Metabolic syndrome and lifestyle modification

Reviews in Endocrine and Metabolic Disorders

Volumn 15, Issue 4, 2014, Pages 317-327

  Takahara, Mitsuyoshi ^a   Shimomura, Iichiro ^a  

^a OSAKA UNIVERSITY GRADUATE SCHOOL OF MEDICINE   (Japan)

Author keywords

Health promotion program in healthcare field; Lifestyle modification; Metabolic syndrome; Visceral fat accumulation

Indexed keywords

ABDOMINAL OBESITY; BODY MASS; CARDIOVASCULAR DISEASE; CARDIOVASCULAR RISK; HISTORY OF MEDICINE; HUMAN; LIFESTYLE MODIFICATION; META ANALYSIS (TOPIC); METABOLIC SYNDROME X; MOLECULAR DIAGNOSIS; RANDOMIZED CONTROLLED TRIAL (TOPIC); REVIEW; RISK REDUCTION; SPHYGMOMANOMETRY; WAIST CIRCUMFERENCE; HEALTH PROMOTION; LIFESTYLE; METABOLISM; OBESITY, ABDOMINAL; UNITED STATES;

HEALTH PROMOTION; HUMANS; LIFE STYLE; METABOLIC SYNDROME X; OBESITY, ABDOMINAL; UNITED STATES;

EID: 84911955004     PISSN: 13899155     EISSN: 15732606     Source Type: Journal    
DOI: 10.1007/s11154-014-9294-8     Document Type: Review

References (109)

1. Kannel WB, Dawber TR, Kagan A, Revotskie N, Stokes 3rd J. Factors of risk in the development of coronary heart disease–six year follow-up experience. The Framingham study. Ann Intern Med. 1961;55:33–50.
2. Stamler J, Wentworth D, Neaton JD. Is relationship between serum cholesterol and risk of premature death from coronary heart disease continuous and graded? Findings in 356,222 primary screenees of the Multiple Risk Factor Intervention Trial (MRFIT). JAMA. 1986;256(20):2823–8.
3. Vague J. La differenciation sexuelle, feateur determinant des formes de l’obesite. Presse Med. 1947;55:339–40.
4. Fujioka S, Matsuzawa Y, Tokunaga K, Tarui S. Contribution of intra-abdominal fat accumulation to the impairment of glucose and lipid metabolism in human obesity. Metabolism. 1987;36(1):54–9.
5. Kanai H, Matsuzawa Y, Kotani K, Keno Y, Kobatake T, Nagai Y, et al. Close correlation of intra-abdominal fat accumulation to hypertension in obese women. Hypertension. 1990;16(5):484–90.
6. Nakamura T, Tokunaga K, Shimomura I, Nishida M, Yoshida S, Kotani K, et al. Contribution of visceral fat accumulation to the development of coronary artery disease in non-obese men. Atherosclerosis. 1994;107(2):239–46.
7. Hotamisligil GS, Shargill NS, Spiegelman BM. Adipose expression of tumor necrosis factor-alpha: direct role in obesity-linked insulin resistance. Science. 1993;259(5091):87–91.
8. Zhang Y, Proenca R, Maffei M, Barone M, Leopold L, Friedman JM. Positional cloning of the mouse obese gene and its human homologue. Nature. 1994;372(6505):425–32. doi:10.1038/372425a0.
9. Maeda K, Okubo K, Shimomura I, Funahashi T, Matsuzawa Y, Matsubara K. cDNA cloning and expression of a novel adipose specific collagen-like factor, apM1 (AdiPose Most abundant Gene transcript 1). Biochem Biophys Res Commun. 1996;221(2):286–9. doi:10.1006/bbrc.1996.0587.
10. Shimomura I, Funahashi T, Takahashi M, Maeda K, Kotani K, Nakamura T, et al. Enhanced expression of PAI-1 in visceral fat: possible contributor to vascular disease in obesity. Nat Med. 1996;2(7):800–3.
11. Matsumoto S, Kishida K, Shimomura I, Maeda N, Nagaretani H, Matsuda M, et al. Increased plasma HB-EGF associated with obesity and coronary artery disease. Biochem Biophys Res Commun. 2002;292(3):781–6. doi:10.1006/bbrc.2002.6720.
12. World Health Organization. 2008–2013 action plan for the global strategy for the prevention and control of noncommunicable diseases: prevent and control cardiovascular diseases, cancers, chronic respiratory diseases and diabetes. Geneva: WHO Press; 2008.
13. Tokunaga K, Matsuzawa Y, Ishikawa K, Tarui S. A novel technique for the determination of body fat by computed tomography. Int J Obes. 1983;7(5):437–45.
14. Anderson PJ, Chan JC, Chan YL, Tomlinson B, Young RP, Lee ZS, et al. Visceral fat and cardiovascular risk factors in Chinese NIDDM patients. Diabetes Care. 1997;20(12):1854–8.
15. Fox CS, Massaro JM, Hoffmann U, Pou KM, Maurovich-Horvat P, Liu CY, et al. Abdominal visceral and subcutaneous adipose tissue compartments: association with metabolic risk factors in the Framingham heart study. Circulation. 2007;116(1):39–48. doi:10.1161/CIRCULATIONAHA.106.675355.
16. Liu J, Fox CS, Hickson DA, May WD, Hairston KG, Carr JJ, et al. Impact of abdominal visceral and subcutaneous adipose tissue on cardiometabolic risk factors: the Jackson heart study. J Clin Endocrinol Metab. 2010;95(12):5419–26. doi:10.1210/jc.2010-1378.
17. Arita Y, Kihara S, Ouchi N, Takahashi M, Maeda K, Miyagawa J, et al. Paradoxical decrease of an adipose-specific protein, adiponectin, in obesity. Biochem Biophys Res Commun. 1999;257(1):79–83.
18. Ryo M, Nakamura T, Kihara S, Kumada M, Shibazaki S, Takahashi M, et al. Adiponectin as a biomarker of the metabolic syndrome. Circ J. 2004;68(11):975–81.
19. Nishimura A, Sawai T. Determination of adiponectin in serum using a latex particle-enhanced turbidimetric immunoassay with an automated analyzer. Clin Chim Acta. 2006;371(1–2):163–8. doi:10.1016/j.cca.2006.03.008.
20. Ai M, Otokozawa S, Asztalos BF, White CC, Cupples LA, Nakajima K, et al. Adiponectin: an independent risk factor for coronary heart disease in men in the Framingham offspring study. Atherosclerosis. 2011;217(2):543–8. doi:10.1016/j.atherosclerosis.2011.05.035.
21. Matsuzawa Y, Funahashi T, Nakamura T. The concept of metabolic syndrome: contribution of visceral fat accumulation and its molecular mechanism. J Atheroscler Thromb. 2011;18(8):629–39.
22. Matsuzawa Y, Funahashi T, Kihara S, Shimomura I. Adiponectin and metabolic syndrome. Arterioscler Thromb Vasc Biol. 2004;24(1):29–33. doi:10.1161/01.ATV.0000099786.99623.EF.
23. Takahara M, Katakami N, Kaneto H, Noguchi M, Shimomura I. Contribution of visceral fat accumulation and Adiponectin to the clustering of metabolic abnormalities in a Japanese population. J Atheroscler Thromb. 2014;21(6):543–53.
24. de Koning L, Merchant AT, Pogue J, Anand SS. Waist circumference and waist-to-hip ratio as predictors of cardiovascular events: meta-regression analysis of prospective studies. Eur Heart J. 2007;28(7):850–6. doi:10.1093/eurheartj/ehm026.
25. Browning LM, Hsieh SD, Ashwell M. A systematic review of waist-to-height ratio as a screening tool for the prediction of cardiovascular disease and diabetes: 0.5 could be a suitable global boundary value. Nutr Res Rev. 2010;23(2):247–69. doi:10.1017/S0954422410000144.
26. Czernichow S, Kengne AP, Stamatakis E, Hamer M, Batty GD. Body mass index, waist circumference and waist-hip ratio: which is the better discriminator of cardiovascular disease mortality risk?: evidence from an individual-participant meta-analysis of 82 864 participants from nine cohort studies. Obes Rev. 2011;12(9):680–7. doi:10.1111/j.1467-789X.2011.00879.x.
27. Wormser D, Kaptoge S, Di Angelantonio E, Wood AM, Pennells L, Thompson A, et al. Separate and combined associations of body-mass index and abdominal adiposity with cardiovascular disease: collaborative analysis of 58 prospective studies. Lancet. 2011;377(9771):1085–95. doi:10.1016/S0140-6736(11)60105-0.
28. Okauchi Y, Nishizawa H, Funahashi T, Ogawa T, Noguchi M, Ryo M, et al. Reduction of visceral fat is associated with decrease in the number of metabolic risk factors in Japanese men. Diabetes Care. 2007;30(9):2392–4. doi:10.2337/dc07-0218.
29. Okauchi Y, Kishida K, Funahashi T, Noguchi M, Ogawa T, Ryo M, et al. Changes in serum adiponectin concentrations correlate with changes in BMI, waist circumference, and estimated visceral fat area in middle-aged general population. Diabetes Care. 2009;32(10):e122. doi:10.2337/dc09-1130.
30. Borel AL, Nazare JA, Smith J, Almeras N, Tremblay A, Bergeron J, et al. Visceral and not subcutaneous abdominal adiposity reduction drives the benefits of a 1-year lifestyle modification program. Obesity (Silver Spring). 2012;20(6):1223–33. doi:10.1038/oby.2011.396.
31. Borel AL, Nazare JA, Smith J, Almeras N, Tremblay A, Bergeron J, et al. Improvement in insulin sensitivity following a 1-year lifestyle intervention program in viscerally obese men: contribution of abdominal adiposity. Metabolism. 2012;61(2):262–72. doi:10.1016/j.metabol.2011.06.024.
32. Pelletier-Beaumont E, Arsenault BJ, Almeras N, Bergeron J, Tremblay A, Poirier P, et al. Normalization of visceral adiposity is required to normalize plasma apolipoprotein B levels in response to a healthy eating/physical activity lifestyle modification program in viscerally obese men. Atherosclerosis. 2012;221(2):577–82. doi:10.1016/j.atherosclerosis.2012.01.023.
33. Okauchi Y, Kishida K, Funahashi T, Noguchi M, Morita S, Ogawa T, et al. 4-year follow-up of cardiovascular events and changes in visceral fat accumulation after health promotion program in the Amagasaki visceral fat study. Atherosclerosis. 2010;212(2):698–700. doi:10.1016/j.atherosclerosis.2010.06.011.
34. The Examination Committee of Criteria for the Metabolic Syndrome in Japan. Definition and diagnostic criteria of the metabolic syndrome. J Japan Soc Intern Med. 2005;94:794–809 (in Japanese).
35. Alberti KG, Zimmet P, Shaw J. Metabolic syndrome–a new world-wide definition. A consensus statement from the international diabetes federation. Diabet Med. 2006;23(5):469–80. doi:10.1111/j.1464-5491.2006.01858.x.
36. Jensen MD, Ryan DH, Apovian CM, Ard JD, Comuzzie AG, Donato KA, et al. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American college of cardiology/American heart association task force on practice guidelines and the obesity society. Circulation. 2014;129(25 Suppl 2):S102–38. doi:10.1161/01.cir.0000437739.71477.ee.
37. Sacks FM, Bray GA, Carey VJ, Smith SR, Ryan DH, Anton SD, et al. Comparison of weight-loss diets with different compositions of fat, protein, and carbohydrates. N Engl J Med. 2009;360(9):859–73. doi:10.1056/NEJMoa0804748.
38. Vissers D, Hens W, Taeymans J, Baeyens JP, Poortmans J, Van Gaal L. The effect of exercise on visceral adipose tissue in overweight adults: a systematic review and meta-analysis. PLoS One. 2013;8(2):e56415. doi:10.1371/journal.pone.0056415.
39. Nazare JA, Smith J, Borel AL, Almeras N, Tremblay A, Bergeron J, et al. Changes in both global diet quality and physical activity level synergistically reduce visceral adiposity in men with features of metabolic syndrome. J Nutr. 2013;143(7):1074–83. doi:10.3945/jn.113.175273.
40. Chilton M, Dunkley A, Carter P, Davies MJ, Khunti K, Gray LJ. The effect of antiobesity drugs on waist circumference: a mixed treatment comparison. Diabetes Obes Metab. 2014;16(3):237–47. doi:10.1111/dom.12198.
41. Chan EW, He Y, Chui CS, Wong AY, Lau WC, Wong IC. Efficacy and safety of lorcaserin in obese adults: a meta-analysis of 1-year randomized controlled trials (RCTs) and narrative review on short-term RCTs. Obes Rev. 2013;14(5):383–92. doi:10.1111/obr.12015.
42. Viner RM, Hsia Y, Tomsic T, Wong IC. Efficacy and safety of anti-obesity drugs in children and adolescents: systematic review and meta-analysis. Obes Rev. 2010;11(8):593–602. doi:10.1111/j.1467-789X.2009.00651.x.
43. Padwal R, Li SK, Lau DC. Long-term pharmacotherapy for obesity and overweight. Cochrane Database Syst Rev. 2004;3, CD004094. doi:10.1002/14651858.CD004094.pub2.
44. Padwal RS, Majumdar SR. Drug treatments for obesity: orlistat, sibutramine, and rimonabant. Lancet. 2007;369(9555):71–7. doi:10.1016/S0140-6736(07)60033-6.
45. Kim MK, Kim W, Kwon HS, Baek KH, Kim EK, Song KH. Effects of bariatric surgery on metabolic and nutritional parameters in severely obese Korean patients with type 2 diabetes: a prospective 2-year follow up. J Diabetes Investig. 2014;5(2):221–7. doi:10.1111/jdi.12137.
46. Bradley D, Conte C, Mittendorfer B, Eagon JC, Varela JE, Fabbrini E, et al. Gastric bypass and banding equally improve insulin sensitivity and beta cell function. J Clin Invest. 2012;122(12):4667–74. doi:10.1172/JCI64895.
47. Olbers T, Bjorkman S, Lindroos A, Maleckas A, Lonn L, Sjostrom L, et al. Body composition, dietary intake, and energy expenditure after laparoscopic Roux-en-Y gastric bypass and laparoscopic vertical banded gastroplasty: a randomized clinical trial. Ann Surg. 2006;244(5):715–22. doi:10.1097/01.sla.0000218085.25902.f8.
48. Miller GD, Carr JJ, Fernandez AZ. Regional fat changes following weight reduction from laparoscopic Roux-en-Y gastric bypass surgery. Diabetes Obes Metab. 2011;13(2):189–92. doi:10.1111/j.1463-1326.2010.01338.x.
49. Adams TD, Gress RE, Smith SC, Halverson RC, Simper SC, Rosamond WD, et al. Long-term mortality after gastric bypass surgery. N Engl J Med. 2007;357(8):753–61. doi:10.1056/NEJMoa066603.
50. Yanovski SZ, Yanovski JA. Long-term drug treatment for obesity: a systematic and clinical review. JAMA. 2014;311(1):74–86. doi:10.1001/jama.2013.281361.
51. Ryo M, Nakamura T, Funahashi T, Noguchi M, Kishida K, Okauchi Y, et al. Health education “Hokenshido” program reduced metabolic syndrome in the Amagasaki visceral fat study. Three-year follow-up study of 3,174 Japanese employees. Intern Med. 2011;50(16):1643–8.
52. Muramoto A, Yamamoto N, Nakamura M, Koike G, Numata T, Tamakoshi A, et al. Effect of intensive lifestyle intervention programs on metabolic syndrome and obesity: how much weight reduction is needed to improve metabolic comorbidities? J Jpn Soc Study Obes. 2010;16(3):182–7 (in Japanese).
53. Alberti KG, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA, et al. Harmonizing the metabolic syndrome: a joint interim statement of the international diabetes federation task force on epidemiology and prevention; national heart, lung, and blood institute; American heart association; world heart federation; international atherosclerosis society; and international association for the study of obesity. Circulation. 2009;120(16):1640–5. doi:10.1161/CIRCULATIONAHA.109.192644.
54. Takahara M, Kaneto H, Shimomura I. High prevalence of normal waist circumference in Japanese employees with a cluster of metabolic abnormalities. J Atheroscler Thromb. 2013;20(3):310–2.
55. Mottillo S, Filion KB, Genest J, Joseph L, Pilote L, Poirier P, et al. The metabolic syndrome and cardiovascular risk a systematic review and meta-analysis. J Am Coll Cardiol. 2010;56(14):1113–32. doi:10.1016/j.jacc.2010.05.034.
56. Shin JA, Lee JH, Lim SY, Ha HS, Kwon HS, Park YM, et al. Metabolic syndrome as a predictor of type 2 diabetes, and its clinical interpretations and usefulness. J Diabetes Investig. 2013;4(4):334–43. doi:10.1111/jdi.12075.
57. Wilson PW, D”Agostino RB, Levy D, Belanger AM, Silbershatz H, Kannel WB. Prediction of coronary heart disease using risk factor categories. Circulation. 1998;97(18):1837–47.
58. Chambless LE, Folsom AR, Sharrett AR, Sorlie P, Couper D, Szklo M, et al. Coronary heart disease risk prediction in the Atherosclerosis Risk in Communities (ARIC) study. J Clin Epidemiol. 2003;56(9):880–90.
59. Assmann G, Cullen P, Schulte H. Simple scoring scheme for calculating the risk of acute coronary events based on the 10-year follow-up of the prospective cardiovascular Munster (PROCAM) study. Circulation. 2002;105(3):310–5.
60. Hippisley-Cox J, Coupland C, Vinogradova Y, Robson J, May M, Brindle P. Derivation and validation of QRISK, a new cardiovascular disease risk score for the United Kingdom: prospective open cohort study. BMJ. 2007;335(7611):136. doi:10.1136/bmj.39261.471806.55.
61. Conroy RM, Pyorala K, Fitzgerald AP, Sans S, Menotti A, De Backer G, et al. Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project. Eur Heart J. 2003;24(11):987–1003.
62. Hippisley-Cox J, Coupland C, Robson J, Sheikh A, Brindle P. Predicting risk of type 2 diabetes in England and Wales: prospective derivation and validation of QDScore. BMJ. 2009;338:b880. doi:10.1136/bmj.b880.
63. Doi Y, Ninomiya T, Hata J, Hirakawa Y, Mukai N, Iwase M, et al. Two risk score models for predicting incident Type 2 diabetes in Japan. Diabet Med. 2012;29(1):107–14. doi:10.1111/j.1464-5491.2011.03376.x.
64. Alssema M, Vistisen D, Heymans MW, Nijpels G, Glumer C, Zimmet PZ, et al. The evaluation of screening and early detection strategies for type 2 Diabetes and Impaired Glucose Tolerance (DETECT-2) update of the Finnish diabetes risk score for prediction of incident type 2 diabetes. Diabetologia. 2011;54(5):1004–12. doi:10.1007/s00125-010-1990-7.
65. Stern MP, Williams K, Haffner SM. Identification of persons at high risk for type 2 diabetes mellitus: do we need the oral glucose tolerance test? Ann Intern Med. 2002;136(8):575–81.
66. Wannamethee SG, Shaper AG, Lennon L, Morris RW. Metabolic syndrome vs Framingham risk score for prediction of coronary heart disease, stroke, and type 2 diabetes mellitus. Arch Intern Med. 2005;165(22):2644–50. doi:10.1001/archinte.165.22.2644.
67. McNeill AM, Rosamond WD, Girman CJ, Golden SH, Schmidt MI, East HE, et al. The metabolic syndrome and 11-year risk of incident cardiovascular disease in the atherosclerosis risk in communities study. Diabetes Care. 2005;28(2):385–90.
68. Wannamethee SG. The metabolic syndrome and cardiovascular risk in the British regional heart study. Int J Obes. 2008;32 Suppl 2:S25–9. doi:10.1038/ijo.2008.32.
69. Cameron AJ, Magliano DJ, Zimmet PZ, Welborn TA, Colagiuri S, Tonkin AM, et al. The metabolic syndrome as a tool for predicting future diabetes: the AusDiab study. J Intern Med. 2008;264(2):177–86. doi:10.1111/j.1365-2796.2008.01935.x.
70. Stern MP, Williams K, Gonzalez-Villalpando C, Hunt KJ, Haffner SM. Does the metabolic syndrome improve identification of individuals at risk of type 2 diabetes and/or cardiovascular disease? Diabetes Care. 2004;27(11):2676–81.
71. Takahara M, Katakami N, Kaneto H, Noguchi M, Shimomura I. Statistical reassessment of the association between waist circumference and clustering metabolic abnormalities in Japanese population. J Atheroscler Thromb. 2012;19(8):767–78.
72. Pouliot MC, Despres JP, Lemieux S, Moorjani S, Bouchard C, Tremblay A, et al. Waist circumference and abdominal sagittal diameter: best simple anthropometric indexes of abdominal visceral adipose tissue accumulation and related cardiovascular risk in men and women. Am J Cardiol. 1994;73(7):460–8.
73. Expert WHO. Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004;363(9403):157–63.
74. Despres JP, Couillard C, Gagnon J, Bergeron J, Leon AS, Rao DC, et al. Race, visceral adipose tissue, plasma lipids, and lipoprotein lipase activity in men and women: the Health, Risk Factors, Exercise Training, and Genetics (HERITAGE) family study. Arterioscler Thromb Vasc Biol. 2000;20(8):1932–8.
75. Tan CE, Ma S, Wai D, Chew SK, Tai ES. Can we apply the national cholesterol education program adult treatment panel definition of the metabolic syndrome to Asians? Diabetes Care. 2004;27(5):1182–6.
76. Lear SA, Toma M, Birmingham CL, Frohlich JJ. Modification of the relationship between simple anthropometric indices and risk factors by ethnic background. Metabolism. 2003;52(10):1295–301.
77. Kadowaki T, Sekikawa A, Murata K, Maegawa H, Takamiya T, Okamura T, et al. Japanese men have larger areas of visceral adipose tissue than Caucasian men in the same levels of waist circumference in a population-based study. Int J Obes. 2006;30(7):1163–5. doi:10.1038/sj.ijo.0803248.
78. Lovejoy JC, de la Bretonne JA, Klemperer M, Tulley R. Abdominal fat distribution and metabolic risk factors: effects of race. Metabolism. 1996;45(9):1119–24.
79. Balkau B, Charles MA. Comment on the provisional report from the WHO consultation. European GROUP for the Study of Insulin Resistance (EGIR). Diabet Med. 1999;16(5):442–3.
80. Executive summary of the third report of the national cholesterol education program (NCEP) Expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). Jama. 2001;285(19):2486–97.
81. Lean ME, Han TS, Morrison CE. Waist circumference as a measure for indicating need for weight management. BMJ. 1995;311(6998):158–61.
82. Lin WY, Lee LT, Chen CY, Lo H, Hsia HH, Liu IL, et al. Optimal cut-off values for obesity: using simple anthropometric indices to predict cardiovascular risk factors in Taiwan. Int J Obes Relat Metab Disord. 2002;26(9):1232–8. doi:10.1038/sj.ijo.0802040.
83. Wildman RP, Gu D, Reynolds K, Duan X, He J. Appropriate body mass index and waist circumference cutoffs for categorization of overweight and central adiposity among Chinese adults. Am J Clin Nutr. 2004;80(5):1129–36.
84. Zhou BF. Predictive values of body mass index and waist circumference for risk factors of certain related diseases in Chinese adults–study on optimal cut-off points of body mass index and waist circumference in Chinese adults. Biomed Environ Sci. 2002;15(1):83–96.
85. Snehalatha C, Viswanathan V, Ramachandran A. Cutoff values for normal anthropometric variables in asian Indian adults. Diabetes Care. 2003;26(5):1380–4.
86. Hiuge-Shimizu A, Kishida K, Funahashi T, Ishizaka Y, Oka R, Okada M, et al. Absolute value of visceral fat area measured on computed tomography scans and obesity-related cardiovascular risk factors in large-scale Japanese general population (the VACATION-J study). Ann Med. 2012;44(1):82–92. doi:10.3109/07853890.2010.526138.
87. Oka R, Miura K, Sakurai M, Nakamura K, Yagi K, Miyamoto S, et al. Impacts of visceral adipose tissue and subcutaneous adipose tissue on metabolic risk factors in middle-aged Japanese. Obesity (Silver Spring). 2010;18(1):153–60. doi:10.1038/oby.2009.180.
88. Despres JP, Lemieux I. Abdominal obesity and metabolic syndrome. Nature. 2006;444(7121):881–7. doi:10.1038/nature05488.
89. Miranda PJ, DeFronzo RA, Califf RM, Guyton JR. Metabolic syndrome: definition, pathophysiology, and mechanisms. Am Heart J. 2005;149(1):33–45. doi:10.1016/j.ahj.2004.07.013.
90. Byrne CD, Targher G. Ectopic fat, insulin resistance, and nonalcoholic fatty liver disease: implications for cardiovascular disease. Arterioscler Thromb Vasc Biol. 2014;34(6):1155–61. doi:10.1161/ATVBAHA.114.303034.
91. Stefan N, Kantartzis K, Machann J, Schick F, Thamer C, Rittig K, et al. Identification and characterization of metabolically benign obesity in humans. Arch Intern Med. 2008;168(15):1609–16. doi:10.1001/archinte.168.15.1609.
92. Jacob S, Machann J, Rett K, Brechtel K, Volk A, Renn W, et al. Association of increased intramyocellular lipid content with insulin resistance in lean nondiabetic offspring of type 2 diabetic subjects. Diabetes. 1999;48(5):1113–9.
93. Yim JE, Heshka S, Albu J, Heymsfield S, Kuznia P, Harris T, et al. Intermuscular adipose tissue rivals visceral adipose tissue in independent associations with cardiovascular risk. Int J Obes. 2007;31(9):1400–5. doi:10.1038/sj.ijo.0803621.
94. Goodpaster BH, Thaete FL, Kelley DE. Thigh adipose tissue distribution is associated with insulin resistance in obesity and in type 2 diabetes mellitus. Am J Clin Nutr. 2000;71(4):885–92.
95. Toledo-Corral CM, Alderete TL, Hu HH, Nayak K, Esplana S, Liu T, et al. Ectopic fat deposition in prediabetic overweight and obese minority adolescents. J Clin Endocrinol Metab. 2013;98(3):1115–21. doi:10.1210/jc.2012-3806.
96. Wang CY, Ou HY, Chen MF, Chang TC, Chang CJ. Enigmatic ectopic fat: prevalence of nonalcoholic fatty pancreas disease and its associated factors in a Chinese population. J Am Heart Assoc. 2014;3(1):e000297. doi:10.1161/JAHA.113.000297.
97. Sacks HS, Fain JN. Human epicardial adipose tissue: a review. Am Heart J. 2007;153(6):907–17. doi:10.1016/j.ahj.2007.03.019.
98. Iacobellis G, Ribaudo MC, Assael F, Vecci E, Tiberti C, Zappaterreno A, et al. Echocardiographic epicardial adipose tissue is related to anthropometric and clinical parameters of metabolic syndrome: a new indicator of cardiovascular risk. J Clin Endocrinol Metab. 2003;88(11):5163–8. doi:10.1210/jc.2003-030698.
99. Iacobellis G, Leonetti F. Epicardial adipose tissue and insulin resistance in obese subjects. J Clin Endocrinol Metab. 2005;90(11):6300–2. doi:10.1210/jc.2005-1087.
100. Rabkin SW. The relationship between epicardial fat and indices of obesity and the metabolic syndrome: a systematic review and meta-analysis. Metab Syndr Relat Disord. 2014;12(1):31–42. doi:10.1089/met.2013.0107.
101. Csendes A, Maluenda F, Burgos AM. A prospective randomized study comparing patients with morbid obesity submitted to laparotomic gastric bypass with or without omentectomy. Obes Surg. 2009;19(4):490–4. doi:10.1007/s11695-008-9660-2.
102. Fabbrini E, Tamboli RA, Magkos F, Marks-Shulman PA, Eckhauser AW, Richards WO, et al. Surgical removal of omental fat does not improve insulin sensitivity and cardiovascular risk factors in obese adults. Gastroenterology. 2010;139(2):448–55. doi:10.1053/j.gastro.2010.04.056.
103. Herrera MF, Pantoja JP, Velazquez-Fernandez D, Cabiedes J, Aguilar-Salinas C, Garcia-Garcia E, et al. Potential additional effect of omentectomy on metabolic syndrome, acute-phase reactants, and inflammatory mediators in grade III obese patients undergoing laparoscopic Roux-en-Y gastric bypass: a randomized trial. Diabetes Care. 2010;33(7):1413–8. doi:10.2337/dc09-1833.
104. Dillard TH, Purnell JQ, Smith MD, Raum W, Hong D, Laut J, et al. Omentectomy added to Roux-en-Y gastric bypass surgery: a randomized, controlled trial. Surg Obes Relat Dis. 2013;9(2):269–75. doi:10.1016/j.soard.2011.09.027.
105. Tamboli RA, Hajri T, Jiang A, Marks-Shulman PA, Williams DB, Clements RH, et al. Reduction in inflammatory gene expression in skeletal muscle from Roux-en-Y gastric bypass patients randomized to omentectomy. PLoS One. 2011;6(12):e28577. doi:10.1371/journal.pone.0028577.
106. Lima MM, Pareja JC, Alegre SM, Geloneze SR, Kahn SE, Astiarraga BD, et al. Visceral fat resection in humans: effect on insulin sensitivity, beta-cell function, adipokines, and inflammatory markers. Obesity (Silver Spring). 2013;21(3):E182–9. doi:10.1002/oby.20030.
107. Schafer S, Kantartzis K, Machann J, Venter C, Niess A, Schick F, et al. Lifestyle intervention in individuals with normal versus impaired glucose tolerance. Eur J Clin Invest. 2007;37(7):535–43. doi:10.1111/j.1365-2362.2007.01820.x.
108. Bosy-Westphal A, Kossel E, Goele K, Blocker T, Lagerpusch M, Later W, et al. Association of pericardial fat with liver fat and insulin sensitivity after diet-induced weight loss in overweight women. Obesity (Silver Spring). 2010;18(11):2111–7. doi:10.1038/oby.2010.49.
109. Kim MK, Tanaka K, Kim MJ, Matuso T, Endo T, Tomita T, et al. Comparison of epicardial, abdominal and regional fat compartments in response to weight loss. Nutr Metab Cardiovasc Dis. 2009;19(11):760–6. doi:10.1016/j.numecd.2009.01.010.