title: Associations of visceral and abdominal subcutaneous adipose tissue with markers of cardiac and metabolic risk in obese adults.
abstract: OBJECTIVE
  Visceral (VAT) and abdominal subcutaneous (SAT) adipose tissues contribute to obesity but may have different metabolic and atherosclerosis risk profiles. We sought to determine the associations of abdominal VAT and SAT mass with markers of cardiac and metabolic risk in a large, multiethnic, population-based cohort of obese adults.
  
  
  METHODS
  Among obese participants in the Dallas Heart Study, we examined the cross-sectional associations of abdominal VAT and SAT mass, assessed by magnetic resonance imaging (MRI) and indexed to body surface area (BSA), with circulating biomarkers of insulin resistance, dyslipidemia, and inflammation (n = 942); and with aortic plaque and liver fat by MRI and coronary calcium by computed tomography (n = 1200). Associations of VAT/BSA and SAT/BSA were examined after adjustment for age, sex, race, menopause, and body mass index.
  
  
  RESULTS
  In multivariable models, VAT significantly associated with the homeostasis model assessment of insulin resistance (HOMA-IR), lower adiponectin, smaller LDL and HDL particle size, larger VLDL size, and increased LDL and VLDL particle number (p < 0.001 for each). VAT also associated with prevalent diabetes, metabolic syndrome, hepatic steatosis, and aortic plaque (p < 0.001 for each). VAT independently associated with C-reactive protein but not with any other inflammatory biomarkers tested. In contrast, SAT associated with leptin and inflammatory biomarkers, but not with dyslipidemia or atherosclerosis. Associations between SAT and HOMA-IR were significant in univariable analyses but attenuated after multivariable adjustment.
  
  
  CONCLUSIONS
  VAT associated with an adverse metabolic, dyslipidemic, and atherogenic obesity phenotype. In contrast, SAT demonstrated a more benign phenotype, characterized by modest associations with inflammatory biomarkers and leptin, but no independent association with dyslipidemia, insulin resistance, or atherosclerosis in obese individuals. These findings suggest that abdominal fat distribution defines distinct obesity sub-phenotypes with heterogeneous metabolic and atherosclerosis risk.
authors.affiliation: Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
authors.forename: Ian J
authors.initials: IJ
authors.lastname: Neeland
authors.forename: Colby R
authors.initials: CR
authors.lastname: Ayers
authors.forename: Anand K
authors.initials: AK
authors.lastname: Rohatgi
authors.forename: Aslan T
authors.initials: AT
authors.lastname: Turer
authors.forename: Jarett D
authors.initials: JD
authors.lastname: Berry
authors.forename: Sandeep R
authors.initials: SR
authors.lastname: Das
authors.forename: Gloria L
authors.initials: GL
authors.lastname: Vega
authors.forename: Amit
authors.initials: A
authors.lastname: Khera
authors.forename: Darren K
authors.initials: DK
authors.lastname: McGuire
authors.forename: Scott M
authors.initials: SM
authors.lastname: Grundy
authors.forename: James A
authors.initials: JA
authors.lastname: de Lemos
mesh_terms: D052242:Adiponectin / Q000097:blood; D000328:Adult; D050197:Atherosclerosis / Q000097:blood / Q000209:etiology* / Q000473:pathology; D015415:Biomarkers / Q000378:metabolism; D050218:Body Fat Distribution; D002097:C-Reactive Protein / Q000378:metabolism; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D015243:Cholesterol, VLDL / Q000097:blood; D050171:Dyslipidemias / Q000150:complications; D005260:Female; D006331:Heart Diseases / Q000097:blood / Q000209:etiology* / Q000473:pathology; D006801:Humans; D007249:Inflammation / Q000097:blood; D018836:Inflammation Mediators / Q000378:metabolism; D007333:Insulin Resistance; D050152:Intra-Abdominal Fat / Q000378:metabolism / Q000473:pathology*; D020738:Leptin / Q000097:blood; D008297:Male; D024821:Metabolic Syndrome / Q000097:blood / Q000209:etiology* / Q000473:pathology; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000097:blood / Q000150:complications* / Q000378:metabolism / Q000473:pathology; D010641:Phenotype; D050151:Subcutaneous Fat / Q000378:metabolism / Q000473:pathology*
chemical_list: D052242:Adiponectin; D015415:Biomarkers; D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D015243:Cholesterol, VLDL; D018836:Inflammation Mediators; D020738:Leptin; D002097:C-Reactive Protein