title: Reducing visceral adipose tissue mass is essential for improving endothelial function in type 2 diabetes prone individuals.
abstract: OBJECTIVE
  In obesity, particularly increased visceral- (VAT), but not total (TAT) adipose tissue mass is a major source of proinflammatory cytokine expression and secretion. VAT, more than TAT, is associated with endothelial dysfunction (ED), which is an accepted risk factor for atherosclerosis. Consequently, we hypothesized that during a lifestyle intervention specifically a decrease in VAT, rather than TAT, is associated with improved ED and vascular adhesion molecules in type 2 diabetes prone subjects.
  
  
  METHODS
  Analyses were done in 189 individuals (age: 45.4±0.8 years) at increased risk of type 2 diabetes, who underwent a 9-month lifestyle intervention. ED expressed as flow mediated dilation (FMD) of the brachial artery, sE-selectin, sV-CAM, sI-CAM, TAT and VAT (measured by magnetic resonance tomography) was determined.
  
  
  RESULTS
  There was a mean decrease in body weight (-3%, p<0.0001), TAT (-7.6%, p<0.0001) and VAT (-12.5%, p<0.0001), while FMD increased (+9.1%, p=0.04). The change in FMD was not associated with change in body weight (p=0.35) or TAT (p=0.21) but with a decrease in VAT (r=-0.19, p=0.009). In a post hoc analysis, the subjects were divided by the median change in VAT into responders and non-responders. FMD increased only in the responders (from 6.2±0.4% to 8.0±0.5%, p=0.0005) but not in the non-responders (p=0.15). Also sE-selectin significantly decreased only in the responders (from 54±4 ng/ml to 47±3 ng/ml; p=0.03).
  
  
  CONCLUSIONS
  During a lifestyle intervention, not weight loss or decrease in TAT, but decrease in VAT is associated with improved ED in individuals prone to type 2 diabetes. Therefore, primary cardiovascular prevention should focus specifically on reducing VAT rather than body weight alone.
authors.affiliation: Department of Endocrinology and Diabetes, Vascular Medicine, Nephrology and Clinical Chemistry, University of Tübingen, Otfried-Müller Straße 10, 72076 Tübingen, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Rittig
authors.forename: A
authors.initials: A
authors.lastname: Hieronimus
authors.forename: C
authors.initials: C
authors.lastname: Thamer
authors.forename: J
authors.initials: J
authors.lastname: Machann
authors.forename: A
authors.initials: A
authors.lastname: Peter
authors.forename: J
authors.initials: J
authors.lastname: Stock
authors.forename: F
authors.initials: F
authors.lastname: Schick
authors.forename: A
authors.initials: A
authors.lastname: Fritsche
authors.forename: N
authors.initials: N
authors.lastname: Stefan
authors.forename: H-U
authors.initials: HU
authors.lastname: Häring
authors.forename: B
authors.initials: B
authors.lastname: Balletshofer
mesh_terms: D000328:Adult; D001835:Body Weight; D001916:Brachial Artery / Q000473:pathology; D002318:Cardiovascular Diseases / Q000473:pathology; D003924:Diabetes Mellitus, Type 2 / Q000473:pathology* / Q000628:therapy; D004730:Endothelium, Vascular / Q000473:pathology*; D005260:Female; D005951:Glucose Tolerance Test; D006801:Humans; D050152:Intra-Abdominal Fat / Q000473:pathology*; D008019:Life Style; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D012307:Risk Factors