Abstract
Sexual dimorphism accounts for significant differences in adipose tissue mass and distribution. However, how the crosstalk between visceral and ectopic fat depots occurs and which are the determinants of ectopic fat expansion and dysfunction remains unknown. Here, we focused on the impact of gender in the crosstalk between visceral and epicardial fat depots and the role of adipocytokines and high-sensitivity C-reactive protein (hs-CRP). A total of 141 outward patients (both men and women) with one or more defining criteria for metabolic syndrome (MetS) were consecutively enrolled. For all patients, demographic and clinical data were collected and ultrasound assessment of visceral adipose tissue (VFth) and epicardial fat (EFth) thickness was performed. Hs-CRP and adipocytokine levels were assessed by enzyme-linked immunosorbent assay (ELISA). Men were characterized by increased VFth and EFth (p-value < 0.001 and 0.014, respectively), whereas women showed higher levels of adiponectin and leptin (p-value < 0.001 for both). However, only in women VFth and EFth significantly correlated between them (p = 0.013) and also with leptin (p < 0.001 for both) and hs-CRP (p = 0.005 and p = 0.028, respectively). Linear regression confirmed an independent association of both leptin and hs-CRP with VFth in women, also after adjustment for age and MetS (p = 0.012 and 0.007, respectively). In conclusion, men and women present differences in epicardial fat deposition and systemic inflammation. An intriguing association between visceral/epicardial fat depots and chronic low-grade inflammation also emerged. In women Although a further validation in larger studies is needed, these findings suggest a critical role of sex in stratification of obese/dysmetabolic patients.
Highlights
The classical paradigm of obesity, defined by body mass index (BMI) >30 kg/m2, is no longer considered representative of this heterogeneous condition, characterized by many phenotypes [1]
We focused on the impact of gender in the crosstalk between visceral and epicardial fat depots and the role of adipocytokines and high-sensitivity C-reactive protein
Only in women VFth and epicardial fat tissue thickness (EFth) significantly correlated between them (p = 0.013) and with leptin (p < 0.001 for both) and high-sensitivity C-reactive protein (hs-C-reactive protein (CRP)) (p = 0.005 and p = 0.028, respectively)
Summary
The classical paradigm of obesity, defined by body mass index (BMI) >30 kg/m2, is no longer considered representative of this heterogeneous condition, characterized by many phenotypes [1]. The growing evidence of individual variation in body fat distribution raised the interest toward the susceptibility of visceral fat storing to genetic factors [3], including racial and sex differences [4,5]. Sexual dimorphism accounts for significant differences in visceral fat mass and distribution, women being characterized by greater BMI with prevalent subcutaneous distribution. This has important clinical implications as visceral and subcutaneous fat greatly differ in terms of function and response to weight gain. Women seem to be protected from macrophage infiltration into the adipose tissue [6], and show a stronger association between adiposity and C-reactive protein (CRP) [7]
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