Abstract
The burden of obesity has increased globally over the last few decades and its association with insulin resistance and related cardio-metabolic problems have adversely affected our ability to reduce population morbidity and mortality. Traditionally, adipose tissue in the visceral fat depot has been considered a major culprit in the development of insulin resistance. However, there is a growing body of evidence supporting the role of subcutaneous truncal/abdominal adipose tissue in the development of insulin resistance. There are significant differences in the functional characteristics of subcutaneous abdominal/truncal vs. intraabdominal vs. gluteo-femoral fat depots. More recently, mounting evidence has been supporting the role of adipose tissue function in the development of metabolic complications independent of adipose tissue volume or distribution. Decreased capacity for adipocyte differentiation and angiogenesis along with adipocyte hypertrophy can trigger a vicious cycle of inflammation leading to subcutaneous adipose tissue dysfunction and ectopic fat deposition. Therapeutic lifestyle change continues to be the most important intervention in clinical practice to improve adipose tissue function and avoid development of insulin resistance and related cardio-metabolic complications.
Highlights
The increasing global burden of obesity has become a major public health problem
Enlarged adipocytes were found in patients with type 2 diabetes and prediabetic individuals and were an independent marker of insulin resistance in prediabetic subcutaneous adipose tissue
O. et al reported that angiogenic capacity of subcutaneous abdominal adipose tissue decreased with increasing body mass index but it did not change in visceral adipose tissue [36]
Summary
The increasing global burden of obesity has become a major public health problem. The most recent (2010) analysis by the International Association for the Study of Obesity (IASO) and InternationalObesity Taskforce (IOTF) reports that the number of adults globally who are overweight or obese is one billion and 475 million, respectively [1]. Waist to Hip ratio, being a simple index of body fat distribution, when elevated crudely indicates increased proportion of abdominal adipose tissue. If visceral fat was a major contributor to metabolic risk, visceral adipose tissue should be the major source of systemic free fatty acid flux. We concluded that subcutaneous truncal fat plays a major role in obesity related insulin resistance in comparison to visceral or retroperitoneal fat.
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