Regional Fat Distribution Research Articles

Androgen inactivation and steroid-converting enzyme expression in abdominal adipose tissue in men

We examined 5alpha-dihydrotestosterone (5alpha-DHT) inactivation and the expression of several steroid-converting enzymes with a focus on aldoketoreductases 1C (AKR1C), especially AKR1C2, in abdominal adipose tissue in men. AKR1C2 is mainly involved in the conversion of the potent androgen 5alpha-DHT to its inactive forms 5alpha-androstane-3alpha/beta,17beta-diol (3alpha/beta-diol). Subcutaneous (s.c.) and omental (Om) adipose tissue biopsies were obtained from 21 morbidly obese men undergoing biliopancreatic derivation surgery and 11 lean to obese men undergoing general abdominal surgery. AKR1C2 mRNA and 5alpha-DHT inactivation were detected in both s.c. and Om adipose tissue. After incubation of preadipocytes with 5alpha-DHT, both 3alpha-diol and 3beta-diol were produced through 3alpha/beta-ketosteroid reductase (3alpha/beta-HSD) activity. In preadipocyte cultures, 3alpha-reductase activity was significantly predominant over 3beta-reductase activity in cells from both the s.c. and Om compartments. Expression levels of AKR1C1, AKR1C3 and of the androgen receptor were significantly higher in s.c. versus Om adipose tissue while mRNA levels of 17beta-HSD-2 (hydroxysteroid dehydrogenase type 2) and 3(alpha-->beta)-hydroxysteroid epimerase were significantly higher in Om fat. 3Alpha/beta-HSD activity was mainly detected in the cytosolic fraction, suggesting that AKR1C may be responsible for this reaction. Experiments with isoform-specific AKR1C inhibitors in preadipocytes showed that AKR1C2 inhibition significantly decreased 3alpha-HSD and 3beta-HSD activities (3alpha-HSD: 30 +/- 24% of control for s.c. and 32 +/- 9% of control for Om, 3beta-HSD: 44 +/- 12% of control for s.c.). When cells were incubated with both AKR1C2 and AKR1C3 inhibitors, no significant additional inhibition was observed. 5Alpha-DHT inactivation was significantly higher in mature adipocytes compared with preadipocyte cultures in s.c. adipose tissue, as expressed per microgram total protein (755 +/- 830 versus 245 +/- 151 fmol 3alpha/beta-diol per microg protein over 24 h, P < 0.05 n = 10 cultures). 5Alpha-DHT inactivation measured in tissue homogenates was significantly higher in the s.c. depot compared with Om fat (117 +/- 39 versus 79 +/- 38 fmol 3alpha/beta-diol per microg prot over 24 h, P < 0.0001). On the other hand, Om 3alpha/beta-HSD activity was significantly higher in obese men (body mass index (BMI) >or= 30 kg/m2) compared with lean and overweight men (84 +/- 37 versus 52 +/- 30 fmol 3alpha/beta-diol per microg protein over 24 h, P < 0.03). No difference was found in s.c. 3alpha/beta-HSD activity between these groups. Positive correlations were found between s.c. 5alpha-DHT inactivation rate and circulating levels of the androgen metabolites androsterone-glucuronide (r = 0.41, P < 0.02) and 3alpha-diol-glucuronide (r = 0.38, P < 0.03) and with the adrenal precursor androstenedione (r = 0.42, P < 0.02). In conclusion, androgen inactivation was detected in abdominal adipose tissue in men, with higher 3alpha/beta-HSD activity in the s.c. versus Om depot. Higher Om 5alpha-DHT inactivation rates were found in obese compared with lean men. Further studies are required to elucidate whether local androgen inactivation in abdominal adipose tissue is involved in the modulation of adipocyte metabolism and regional fat distribution in men.

Body composition is distinctly altered in Turner syndrome: relations to glucose metabolism, circulating adipokines, and endothelial adhesion molecules

Body composition in Turner syndrome (TS) is altered with final height of TS decreased; anthropometry and bone mass distinctly changed. To describe total and regional distribution of fat and muscle mass in TS and the relation to measures of glucose metabolism, sex hormones, IGFs, and markers of inflammation and vascular function. Fifty-four women with TS (mean age, 42.5 +/- 9.7 years) and an age-matched group of controls (n = 55) were examined by dual-energy X-ray absorptiometry scans with determination of regional body composition and estimation of visceral fat and skeletal muscle mass. We determined maximal oxygen uptake and assessed physical activity using a questionnaire. We measured serum adiponectin, ghrelin, IGF-I, IGF-binding protein-3 (IGFBP-3), estradiol, testosterone, sex hormone-binding globulin (SHBG), insulin, glucose, cytokines, vascular cell adhesion molecule-I, and intercellular cell adhesion molecule-I. Insulin sensitivity was estimated. Multiple linear regression models were used to examine the relationships between variables. TS had lower total lean body mass (LBM), while body mass index (BMI) and total fat mass (FM) were increased. We found increased visceral FM, and decreased trunk LBM, appendicular LBM, and skeletal muscle mass. VO2max and physical activity were significantly lower in TS, as were most hormone levels, except increased leptin. In multiple linear regression models, status (i.e. TS or control) was a consistent contributing variable. Profound changes are present in body composition in TS, with increased FM, and decreased skeletal muscle mass. Circulating hormones, VO2max, and insulin sensitivity influence body composition. The accumulation of visceral fat would predict a higher risk of development of the insulin resistance syndrome.

Obesity and the heart: redefinition of the relationship

Although obesity is an important cardiovascular risk factor, growing evidence shows that obesity is not always related to an unfavourable cardio-metabolic profile or poor cardiac outcomes. Recent studies show that excess fat even in the absence of comorbidities (uncomplicated obesity) can lead to adaptive cardiac morphological and functional changes. Uncomplicated obesity represents a well-defined clinical entity that should be carefully considered and followed up. The existence of metabolically healthy subjects presenting a lower prevalence of cardiac modifications and risk factors strongly suggests that a redefinition of obesity based on regional fat distribution indices like waist-to-hip ratio instead of body mass index is warranted.

Sex-specific differences in leg fat uptake are revealed with a high-fat meal

The mechanism(s) by which sex specific differences in regional body fat distribution develop are not known. We assessed the effects of a high-fat (HF) meal on fatty acid oxidation and uptake into regional fat depots using isotopic tracers and adipose biopsies. Thirty men (BMI 23.6 +/- 0.3 kg/m(2)) and 29 women (BMI 22.4 +/- 0.3 kg/m(2)) received a meal containing [(3)H]triolein. Twelve of the men and 13 of the women received an additional 80 g of triolein in the meal (HF) and the remainder received a normal-fat (NF) meal. Adipose tissue lipoprotein lipase (LPL) activity was measured in the fed and fasted state. After 24 h, meal fatty acid uptake into subcutaneous adipose tissue was assessed. The efficiency of meal fat uptake into upper body subcutaneous fat was similar in both sexes, but women had a greater leg fat uptake, especially in response to a HF meal (P < 0.0001). A correlation between fed-state LPL activity and meal fat uptake was found in both upper and lower body fat (P < 0.0001, r = 0.69). These studies show that, in times of net fat storage, women preferentially increase uptake in leg adipose tissue, and this is likely mediated by fed-state LPL activity.

Combined Treatment With Exercise Training and Acarbose Improves Metabolic Control and Cardiovascular Risk Factor Profile in Subjects With Mild Type 2 Diabetes

The effect of exercise training and acarbose on glycemic control, insulin sensitivity, and phenotype was investigated in mild type 2 diabetes. Sixty-two men and women with type 2 diabetes were randomized to 12 weeks of structured exercise training with or without acarbose treatment or to acarbose alone. Glycemic control was determined by HbA(1c) (A1C), insulin sensitivity (M value) by euglycemic-hyperinsulinemic clamp, and regional fat distribution by computerized tomography and dual X-ray absorptiometry. Physical fitness was determined as maximal oxygen uptake (Vo(2max)). All investigations were performed before and after the intervention. Forty-eight subjects completed the study. Exercise improved M value by 92% (P = 0.017) and decreased total and truncal fat (P = 0.002, 0.001) and systolic blood pressure (P = 0.01) but had no significant effect on Vo(2max) or A1C level. The combination of exercise and acarbose significantly decreased fasting plasma glucose, A1C, lipids, and diastolic blood pressure and increased Vo(2max), whereas effects on M value and body composition were comparable with that of exercise alone. Acarbose alone had no significant effect on either M value or A1C but decreased systolic (P = 0.001) and diastolic blood pressure (P = 0.001) and fasting proinsulin level (P = 0.009). Multiple regression analysis showed that addition of acarbose to exercise improved glycemic control. In subjects with mild type 2 diabetes, exercise training improved insulin sensitivity but had no effect on glycemic control. The addition of acarbose to exercise, however, was associated with significant improvement of glycemic control and possibly cardiovascular risk factors.

Effects of transdermal testosterone administration on insulin sensitivity, fat mass and distribution, and markers of inflammation and thrombolysis in human immunodeficiency virus–infected women with mild to moderate weight loss

To determine the effects of raising serum T levels into the high normal female range by transdermal T administration on insulin sensitivity, fat volume, and markers of inflammation and thrombolysis in HIV-infected women with recent weight loss. Placebo-controlled, randomized clinical trial. Academic clinical research center. Fifty-two HIV-infected, menstruating women with >5% weight loss over the prior 6 months and current T<33 ng/dL. Placebo or T patches twice weekly for 24 weeks to achieve nominal delivery of 300 microg T daily. Testosterone by liquid chromatography-tandem mass spectrometry, insulin sensitivity by the frequently sampled intravenous glucose tolerance test (FSIVGT), abdominal and thigh fat volumes by magnetic resonance imaging (MRI), and C-reactive protein (CRP) as a measure of inflammation and plasminogen-activated inhibitor-1 (PAI-1) levels as a marker of thrombolysis. Serum and free T levels significantly increased into the high normal female range in T-treated but not placebo-treated women. Insulin sensitivity by FSIVGT, whole body, thigh SC, and intra-abdominal fat volumes, and CRP and PAI-1 levels did not change significantly in either group and were not significantly different between the two groups. Fasting insulin increased in the placebo group and fell slightly in the T group, resulting in significant differences in change between groups. Twenty-four weeks of elevation of serum T levels into the high normal female range in HIV-infected women with mild to moderate weight loss by transdermal T patches did not adversely affect insulin sensitivity, whole-body fat mass or regional fat distribution, or markers of inflammation and thrombolysis. More prolonged and larger studies are needed to determine the effects of higher doses of T on body composition and insulin sensitivity in women.

Sex differences in the relationships between BMI, WHR and incidence of cardiovascular disease: a population-based cohort study

Body mass index (BMI) is associated with increased incidence of cardiovascular disease (CVD). However, the risk could be very different for individuals with the same body mass. The present study explored whether regional fat distribution, as measured by waist-hip ratio (WHR), could modify the impact of BMI on the risk of CVD in men and women. Prospective population-based study. A total of 10 369 men and 16 638 women, 45-73 years old, from general population in Malmö, Sweden. All subjects were followed over 7 years for the incidences of first-ever cardiac event (CE) and ischemic stroke in relation to BMI category (<25.0, 25.0-29.9, > or =30.0) and WHR. The prevalence of overweight and obesity was 39.4 and 13.0%, respectively. During follow-up, 1280 subjects suffered a CVD event (750 CE, 530 ischemic stroke). The risk of CVD in women increased with increasing levels of WHR, irrespective of BMI category. In men, WHR (per 1 s.d. increase) was associated with increased incidence of CVD in those with normal weight (relative risk (RR)=1.24; 95% CI: 1.13-1.37) after adjustments for confounding factors. However, WHR was not related to CVD in overweight men (RR=1.06; 95%CI: 0.94-1.20) or obese men (RR=1.04; 95%CI: 0.87-1.24). A significant interaction was observed between sex and WHR on the CVD risk. The effect of WHR on incidence of CVD is modified by the overall body weight and by gender. WHR adds prognostic information on the cardiovascular risk in women at all levels of BMI, and in men with normal weight.

Role of Cortisol in Menstrual Recovery in Adolescent Girls with Anorexia Nervosa

Neuroendocrine abnormalities in anorexia nervosa (AN) include hypercortisolemia, hypogonadism, and hypoleptinemia, and neuroendocrine predictors of menstrual recovery are unclear. Preliminary data suggest that increases in fat mass may better predict menstrual recovery than leptin. High doses of cortisol decrease luteinizing hormone (LH) pulse frequency, and cortisol predicts regional fat distribution. We hypothesized that an increase in fat mass and decrease in cortisol would predict menstrual recovery in adolescents with AN. Thirty-three AN girls 12-18 y old and 33 controls were studied prospectively for 1 y. Body composition [dual energy x-ray absorptiometry (DXA)], leptin, and urinary cortisol (UFC) were measured at 0, 6, and 12 mo. Serum cortisol was measured overnight (every 30 min) in 18 AN subjects and 17 controls. AN subjects had higher UFC/cr x m2 and cortisol area under curve (AUC), and lower leptin levels than controls. Leptin increased significantly with recovery. When menses-recovered AN subjects were compared with AN subjects not recovering menses and controls, menses-recovered AN subjects had higher baseline cortisol levels and greater increases in leptin than controls and greater increases in fat mass than AN subjects not recovering menses and controls (adjusted for multiple comparisons). In a logistic regression model, increasing fat mass, but not leptin, predicted menstrual recovery. Baseline cortisol level strongly predicted increases in the percentage of body fat. We demonstrate that 1) high baseline cortisol level predicts increases in body fat and 2) increases in body fat predict menses recovery in AN.

Sex Difference in the Fraction of Adipose‐derived Stromovascular Cells as Preadipocytes

Women differ from men by the larger lower-body subcutaneous fat mass and the tendency to gain more fat in that depot if obesity develops. We hypothesized that these differences in fat distribution may depend on preadipocyte availability. We identified the proportion of preadipocytes from the stromovascular (SV) cells in adipose tissue by immunofluorescent staining for aP2 (the adipocyte fatty acid trafficking protein) and CD68 (a macrophage marker). Macrophages are the other cell type, aside from preadipocytes, in the SV fraction of adipose tissue that express aP2. We determined the percent preadipocytes in the SV fraction of subcutaneous abdominal and femoral adipose tissue of 17 premenopausal lean women and 10 age-matched lean men. Body fat compartments were measured by DEXA and CT scans of the abdomen. Compared to men, women had less visceral fat and more subcutaneous fat mass, predominantly in the lower-body compartment: 7.0 ± 0.3 kg vs. 5.2 ± 0.4 kg, respectively (p < 0.01). Femoral adipocytes were significantly larger than abdominal adipocytes in both groups (lipid per fat cell in women and men: abdomen, 0.46 ± 0.03 and 0.44 ± 0.06 μg/cell; thigh, 0.66 ± 0.04 and 0.55 ± 0.08 μg/cell, respectively). The percent preadipocytes in the SV fraction from femoral subcutaneous adipose tissue was greater in women than in men (29.7 ± 2.6% vs. 19.3 ± 2.0%, p < 0.02) but similar when isolated from the abdominal depot (29.9 ± 3.3% vs. 27.2 ± 1.9%). Our findings suggest that the fraction of femoral stromovascular cells as preadipocytes is a potential factor for sex-dependent differences in regional fat distribution. The study was funded by RO1 DK 45343-13S to M. Jensen.

Letter Regarding Article by Ruttmann et al, “γ-Glutamyltransferase as a Risk Factor for Cardiovascular Disease Mortality: An Epidemiological Investigation in a Cohort of 163 944 Austrian Adults”

To the Editor: In their article, Ruttmann et al1 showed that γ-glutamyltransferase(GGT) was independently associated with cardiovascular (CV) mortality. GGT was significantly correlated with components of the metabolic syndrome,2 including uric acid level, but waist circumference was not measured. Measurement of GGT activity is a very commonly used diagnostic test for liver dysfunction, and it increases with alcohol consumption and steatosis. Elevation of hepatic enzyme activities occurs frequently in patients with multiple CV risk factors. Indeed, we have shown that approximately one fourth of a population of 8501 dyslipidemic patients3 displayed hepatic enzymatic elevations. We found correlation coefficients similar to those reported by Ruttmann et al1 when GGT, aspartate aminotransferase, or alanine aminotransferase was selected. In subgroup analysis, the relation between waist circumference, body mass index (BMI), and GGT (n=1911) was …

Possible Role of Adiponectin and Insulin Sensitivity in Mediating the Favorable Effects of Lower Body Fat Mass on Blood Lipids

The objective of this study was to investigate the role of insulin sensitivity and serum adiponectin concentration as determinants, in middle-aged men, of the relationship between lower body fat and blood lipids after truncal fat has been accounted for. Men (443) aged 39-65 yr, body mass index 18-43 kg/m(2), participated in the study. The following variables were measured: regional body fat distribution as assessed by dual-energy x-ray absorptiometry, maximal oxygen uptake, physical activity, fasting levels of serum adiponectin, triglycerides, and high-density lipoprotein- and total cholesterol. Plasma glucose and serum insulin were measured in the fasting state and after an oral glucose load. Lower body fat mass was inversely associated with serum triglycerides and total cholesterol and positively with serum high-density lipoprotein-cholesterol after adjustment for age, lean tissue mass, truncal fat mass, weight history, maximal oxygen uptake, and the level of physical activity (P < 0.0005). Serum adiponectin level and Matsudas insulin sensitivity index were positively intercorrelated, and both were positively correlated to lower body fat mass. When including adiponectin and insulin sensitivity in the analyses, the relationships between lower body fat mass and serum lipids were partly explained. For a given level of truncal fat mass, a large lower body fat mass is associated with an advantageous blood lipid profile, which may be partially mediated by the relationships to both insulin sensitivity and serum adiponectin level.

Longitudinal Variance of Fat Mass Deposition during Pregnancy Evaluated by Ultrasonography: The Ratio of Visceral Fat to Subcutaneous Fat in the Abdomen

Background: Defining regional fat distribution is of importance because of regional variation in adipocyte metabolism. In order to investigate whether maternal body fat distribution changes during pregnancy we measured the abdominal maternal fat thickness. Methods: A longitudinal study of the thickness of the preperitoneal fat layer (P) and subcutaneous fat layer (S) in the abdomen was conducted; ultrasonography was used to obtain the measurements and the P/S ratio was calculated during each trimester as well as postpartum. Results: When compared with the first and second trimesters, a significant increase in both the P and P/S ratios was observed in the third trimester; thus, regional fat distribution changes during pregnancy. Conclusion: Intra-abdominal visceral fat accumulation increases during pregnancy.

Serum lipid concentration in relation to anthropometric indices of central and peripheral fat distribution in 20,021 British men and women: Results from the EPIC-Norfolk population-based cohort study

Aims Central adiposity has been linked with adverse metabolic profile including dyslipidaemia but recent studies suggested that peripheral fat distribution play a role in regulating daily fluxes in circulating non-esterified fatty acids. We examine whether lipid levels vary between central and peripheral fat distribution in the general population. Methods and results We examined the cross-sectional relation between fat distribution indices and lipid concentration in 20,021 apparently healthy men and women of the Norfolk cohort of the European Investigation into Cancer and Nutrition (EPIC-Norfolk). Waist–hip ratio was positively related to total and low density lipoprotein (LDL) cholesterol and negatively related to high density lipoprotein (HDL) cholesterol in both men and women, independently of body mass index (BMI). Although similar results were noted for waist circumference, individuals with bigger hip circumference had lower total and LDL-cholesterol and higher HDL-cholesterol when adjusting for BMI and/or waist circumference in both men and women. Conclusion Regional fat distribution was related to lipid profile independently of BMI. The independent contribution of waist and hip circumference in opposite directions was intriguing. These findings may help explain the associations observed between different fat distribution phenotypes and coronary heart disease.

Chronic blockade of the angiotensin II receptor has a differential effect on adipose and vascular PAI-1 in OLETF rats

Angiotensinogen (AGT) and plasminogen activator inhibitor-1 (PAI-1) are expressed in both vascular and adipose tissues. Angiotensin II (AG II) has an adipogenic effect and increases PAI-1 expression. To evaluate the chronic effects of AG II type 1 receptor (AT 1R) antagonism on adipose mass and PAI-1 expression in vascular and adipose tissues, losartan (30 mg/kg/day) was administered to Otsuka Long-Evans Tokushima Fatty (OLETF) rats, a model of type 2 diabetes, for 20 weeks. Adipose mass and regional fat distribution in the abdomen did not change after chronic AT 1R antagonism in OLETF rats. AGT and PAI-1 mRNA expressions in adipose tissue of OLETF rats were significantly increased compared with Long-Evans Tokushima Otsuka (LETO) rats, the normal control. Chronic losartan therapy further increased the level of adipose AGT in OLETF rats, but did not affect the level of adipose PAI-1 mRNA. In contrast, aortic PAI-1 expression in OLETF rats was attenuated by chronic losartan therapy. Our results have two implications. First, adipose tissue may be an important source of AG II in metabolic syndrome even after chronic losartan therapy. Second, chronic AT 1R antagonism with losartan causes differential effects on vascular and adipose PAI-1 expression.

Visceral obesity, the metabolic syndrome, androgens and estrogens

Adult men and women differ in their fat distribution; the regional distribution of body fat is a characteristic of masculinity and femininity. In premenopausal women a larger proportion of fat is s...

Total and Regional Fat Distribution is Strongly Influenced by Genetic Factors in Young and Elderly Twins

Indirect estimates of obesity such as BMI seem to be strongly influenced by genetic factors in twins. Precise measurements of total and regional fat as determined by direct techniques such as DXA scan have only been applied in a few twin studies. The aim of the present study was to estimate the heritability (h(2)) of total and regional fat distribution in young and elderly Danish twins. Monozygotic (108) and dizygotic (88) twins in two age groups (25 to 32 and 58 to 66 years) underwent anthropometric measurements and DXA scans. Intraclass correlations and etiologic components of variance were estimated for total and regional fat percentages using biometric modeling. The intraclass correlations demonstrated higher correlations for all fat percentages among monozygotic twins as compared with dizygotic twins. The biometric modeling revealed a major genetic component (h(2)) of total (h(2)(young) = 0.83, h(2)(elderly) = 0.86) and regional fat percentages (trunk, h(2)(young) = 0.82, h(2)(elderly) = 0.85; lower body, h(2)(young) = 0.83, h(2)(elderly) = 0.81; and trunk/lower body, h(2)(young) = 0.83, h(2)(elderly) = 0.71) in both the young and elderly twins. The h(2) estimates emphasize that body fat and distribution as determined by DXA scan are under extensive genetic control.

Pronounced lipoatrophy in HIV‐infected men receiving HAART for more than 6 years compared with the background population

To establish the prevalence and quantify the severity of body fat redistribution and dyslipidaemia in HIV-infected men after long-term highly active antiretroviral therapy (HAART) compared with the background population. In a cross-sectional study, we included 87 HIV-infected men who had received HAART for at least 6 years and 34 HIV-negative men. Regional body composition was assessed using dual-energy X-ray absorptiometry. Fasting metabolic parameters were obtained. Associations between regional body fat distribution and metabolic parameters were evaluated. HIV-infected patients and controls did not differ with regard to height and lean body mass. Compared with controls, HIV-infected men had reduced total fat mass (median 12.3 versus 19.2 kg, P<0.001), limb fat mass (4.3 versus 7.9 kg, P<0.001), and trunk fat mass (6.7 versus 10.8 kg, P<0.001) and higher trunk/limb fat ratio (1.7 versus 1.2, P<0.001). Also, patients without clinical lipodystrophy had reduced amounts of limb and trunk fat. In HIV-infected men, triglyceride levels were higher (2.0 versus 1.2 mmol/L, P<0.001), high-density lipoprotein (HDL)-cholesterol levels were lower (1.2 versus 1.3 mmol/L, P<0.05) and insulin levels were higher (40.8 versus 29.9 pmol/L, P<0.01) than in controls. All adverse metabolic parameters correlated with increased trunk/limb fat ratio, and insulin levels correlated positively with trunk fat mass (P<0.01). Peripheral as well as central fat loss is a general characteristic of HIV-infected men after long-term HAART. Although lipoatrophy was the dominant morphological presentation, the adverse metabolic parameters were mainly associated with the increased ratio of trunk/limb fat.

Effects of raloxifene on body fat distribution and lipid profile in healthy post-menopausal women

The aim of our prospective, randomised, controlled and open-label clinical study was to evaluate in healthy post-menopausal women the effects of raloxifene (RLX) on body fat distribution and lipids, and the correlations between these parameters. The fat distribution, by dual energy X-ray absorptiometry, and lipids were evaluated at baseline and after 1 yr in 50 post-menopausal women: 25 were treated with RLX 60 mg/die, while 25 served as control group (CG). After 1 yr, we observed in RLX-users a slight reduction of fat mass in trunk and central region and an increase in legs and, in relation to CG, significantly lower values of adiposity in trunk and abdominal region (p < 0.05). At the same time, HDL-cholesterol (HDL-C) and apolipoprotein A1 (ApoA1) were significantly increased in relation to baseline values and CG (p < 0.05) and apolipoprotein B (ApoB), total cholesterol/HDL-C, LDL cholesterol/ HDL-C, and ApoB/ApoA1 ratios significantly decreased compared to baseline values and CG (p < 0.05). No correlation was underlined among lipids and regional fat distribution. These results highlight the positive effect of RLX on lipids and suggest, for the first time, that RLX promotes the shift from android to gynoid fat distribution, and prevents the uptrend of abdominal adiposity and body weight compared with untreated women.

Epicardial adipose tissue: anatomic, biomolecular and clinical relationships with the heart

A growing amount of evidence suggests that regional fat distribution plays an important part in the development of an unfavorable metabolic and cardiovascular risk profile. Epicardial fat is a metabolically active organ that generates various bioactive molecules, which might significantly affect cardiac function. This small, visceral fat depot is now recognized as a rich source of free fatty acids and a number of bioactive molecules, such as adiponectin, resistin and inflammatory cytokines, which could affect the coronary artery response. The observed increases in concentrations of inflammatory factors in patients who have undergone coronary artery bypass grafting remain to be confirmed in healthy individuals. Furthermore, epicardial adipose mass might reflect intra-abdominal visceral fat. Therefore, we propose that echocardiographic assessment of this tissue could serve as a reliable marker of visceral adiposity. Epicardial adipose tissue is also clinically related to left ventricular mass and other features of the metabolic syndrome, such as concentrations of LDL cholesterol, fasting insulin and adiponectin, and arterial blood pressure. Echocardiographic assessment of epicardial fat could be a simple and practical tool for cardiovascular risk stratification in clinical practice and research. In this paper, we briefly review the rapidly emerging evidence pointing to a specific role of epicardial adipose tissue both as a cardiac risk marker and as a potentially active player in the development of cardiac pathology.

Central Fat Excess in Polycystic Ovary Syndrome: Relation to Low-Grade Inflammation and Insulin Resistance

It is controversial whether the polycystic ovary syndrome (PCOS) per se increases low-grade chronic inflammation and whether this relates to central fat excess. In addition, the association between circulating sex hormones and body fat distribution in premenopausal women is debated. Blood was drawn from 20 patients with PCOS and compared with 15 controls, matched for body mass index and age. Regional fat distribution was assessed using dual x-ray absorptiometry. Compared with controls, patients with PCOS had a higher trunk to extremity fat ratio (T/E fat), were more insulin resistant (higher homeostasis model assessment of insulin resistance and lower SHBG concentrations), and had higher levels of highly sensitive C-reactive protein, TNF-alpha, procalcitonin, and white blood cell count (all P < or = 0.04), even after adjusting for total body fat. However, additional adjusting for T/E fat eliminated or attenuated the effect of PCOS status on estimates of insulin resistance, on inflammatory mediators, and on white blood cell count but not on circulating sex hormones. Independently of each other, total body fat as well as T/E fat correlated with estimates of insulin resistance and most inflammatory mediators (P < or = 0.04). However, the correlations between T/E fat and circulating sex hormones (P < or = 0.02) were greatly reduced after adjustment for the presence of PCOS. The increase in low-grade chronic inflammation and in insulin resistance in women with PCOS is primarily associated with increased central fat excess rather than PCOS status per se. Procalcitonin represents a novel marker of the inflammatory activity of body fat and of PCOS.