ECTOPIC FAT DISTRIBUTION AND ORGAN FUNCTION
The association between visceral fat and metabolic and cardiovascular disorders is also related to accumulation of ectopic fat that accompanies visceral adiposity[46]. Moreover, the hepatic fat observed in patients with insulin resistance could be independent from the visceral fat content[47].
Healthy expansion of subcutaneous fat in response to obesity is accompanied by enlargement of fat mass through enhanced recruitment of preadipocytes along with adequate vascularization of expanding adipose tissue and minimal fibrosis and minimal infiltration of inflammatory ATMs. In contrast, pathologic expansion is associated with rapid growth of fat tissue through the enlargement of existing adipocytes and inadequate vascularization leading to fibrosis and inflammatory ATM infiltration that secrete high levels of inflammatory cytokines[48].
This pathologic expansion is associated with adipose tissue accumulation in ectopic locations such as liver, skeletal muscle, and pancreas as well as visceral adiposity[49].
The existence of “metabolically healthy obese (MHO)”[50,51] further supports this concept as these individuals have less ectopic fat despite high amount of subcutaneous fat in gluteal depot and are insulin sensitive[51].
Therefore, adipose tissue distribution is a more significant predictor of metabolic and cardiovascular risk than overall adiposity. Inability to expand subcutaneous depots in response to positive energy balance[52] results in metabolic and cardiovascular complications.
ECTOPIC FAT DISTRIBUTION AND ORGAN FUNCTIONThe association between visceral fat and metabolic and cardiovascular disorders is also related to accumulation of ectopic fat that accompanies visceral adiposity[46]. Moreover, the hepatic fat observed in patients with insulin resistance could be independent from the visceral fat content[47].Healthy expansion of subcutaneous fat in response to obesity is accompanied by enlargement of fat mass through enhanced recruitment of preadipocytes along with adequate vascularization of expanding adipose tissue and minimal fibrosis and minimal infiltration of inflammatory ATMs. In contrast, pathologic expansion is associated with rapid growth of fat tissue through the enlargement of existing adipocytes and inadequate vascularization leading to fibrosis and inflammatory ATM infiltration that secrete high levels of inflammatory cytokines[48]. This pathologic expansion is associated with adipose tissue accumulation in ectopic locations such as liver, skeletal muscle, and pancreas as well as visceral adiposity[49].The existence of “metabolically healthy obese (MHO)”[50,51] further supports this concept as these individuals have less ectopic fat despite high amount of subcutaneous fat in gluteal depot and are insulin sensitive[51].Therefore, adipose tissue distribution is a more significant predictor of metabolic and cardiovascular risk than overall adiposity. Inability to expand subcutaneous depots in response to positive energy balance[52] results in metabolic and cardiovascular complications.
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