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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 obesity is associated with a variety of conditions that increases the risk developing type 2 diabetes and cardiovascular disease [Kissebah AH, Krakower GR. \u003Cem\u003EPhysiol Rev\u003C\/em\u003E 1994; Despr\u00e9s JP, Lemieux I. \u003Cem\u003ENature\u003C\/em\u003E 2006; Tchernof A, Despr\u00e9s JP. \u003Cem\u003EPhysiol Rev\u003C\/em\u003E 2013]. This article discusses visceral adipose tissue metabolism and its association with cardiometabolic risk.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiometabolic Disorder\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiometabolic Disorder\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EEndocrinology\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EDiabetes \u0026amp; Metabolic Syndrome\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EAndr\u00e9 Tchernof, PhD, Universit\u00e9 Laval, Laval, Qu\u00e9bec, Canada, discussed visceral adipose tissue metabolism and its association with cardiometabolic risk.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EVisceral obesity is associated with a variety of conditions that increases the risk developing type 2 diabetes and cardiovascular disease [Kissebah AH, Krakower GR. \u003Cem\u003EPhysiol Rev\u003C\/em\u003E 1994; Despr\u00e9s JP, Lemieux I. \u003Cem\u003ENature\u003C\/em\u003E 2006; Tchernof A, Despr\u00e9s JP. \u003Cem\u003EPhysiol Rev\u003C\/em\u003E 2013]. These features include:\u003C\/p\u003E\u003Cul class=\u0022list-simple \u0022 id=\u0022list-1\u0022\u003E\u003Cli id=\u0022list-item-1\u0022\u003E\n            \n            \u003Cp id=\u0022p-4\u0022\u003E\u003Cspan class=\u0022list-label\u0022\u003E\u25aa \u003C\/span\u003EGlucose intolerance\u003C\/p\u003E\n         \u003C\/li\u003E\u003Cli id=\u0022list-item-2\u0022\u003E\n            \n            \u003Cp id=\u0022p-5\u0022\u003E\u003Cspan class=\u0022list-label\u0022\u003E\u25aa \u003C\/span\u003EInsulin resistance\u003C\/p\u003E\n         \u003C\/li\u003E\u003Cli id=\u0022list-item-3\u0022\u003E\n            \n            \u003Cp id=\u0022p-6\u0022\u003E\u003Cspan class=\u0022list-label\u0022\u003E\u25aa \u003C\/span\u003EHyperinsulinemia\u003C\/p\u003E\n         \u003C\/li\u003E\u003Cli id=\u0022list-item-4\u0022\u003E\n            \n            \u003Cp id=\u0022p-7\u0022\u003E\u003Cspan class=\u0022list-label\u0022\u003E\u25aa \u003C\/span\u003EDyslipidemia\u003C\/p\u003E\n         \u003C\/li\u003E\u003Cli id=\u0022list-item-5\u0022\u003E\n            \n            \u003Cp id=\u0022p-8\u0022\u003E\u003Cspan class=\u0022list-label\u0022\u003E\u25aa \u003C\/span\u003EHypertension\u003C\/p\u003E\n         \u003C\/li\u003E\u003Cli id=\u0022list-item-6\u0022\u003E\n            \n            \u003Cp id=\u0022p-9\u0022\u003E\u003Cspan class=\u0022list-label\u0022\u003E\u25aa \u003C\/span\u003EProinflammatory and prothrombotic state\u003C\/p\u003E\n         \u003C\/li\u003E\u003Cli id=\u0022list-item-7\u0022\u003E\n            \n            \u003Cp id=\u0022p-10\u0022\u003E\u003Cspan class=\u0022list-label\u0022\u003E\u25aa \u003C\/span\u003EHepatic stenosis\u003C\/p\u003E\n         \u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-11\u0022\u003ERegional differences in the average size and number of adipocytes found in subcutaneous and visceral adipose tissue have been described [Tchernof A. Sex differences in energy balance, body composition, and body fat distribution. In: Tsatsoulis A, Wyckoff J, Brown FM, eds. \u003Cem\u003EDiabetes in Women.\u003C\/em\u003E USA: Springer; 2010: 1\u201324.]. Other mechanisms by which obesity may increase cardiometablic risk include changes in lipoprotein lipase activity and in the release of free fatty acids, adiponectin, and interleukin-6 that occur in obese patients.\u003C\/p\u003E\u003Cp id=\u0022p-12\u0022\u003EIncreasing body fat mass is associated with increased adipocyte diameter. In addition, there is an increased number of larger diameter adipocytes in subcutaneous and visceral adipose tissue [Spalding KL et al. \u003Cem\u003ENature\u003C\/em\u003E 2008; Veilleux A et al. \u003Cem\u003EDiabetes\u003C\/em\u003E 2011]. The enlargement of existing adipocytes\u2014adipocyte hypertrophy\u2014that occurs in visceral fat maybe associated with an altered lipid profile independent of body composition and fat distribution in women [Veilleux A et al. \u003Cem\u003EDiabetes\u003C\/em\u003E 2011].\u003C\/p\u003E\u003Cp id=\u0022p-13\u0022\u003EVisceral adipocyte hypertrophy is associated with a hyperlipolytic response to beta-adrenergic and post-receptor agents in adipose cells as well as elevated expression of CCAAT enhancer-binding protein beta (C\/EBPB), and reduced expression of glucose transporter type 4 in subcutaneous adipose tissue. In addition, visceral adipocyte hypertrophy is associated with elevated expression of CD31 and von Willebrand factor in subcutaneous and omental adipose, and elevated expression of CD68 in omental adipose.\u003C\/p\u003E\u003Cp id=\u0022p-14\u0022\u003EIn the metabolic syndrome, adipocyte hypertrophy plays a role in lipid uptake and lipolytic rate of adipocytes [Varlamov O et al. \u003Cem\u003EAm J Physiol Endocrinol Metab\u003C\/em\u003E 2010; Tchernof A et al. \u003Cem\u003EDiabetes\u003C\/em\u003E 2006], release of adiponectin and leptin [Drolet R et al. \u003Cem\u003EObesity\u003C\/em\u003E 2009; Lee MJ, Fried SK. \u003Cem\u003EAm J Physiol Endocrinol Metab\u003C\/em\u003E 2009], macrophage infiltration [Michaud A et al. \u003Cem\u003EMetabolism\u003C\/em\u003E 2012], insulin resistance [McLaughlin T et al. \u003Cem\u003EDiabetologia\u003C\/em\u003E 2007], and dyslipidemia [Veilleux A et al. \u003Cem\u003EDiabetes 2011].\u003C\/em\u003E\n      \u003C\/p\u003E\u003Cp id=\u0022p-15\u0022\u003EAdipocyte hyperplasia is associated with subcutaneous fat in men and women. Prof. Tchernof noted that in many instances visceral adipocyte hypertrophy is a stronger predictor of metabolic alterations than subcutaneous adipocyte hypertrophy. Visceral fat quickly becomes inefficient for lipid storage as its mass and the size of its adipocytes increase, perhaps because expansion is mostly through lipogenesis.\u003C\/p\u003E\u003Cp id=\u0022p-16\u0022\u003EIt is important to note that the previously described results have been obtained in lean-to-moderately obese subjects, in whom fat cell size tends to increase linearly with adiposity. The same relationship has not been described in more obese individuals where the predictive ability and pathophysiological importance of fat cell size may differ.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2013 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\/13\/16\/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_openurl.js?nznm21\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}