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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EEctopic fat is defined as storage of triglycerides in tissues other than adipose tissue, such as the liver, skeletal muscle, heart, and pancreas [Snel M et al. \u003Cem\u003EInt J Endocrinol\u003C\/em\u003E 2012]. This article discusses ectopic fat accumulation and cardiometabolic risk.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiometabolic Disorder\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EObesity\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EEctopic fat is defined as storage of triglycerides in tissues other than adipose tissue, such as the liver, skeletal muscle, heart, and pancreas [Snel M et al. \u003Cem\u003EInt J Endocrinol\u003C\/em\u003E 2012]. Marja-Riitta Taskinen, MD, University of Helsinki, Helsinki, Finland, discussed ectopic fat accumulation and cardiometabolic risk.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EExcess body adiposity, especially abdominal obesity and ectopic fat accumulation, is a key risk factor in the development of a number of chronic diseases [Thomas EL et al. \u003Cem\u003ENutr Res Rev\u003C\/em\u003E 2012]. It can interfere with cellular functions, and, hence, organ functions, and is associated with insulin resistance [Snel M et al. \u003Cem\u003EInt J Endocrinol\u003C\/em\u003E 2012].\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EAdipose tissue dysfunction is largely characterized by large adipocytes and secretion of adipokines with a proinflammatory profile, ultimately leading to ectopic fat deposition (among others) [Bl\u00fcher M. \u003Cem\u003EExp Clin Endocrinol Diabetes\u003C\/em\u003E 2009].\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EAlthough visceral fat accounts for only 10% to 15% of ectopic fat accumulation, 82% to 97% is stored as subcutaneous fat. Other major sites of ectopic fat accumulation include the heart (0% to 3%), the liver (5% to 30%), and skeletal muscle fat (10% to 15%).\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EEctopic fat is an important predictor of metabolic (in particular, insulin resistance) and cardiovascular disease (CVD), carrying more risk than general fat accumulation. Recent studies have shown a link between ectopic fat accumulation, as cardiac (epicardial or intramyocardial fat) and\/or visceral and\/or hepatic fat, and development of atherosclerosis, coronary heart disease, and hypertension (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E) [Gastaldelli A, Basta G. \u003Cem\u003ENutr Metab Cardiovasc Dis\u003C\/em\u003E 2010].\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/11\/11\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Ectopic Fat and Cardiometabolic Risk.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1122457073\u0022 data-figure-caption=\u0022Ectopic Fat and Cardiometabolic Risk.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/11\/11\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/11\/11\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/11\/11\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/14185\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-7\u0022 class=\u0022first-child\u0022\u003EEctopic Fat and Cardiometabolic Risk.\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EReprinted from \u003Cem\u003ENutr Metab Cardiovasc Dis\u003C\/em\u003E, Vol 20\/7, Gastaldelli A \u0026amp; Basta G, Ectopic fat and cardiovascular disease: What is the link?, 481\u201390, Copyright (2010), with permission from Elsevier.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-8\u0022\u003EAccording to Dr. Taskinen, fatty liver produces a plethora of risk factors for CVD. The mediators that may link it and CVD include glucose, very low-density lipoprotein (VLDL), high-density lipoprotein (HDL), alanine aminotransferase and aspartate aminotransferase, fibrinogen, factor VII and plasminogen activator inhibitor-1, angiotensinogen, C-reactive protein and serum amyloid A, and tumor necrosis factor-\u03b1 and interleukin-6. The atherogenic lipoprotein triad (increased large VLDL, increased small dense LDL, and decreased HDL-C) and hepatic steatosis lead to an increased risk of coronary artery disease.\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003EAlthough obesity increases the risk of CVD and premature death, not all obese people (20% to 30%) develop the metabolic abnormalities associated with obesity [Taskinen MR et al. \u003Cem\u003EArterioscler Thromb Vasc Biol\u003C\/em\u003E 2011]. In those who do, nonalcoholic fatty liver disease, especially in its more severe forms, is linked to an increased risk of CVD, independent of underlying cardiometabolic risk factors [Stefan N et al. \u003Cem\u003EEndocr Rev\u003C\/em\u003E 2008; Gastaldelli A et al. \u003Cem\u003EHepatology\u003C\/em\u003E 2009; Speliotes EK et al. \u003Cem\u003EHepatology\u003C\/em\u003E 2010].\u003C\/p\u003E\u003Cp id=\u0022p-10\u0022\u003ETaskinen and colleagues investigated if hypertriglyceridemia (HTG) in obese men with similar body mass indexes, waist circumferences, and levels of visceral adiposity is caused by increased hepatic secretion induced by increased liver fat. Results showed that dual metabolic defects are required to produce HTG in obese subjects with similar levels of visceral adiposity, ie, the combination of increased secretion driven by liver fat content and severely impaired clearance of triglyceride-rich VLDL\u003Csub\u003E1\u003C\/sub\u003E particles linked to the elevation of apolipoprotein CIII. Notably, there was an overproduction of large VLDL particles associated with small dense LDL and lowering of HDL as seen in the atherogenic lipid triad. The data suggest that overproduction of VLDL particles is a mechanism to export extra fat out of the liver (\u003Ca id=\u0022xref-fig-2-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F2\u0022\u003EFigure 2\u003C\/a\u003E) [Taskinen MR et al. \u003Cem\u003EArterioscler Thromb Vasc Biol\u003C\/em\u003E 2011]. The data highlights the clinical importance of assessing hypertriglyceridemic waist to indentify obese subjects at high cardiometabolic risk.\u003C\/p\u003E\u003Cdiv id=\u0022F2\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/11\/11\/F2.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Liver Fat Drives Production of VLDL1.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1122457073\u0022 data-figure-caption=\u0022Liver Fat Drives Production of VLDL1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 2.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/11\/11\/F2.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/11\/11\/F2.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 2.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/11\/11\/F2.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/14187\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 2.\u003C\/span\u003E \n            \u003Cp id=\u0022p-11\u0022 class=\u0022first-child\u0022\u003ELiver Fat Drives Production of VLDL1.\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-2\u0022\u003EReproduced with permission from MR Taskinen, MD.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-12\u0022\u003EStrategies that decrease liver fat and improve insulin sensitivity may boost whole-body insulin sensitivity [Byrne CD. \u003Cem\u003EDiabet Med\u003C\/em\u003E 2012] and reduce CVD risk factors and lipotoxicity related to contractile, mitochondrial, and endoplasmic reticulum dysfunction; steatosis; and apoptosis [Wende AR, Abel ED. \u003Cem\u003EBiochim Biophys Acta\u003C\/em\u003E 2010].\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2012 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/12\/11\/11.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nznc71\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nznc71\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}