Health consequences of visceral obesity

Visceral obesity is associated with metabolic abnormalities that increase t he risk of type 2 diabetes and coronary heart disease. Obese patients with a substantial accumulation of visceral adipose tissue are characterized by higher insulinaemic and glycaemic responses during an oral glucose challeng e as well as by a deteriorated plasma lipoprotein-lipid profile compared wi th individuals with normal body weights or obese subjects with low levels o f visceral adipose tissue. Results of the Quebec Cardiovascular Study have shown that the cluster of metabolic disturbances observed among subjects wi th visceral obesity (hyperinsulinaemia, hyperapolipoprotein B and small, de nse low-density lipoprotein (LDL) particles) is associated with a 20-fold i ncrease in the risk of coronary heart disease in 2 sample of middle-aged me n followed over 5 years. Therefore, we have developed a simple screening ap proach in order to help physicians and health professionals identify at low cost individuals who would be characterized by this cluster of atherogenic abnormalities. We found that the simultaneous presence of an elevated wais t girth, combined with moderate hypertriglyceridaemia ('hypertriglyceridaem ic waist') could adequately identify a large proportion (similar to 80%) of carriers of the above triad of atherogenic metabolic abnormalities (hyperi nsulinaemia, hyperapolipoprotein B and small, dense LDL particles). Finally , there is evidence suggesting that the risk of an acute coronary syndrome in these viscerally obese patients may not always be related to the extent of coronary artery stenosis, providing further support to the notion that a dditional markers of thrombosis/inflammation should be considered. Thus, th e stabilization of the atherosclerotic plaque, rather than its regression m ay even become a more legitimate and feasible therapeutic objective for the management of the coronary heart disease.,risk in the viscerally obese pat ient. Although these notions are based on a plausible metabolic rationale, randomized trials with proper end-points will be needed to determine the cl inical benefits associated with the management of visceral obesity and rela ted metabolic complications.