Abstract
AimsVisceral adipose tissue measured by CT or MRI is strongly associated with an adverse metabolic risk profile. We assessed whether similar associations can be found with ultrasonography, by quantifying the strength of the relationship between different measures of obesity and indices of glucose metabolism in a population at high risk of type 2 diabetes.MethodsA cross-sectional analysis of 1342 participants of the ADDITION-PRO study. We measured visceral adipose tissue and subcutaneous adipose tissue with ultrasonography, anthropometrics and body fat percentage by bioelectrical impedance. Indices of glucose metabolism were derived from a three point oral glucose tolerance test. Linear regression of obesity measures on indices of glucose metabolism was performed.ResultsMean age was 66.2 years, BMI 26.9kg/m2, subcutaneous adipose tissue 2.5cm and visceral adipose tissue 8.0cm. All measures of obesity were positively associated with indicators of glycaemia and inversely associated with indicators of insulin sensitivity. Associations were of equivalent magnitude except for subcutaneous adipose tissue and the visceral/subcutaneous adipose tissue ratio, which showed weaker associations. One standard deviation difference in BMI, visceral adipose tissue, waist circumference, waist/height ratio and body fat percentage corresponded approximately to 0.2mmol/l higher fasting glucose, 0.7mmol/l higher 2-hr glucose, 0.06-0.1% higher HbA1c, 30 % lower HOMA index of insulin sensitivity, 20% lower Gutt’s index of insulin sensitivity, and 100 unit higher Stumvoll’s index of beta-cell function. After adjustment for waist circumference visceral adipose tissue was still significantly associated with glucose intolerance and insulin resistance, whereas there was a trend towards inverse or no associations with subcutaneous adipose tissue. After adjustment, a 1cm increase in visceral adipose tissue was associated with ~5% lower insulin sensitivity (p≤0.0004) and ~0.18mmol/l higher 2-hr glucose (p≤0.001).ConclusionVisceral and subcutaneous adipose tissue assessed by ultrasonography are significantly associated with glucose metabolism, even after adjustment for other measures of obesity.
Highlights
Obesity is a major risk factor for the development of type 2 diabetes (DM), but the risk is heterogeneous among obese individuals [1]
All measures of obesity were positively associated with indicators of glycaemia and inversely associated with indicators of insulin sensitivity
Associations were of equivalent magnitude except for subcutaneous adipose tissue and the visceral/subcutaneous adipose tissue ratio, which showed weaker associations
Summary
Obesity is a major risk factor for the development of type 2 diabetes (DM), but the risk is heterogeneous among obese individuals [1]. Independent of overall obesity, central obesity is an established risk factor for the disease [2]. That patterns of visceral rather than subcutaneous fat distribution around the waist may confer increased metabolic risk. In recent years studies spanning populations of different genders, ages, BMI levels and ethnicities, have indicated that visceral adipose tissue (VAT) plays a different and more adverse metabolic role than subcutaneous adipose tissue (SAT) [3,4,5,6,7]. VAT is thought to be an indicator of the relative inability of SAT to store more energy during continued positive caloric balance. People who are not able to store their energy surplus in SAT will be characterised by accumulation of fat at undesired sites such as intra-abdominally [8]
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