Skip to main content
Log in

The link between abdominal obesity and the metabolic syndrome

  • Published:
Current Hypertension Reports Aims and scope Submit manuscript

Abstract

The clustering of cardiovascular risk factors associated with abdominal obesity is well established. Although currently lacking a universal definition, the metabolic syndrome describes a constellation of metabolic abnormalities, including abdominal obesity, and was originally introduced to characterize a population at high cardiovascular risk. Adipose tissue is a dynamic endocrine organ that secretes several inflammatory and immune mediators known as adipokines. Dysregulation of adipokine secretion, free fatty acid toxicity, and the site-specific differences in abdominal (visceral) versus subcutaneous fat support abdominal obesity as a causal factor mediating the insulin resistance, increased risk of diabetes, and cardiovascular disease in the metabolic syndrome.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References and Recommended Reading

  1. World Health Organization: Global strategy on diet, physical activity and health. Available at: http://www.who.int/dietphysicalactivity/publications/facts/obesity/en/. Accessed November 2007.

  2. Vague J: The degree of masculine differentiation of obesities: a factor determining predisposition to diabetes, atherosclerosis, gout, and uric calculous disease. Am J Clin Nutr 1956, 4:20–34.

    PubMed  CAS  Google Scholar 

  3. Wajchenberg BL: Subcutaneous and visceral adipose tissue: their relation to the metabolic syndrome. Endocr Rev 2000, 21:697–738.

    Article  PubMed  CAS  Google Scholar 

  4. Alberti KG, Zimmet P, Shaw J: The metabolic syndrome—a new worldwide definition. Lancet 2005, 366:1059–1062.

    Article  PubMed  Google Scholar 

  5. Grundy SM, Cleeman JI, Daniels SR, et al.: Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation 2005, 112:2735–2752.

    Article  PubMed  Google Scholar 

  6. Kershaw EE, Flier JS: Adipose tissue as an endocrine organ. J Clin Endocrinol Metab 2004, 89:2548–2556.

    Article  PubMed  CAS  Google Scholar 

  7. Hotamisligil GS: Inflammation and metabolic disorders. Nature 2006, 444:860–867.

    Article  PubMed  CAS  Google Scholar 

  8. Weisberg SP, McCann D, Desai M, et al.: Obesity is associated with macrophage accumulation in adipose tissue. J Clin Invest 2003, 112:1796–1808.

    PubMed  CAS  Google Scholar 

  9. Xu H, Barnes GT, Yang Q, et al.: Chronic inflammation in fat plays a crucial role in the development of obesity-related insulin resistance. J Clin Invest 2003, 112:1821–1830.

    PubMed  CAS  Google Scholar 

  10. Kahn R, Buse J, Ferrannini E, Stern M: The metabolic syndrome: time for a critical appraisal: joint statement from the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care 2005, 28:2289–2304.

    Article  PubMed  Google Scholar 

  11. Galassi A, Reynolds K, He J: Metabolic syndrome and risk of cardiovascular disease: a meta-analysis. Am J Med 2006, 119:812–819.

    Article  PubMed  CAS  Google Scholar 

  12. Definition, Diagnosis, and Classification of Diabetes Mellitus and its Complications. Part 1: Diagnosis and Classification of Diabetes Mellitus. In Report of a WHO Consultation. Geneva: World Health Organization, Department of Noncommunicable Disease Surveillance; 1999:1–59.

    Google Scholar 

  13. Ford ES: Prevalence of the metabolic syndrome defined by the International Diabetes Federation among adults in the U.S. Diabetes Care 2005, 28:2745–2749.

    Article  PubMed  Google Scholar 

  14. Rosen ED, Spiegelman BM: Adipocytes as regulators of energy balance and glucose homeostasis. Nature 2006, 444:847–853.

    Article  PubMed  CAS  Google Scholar 

  15. Badman MK, Flier JS: The adipocyte as an active participant in energy balance and metabolism. Gastroenterology 2007, 132:2103–2115.

    Article  PubMed  CAS  Google Scholar 

  16. Whitehead JP, Richards AA, Hickman IJ, et al.: Adiponectin—a key adipokine in the metabolic syndrome. Diabetes Obes Metab 2006, 8:264–280.

    Article  PubMed  CAS  Google Scholar 

  17. Richards AA, Stephens T, Charlton HK, et al.: Adiponectin multimerization is dependent on conserved lysines in the collagenous domain: evidence for regulation of multimerization by alterations in posttranslational modifications. Mol Endocrinol 2006, 20:1673–1687.

    Article  PubMed  CAS  Google Scholar 

  18. Yamauchi T, Kamon J, Ito Y, et al.: Cloning of adiponectin receptors that mediate antidiabetic metabolic effects. Nature 2003, 423:762–769.

    Article  PubMed  CAS  Google Scholar 

  19. Yamauchi T, Kamon J, Minokoshi Y, et al.: Adiponectin stimulates glucose utilization and fatty-acid oxidation by activating AMP-activated protein kinase. Nat Med 2002, 8:1288–1295.

    Article  PubMed  CAS  Google Scholar 

  20. Kubota N, Yano W, Kubota T, et al.: Adiponectin stimulates AMP-activated protein kinase in the hypothalamus and increases food intake. Cell Metab 2007, 6:55–68.

    Article  PubMed  CAS  Google Scholar 

  21. Hug C, Wang J, Ahmad NS, et al.: T-cadherin is a receptor for hexameric and high-molecular-weight forms of Acrp30/adiponectin. Proc Natl Acad Sci U S A 2004, 101:10308–10313.

    Article  PubMed  CAS  Google Scholar 

  22. Takemura Y, Ouchi N, Shibata R, et al.: Adiponectin modulates inflammatory reactions via calreticulin receptor-dependent clearance of early apoptotic bodies. J Clin Invest 2007, 117:375–386.

    Article  PubMed  CAS  Google Scholar 

  23. Yamauchi T, Nio Y, Maki T, et al.: Targeted disruption of AdipoR1 and AdipoR2 causes abrogation of adiponectin binding and metabolic actions. Nat Med 2007, 13:332–339.

    Article  PubMed  CAS  Google Scholar 

  24. Xu A, Wang Y, Keshaw H, et al.: The fat-derived hormone adiponectin alleviates alcoholic and nonalcoholic fatty liver diseases in mice. J Clin Invest 2003, 112:91–100.

    PubMed  CAS  Google Scholar 

  25. Covey SD, Wideman RD, McDonald C, et al.: The pancreatic beta cell is a key site for mediating the effects of leptin on glucose homeostasis. Cell Metab 2006, 4:291–302.

    Article  PubMed  CAS  Google Scholar 

  26. Chen K, Li F, Li J, et al.: Induction of leptin resistance through direct interaction of C-reactive protein with leptin. Nat Med 2006, 12:425–432.

    Article  PubMed  CAS  Google Scholar 

  27. Farooqi IS, O’Rahilly S: Is leptin an important physiological regulator of CRP? Nat Med 2007, 13:16–17; author reply 19–21.

    Article  PubMed  CAS  Google Scholar 

  28. Fukuhara A, Matsuda M, Nishizawa M, et al.: Visfatin: a protein secreted by visceral fat that mimics the effects of insulin. Science 2005, 307:426–430.

    Article  PubMed  CAS  Google Scholar 

  29. Varma V, Yao-Borengasser A, Rasouli N, et al.: Human visfatin expression: relationship to insulin sensitivity, intramyocellular lipids, and inflammation. J Clin Endocrinol Metab 2007, 92:666–672.

    Article  PubMed  CAS  Google Scholar 

  30. Stephens JM, Vidal-Puig AJ: An update on visfatin/pre-B cell colony-enhancing factor, an ubiquitously expressed, illusive cytokine that is regulated in obesity. Curr Opin Lipidol 2006, 17:128–131.

    Article  PubMed  CAS  Google Scholar 

  31. Ingelsson E, Larson MG, Fox CS, et al.: Clinical correlates of circulating visfatin levels in a community-based sample. Diabetes Care 2007, 30:1278–1280.

    Article  PubMed  CAS  Google Scholar 

  32. Korner A, Garten A, Bluher M, et al.: Molecular characteristics of serum visfatin and differential detection by immunoassays. J Clin Endocrinol Metab 2007, 92:4783–4791.

    Article  PubMed  Google Scholar 

  33. Yang RZ, Lee MJ, Hu H, et al.: Identification of omentin as a novel depot-specific adipokine in human adipose tissue: possible role in modulating insulin action. Am J Physiol Endocrinol Metab 2006, 290:E1253–E1261.

    Article  PubMed  CAS  Google Scholar 

  34. de Souza Batista CM, Yang RZ, Lee MJ, et al.: Omentin plasma levels and gene expression are decreased in obesity. Diabetes 2007, 56:1655–1661.

    Article  PubMed  Google Scholar 

  35. Ma LJ, Mao SL, Taylor KL, et al.: Prevention of obesity and insulin resistance in mice lacking plasminogen activator inhibitor 1. Diabetes 2004, 53:336–346.

    Article  PubMed  CAS  Google Scholar 

  36. Hida K, Wada J, Eguchi J, et al.: Visceral adipose tissue-derived serine protease inhibitor: a unique insulin-sensitizing adipocytokine in obesity. Proc Natl Acad Sci U S A 2005, 102:10610–10615.

    Article  PubMed  CAS  Google Scholar 

  37. Seeger J, Ziegelmeier M, Bachmann A, et al.: serum levels of the adipokine vaspin in relation to metabolic and renal parameters. J Clin Endocrinol Metab 2008, 93:247–251.

    Article  PubMed  CAS  Google Scholar 

  38. Bernstein LE, Berry J, Kim S, et al.: Effects of etanercept in patients with the metabolic syndrome. Arch Intern Med 2006, 166:902–908.

    Article  PubMed  CAS  Google Scholar 

  39. Arkan MC, Hevener AL, Greten FR, et al.: IKK-beta links inflammation to obesity-induced insulin resistance. Nat Med 2005, 11:191–198.

    Article  PubMed  CAS  Google Scholar 

  40. Weisberg SP, Hunter D, Huber R, et al.: CCR2 modulates inflammatory and metabolic effects of high-fat feeding. J Clin Invest 2006, 116:115–124.

    Article  PubMed  CAS  Google Scholar 

  41. Kanda H, Tateya S, Tamori Y, et al.: MCP-1 contributes to macrophage infiltration into adipose tissue, insulin resistance, and hepatic steatosis in obesity. J Clin Invest 2006, 116:1494–1505.

    Article  PubMed  CAS  Google Scholar 

  42. Desbriere R, Vuaroqueaux V, Achard V, et al.: 11beta-hydroxysteroid dehydrogenase type 1 mRNA is increased in both visceral and subcutaneous adipose tissue of obese patients. Obesity (Silver Spring) 2006, 14:794–798.

    Article  CAS  Google Scholar 

  43. Shi H, Kokoeva MV, Inouye K, et al.: TLR4 links innate immunity and fatty acid-induced insulin resistance. J Clin Invest 2006, 116:3015–3025.

    Article  PubMed  CAS  Google Scholar 

  44. Nielsen S, Guo Z, Johnson CM, et al.: Splanchnic lipolysis in human obesity. J Clin Invest 2004, 113:1582–1588.

    PubMed  CAS  Google Scholar 

  45. Fain JN, Madan AK, Hiler ML, et al.: Comparison of the release of adipokines by adipose tissue, adipose tissue matrix, and adipocytes from visceral and subcutaneous abdominal adipose tissues of obese humans. Endocrinology 2004, 145:2273–2282.

    Article  PubMed  CAS  Google Scholar 

  46. Aronne LJ: Therapeutic options for modifying cardiometabolic risk factors. Am J Med 2007, 120:S26–S34.

    Article  PubMed  CAS  Google Scholar 

  47. Barzilai N, She L, Liu BQ, et al.: Surgical removal of visceral fat reverses hepatic insulin resistance. Diabetes 1999, 48:94–98.

    Article  PubMed  CAS  Google Scholar 

  48. Klein S, Fontana L, Young VL, et al.: Absence of an effect of liposuction on insulin action and risk factors for coronary heart disease. N Engl J Med 2004, 350:2549–2557.

    Article  PubMed  CAS  Google Scholar 

  49. Guarente L: Sirtuins as potential targets for metabolic syndrome. Nature 2006, 444:868–874.

    Article  PubMed  CAS  Google Scholar 

  50. Nuotio-Antar AM, Hachey D, Hasty AH: Carbenoxolone treatment attenuates symptoms of metabolic syndrome and atherogenesis in obese, hyperlipidemic mice. Am J Physiol Endocrinol Metab 2007, 293:E1517–E1528.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Johannes B. Prins.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Phillips, L.K., Prins, J.B. The link between abdominal obesity and the metabolic syndrome. Current Science Inc 10, 156–164 (2008). https://doi.org/10.1007/s11906-008-0029-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11906-008-0029-7

Keywords

Navigation