Visceral and Ectopic Fat : Risk Factors for Type 2 Diabetes, Atherosclerosis, and Cardiovascular Disease

While the health consequences and mechanisms by which visceral fat causes disease are well-studied, relatively less is known about ectopic fat, its patterns of deposition and its effects on the pathoetiology of type 2 diabetes, atherosclerosis, and cardiovascular disease. Visceral and Ectopic Fat: Risk Factors for Type 2 Diabetes, Atherosclerosis, and Cardiovascular Disease covers the wealth of literature that has been amassed over the past decade on this topic. This reference brings all the research and clinical data together in one volume and helps clinicians and academic researchers understand more thoroughly the underlying mechanisms and interrelation between fat depots and ectopic fat stores in relation to health and disease. It showcases some of the recent developments in adipose tissue biology, particularly on the impact of interventional strategies - bariatric surgery, liposuction, physical and dietary intervention - of which information is desired among health specialists and policy makers. Brings together up-to-date research on imaging, genetics, and risk factors for chronic diseases such as diabetes, heart disease, cancer, and fatty liver disease Takes a deep dive into the current state of knowledge regarding fat stores, ectopic fat, regulation of fat stores, clinical implications, interventions, and imagining techniques Provides up-to-date information specifically focused on visceral and ectopic fat. In addition, both pathophysiological and preventive and treatment aspects of the problem will be considered Covers a broad range of organs - different fat stores such as skeletal muscle, bone marrow, liver and kidney Discusses potential interventions to reduce abdominal fat Front Cover Visceral and Ectopic Fat Visceral and Ectopic Fat Copyright Contents List of contributors Preface I - Fat stores 1 - Overall, abdominal, and visceral obesity in men and women: an introduction Overweight and obesity: definition, prevalence, and relation to disease Definition of overweight and obesity Prevalence of overweight and obesity Obesity-related mortality and diseases Body fat distribution: abdominal obesity, visceral fat, and ectopic fat Body fat distribution and abdominal obesity Visceral adipose tissue and subcutaneous adipose tissue Lipid overflow hypothesis and ectopic fat accumulation Sex differences in body fat distribution and health consequences Summary and conclusion References 2 - Obesity and fat distribution in children and adolescents Childhood obesity has reached pandemic proportions Abdominal obesity in children is a better indicator of health risks than BMI Visceral fat in relation to cardiomentabolic health in young people Determinants of visceral fat in children and adolescents Sex Genetics of visceral fat accumulation Ethnicity Chronic stress (cortisol) Behavioral determinants of visceral fat Measurement of visceral fat in children Imaging techniques The waist circumference or waist/height ratio as a measure of visceral fat in clinical practice and public health Classification of abdominal obesity in children by the waist/height ratio Visceral fat and metabolic risk factors in children and adolescents Conclusions References 3 - Brown adipose tissue: metabolic role and non-invasive quantification in humans BAT physiology Background on history of BAT: perceived impact on human health and scientific interest in past three decades Overview of potential analysis techniques for assessing BAT activity Invasive techniques Noninvasive techniques Overview of tracers with their molecular targets Discussion: clinical applications? References 4 - Epicardial and pericoronary fat Introduction Terminology Anatomical characteristics of EAT Data based on autopsy Findings from clinical settings Biochemical features and physiological function of EAT Cardiac imaging of EAT EAT in the pathomechanism of atherosclerosis EAT in other cardiac diseases Atrial fibrillation Heart failure Inflammation Epicardial fat necrosis EAT in metabolic diseases EAT in patients with COVID-19 Treatment options for modifying EAT volume References II - Ectopic fat stores 5 - Non-invasive profiling of ectopic and adipose lipids using magnetic resonance spectroscopy and imaging Introduction Lipid composition and its consequences in magnetic resonance spectroscopy In vivo magnetic resonance spectroscopy Magnetic resonance spectroscopy data acquisition Analysis of the magnetic resonance spectrscopy data Magnetic resonance imaging Applications Adipose tissue (deep subcutaneous adipose tissue/visceral adipose tissue/brown adipose tissue) Bone marrow fat Breast Liver Heart Skeletal muscle Summary References 6 - Flexibility of ectopic lipids in skeletal/cardiac muscle and liver Measurement of the flexibility of ectopic lipids Biopsy 1H-magnetic resonance spectroscopy (MRS) Ectopic lipids in the context of negative energy balance Single bout of exercise Fasting Ectopic lipids in the context of positive energy balance Short-term high fat diet Long-term high fat diet High fructose/glucose diet References 7 - Nonalcoholic fatty liver disease: from a benign finding to a life-threatening cardiometabolic liver disease Introduction Pathogenesis Genetic and epigenetic determinants Nutrition Insulin resistance and lipotoxicity Inflammation and necroapoptosis Adipocytokines Formation of fibrosis Urea cycle dysregulation Bile acids Microbiome Clinical consequences Liver cirrhosis Hepatocellular carcinoma Cardiovascular disease Diagnostics Treatment Obesity and lifestyle Nutrition Insulin sensitivity GLP1 receptor agonists and GLP1 analogs SGLT2 inhibitors Lipotoxicity Oxidative stress Bile acids Apoptosis Inflammation and fibrosis Combination therapy Probiotics and fecal microbiome transplantation Development and implementation of clinical care paths and guidelines for NAFLD Primary care Secondary and tertiary care Conclusion References 8 - Myocardial lipids—techniques and applications of proton magnetic resonance spectroscopy of the human heart Localized proton magnetic resonance spectroscopy of the heart Quantification of myocardial metabolite content Lipids in the healthy human myocardium—effects of nutrition, fasting, and exercise Gender Aging Body mass index Athletes and exercise Nutrition Myocardial lipids in disease Insulin resistance and type 2 diabetes Other diseases Concluding remarks and outlook References 9 - Pancreas ectopic fat: imaging-based quantification Introduction Pancreas and ectopic fat Pancreas state assessment Information from MRI Pancreas volume MRI-derived fat fraction Pancreas morphology Pancreas fibroinflammation Big Data and AI Future directions References 10 - Fat accumulation around and within the kidney Introduction Perirenal fat and renal sinus fat Anatomical characteristics Histological and pathophysiological characteristics Imaging-based quantification Quantification of perirenal fat Quantification of renal sinus fat Renal parenchyma triglyceride Histological characteristics and pathophysiological relevance Imaging-based quantification Clinical implications of excessive kidney fat Association with chronic kidney disease and insulin resistance Association with cardiovascular diseases Implications for other diseases Changes of excessive kidney fat after intervention Summary and perspectives References 11 - Skeletal muscle fat Introduction Skeletal muscle fat infiltration Flexibility of IMAT fatty infiltration Intramyocellular lipids Flexibility of IMCL Methods to assess lipids in the muscle Computed tomography—CT MRI of skeletal muscle Postprocessing and assessment of fat infiltration imaging MRS of skeletal muscle Postprocessing and quantitation of 1H-MR spectra from skeletal muscle Summary References 12 - Bone marrow adipose tissue Introduction Bone marrow fat origin Main characteristics in physiology Main characteristics Variation during growth Variation with aging Regional specific differences in BMAT composition Effect of exercise and caloric restriction Impact of unloading Microscopic aspect In vivo imaging Computed tomography Single-energy CT (SECT) Dual-energy CT (DECT) Magnetic resonance imaging T1-weighted MRI Water-fat imaging Proton magnetic resonance spectroscopy 1H-MRS Secretory profile and endocrine regulation of BMAT BMAT and skeletal health BMAT and hematopoiesis BMAT in cancer BMAT and metabolic diseases Concluding remarks References III - Regulation of fat stores 13 - Regulation of fat stores—endocrinological pathways Insulin Thyroid hormone Growth hormone Cortisol Sex hormones Summary Acknowledgments References 14 - Inflammation of the adipose tissue: metabolic consequences during weight (re)gain and loss Introduction Chronic low-grade inflammation of the adipose tissue Weight gain Weight loss Weight regain Adipose tissue inflammation during obesity: how does it lead to complications? Insulin resistance Atherosclerosis Determining adipose tissue inflammation Conclusion References IV - Clinical aspects 15 - Role of adipose tissue remodeling in diabetic heart disease Adipose tissue physiology in health and the pathophysiological role of adipose tissue in transition from obesity to diabetes Adipose tissue and signaling pathways in diabetes and heart disease Sex differences in adipose tissue remodeling effects on cardiovascular disease Adiponectin, proinflammatory adipocytokines, and cardiovascular disease in diabetes Imaging ectopic adiposity in patients with type 2 diabetes mellitus Conclusions References 16 - Cardiovascular disease Introduction Obesity hypertension: role of magnetic resonance imaging Fat deposits in obesity hypertension Cardiovascular structure and function in obesity hypertension Coronary artery disease in obesity Arrhythmias Heart failure Conclusion References 17 - Obesity in relation to cardiorenal function Introduction Obesity-related cardiorenal dysfunction Overview of five-part classification system for cardiorenal syndrome The pathophysiology of cardiorenal syndrome Metabolic syndrome Dyslipidemia and atherosclerosis Systemic inflammation, microvascular dysfunction, and heart failure Sympathetic activation and leptin Renin-angiotensin-aldosterone system (RAAS) Hyperuricemia Preclinical studies Obese animal models of cardiorenal syndrome The Zucker rat and substrains as proposed models of the metabolic cardiorenal syndrome Abnormalities in cardiac function in obesity Abnormalities in renal function in obesity CKD as a risk factor for HFpEF in obese animals Sex differences in the cardiorenal interaction Epidemiological and translational studies in humans Estimating obesity's risk for renal and cardiac dysfunction Metabolic imaging studies of ectopic fat storage in heart and kidney Dietary effects on ectopic fat storage in heart and kidney Effects of glycemic control on ectopic fat storage in heart and kidney Future outlook Novel developments in preclinical studies Multiorgan imaging in the management of CRS in obese individuals Personalized approach in the management of obesity-related CRS Conclusion Funding References 18 - Obesity and asthma Physical function: lung function and genetic factors Physical effects and genetic background of obesity and asthma Obesity and respiratory function Racial differences Genetic factors in obesity and asthma Epidemiology: clinical features and findings Epidemiological study of obesity and asthma in children and adults Epidemiological studies in children Obesity and asthma Definition of obesity in pediatric clinical studies Relationship between weight change and asthma Relationship between obesity and weight gain in pregnant mothers and asthma in childhood Sex differences in obesity and asthma in children Epidemiological studies in adults Obesity and asthma Definition of obesity in adult clinical studies Phenotypes of obese patients with asthma Sex differences in obesity and asthma in adults Effect on asthma due to obesity-related complications Disease pathogenesis: immunological mechanisms Pathogenesis of obesity and asthma Abnormal lipid metabolism Increased oxidative stress Increased airway inflammation Inflammation in adipose tissue Abnormalities in adipokines Decreased steroid responsiveness Insulin resistance Summary Acknowledgments References 19 - Obesity and the brain: structural and functional imaging studies, and opportunities for large-scale imaging ge ... Introduction Structural brain imaging and obesity Body Mass Index Fat distribution Diffusion tensor imaging Visceral fat Hypothalamic function Functional brain imaging studies and obesity Genetic analyses of obesity and the brain Genome-wide association studies Polygenic risk scores Mendelian randomization Future directions Conclusions References V - Interventions 20 - The impact of very-low-calorie diets on ectopic fat deposition Introduction Visceral adipose tissue Hepatic ectopic fat Very-low-calorie diet in the treatment of type II diabetes Calorie restriction and cardiac lipid deposition Skeletal muscle lipid metabolism and very-low-calorie diets Impact of very-low-calorie diet on bone marrow fat Conclusion References 21 - Intermittent fasting Intermittent fasting methods Physiology of intermittent energy restriction Effect of intermittent energy restriction on health parameters in animal models Effect of intermittent energy restriction on weight and fat in animal models Effect of intermittent energy restriction on metabolic parameters in animal models Effect of intermittent energy restriction on other health parameters in animal models Effect of intermittent energy restriction on health parameters in humans Effect of intermittent energy restriction on weight and fat in humans Effect of intermittent energy restriction on metabolic parameters in humans Effect of intermittent energy restriction on other health parameters in humans The effect of intermittent energy restriction versus continuous energy restriction on weight and fat in humans Sustainability of intermittent energy restriction Potential risks of intermittent energy restriction Conclusion References 22 - Exercise Introduction Definition of key terms Current recommendations Aerobic training interventions Resistance training interventions Aerobic and resistance training interventions The role of intensity How much is enough? Mechanisms underlying the effects of exercise on visceral and ectopic adipose tissue Are exercise-induced changes in body weight necessary for reductions in visceral adipose tissue and how does this compare t ... The unique role of exercise in the prevention and management of chronic disease Conclusion References 23 - Combined lifestyle interventions Introduction Medical nutrition therapy Introduction Dietary patterns Summary Physical activity Introduction Benefits of physical activity Recommendations for physical activity Adipose tissue and physical activity Type and duration of physical activity Recommendations Sleep Introduction Obstructive sleep apnea Recommendations Behavioral interventions Treatment structure Behavior therapy principles Goal setting Self-monitoring Problem-solving Cognitive techniques Efficacy of multicomponent behavioral interventions The challenge of dissemination Behavioral intervention and antiobesity medication Behavioral intervention and bariatric surgery Summary References bksec2_23 bksec2_24 bksec2_25 bksec2_26 24 - Medical therapy Introduction Metformin Mechanism of action/side effects Clinical efficacy Orlistat Mechanism of actions/side effects Clinical efficacy Glucagon-like peptide 1 receptor agonists Mechanisms of action/side effects Clinical efficacy Sodium glucose cotransporter-2 inhibitors Mechanisms of action/side effects Clinical efficacy Conclusions References 25 - Gastric volume reduction interventions and effects on visceral fat and metabolic biomarkers Introduction Endoscopic sleeve gastroplasty Meta-analyses Case series Metabolic effects Primary obesity surgery endoluminal (POSE) procedure Meta-analysis Metabolic effects Intragastric balloon therapy IGB types Meta-analyses and controlled trials Orbera Obalon Elipse Metabolic and visceral fat effects of intragastric balloons NAFLD and NASH Metabolism and body composition Conclusion References 26 - Roux-en-Y gastric bypass: influence on adipose tissue and metabolic homeostasis Introduction RYGB procedure description Mechanisms of RYGB RYGB—effect on weight loss and obesity-related comorbidities Pathogenesis of obesity through adipose tissue Molecular markers in obesity have changed quantities after RYGB Changes in adipose tissue Bile acids and metabolic and bariatric surgery Visceral fat Ectopic fat Subcutaneous fat Overview of metabolic benefits after RYGB Class 1 obesity and metabolic and bariatric surgery Conclusion References 27 - Fecal transplant The gut microbiome Gut microbiome modulation Fecal microbiome transplantation Fecal transplantations—murine models Fecal microbiome transplantation in humans References Index A B C D E F G H I L M N O P R S T U V W Back Cover