LDL), triglycerides (TG), insulin, glucose, glycated hemoglobin (HbA1c), homeostatic model assessment 2 beta, insulin sensibility and resistance (HOMA2B, S, IR), triglycerides and glucose index (TYG index), Quick index, systolic and diastolic blood pressure and diabetes mellitus type 2 index risk (T2DM index risk). (17). All assessments were performed by the same professional.…”

Body fat distribution: the answer to the apparent paradox of obesity in cardiology?

“…В соответствии с этой мо-делью, висцеральная жировая ткань (ВЖТ), жировые отложения в печени и скелетных мышцах характеризу-ются системным эффектом, в то время как периваску-лярные, эпикардиальные и паранефральные жировые депо оказывают преимущественно локальное воздей-ствие [14]. Большинство эктопических жировых от-ложений продемонстрировало тесную ассоциацию с кардиометаболическими рисками и клиническими проявлениями большинства ССЗ [15].…”