Relationship between abdominal fat distribution and pulmonary ventilation function_West China Medical Journal

Authors：

HUANG Lu ¹ , WANG Zhetao ² ^共 ,  LUO Fengming ¹

1. Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

LUO Fengming, Email: fengmingluo@outlook.com

Keywords：

Visceral adipose tissue area; subcutaneous adipose tissue area; pulmonary ventilation function; correlation analysis

DOI：

10.7507/1002-0179.202012128

Video：

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Objective To study the effects of visceral adipose tissue area (VTA) and subcutaneous adipose tissue area (STA) on pulmonary ventilation function (PVF), and then to evaluate the impact of abdominal fat distribution on PVF.Methods Patients who underwent both PVF examination and abdominal CT between January 1st and December 31st, 2017 were selected from the electronic medical record system of West China Hospital of Sichuan University. The demographic data and PVF indexes [vital capacity (VC), forced vital capacity (FVC), forced expiratory volume in one second (FEV₁), and 1 s rate (FEV₁/FVC)] were collected. VTA and STA were obtained by abdominal CT measurement. The correlations between PVF indexes and VTA or STA were compared. Results A total of 224 patients were included. According to the VTA/STA ratio, there were 92 cases (41.07%) in group VTA/STA<1 and 132 cases (58.93%) in group VTA/STA≥1. VTA was not correlated with FVC (r_s=−0.078, P=0.244), but negatively correlated with VC (r_s=−0.138, P=0.040), FEV₁ (r_s=−0.141, P=0.034) and FEV₁/FVC (r_s=−0.137, P=0.041); STA had no correlation with VC, FVC, FEV₁ or FEV₁/FVC (P>0.05). VTA/STA was negatively correlated with VC (r_s=−0.220, P=0.001), FEV₁ (r_s=−0.273, P<0.001) and FEV₁/FVC (r_s=−0.380, P<0.001), but it had no correlation with FVC (r_s=−0.083, P=0.214). In group VTA/STA<1, VTA/STA was negatively correlated with FEV₁ (r_s =−0.205, P=0.050) and FEV₁/FVC (r_s=−0.317, P=0.002), but it had no correlation with VC or FVC (P>0.05). In group VTA/STA≥1, VTA/STA was negatively correlated with VC, FVC, FEV₁ and FEV₁/FVC (P<0.05). Conclusions VTA and STA are negatively correlated with PVF. The ratio of VTA/STA can be used as an index to evaluate the effect of abdominal fat distribution on lung function.

Citation： HUANG Lu, WANG Zhetao, LUO Fengming. Relationship between abdominal fat distribution and pulmonary ventilation function. West China Medical Journal, 2022, 37(1): 27-32. doi: 10.7507/1002-0179.202012128 Copy

1.	Srivastava K, Thakur D, Sharma S, et al. Systematic review of humanistic and economic burden of symptomatic chronic obstructive pulmonary disease. Pharmacoeconomics, 2015, 33(5): 467-488.
2.	Fried SK, Bunkin DA, Greenberg AS. Omental and subcutaneous adipose tissues of obese subjects release interleukin-6: depot difference and regulation by glucocorticoid. J Clin Endocrinol Metab, 1998, 83(3): 847-850.
3.	Lebovitz HE, Banerji MA. Point: visceral adiposity is causally related to insulin resistance. Diabetes Care, 2005, 28(9): 2322-2325.
4.	Manuel AR, Hart N, Stradling JR. Correlates of obesity-related chronic ventilatory failure. BMJ Open Respir Res, 2016, 3(1): e000110.
5.	Mafort TT, Rufino R, Costa CH, et al. Obesity: systemic and pulmonary complications, biochemical abnormalities, and impairment of lung function. Multidiscip Respir Med, 2016, 11: 28.
6.	de Oliveira PD, Wehrmeister FC, Horta BL, et al. Visceral and subcutaneous abdominal adiposity and pulmonary function in 30-year-old adults: a cross-sectional analysis nested in a birth cohort. BMC Pulm Med, 2017, 17(1): 157.
7.	Inomata M, Kawagishi Y, Taka C, et al. Visceral adipose tissue level, as estimated by the bioimpedance analysis method, is associated with impaired lung function. J Diabetes Investig, 2012, 3(3): 331-336.
8.	Yoshizumi T, Nakamura T, Yamane M, et al. Abdominal fat: standardized technique for measurement at CT. Radiology, 1999, 211(1): 283-286.
9.	Cheng X, Zhang Y, Wang C, et al. The optimal anatomic site for a single slice to estimate the total volume of visceral adipose tissue by using the quantitative computed tomography (QCT) in Chinese population. Eur J Clin Nutr, 2018, 72(11): 1567-1575.
10.	Shuster A, Patlas M, Pinthus JH, et al. The clinical importance of visceral adiposity: a critical review of methods for visceral adipose tissue analysis. Br J Radiol, 2012, 85(1009): 1-10.
11.	Ibrahim MM. Subcutaneous and visceral adipose tissue: structural and functional differences. Obes Rev, 2010, 11(1): 11-18.
12.	Wajchenberg BL. Subcutaneous and visceral adipose tissue: their relation to the metabolic syndrome. Endocr Rev, 2000, 21(6): 697-738.
13.	Arner P. Regional adipocity in man. J Endocrinol, 1997, 155(2): 191-192.
14.	Raz I, Eldor R, Cernea S, et al. Diabetes: insulin resistance and derangements in lipid metabolism. Cure through intervention in fat transport and storage. Diabetes Metab Res Rev, 2005, 21(1): 3-14.
15.	Arner P. Regional differences in protein production by human adipose tissue. Biochem Soc Trans, 2001, 29(Pt 2): 72-75.
16.	Bujalska IJ, Kumar S, Stewart PM. Does central obesity reflect “cushing’s disease of the omentum”?. Lancet, 1997, 349(9060): 1210-1213.
17.	Carr MC, Brunzell JD. Abdominal obesity and dyslipidemia in the metabolic syndrome: importance of type 2 diabetes and familial combined hyperlipidemia in coronary artery disease risk. J Clin Endocrinol Metab, 2004, 89(6): 2601-2607.
18.	Bays HE, Laferrère B, Dixon J, et al. Adiposopathy and bariatric surgery: is ‘sick fat’ a surgical disease?. Int J Clin Pract, 2009, 63(9): 1285-1300.
19.	Heilbronn L, Smith SR, Ravussin E. Failure of fat cell proliferation, mitochondrial function and fat oxidation results in ectopic fat storage, insulin resistance and typeⅡdiabetes mellitus. Int J Obes Relat Metab Disord, 2004, 28(Suppl 4): S12-S21.
20.	Ravussin E, Smith SR. Increased fat intake, impaired fat oxidation, and failure of fat cell proliferation result in ectopic fat storage, insulin resistance, and type 2 diabetes mellitus. Ann N Y Acad Sci, 2002, 967: 363-378.
21.	Gregoire FM. Adipocyte differentiation: from fibroblast to endocrine cell. Exp Biol Med (Maywood), 2001, 226(11): 997-1002.
22.	Rosen ED, Spiegelman BM. Molecular regulation of adipogenesis. Annu Rev Cell Dev Biol, 2000, 16: 145-171.
23.	Björntorp P. Do stress reactions cause abdominal obesity and comorbidities?. Obes Rev, 2001, 2(2): 73-86.
24.	Bruun JM, Lihn AS, Pedersen SB, et al. Monocyte chemoattractant protein-1 release is higher in visceral than subcutaneous human adipose tissue (AT): implication of macrophages resident in the AT. J Clin Endocrinol Metab, 2005, 90(4): 2282-2289.
25.	Bergman RN, Kim SP, Catalano KJ, et al. Why visceral fat is bad: mechanisms of the metabolic syndrome. Obesity (Silver Spring), 2006, 14(Suppl 1): 16s-19s.
26.	Moualla M, Qualls C, Arynchyn A, et al. Rapid decline in lung function is temporally associated with greater metabolically active adiposity in a longitudinal study of healthy adults. Thorax, 2017, 72(12): 1113-1120.
27.	Choe EK, Kang HY, Lee Y, et al. The longitudinal association between changes in lung function and changes in abdominal visceral obesity in Korean non-smokers. PLoS One, 2018, 13(2): e0193516.
28.	Bray GA. Medical consequences of obesity. J Clin Endocrinol Metab, 2004, 89(6): 2583-2589.
29.	Weyer C, Foley JE, Bogardus C, et al. Enlarged subcutaneous abdominal adipocyte size, but not obesity itself, predicts typeⅡdiabetes independent of insulin resistance. Diabetologia, 2000, 43(12): 1498-1506.
30.	Ladeiras-Lopes R, Sampaio F, Bettencourt N, et al. The ratio between visceral and subcutaneous abdominal fat assessed by computed tomography is an independent predictor of mortality and cardiac events. Rev Esp Cardiol (Engl Ed), 2017, 70(5): 331-337.
31.	Higuchi S, Kabeya Y, Kato K. Visceral-to-subcutaneous fat ratio is independently related to small and large cerebrovascular lesions even in healthy subjects. Atherosclerosis, 2017, 259: 41-45.
32.	Tokunaga K, Matsuzawa Y, Ishikawa K, et al. A novel technique for the determination of body fat by computed tomography. Int J Obes, 1983, 7(5): 437-445.
33.	Ortega FB, Lavie CJ, Blair SN. Obesity and cardiovascular disease. Circ Res, 2016, 118(11): 1752-1770.
34.	Choi B, Steiss D, Garcia-Rivas J, et al. Comparison of body mass index with waist circumference and skinfold-based percent body fat in firefighters: adiposity classification and associations with cardiovascular disease risk factors. Int Arch Occup Environ Health, 2016, 89(3): 435-448.
35.	Rosenquist KJ, Massaro JM, Pedley A, et al. Fat quality and incident cardiovascular disease, all-cause mortality, and cancer mortality. J Clin Endocrinol Metab, 2015, 100(1): 227-234.
36.	Britton KA, Massaro JM, Murabito JM, et al. Body fat distribution, incident cardiovascular disease, cancer, and all-cause mortality. J Am Coll Cardiol, 2013, 62(10): 921-925.
37.	McLaughlin T, Lamendola C, Liu A, et al. Preferential fat deposition in subcutaneous versus visceral depots is associated with insulin sensitivity. J Clin Endocrinol Metab, 2011, 96(11): E1756-E1760.
38.	Nicklas BJ, Penninx BW, Cesari M, et al. Association of visceral adipose tissue with incident myocardial infarction in older men and women: the health, aging and body composition study. Am J Epidemiol, 2004, 160(8): 741-749.

1. Srivastava K, Thakur D, Sharma S, et al. Systematic review of humanistic and economic burden of symptomatic chronic obstructive pulmonary disease. Pharmacoeconomics, 2015, 33(5): 467-488.
2. Fried SK, Bunkin DA, Greenberg AS. Omental and subcutaneous adipose tissues of obese subjects release interleukin-6: depot difference and regulation by glucocorticoid. J Clin Endocrinol Metab, 1998, 83(3): 847-850.
3. Lebovitz HE, Banerji MA. Point: visceral adiposity is causally related to insulin resistance. Diabetes Care, 2005, 28(9): 2322-2325.
4. Manuel AR, Hart N, Stradling JR. Correlates of obesity-related chronic ventilatory failure. BMJ Open Respir Res, 2016, 3(1): e000110.
5. Mafort TT, Rufino R, Costa CH, et al. Obesity: systemic and pulmonary complications, biochemical abnormalities, and impairment of lung function. Multidiscip Respir Med, 2016, 11: 28.
6. de Oliveira PD, Wehrmeister FC, Horta BL, et al. Visceral and subcutaneous abdominal adiposity and pulmonary function in 30-year-old adults: a cross-sectional analysis nested in a birth cohort. BMC Pulm Med, 2017, 17(1): 157.
7. Inomata M, Kawagishi Y, Taka C, et al. Visceral adipose tissue level, as estimated by the bioimpedance analysis method, is associated with impaired lung function. J Diabetes Investig, 2012, 3(3): 331-336.
8. Yoshizumi T, Nakamura T, Yamane M, et al. Abdominal fat: standardized technique for measurement at CT. Radiology, 1999, 211(1): 283-286.
9. Cheng X, Zhang Y, Wang C, et al. The optimal anatomic site for a single slice to estimate the total volume of visceral adipose tissue by using the quantitative computed tomography (QCT) in Chinese population. Eur J Clin Nutr, 2018, 72(11): 1567-1575.
10. Shuster A, Patlas M, Pinthus JH, et al. The clinical importance of visceral adiposity: a critical review of methods for visceral adipose tissue analysis. Br J Radiol, 2012, 85(1009): 1-10.
11. Ibrahim MM. Subcutaneous and visceral adipose tissue: structural and functional differences. Obes Rev, 2010, 11(1): 11-18.
12. Wajchenberg BL. Subcutaneous and visceral adipose tissue: their relation to the metabolic syndrome. Endocr Rev, 2000, 21(6): 697-738.
13. Arner P. Regional adipocity in man. J Endocrinol, 1997, 155(2): 191-192.
14. Raz I, Eldor R, Cernea S, et al. Diabetes: insulin resistance and derangements in lipid metabolism. Cure through intervention in fat transport and storage. Diabetes Metab Res Rev, 2005, 21(1): 3-14.
15. Arner P. Regional differences in protein production by human adipose tissue. Biochem Soc Trans, 2001, 29(Pt 2): 72-75.
16. Bujalska IJ, Kumar S, Stewart PM. Does central obesity reflect “cushing’s disease of the omentum”?. Lancet, 1997, 349(9060): 1210-1213.
17. Carr MC, Brunzell JD. Abdominal obesity and dyslipidemia in the metabolic syndrome: importance of type 2 diabetes and familial combined hyperlipidemia in coronary artery disease risk. J Clin Endocrinol Metab, 2004, 89(6): 2601-2607.
18. Bays HE, Laferrère B, Dixon J, et al. Adiposopathy and bariatric surgery: is ‘sick fat’ a surgical disease?. Int J Clin Pract, 2009, 63(9): 1285-1300.
19. Heilbronn L, Smith SR, Ravussin E. Failure of fat cell proliferation, mitochondrial function and fat oxidation results in ectopic fat storage, insulin resistance and typeⅡdiabetes mellitus. Int J Obes Relat Metab Disord, 2004, 28(Suppl 4): S12-S21.
20. Ravussin E, Smith SR. Increased fat intake, impaired fat oxidation, and failure of fat cell proliferation result in ectopic fat storage, insulin resistance, and type 2 diabetes mellitus. Ann N Y Acad Sci, 2002, 967: 363-378.
21. Gregoire FM. Adipocyte differentiation: from fibroblast to endocrine cell. Exp Biol Med (Maywood), 2001, 226(11): 997-1002.
22. Rosen ED, Spiegelman BM. Molecular regulation of adipogenesis. Annu Rev Cell Dev Biol, 2000, 16: 145-171.
23. Björntorp P. Do stress reactions cause abdominal obesity and comorbidities?. Obes Rev, 2001, 2(2): 73-86.
24. Bruun JM, Lihn AS, Pedersen SB, et al. Monocyte chemoattractant protein-1 release is higher in visceral than subcutaneous human adipose tissue (AT): implication of macrophages resident in the AT. J Clin Endocrinol Metab, 2005, 90(4): 2282-2289.
25. Bergman RN, Kim SP, Catalano KJ, et al. Why visceral fat is bad: mechanisms of the metabolic syndrome. Obesity (Silver Spring), 2006, 14(Suppl 1): 16s-19s.
26. Moualla M, Qualls C, Arynchyn A, et al. Rapid decline in lung function is temporally associated with greater metabolically active adiposity in a longitudinal study of healthy adults. Thorax, 2017, 72(12): 1113-1120.
27. Choe EK, Kang HY, Lee Y, et al. The longitudinal association between changes in lung function and changes in abdominal visceral obesity in Korean non-smokers. PLoS One, 2018, 13(2): e0193516.
28. Bray GA. Medical consequences of obesity. J Clin Endocrinol Metab, 2004, 89(6): 2583-2589.
29. Weyer C, Foley JE, Bogardus C, et al. Enlarged subcutaneous abdominal adipocyte size, but not obesity itself, predicts typeⅡdiabetes independent of insulin resistance. Diabetologia, 2000, 43(12): 1498-1506.
30. Ladeiras-Lopes R, Sampaio F, Bettencourt N, et al. The ratio between visceral and subcutaneous abdominal fat assessed by computed tomography is an independent predictor of mortality and cardiac events. Rev Esp Cardiol (Engl Ed), 2017, 70(5): 331-337.
31. Higuchi S, Kabeya Y, Kato K. Visceral-to-subcutaneous fat ratio is independently related to small and large cerebrovascular lesions even in healthy subjects. Atherosclerosis, 2017, 259: 41-45.
32. Tokunaga K, Matsuzawa Y, Ishikawa K, et al. A novel technique for the determination of body fat by computed tomography. Int J Obes, 1983, 7(5): 437-445.
33. Ortega FB, Lavie CJ, Blair SN. Obesity and cardiovascular disease. Circ Res, 2016, 118(11): 1752-1770.
34. Choi B, Steiss D, Garcia-Rivas J, et al. Comparison of body mass index with waist circumference and skinfold-based percent body fat in firefighters: adiposity classification and associations with cardiovascular disease risk factors. Int Arch Occup Environ Health, 2016, 89(3): 435-448.
35. Rosenquist KJ, Massaro JM, Pedley A, et al. Fat quality and incident cardiovascular disease, all-cause mortality, and cancer mortality. J Clin Endocrinol Metab, 2015, 100(1): 227-234.
36. Britton KA, Massaro JM, Murabito JM, et al. Body fat distribution, incident cardiovascular disease, cancer, and all-cause mortality. J Am Coll Cardiol, 2013, 62(10): 921-925.
37. McLaughlin T, Lamendola C, Liu A, et al. Preferential fat deposition in subcutaneous versus visceral depots is associated with insulin sensitivity. J Clin Endocrinol Metab, 2011, 96(11): E1756-E1760.
38. Nicklas BJ, Penninx BW, Cesari M, et al. Association of visceral adipose tissue with incident myocardial infarction in older men and women: the health, aging and body composition study. Am J Epidemiol, 2004, 160(8): 741-749.

West China Medical Journal

Relationship between abdominal fat distribution and pulmonary ventilation function

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