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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\u003EAbdominal obesity is a marker of dysfunctional adipose tissue [Despr\u00e9s JP, Lemieux I. \u003Cem\u003ENature\u003C\/em\u003E 2006]. This article provides an overview of alterations in visceral and subcutaneous adipose tissue function in individuals with visceral obesity, with an emphasis on adipose tissue metabolism. He also discussed fat cell size, adipocyte hypertrophy and storage capacity; adipose tissue lipolysis; excess substrate and inflammation; mesenteric adipose tissue; and abdominal fat in severe obesity.\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\u003EAbdominal obesity is a marker of dysfunctional adipose tissue [Despr\u00e9s JP, Lemieux I. \u003Cem\u003ENature\u003C\/em\u003E 2006]. Andr\u00e9 Tchernof, PhD, Universit\u00e9 Laval, Qu\u00e9bec City, Qu\u00e9bec, Canada, provided an overview of alterations in visceral and subcutaneous adipose tissue function in individuals with visceral obesity, with an emphasis on adipose tissue metabolism. He also discussed fat cell size, adipocyte hypertrophy and storage capacity; adipose tissue lipolysis; excess substrate and inflammation; mesenteric adipose tissue; and abdominal fat in severe obesity.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EIn a study of regional differences in adipocyte metabolism and visceral versus subcutaneous parameters across adiposity values in women, Tchernof et al. [\u003Cem\u003EDiabetes\u003C\/em\u003E 2006] found that compared with omental adipocytes, subcutaneous adipocytes are larger, have higher lipoprotein lipase activity, and are more lipolytic on an absolute basis\u2014factors that may reflect higher fat storage capacity. They also demonstrated that overall and visceral obesity had only minor effects on regional differences in adipose tissue metabolism.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EVeilleux et al. [\u003Cem\u003EDiabetes\u003C\/em\u003E 2011] reported that women characterized by omental adipocyte hypertrophy presented a deleterious lipid profile compared with those characterized by omental hyperplasia. Findings indicate that a 10% enlargement of omental adipocytes increased the risk of hypertriglyceridemia more than 4-fold, whereas enlarged subcutaneous adipocytes failed to significantly alter the risk of hypertriglyceridemia.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EObesity engenders a complex immune response in which macrophage accumulation in adipose tissue is a characteristic feature [Kosteli A et al. \u003Cem\u003EJ Clin Invest\u003C\/em\u003E 2010]. In women, visceral fat accumulation is an indicator of adipose tissue macrophage infiltration, and it is the best correlate of macrophage infiltration in both subcutaneous and fat compartments of lean to obese women [Michaud A et al. \u003Cem\u003EMetabolism\u003C\/em\u003E 2012]. According to Kosteli et al. [\u003Cem\u003EJ Clin Inves\u003C\/em\u003E 2010] excess lipolysis could be one of the causal factors for adipose tissue macrophage infiltration (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E).\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\/10\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Lipolysis, Macrophage Infiltration, and Inflammation.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1017038793\u0022 data-figure-caption=\u0022Lipolysis, Macrophage Infiltration, and Inflammation.\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\/10\/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\/10\/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\/10\/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\/14181\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-6\u0022 class=\u0022first-child\u0022\u003ELipolysis, Macrophage Infiltration, and Inflammation.\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EReproduced with permission from A. Tchernof, PhD.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-7\u0022\u003ERegarding the correlations of fat cell size with obesity and fat distribution, all adiposity measures, including body mass index (BMI) and total body fat mass, as well as adipose tissue areas measured by computed tomography, are strongly and positively correlated with subcutaneous and omental adipocyte diameter (\u003Ca id=\u0022xref-fig-2-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F2\u0022\u003EFigure 2\u003C\/a\u003E) [Tchernof A et al. \u003Cem\u003EDiabetes\u003C\/em\u003E 2006].\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\/10\/F2.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Adipocyte Diameter as a Function of BMI in Men and Women.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1017038793\u0022 data-figure-caption=\u0022Adipocyte Diameter as a Function of BMI in Men and Women.\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\/10\/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\/10\/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\/10\/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\/14183\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-8\u0022 class=\u0022first-child\u0022\u003EAdipocyte Diameter as a Function of BMI in Men and Women.\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-2\u0022\u003EReproduced with permission from A. Tchernof, 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\u003EProf. Tchernof noted that in the lean to moderately obese range, visceral adipocyte hypertrophy is clearly related to dyslipidemia, independent of total adiposity and body fat distribution. However, the fact that fat cell size reaches a plateau in individuals with severe obesity suggests it may not predict metabolic complications in this population. This conclusion coincides with reports from Lemieux et al. [\u003Cem\u003EDiabetes Care\u003C\/em\u003E 2006] and Drapeau et al. [\u003Cem\u003EObes Surg\u003C\/em\u003E 2007] that cast doubt on the utility of waist circumference to predict metabolic abnormalities and complications in severely obese men and women.\u003C\/p\u003E\u003Cp id=\u0022p-10\u0022\u003EProf. Tchernof concluded the following:\u003C\/p\u003E\u003Cul class=\u0022list-unord \u0022 id=\u0022list-1\u0022\u003E\u003Cli id=\u0022list-item-1\u0022\u003E\n            \u003Cp id=\u0022p-11\u0022\u003EVisceral adipose tissue expands mostly through adipocyte hypertrophy and quickly becomes inefficient in storing excess lipids.\u003C\/p\u003E\n         \u003C\/li\u003E\u003Cli id=\u0022list-item-2\u0022\u003E\n            \u003Cp id=\u0022p-12\u0022\u003ELimited adipose tissue lipid storage capacity has emerged as a critical determinant of cardiometabolic alterations.\u003C\/p\u003E\n         \u003C\/li\u003E\u003Cli id=\u0022list-item-3\u0022\u003E\n            \u003Cp id=\u0022p-13\u0022\u003ELipolytic responsiveness of visceral adipocytes to positive stimuli is increased in visceral obesity, but most studies support a reduced inhibitory response to insulin in visceral adipocytes compared with subcutaneous adipocytes.\u003C\/p\u003E\n         \u003C\/li\u003E\u003Cli id=\u0022list-item-4\u0022\u003E\n            \u003Cp id=\u0022p-14\u0022\u003EVisceral obesity and high lipolytic rates are closely related to macrophage infiltration and inflammation.\u003C\/p\u003E\n         \u003C\/li\u003E\u003Cli id=\u0022list-item-5\u0022\u003E\n            \u003Cp id=\u0022p-15\u0022\u003EThe pathophysiology of metabolic disorders in severe obesity may no longer be related solely to excess visceral fat and\/or visceral adipocyte hypertrophy.\u003C\/p\u003E\n         \u003C\/li\u003E\u003C\/ul\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\/10.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"}