Relationship of visceral adipose tissue to metabolic risk factors for coronary heart disease: Is there a contribution of subcutaneous fat cell hypertrophy?

Visceral adipose tissue (VAT) accumulation is an important correlate of the metabolic complications found in obese patients. The aim of this study was to evaluate the respective contribution of VAT deposition versus subcutane ous abdominal or femoral fat cell hypertrophy as correlates of the metaboli c risk profile in 69 men and 65 premenopausal women (aged 35 +/- 5 years) w ith a wide range of fatness (body mass index, 18 to 57 kg/m(2)). In both ge nders, VAT accumulation was positively correlated with fasting plasma insul in, triglyceride (TG), and low-density lipoprotein (LDL)-apolipoprotein B ( apo B) levels and the cholesterol (CHOL)/high-density lipoprotein (HDL)-CHO L ratio (.24 less than or equal to r less than or equal to .71, P < .05). A similar pattern of positive relationships was found between subcutaneous a bdominal fat cell weight And metabolic risk variables in men and women (.33 less than or equal to r less than or equal to .60, P < .01). Positive asso ciations were also observed in women between femoral fat cell weight and fa sting plasma insulin, TG, and CHOL levels and the CHOL/HDL-CHOL ratio (.29 less than or equal to r less than or equal to .42, P < .05). However, only plasma TG concentrations and the CHOL/HDL-CHOL ratio were positively correl ated with femoral fat cell weight in men (r = .30, P < .05). To better inve stigate the relationships between the metabolic risk profile and hypertroph ic subcutaneous obesity, individuals with small versus large subcutaneous a bdominal adipocytes were matched according to VAT accumulation. Men with la rge abdominal fat cells displayed higher plasma TG and LDL-apo B levels com pared with men characterized by small abdominal adipocytes (P < .05). Stepw ise multiple regression analyses showed that subcutaneous abdominal fat cel l weight was the best independent variable predicting plasma TG and LDL-apo B levels in men. No significant difference was found in the metabolic prof ile of subjects displaying small versus large femoral adipocytes. Taken tog ether, these results suggest that for a given VAT deposition, the presence of hypertrophied subcutaneous abdominal adipocytes in men appears to be ass ociated with further deterioration in the metabolic risk profile. On the ot her hand, the hypertrophy of femoral adipocytes does not further alter the metabolic complications generally related to obesity in both men and women. Copyright (C) 1999 by W.B. Saunders Company.