Abdominal obesity
Abdominal obesity, also known as central obesity and truncal obesity, is the human condition of an excessive concentration of visceral fat around the stomach and abdomen to such an extent that it is likely to harm its bearer's health. Abdominal obesity has been strongly linked to cardiovascular disease, Alzheimer's disease, and other metabolic and vascular diseases.
Visceral fat, central abdominal fat, and waist circumference show a strong association with type 2 diabetes.
Visceral fat, also known as organ fat or intra-abdominal fat, is located inside the peritoneal cavity, packed in between internal organs and torso, as opposed to subcutaneous fat, which is found underneath the skin, and intramuscular fat, which is found interspersed in skeletal muscle. Visceral fat is composed of several adipose depots including mesenteric, epididymal white adipose tissue, and perirenal fat. An excess of adipose visceral fat is known as central obesity, the "pot belly" or "beer belly" effect, in which the abdomen protrudes excessively. This body type is also known as "apple shaped", as opposed to "pear shaped" in which fat is deposited on the hips and buttocks.
Researchers first started to focus on abdominal obesity in the 1980s when they realized it had an important connection to cardiovascular disease, diabetes, and dyslipidemia. Abdominal obesity was more closely related with metabolic dysfunctions connected with cardiovascular disease than was general obesity. In the late 1980s and early 1990s insightful and powerful imaging techniques were discovered that would further help advance the understanding of the health risks associated with body fat accumulation. Techniques such as computed tomography and magnetic resonance imaging made it possible to categorize mass of adipose tissue located at the abdominal level into intra-abdominal fat and subcutaneous fat.
Abdominal obesity is linked with higher cardiovascular events among South Asian ethnic populations.
Health risks
Heart disease
Abdominal obesity is typically associated with a statistically higher risk of heart disease, hypertension, insulin resistance, and type 2 diabetes. With an increase in the waist to hip ratio and overall waist circumference the risk of death increases as well. Metabolic syndrome is associated with abdominal obesity, blood lipid disorders, inflammation, insulin resistance, type 2 diabetes, and an increased risk of developing cardiovascular disease. It is now generally believed that intra-abdominal fat is the depot that conveys the biggest health risk.Recent validation has concluded that total and regional body volume estimates correlate positively and significantly with biomarkers of cardiovascular risk and that BVI calculations correlate significantly with all biomarkers of cardiovascular risk.
Diabetes
There are numerous theories as to the exact cause and mechanism in type 2 diabetes. Central obesity is known to predispose individuals for insulin resistance. Abdominal fat is especially active hormonally, secreting a group of hormones called adipokines that may possibly impair glucose tolerance. But adiponectin, an anti-inflammatory adipokine, which is found in lower concentration in obese and diabetic individuals has shown to be beneficial and protective in type 2 diabetes mellitus.Insulin resistance is a major feature of diabetes mellitus type 2, and central obesity is correlated with both insulin resistance and T2DM itself. Increased adiposity raises serum resistin levels, which in turn directly correlate to insulin resistance. Studies have also confirmed a direct correlation between resistin levels and T2DM. And it is waistline adipose tissue which seems to be the foremost type of fat deposits contributing to rising levels of serum resistin. Conversely, serum resistin levels have been found to decline with decreased adiposity following medical treatment.
Asthma
Developing asthma due to abdominal obesity is also a main concern. As a result of breathing at low lung volume, the muscles are tighter and the airway is narrower. Obesity causes decreased tidal volumes due to a reduction in chest expansion that is caused both by the weight on the chest itself and the effect of abdominal obesity on flattening the diaphragm. It is commonly seen that people who are obese breathe quickly and often, while inhaling small volumes of air. People with obesity are also more likely to be hospitalized for asthma. A study has stated that 75% of patients treated for asthma in the emergency room were either overweight or obese.Alzheimer's disease
Based on studies, it is evident that obesity has a strong association with vascular and metabolic disease which could potentially be linked to Alzheimer's disease. Recent studies have also shown an association between mid-life obesity and dementia, but the relationship between later life obesity and dementia is less clear. A study by Debette et al. examining over 700 adults found evidence to suggest higher volumes of visceral fat, regardless of overall weight, were associated with smaller brain volumes and increased risk of dementia. Alzheimer's disease and abdominal obesity has a strong correlation and with metabolic factors added in, the risk of developing Alzheimer's disease was even higher. Based on logistic regression analyses, it was found that obesity was associated with an almost 10-fold increase risk of Alzheimer's disease.Cancer
Abdominal obesity has been associated with an increased risk of several cancers, particularly malignancies of the digestive system. These include colorectal, pancreatic, and esophageal cancers. These associations often remain even after adjustment for overall body mass index, which suggests that abdominal fat distribution is an independent risk factor. In women, abdominal obesity has also been linked to higher rates of breast cancer in both the pre- and post-menopausal periods, beyond the effects of general obesity.Obstructive sleep apnea
Abdominal obesity is an important risk factor for obstructive sleep apnea, as increased abdominal fat can place pressure on the airway and narrow it. This can lead to reduced lung volumes during sleep. Higher waist circumference and waist-to-hip ratio are associated with obstructive sleep apnea, even in individuals whose body mass index is only in the overweight range.Other health risks
Central obesity can be a feature of lipodystrophies, a group of diseases that is either inherited, or due to secondary causes. Central obesity is a symptom of Cushing's syndrome and is also common in patients with polycystic ovary syndrome. Central obesity is associated with glucose intolerance and dyslipidemia. Once dyslipidemia becomes a severe problem, an individual's abdominal cavity would generate elevated free fatty acid flux to the liver. The effect of abdominal adiposity occurs not just in those who are obese, but also affects people who are non-obese and it also contributes to insulin sensitivity.Ghroubi et al. examined whether abdominal circumference is a more reliable indicator than BMI or the presence of knee osteoarthritis in obese patients. They found that it actually appears to be a factor linked with the presence of knee pain as well as osteoarthritis in obese study subjects. Ghroubi et al. concluded that a high abdominal circumference is associated with great functional repercussion.
Research published in The Lancet found that high levels of visceral fat were related to poorer cognitive performance. The findings suggest that maintaining a healthy weight and metabolic health may be important for preserving cognitive function.
Causes
Diet
The currently prevalent belief is that the immediate cause of obesity is net energy imbalance—the organism consumes more usable calories than it expends, wastes, or discards through elimination. Some studies indicate that visceral adiposity, together with lipid dysregulation and decreased insulin sensitivity, is related to the excessive consumption of fructose. Some evidence shows that in regards to juveniles, when free fructose is present as children's fat cells mature, it makes more of these cells mature into fat cells in the abdominal region. It also caused both visceral fat and subcutaneous fat to be less sensitive to insulin. These effects were not attenuated when compared to similar glucose consumption.Intake of trans fat from industrial oils has been associated with increased abdominal obesity in men and increased weight and waist circumference in women. These associations were not attenuated when fat intake and calorie intake was accounted for. Greater meat consumption has also been positively associated with greater weight gain, and specifically abdominal obesity, even when accounting for calories. Conversely, studies suggest that oily fish consumption is negatively associated with total body fat and abdominal fat distribution even when body mass remains constant. Similarly, increased soy protein consumption is correlated with lower amounts of abdominal fat in postmenopausal women even when calorie consumption is controlled.
Numerous large studies have demonstrated that ultra-processed foods have a positive dose-dependent relationship with both abdominal obesity and general obesity in both men and women. Consuming a diet rich in unprocessed food and minimally processed food is linked with lower obesity risk, lower waist circumference and less chronic disease. These findings are consistent among American, Canadian, Latin American, Australian, British, French, Spaniard, Swedish, South Korean, Chinese and Sub-Saharan African populations.
Obesity plays an important role in the impairment of lipid and carbohydrate metabolism shown in high-carbohydrate diets. It has also been shown that quality protein intake during a 24-hour period and the number of times the essential amino acid threshold of approximately 10 g has been achieved is inversely related to the percentage of central abdominal fat. Quality protein uptake is defined as the ratio of essential amino acids to daily dietary protein.
Visceral fat cells will release their metabolic by-products in the portal circulation, where the blood leads straight to the liver. Thus, the excess of triglycerides and fatty acids created by the visceral fat cells will go into the liver and accumulate there. In the liver, most of it will be stored as fat. This concept is known as 'lipotoxicity'.