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Abdominal Obesity, Intra-abdominal Adiposity and Related Cardiometabolic Risk:  Part I Jean-Pierre Després, PhD, FAHA Dire...
Relative Risk of Mortality, Coronary Heart Disease (CHD), and Type 2 Diabetes According to Body Mass Index (BMI) <21.0  2...
Is waist circumference better than body mass index to predict cardiometabolic risk?
Saving and Overconsuming Energy
Obesity: Body Mass Index (BMI) BMI =  Adapted from the World Health Organization. Obesity: Preventing  and Managing the Gl...
The “Heavyweights” of Modifiable Cardiovascular Disease (CVD) Risk Factors Cholesterol Diabetes Smoking Hypertension Globa...
Obesity: An Ill-defined Modifiable Cardiovascular Disease (CVD) Risk Factor Obesity BMI Others ? Cholesterol Diabetes Smok...
Android (Apple) vs. Gynoid (Pear) Obesity A Tribute to a Pioneer Jean Vague (1947) Adapted from Vague J. Presse Med 1947; ...
Obesity as a Risk Factor for Type 2 Diabetes: Importance of Abdominal Fat Accumulation Another Pioneer…the Late III II I I...
Risk of Myocardial Infarction Across Quintiles of BMI and WHR: INTERHEART 4.0 3.0 2.5 2.0 1.5 Odds ratio (95% CI) 1.25 1.0...
Abdominal Obesity and Coronary Heart Disease in Women: The Nurses’ Health Study Low Middle High High (81.8 - <139.7) Middl...
<ul><li>Is total adiposity (body mass index, body fat mass) or subcutaneous fat better than intra-abdominal (visceral) fat...
Intra-abdominal (Visceral) Fat: The Dangerous Inner Fat Intra-abdominal adipose tissue Subcutaneous adipose tissue Front A...
Association Between Fat Mass and Intra-abdominal (Visceral) Adipose Tissue in Men and Premenopausal Women Adapted from Lem...
Intra-abdominal (Visceral) Fat Accumulation in Equally Overweight Men Fat mass:   19.8 kg Intra-abdominal fat :  155 cm 2 ...
Individual Variation in Subcutaneous / Intra-abdominal (Visceral) Fat Accumulation in Obese Women Adapted from Després JP ...
Intra-abdominal (Visceral) Fat Increases the Risk of Type 2 Diabetes in Premenopausal Women Time (min.) Glucose (mmol/l)  ...
Intra-abdominal (Visceral) Fat Increases Cardiovascular Risk in Premenopausal Women HDL cholesterol (mmol/l)   Triglycerid...
Features of the Metabolic Syndrome Commonly Found Among Intra-abdominally (Viscerally) Obese Patients Genetic susceptibili...
The Atherogenic Metabolic Triad of Intra-abdominal (Visceral) Obesity Hyperinsulinemia Small, dense LDL particles Elevated...
Risk of Ischemic Heart Disease (IHD) According to the Cumulative Number of “Traditional” and “Nontraditional” Risk Factors...
The Prevalent Form of the Metabolic Syndrome as Defined by NCEP-ATP III and IDF Pro-inflammatory state Elevated blood pres...
Intra-abdominal (Visceral) Adipose Tissue Area and Waist Girth According to C-Reactive Protein (CRP) Quintiles Intra-abdom...
Inflammation and Cardiovascular Disease: Is Abdominal Obesity the Missing Link?   TNF-  IL-6 Atherogenic, insulin resista...
Potential Contribution of Ectopic Fat Deposition to the Cardiometabolic Risk Profile of Intra-abdominally Obese Patients A...
Intra-abdominal (Visceral) Fat: The Dangerous Inner Fat Intra-abdominal adipose tissue Subcutaneous adipose tissue Front A...
Intra-abdominal (Visceral) Fat is an Independent Predictor of All-cause Mortality in Men Subject A Subject B Subject B  is...
Intra-abdominal (Visceral) Fat is an Independent Predictor of All-cause Mortality in Men * Odds ratios are expressed per s...
The Prevalent Form of the Metabolic Syndrome as Defined by NCEP-ATP III and IDF Pro-inflammatory state Elevated blood pres...
<ul><li>www.cardiometabolic-risk.org </li></ul>
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Abdominal obesity, intra-abdominal adiposity and related cardiometabolic risk: part I

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By Jean-Pierre Després, PhD, FAHA, Scientific Director, International Chair on Cardiometabolic Risk, Professor, Division of Kinesiology, Université Laval, Centre de recherche de l’Institut universitaire de cardiologie et de pneumologie de Québec, Québec, QC, Canada.

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Abdominal obesity, intra-abdominal adiposity and related cardiometabolic risk: part I

  1. 1. Abdominal Obesity, Intra-abdominal Adiposity and Related Cardiometabolic Risk: Part I Jean-Pierre Després, PhD, FAHA Director of Research, Cardiology Centre de recherche de l’Institut universitaire de cardiologie et de pneumologie de Québec Scientific Director, International Chair on Cardiometabolic Risk Québec, Canada
  2. 2. Relative Risk of Mortality, Coronary Heart Disease (CHD), and Type 2 Diabetes According to Body Mass Index (BMI) <21.0  29.0 BMI (kg/m 2 ) <22.0  35.0 BMI (kg/m 2 ) <19.0  32.0 BMI (kg/m 2 ) Adapted from Manson JE et al. N Engl J Med 1995; 333: 677–85 | Willett WC et al. JAMA 1995; 273: 461–5 | Colditz GA et al. Ann Intern Med 1995; 122: 481-6 Relative risk of: 2.0 1.5 1.0 0.5 0.0 4.0 3.0 2.0 1.0 0.0 8.0 6.0 4.0 2.0 0.0 Mortality CHD Diabetes
  3. 3. Is waist circumference better than body mass index to predict cardiometabolic risk?
  4. 4. Saving and Overconsuming Energy
  5. 5. Obesity: Body Mass Index (BMI) BMI = Adapted from the World Health Organization. Obesity: Preventing and Managing the Global Epidemic. Geneva: WHO, 2000 Weight (kg) Height (m 2 ) BMI (kg/m 2 ) Risk of Comorbidities Healthy weight 18.5 – 24.9 Normal Overweight 25.0 – 29.9 Increased Obese Class I 30.0 – 34.9 High Obese Class II 35.0 – 39.9 Very High Obese Class III > 40.0 Extremely High
  6. 6. The “Heavyweights” of Modifiable Cardiovascular Disease (CVD) Risk Factors Cholesterol Diabetes Smoking Hypertension Global CVD Risk LDL HDL
  7. 7. Obesity: An Ill-defined Modifiable Cardiovascular Disease (CVD) Risk Factor Obesity BMI Others ? Cholesterol Diabetes Smoking Hypertension LDL HDL Global CVD Risk BMI: body mass index
  8. 8. Android (Apple) vs. Gynoid (Pear) Obesity A Tribute to a Pioneer Jean Vague (1947) Adapted from Vague J. Presse Med 1947; 30: 339–40
  9. 9. Obesity as a Risk Factor for Type 2 Diabetes: Importance of Abdominal Fat Accumulation Another Pioneer…the Late III II I I II III 13.5-year incidence of type 2 diabetes (%) (Overweight) (Lean) Body mass index tertiles Waist-to-hip ratio tertiles Per Björntorp Adapted from Ohlson LO et al. Diabetes 1985; 34: 1055-8
  10. 10. Risk of Myocardial Infarction Across Quintiles of BMI and WHR: INTERHEART 4.0 3.0 2.5 2.0 1.5 Odds ratio (95% CI) 1.25 1.0 0.9 0.8 <20 20–23 23.1–25 25.1–27 27.1–29 >30 BMI (kg/m 2 ) Adapted from Yusuf S et al. Lancet 2005; 366: 1640-9 Copyright 2005, with permission from Elsevier BMI: body mass index WHR: waist-to-hip ratio 3.5
  11. 11. Abdominal Obesity and Coronary Heart Disease in Women: The Nurses’ Health Study Low Middle High High (81.8 - <139.7) Middle (73.7 - <81.8) Low (38.1 - <73.7) (25.2 - <48.8) (22.2 - <25.2) (12.2 - <22.2) Waist girth tertiles (cm) Incidence rate per 100,000 person-years Body mass index tertiles (kg/m 2 ) Adapted from Rexrode KM et al. JAMA 1998; 280: 1843-8 Follow-up of 8 years 140 120 100 80 60 40 20 0
  12. 12. <ul><li>Is total adiposity (body mass index, body fat mass) or subcutaneous fat better than intra-abdominal (visceral) fat to predict cardiometabolic risk? </li></ul>
  13. 13. Intra-abdominal (Visceral) Fat: The Dangerous Inner Fat Intra-abdominal adipose tissue Subcutaneous adipose tissue Front Adapted from Lemieux I et al. Ann Endocrinol 2001; 62: 255-61 Back
  14. 14. Association Between Fat Mass and Intra-abdominal (Visceral) Adipose Tissue in Men and Premenopausal Women Adapted from Lemieux S et al. Am J Clin Nutr 1993; 58: 463-7 Intra-abdominal adipose tissue (cm 2 ) 0 10 20 30 40 50 60 70 Fat mass (kg) 300 250 200 150 100 50 0 Women: r=0.85 Men: r=0.69
  15. 15. Intra-abdominal (Visceral) Fat Accumulation in Equally Overweight Men Fat mass: 19.8 kg Intra-abdominal fat : 155 cm 2 Fat mass: 19.8 kg Intra-abdominal fat : 96 cm 2 Adapted from Després JP et al. In: AF Roche, SB Heymsfield, TG Lohman (eds.), Human Body Composition, Human Kinetics,149-66,1996
  16. 16. Individual Variation in Subcutaneous / Intra-abdominal (Visceral) Fat Accumulation in Obese Women Adapted from Després JP Nutrition 1993; 9: 452-9
  17. 17. Intra-abdominal (Visceral) Fat Increases the Risk of Type 2 Diabetes in Premenopausal Women Time (min.) Glucose (mmol/l) 0 1,2 1,2 1,2 1,2 1,2 1,2 1 30 60 90 120 150 180 10.0 9.0 8.0 7.0 6.0 5.0 4.0 Nonobese controls (1) Obese low intra-abdominal fat (2) Obese high intra-abdominal fat 1000 800 600 400 200 0 Time (min.) 0 30 60 90 120 150 180 Insulin (pmol/l) 1,2 1 1,2 1,2 1,2 1 1 1 1 1 1 From Després JP. In: H Rifkin, JA Colwell, SI Taylor (eds.), Diabetes 1991, Elsevier Science Publishers BV Amsterdam, The Netherlands, 95-9, 1991 Reproduced with permission 1,2: significantly different from the corresponding subgroups 1 1
  18. 18. Intra-abdominal (Visceral) Fat Increases Cardiovascular Risk in Premenopausal Women HDL cholesterol (mmol/l) Triglycerides (mmol/l) 1,2 1 Adapted from Després JP et al. Arteriosclerosis 1990; 10: 497-511 1,2 1.5 1.4 1.3 1.2 1.1 1.0 0.9 0.8 3.0 2.5 2.0 1.5 1.0 0.5 0.0 1,2: significantly different from the corresponding subgroup Nonobese controls (1) Obese low intra-abdominal fat (2) Obese high intra-abdominal fat
  19. 19. Features of the Metabolic Syndrome Commonly Found Among Intra-abdominally (Viscerally) Obese Patients Genetic susceptibility to hypertension, type 2 diabetes, and coronary heart disease ultimately affects the clinical features of the metabolic syndrome Adapted from Lemieux I and Després JP. In: PG Kopelman (ed.), Management of Obesity and Related Disorders, Martin Dunitz, 45-63, 2001 <ul><li>Hypertriglyceridemia </li></ul><ul><li>Insulin resistance </li></ul><ul><li>Low HDL cholesterol </li></ul><ul><li>Hyperinsulinemia </li></ul><ul><li>Elevated apolipoprotein B </li></ul><ul><li>Glucose intolerance </li></ul><ul><li>Small, dense LDL particles </li></ul><ul><li>Impaired fibrinolysis </li></ul><ul><li>Inflammatory profile </li></ul><ul><li>Endothelial dysfunction </li></ul>
  20. 20. The Atherogenic Metabolic Triad of Intra-abdominal (Visceral) Obesity Hyperinsulinemia Small, dense LDL particles Elevated apo B concentrations Beyond LDL cholesterol, blood pressure, type 2 diabetes… The atherogenic metabolic triad
  21. 21. Risk of Ischemic Heart Disease (IHD) According to the Cumulative Number of “Traditional” and “Nontraditional” Risk Factors: The Québec Cardiovascular Study Adapted from Lamarche B et al. JAMA 1998; 279: 1955-61 Odds ratio* * Odds ratios are adjusted for systolic blood pressure, family history of IHD, and medication use 25 20 15 10 5 0 0 1 2 3 1.0 1.0 1.8 4.7 2.8 9.1 (p=0.01) 4.4 (p=0.01) 20.8 (p<0.001) Traditional risk factors: LDL cholesterol, triglycerides and HDL cholesterol Nontraditional risk factors: Insulin, apolipoprotein B and small, dense LDL particles
  22. 22. The Prevalent Form of the Metabolic Syndrome as Defined by NCEP-ATP III and IDF Pro-inflammatory state Elevated blood pressure Insulin resistance Atherogenic dyslipidemia NCEP-ATP III: National Cholesterol Education Program – Adult Treatment Panel III IDF: International Diabetes Federation Abdominal obesity Pro-thrombotic state
  23. 23. Intra-abdominal (Visceral) Adipose Tissue Area and Waist Girth According to C-Reactive Protein (CRP) Quintiles Intra-abdominal adipose tissue (cm 2 ) CRP quintiles 1 1 1 1,3 Waist circumference (cm) CRP quintiles 1 1 1,2 1,2,3 Adapted from Lemieux I et al. Arterioscler Thromb Vasc Biol 2001; 21: 961-7 Legend: 1,2,3: significantly different from the corresponding quintiles (1) (2) (3) (4) (5) (1) (2) (3) (4) (5)
  24. 24. Inflammation and Cardiovascular Disease: Is Abdominal Obesity the Missing Link? TNF-  IL-6 Atherogenic, insulin resistant “dysmetabolic milieu”  CRP ? ?  Risk of acute coronary syndrome ? Adipose tissue Adapted from Després JP Int J Obes 2003; 27: S22-4 Reproduced with permission CRP: C-reactive protein IL-6: interleukin-6 TNF-  : tumor necrosis factor- 
  25. 25. Potential Contribution of Ectopic Fat Deposition to the Cardiometabolic Risk Profile of Intra-abdominally Obese Patients Altered cardiometabolic risk profile  Systemic free fatty acids Coronary atherosclerosis unstable plaque  Intra-abdominal (visceral) adipose tissue  Lipoprotein lipase Insulin resistance  Hepatic lipase Lipid deposition Insulin-resistant subcutaneous adipose tissue ?  Portal free fatty acids  Insulin  Glucose  Triglycerides  Apolipoprotein B Adapted from Després JP. Ann Med 2006; 38: 52-63 Reproduced with permission  Plasminogen activator inhibitor-1  Interleukin-6  Tumor necrosis factor-   Adiponectin Skeletal muscle Liver
  26. 26. Intra-abdominal (Visceral) Fat: The Dangerous Inner Fat Intra-abdominal adipose tissue Subcutaneous adipose tissue Front Adapted from Lemieux I et al. Ann Endocrinol 2001; 62: 255-61 Back
  27. 27. Intra-abdominal (Visceral) Fat is an Independent Predictor of All-cause Mortality in Men Subject A Subject B Subject B is at a 2-fold higher risk for mortality Risk of death Intra-abdominal fat (kg) Intra-abdominal fat is shown in red Adapted from Kuk JL et al. Obesity 2006; 14: 336-41 0 0.5 1.0 1.5
  28. 28. Intra-abdominal (Visceral) Fat is an Independent Predictor of All-cause Mortality in Men * Odds ratios are expressed per standard deviation for each variable Adapted from Kuk JL et al. Obesity 2006; 14: 336-41 Odds ratios for mortality* MODEL 1 1.8 1.4 1.4 0.8 1.8 1.0 0.6 1.3 MODEL 2 Control for age + follow-up time Control for age, follow-up time, abdominal subcutaneous fat, intra-abdominal fat, and liver fat 3.5 3.0 2.5 2.0 1.5 1.0 0.5 0.0 3.5 3.0 2.5 2.0 1.5 1.0 0.5 0.0 Odds ratios for mortality* Subcutaneous fat CTL / CTS (index of liver fat) Intra-abdominal fat Waist circumference
  29. 29. The Prevalent Form of the Metabolic Syndrome as Defined by NCEP-ATP III and IDF Pro-inflammatory state Elevated blood pressure Insulin resistance Atherogenic dyslipidemia NCEP-ATP III: National Cholesterol Education Program – Adult Treatment Panel III IDF: International Diabetes Federation Abdominal obesity Pro-thrombotic state
  30. 30. <ul><li>www.cardiometabolic-risk.org </li></ul>

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