Visceral and Ectopic Fat: Risk Factors for Type 2 Diabetes, Atherosclerosis, and Cardiovascular Disease

Front Cover
Visceral and Ectopic Fat
Visceral and Ectopic Fat
Copyright
Contents
List of contributors
Preface
I -
Fat stores
1 - Overall, abdominal, and visceral obesity in men and women: an introduction
Overweight and obesity: definition, prevalence, and relation to disease
Definition of overweight and obesity
Prevalence of overweight and obesity
Obesity-related mortality and diseases
Body fat distribution: abdominal obesity, visceral fat, and ectopic fat
Body fat distribution and abdominal obesity
Visceral adipose tissue and subcutaneous adipose tissue
Lipid overflow hypothesis and ectopic fat accumulation
Sex differences in body fat distribution and health consequences
Summary and conclusion
References
2 - Obesity and fat distribution in children and adolescents
Childhood obesity has reached pandemic proportions
Abdominal obesity in children is a better indicator of health risks than BMI
Visceral fat in relation to cardiomentabolic health in young people
Determinants of visceral fat in children and adolescents
Sex
Genetics of visceral fat accumulation
Ethnicity
Chronic stress (cortisol)
Behavioral determinants of visceral fat
Measurement of visceral fat in children
Imaging techniques
The waist circumference or waist/height ratio as a measure of visceral fat in clinical practice and public health
Classification of abdominal obesity in children by the waist/height ratio
Visceral fat and metabolic risk factors in children and adolescents
Conclusions
References
3 - Brown adipose tissue: metabolic role and non-invasive quantification in humans
BAT physiology
Background on history of BAT: perceived impact on human health and scientific interest in past three decades
Overview of potential analysis techniques for assessing BAT activity
Invasive techniques
Noninvasive techniques
Overview of tracers with their molecular targets
Discussion: clinical applications?
References
4 - Epicardial and pericoronary fat
Introduction
Terminology
Anatomical characteristics of EAT
Data based on autopsy
Findings from clinical settings
Biochemical features and physiological function of EAT
Cardiac imaging of EAT
EAT in the pathomechanism of atherosclerosis
EAT in other cardiac diseases
Atrial fibrillation
Heart failure
Inflammation
Epicardial fat necrosis
EAT in metabolic diseases
EAT in patients with COVID-19
Treatment options for modifying EAT volume
References
II - Ectopic fat stores
5 - Non-invasive profiling of ectopic and adipose lipids using magnetic resonance spectroscopy and imaging
Introduction
Lipid composition and its consequences in magnetic resonance spectroscopy
In vivo magnetic resonance spectroscopy
Magnetic resonance spectroscopy data acquisition
Analysis of the magnetic resonance spectrscopy data
Magnetic resonance imaging
Applications
Adipose tissue (deep subcutaneous adipose tissue/visceral adipose tissue/brown adipose tissue)
Bone marrow fat
Breast
Liver
Heart
Skeletal muscle
Summary
References
6 - Flexibility of ectopic lipids in skeletal/cardiac muscle and liver
Measurement of the flexibility of ectopic lipids
Biopsy
1H-magnetic resonance spectroscopy (MRS)
Ectopic lipids in the context of negative energy balance
Single bout of exercise
Fasting
Ectopic lipids in the context of positive energy balance
Short-term high fat diet
Long-term high fat diet
High fructose/glucose diet
References
7 - Nonalcoholic fatty liver disease: from a benign finding to a life-threatening cardiometabolic liver disease
Introduction
Pathogenesis
Genetic and epigenetic determinants
Nutrition
Insulin resistance and lipotoxicity
Inflammation and necroapoptosis
Adipocytokines
Formation of fibrosis
Urea cycle dysregulation
Bile acids
Microbiome
Clinical consequences
Liver cirrhosis
Hepatocellular carcinoma
Cardiovascular disease
Diagnostics
Treatment
Obesity and lifestyle
Nutrition
Insulin sensitivity
GLP1 receptor agonists and GLP1 analogs
SGLT2 inhibitors
Lipotoxicity
Oxidative stress
Bile acids
Apoptosis
Inflammation and fibrosis
Combination therapy
Probiotics and fecal microbiome transplantation
Development and implementation of clinical care paths and guidelines for NAFLD
Primary care
Secondary and tertiary care
Conclusion
References
8 - Myocardial lipids—techniques and applications of proton magnetic resonance spectroscopy of the human heart
Localized proton magnetic resonance spectroscopy of the heart
Quantification of myocardial metabolite content
Lipids in the healthy human myocardium—effects of nutrition, fasting, and exercise
Gender
Aging
Body mass index
Athletes and exercise
Nutrition
Myocardial lipids in disease
Insulin resistance and type 2 diabetes
Other diseases
Concluding remarks and outlook
References
9 - Pancreas ectopic fat: imaging-based quantification
Introduction
Pancreas and ectopic fat
Pancreas state assessment
Information from MRI
Pancreas volume
MRI-derived fat fraction
Pancreas morphology
Pancreas fibroinflammation
Big Data and AI
Future directions
References
10 - Fat accumulation around and within the kidney
Introduction
Perirenal fat and renal sinus fat
Anatomical characteristics
Histological and pathophysiological characteristics
Imaging-based quantification
Quantification of perirenal fat
Quantification of renal sinus fat
Renal parenchyma triglyceride
Histological characteristics and pathophysiological relevance
Imaging-based quantification
Clinical implications of excessive kidney fat
Association with chronic kidney disease and insulin resistance
Association with cardiovascular diseases
Implications for other diseases
Changes of excessive kidney fat after intervention
Summary and perspectives
References
11 - Skeletal muscle fat
Introduction
Skeletal muscle fat infiltration
Flexibility of IMAT fatty infiltration
Intramyocellular lipids
Flexibility of IMCL
Methods to assess lipids in the muscle
Computed tomography—CT
MRI of skeletal muscle
Postprocessing and assessment of fat infiltration imaging
MRS of skeletal muscle
Postprocessing and quantitation of 1H-MR spectra from skeletal muscle
Summary
References
12 - Bone marrow adipose tissue
Introduction
Bone marrow fat origin
Main characteristics in physiology
Main characteristics
Variation during growth
Variation with aging
Regional specific differences in BMAT composition
Effect of exercise and caloric restriction
Impact of unloading
Microscopic aspect
In vivo imaging
Computed tomography
Single-energy CT (SECT)
Dual-energy CT (DECT)
Magnetic resonance imaging
T1-weighted MRI
Water-fat imaging
Proton magnetic resonance spectroscopy 1H-MRS
Secretory profile and endocrine regulation of BMAT
BMAT and skeletal health
BMAT and hematopoiesis
BMAT in cancer
BMAT and metabolic diseases
Concluding remarks
References
III - Regulation of fat stores
13 - Regulation of fat stores—endocrinological pathways
Insulin
Thyroid hormone
Growth hormone
Cortisol
Sex hormones
Summary
Acknowledgments
References
14 - Inflammation of the adipose tissue: metabolic consequences during weight (re)gain and loss
Introduction
Chronic low-grade inflammation of the adipose tissue
Weight gain
Weight loss
Weight regain
Adipose tissue inflammation during obesity: how does it lead to complications?
Insulin resistance
Atherosclerosis
Determining adipose tissue inflammation
Conclusion
References
IV -
Clinical aspects
15 - Role of adipose tissue remodeling in diabetic heart disease
Adipose tissue physiology in health and the pathophysiological role of adipose tissue in transition from obesity to diabetes
Adipose tissue and signaling pathways in diabetes and heart disease
Sex differences in adipose tissue remodeling effects on cardiovascular disease
Adiponectin, proinflammatory adipocytokines, and cardiovascular disease in diabetes
Imaging ectopic adiposity in patients with type 2 diabetes mellitus
Conclusions
References
16 - Cardiovascular disease
Introduction
Obesity hypertension: role of magnetic resonance imaging
Fat deposits in obesity hypertension
Cardiovascular structure and function in obesity hypertension
Coronary artery disease in obesity
Arrhythmias
Heart failure
Conclusion
References
17 - Obesity in relation to cardiorenal function
Introduction
Obesity-related cardiorenal dysfunction
Overview of five-part classification system for cardiorenal syndrome
The pathophysiology of cardiorenal syndrome
Metabolic syndrome
Dyslipidemia and atherosclerosis
Systemic inflammation, microvascular dysfunction, and heart failure
Sympathetic activation and leptin
Renin-angiotensin-aldosterone system (RAAS)
Hyperuricemia
Preclinical studies
Obese animal models of cardiorenal syndrome
The Zucker rat and substrains as proposed models of the metabolic cardiorenal syndrome
Abnormalities in cardiac function in obesity
Abnormalities in renal function in obesity
CKD as a risk factor for HFpEF in obese animals
Sex differences in the cardiorenal interaction
Epidemiological and translational studies in humans
Estimating obesity's risk for renal and cardiac dysfunction
Metabolic imaging studies of ectopic fat storage in heart and kidney
Dietary effects on ectopic fat storage in heart and kidney
Effects of glycemic control on ectopic fat storage in heart and kidney
Future outlook
Novel developments in preclinical studies
Multiorgan imaging in the management of CRS in obese individuals
Personalized approach in the management of obesity-related CRS
Conclusion
Funding
References
18 - Obesity and asthma
Physical function: lung function and genetic factors
Physical effects and genetic background of obesity and asthma
Obesity and respiratory function
Racial differences
Genetic factors in obesity and asthma
Epidemiology: clinical features and findings
Epidemiological study of obesity and asthma in children and adults
Epidemiological studies in children
Obesity and asthma
Definition of obesity in pediatric clinical studies
Relationship between weight change and asthma
Relationship between obesity and weight gain in pregnant mothers and asthma in childhood
Sex differences in obesity and asthma in children
Epidemiological studies in adults
Obesity and asthma
Definition of obesity in adult clinical studies
Phenotypes of obese patients with asthma
Sex differences in obesity and asthma in adults
Effect on asthma due to obesity-related complications
Disease pathogenesis: immunological mechanisms
Pathogenesis of obesity and asthma
Abnormal lipid metabolism
Increased oxidative stress
Increased airway inflammation
Inflammation in adipose tissue
Abnormalities in adipokines
Decreased steroid responsiveness
Insulin resistance
Summary
Acknowledgments
References
19 - Obesity and the brain: structural and functional imaging studies, and opportunities for large-scale imaging ge ...
Introduction
Structural brain imaging and obesity
Body Mass Index
Fat distribution
Diffusion tensor imaging
Visceral fat
Hypothalamic function
Functional brain imaging studies and obesity
Genetic analyses of obesity and the brain
Genome-wide association studies
Polygenic risk scores
Mendelian randomization
Future directions
Conclusions
References
V -
Interventions
20 - The impact of very-low-calorie diets on ectopic fat deposition
Introduction
Visceral adipose tissue
Hepatic ectopic fat
Very-low-calorie diet in the treatment of type II diabetes
Calorie restriction and cardiac lipid deposition
Skeletal muscle lipid metabolism and very-low-calorie diets
Impact of very-low-calorie diet on bone marrow fat
Conclusion
References
21 - Intermittent fasting
Intermittent fasting methods
Physiology of intermittent energy restriction
Effect of intermittent energy restriction on health parameters in animal models
Effect of intermittent energy restriction on weight and fat in animal models
Effect of intermittent energy restriction on metabolic parameters in animal models
Effect of intermittent energy restriction on other health parameters in animal models
Effect of intermittent energy restriction on health parameters in humans
Effect of intermittent energy restriction on weight and fat in humans
Effect of intermittent energy restriction on metabolic parameters in humans
Effect of intermittent energy restriction on other health parameters in humans
The effect of intermittent energy restriction versus continuous energy restriction on weight and fat in humans
Sustainability of intermittent energy restriction
Potential risks of intermittent energy restriction
Conclusion
References
22 - Exercise
Introduction
Definition of key terms
Current recommendations
Aerobic training interventions
Resistance training interventions
Aerobic and resistance training interventions
The role of intensity
How much is enough?
Mechanisms underlying the effects of exercise on visceral and ectopic adipose tissue
Are exercise-induced changes in body weight necessary for reductions in visceral adipose tissue and how does this compare t ...
The unique role of exercise in the prevention and management of chronic disease
Conclusion
References
23 - Combined lifestyle interventions
Introduction
Medical nutrition therapy
Introduction
Dietary patterns
Summary
Physical activity
Introduction
Benefits of physical activity
Recommendations for physical activity
Adipose tissue and physical activity
Type and duration of physical activity
Recommendations
Sleep
Introduction
Obstructive sleep apnea
Recommendations
Behavioral interventions
Treatment structure
Behavior therapy principles
Goal setting
Self-monitoring
Problem-solving
Cognitive techniques
Efficacy of multicomponent behavioral interventions
The challenge of dissemination
Behavioral intervention and antiobesity medication
Behavioral intervention and bariatric surgery
Summary
References
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24 - Medical therapy
Introduction
Metformin
Mechanism of action/side effects
Clinical efficacy
Orlistat
Mechanism of actions/side effects
Clinical efficacy
Glucagon-like peptide 1 receptor agonists
Mechanisms of action/side effects
Clinical efficacy
Sodium glucose cotransporter-2 inhibitors
Mechanisms of action/side effects
Clinical efficacy
Conclusions
References
25 - Gastric volume reduction interventions and effects on visceral fat and metabolic biomarkers
Introduction
Endoscopic sleeve gastroplasty
Meta-analyses
Case series
Metabolic effects
Primary obesity surgery endoluminal (POSE) procedure
Meta-analysis
Metabolic effects
Intragastric balloon therapy
IGB types
Meta-analyses and controlled trials
Orbera
Obalon
Elipse
Metabolic and visceral fat effects of intragastric balloons
NAFLD and NASH
Metabolism and body composition
Conclusion
References
26 - Roux-en-Y gastric bypass: influence on adipose tissue and metabolic homeostasis
Introduction
RYGB procedure description
Mechanisms of RYGB
RYGB—effect on weight loss and obesity-related comorbidities
Pathogenesis of obesity through adipose tissue
Molecular markers in obesity have changed quantities after RYGB
Changes in adipose tissue
Bile acids and metabolic and bariatric surgery
Visceral fat
Ectopic fat
Subcutaneous fat
Overview of metabolic benefits after RYGB
Class 1 obesity and metabolic and bariatric surgery
Conclusion
References
27 - Fecal transplant
The gut microbiome
Gut microbiome modulation
Fecal microbiome transplantation
Fecal transplantations—murine models
Fecal microbiome transplantation in humans
References
Index
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