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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\u003EVisceral adiposity is an important correlate of cardiometabolic risk, yet its association after the diagnosis of type 2 diabetes remains unclear [Smith JD et al. \u003Cem\u003EJ Clin Endocrinol Metab\u003C\/em\u003E 2012]. This article discusses the association between visceral adiposity, fatty liver, and cardiometabolic risk, and presents results from the International Study of Prediction of Intra-Abdominal Adiposity and Its Relationships with Cardiometabolic Risk\/Intra-Abdominal Adiposity [INSPIRE ME IAA; Smith JD et al. \u003Cem\u003EJ Clin Endocrinol Metab\u003C\/em\u003E 2012].\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\u003Cli class=\u0022kwd\u0022\u003EDiabetes Mellitus\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EVisceral adiposity is an important correlate of cardiometabolic risk, yet its association after the diagnosis of type 2 diabetes remains unclear [Smith JD et al. \u003Cem\u003EJ Clin Endocrinol Metab\u003C\/em\u003E 2012]. Jean-Pierre Despr\u00e9s, PhD, Universit\u00e9 Laval, Qu\u00e9bec City, Qu\u00e9bec, Canada, discussed the association between visceral adiposity, fatty liver, and cardiometabolic risk, and presented results from the International Study of Prediction of Intra-Abdominal Adiposity and Its Relationships with Cardiometabolic Risk\/Intra-Abdominal Adiposity [INSPIRE ME IAA; Smith JD et al. \u003Cem\u003EJ Clin Endocrinol Metab\u003C\/em\u003E 2012].\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EINSPIRE ME IAA, a computed-tomography (CT) imaging study, addressed a lack of international data on the contribution of excess visceral adiposity and liver fat to the cardiometabolic risk profile of patients with impaired glucose homeostasis, type 2 diabetes, or cardiovascular (CVD) disease.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EThe aims of the study were to cross-sectionally determine the history of ischemic CV events and type 2 diabetes and to determine the relationship between visceral adiposity and cardiometabolic risk markers\/factors, including waist circumference. As the study included a 3-year follow-up, investigators also studied the relationship between visceral adiposity and the incidence of ischemic CV events and type 2 diabetes over the planned 3-year follow-up period. The primary objective was to assess the independent and combined associations of visceral adiposity and type 2 diabetes to cardiometabolic risk.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EThe multinational study involved 4277 patients (52% male). Their mean age was 57 years; 60% had hypertension; 39% had type 2 diabetes (fasting glucose \u22657 mmol\/L or glucose \u226511.1mmol\/L 120\u0027) or treatment for diabetes or history of diabetes; 62% had metabolic syndrome (American Heart Association\/National Heart, Lung, and Blood Institute); 24% had CVD. Patients were categorized according to visceral adiposity tertiles, type 2 diabetes status, and sex. All results were adjusted for age, body mass index (BMI), geographic region, and physician\u0027s specialty.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003ECT scans were performed at the L4-L5 vertebrae level for abdominal adipose tissue and at the Th12-L1 level for liver attenuation (a marker of liver fat content) between 1 and 3 weeks after the baseline visit [Shores NJ, et al. \u003Cem\u003EDig Dis Sci\u003C\/em\u003E 2011].\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EPatients were categorized as having type 2 diabetes if their fasting plasma glucose was at least 126 mg\/dL, their 120-min post-75-g oral glucose tolerance test (OGTT) glucose was at least 200 mg\/dL, they used antidiabetes medication, and\/or had a previous diagnosis of type 2 diabetes [\u003Cem\u003ESmith JD et al. J Clin Endocrinol Metab\u003C\/em\u003E 2012]. \u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E shows the proportion of subjects according to glucose tolerance standards [Despr\u00e9s JP et al. EASD 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\/6\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Proportion of Subjects According to Glucose Tolerance Status.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-2098914405\u0022 data-figure-caption=\u0022Proportion of Subjects According to Glucose Tolerance Status.\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\/6\/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\/6\/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\/6\/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\/14193\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-8\u0022 class=\u0022first-child\u0022\u003EProportion of Subjects According to Glucose Tolerance Status.\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EReproduced with permission from JP Depr\u00e9s, PhD.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-9\u0022\u003EOutcomes showed that higher levels of visceral adipose tissue (VAT) are associated with increased levels of cardiometabolic risk factors, including a more deleterious plasma\/lipoprotein profile with higher apolipoprotein (Apo) B and triglycerides and lower high-density lipoprotein-cholesterol in men and women, and lower ApoA1 in women only. Plasma glucose, insulin (fasting and after OGTT), and HbA1C levels were significantly higher with increasing VAT in men and women, and all indices of plasma glucose\/insulin homeostasis were higher in men and women with type 2 diabetes.\u003C\/p\u003E\u003Cp id=\u0022p-10\u0022\u003EThe prevalence of CVD increased with increasing levels of VAT. Higher levels of VAT were associated with greater prevalence of several clinical CV manifestations in individuals with and without type 2 diabetes (\u003Ca id=\u0022xref-fig-2-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F2\u0022\u003EFigure 2\u003C\/a\u003E). Type 2 diabetes status was positively associated with the presence of CVD in women (p=0.008) but had no effect in men (p=0.5).\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\/6\/F2.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Frequency of Prevalent CV Disease in Men and Women Without and with Type 2 Diabetes.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-2098914405\u0022 data-figure-caption=\u0022Frequency of Prevalent CV Disease in Men and Women Without and with Type 2 Diabetes.\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\/6\/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\/6\/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\/6\/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\/14195\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\u003EFrequency of Prevalent CV Disease in Men and Women Without and with Type 2 Diabetes.\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-2\u0022\u003EReproduced with permission from JP Depr\u00e9s, PhD.\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\u003EData indicated that VAT is associated with type 2 diabetes independent of BMI. Adjustment of each parameter separately for age, geographical region, BMI, and recruiting physician\u0027s specialty yielded a positive association between waist circumference, systolic blood pressure, triglycerides, and VAT with type 2 diabetes in both men and women.\u003C\/p\u003E\u003Cp id=\u0022p-13\u0022\u003EBased on these outcomes, the researchers concluded that excess visceral adiposity\/fatty liver is a key correlate of metabolic abnormalities in patients with and without type 2 diabetes. According to Prof. Despr\u00e9s, although waist circumference and BMI are strongly correlated, yet for a given BMI unit, there is substantial individual variation in waist circumference. He noted that waist circumference should not replace but complement BMI in risk assessment [Despr\u00e9s JP. \u003Cem\u003EJ Am Coll Cardiol\u003C\/em\u003E 2011].\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\/6.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?nznbyq\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?nznbyq\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}