Relationship between deep subcutaneous abdominal adipose tissue and metabolic syndrome: a case control study

Abstract

Background: The deep subcutaneous adipose tissue (dSAT) is closely related to the obesity-associated complications similarly to the characteristics of visceral adipose tissue (VAT). However, the association between dSAT and metabolic syndrome (MS) is unclear. The purpose of our study was to evaluate the association of distinct abdominal adipose tissue with the cardiometabolic risk factors and MS.

Methods: Abdominal computed tomography (CT) images were obtained in 365 asymptomatic subjects (187 subjects with MS and 178 without MS). The axial images segmented into superficial and deep SAT by manually tracing the fascia superficialis at L4-5 levels. The concentrations of serum inflammatory cytokines and adipokines were also measured.

Results: The MS group had significantly lower adiponectin levels but significantly higher levels of resistin, leptin, tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), intercellular adhesion molecule (ICAM), monocyte chemotactic protein-1 (MCP-1), and oxLDL than the control group (p < 0.05). All inflammatory cytokines and adipokines were associated with the sum of VAT and dSAT areas (VDAT) (P for trend < 0.05), but no significant correlation was found between inflammatory cytokines and sSAT. dSAT was significantly associated with MS in both men and women (OR 2.371; p < 0.001) whereas the ORs between sSAT and MS were not significant (p = 0.597). The age-adjusted ORs between VDAT and MS (OR of 8.359 in men and 3.183 in women, p < 0.001) were higher than those of VAT (OR of 7.941 in men and 2.570 in women, p < 0.05) and dSAT (OR of 2.954 in men and 1.856 in women, p < 0.05).

Conclusions: We demonstrated that dSAT was associated with increased inflammation and oxidative stress, suggesting that dSAT is an important determinant of MS. Therefore, abdominal subcutaneous fat should be considered as two functionally distinct compartments rather than a single entity.

Keywords: Adipocytokine; Deep subcutaneous adipose tissue; Inflammatory cytokine; Metabolic syndrome; Superficial subcutaneous adipose tissue; Visceral adipose tissue.

Fig. 1

Measurement of deep and superficial subcutaneous adipose tissue area by cross-sectional abdominal computed tomography (CT) scans. The fascia superficialis (arrowhead) was used to separate superficial and deep compartments from SAT (a). The measurement of adipose tissue area was performed by tracing the fascia superficialis in the transverse CT image. After drawing the region of interest (ROI), the pixels with a threshold range of −190 to −30 Hounsfield units (HU) were identified as each adipose tissue area (b, c) as follows: red color superficial subcutaneous fat; blue deep subcutaneous fat; black visceral adipose tissue

Fig. 2

Comparison of the cytokine levels according to the subdivisions of abdominal adiposity in male. The areas of visceral and deep subcutaneous adipose tissue (VDAT), visceral adipose tissue (VAT), deep subcutaneous adipose tissue (dSAT), and superficial subcutaneous adipose tissue (sSAT) were divided into tertiles for comparison of various cytokines. Values are expressed as mean ± standard error of the mean

Fig. 3

Comparison of the cytokine levels according to the subdivisions of abdominal adiposity in female. The areas of visceral and deep subcutaneous adipose tissue (VDAT), visceral adipose tissue (VAT), deep subcutaneous adipose tissue (dSAT), and superficial subcutaneous adipose tissue (sSAT) were divided into tertiles for comparison of various cytokines. Values are expressed as mean ± standard error of the mean