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. 2020 Dec 29;11(1):40.
doi: 10.3390/diagnostics11010040.

Visceral Adiposity, Pro-Inflammatory Signaling and Vasculopathy in Metabolically Unhealthy Non-Obesity Phenotype

Meng-Ting Tsou  1   2 , Chun-Ho Yun  3   4 , Jiun-Lu Lin  5 , Kuo-Tzu Sung  3   6 , Jui-Peng Tsai  3   6 , Wen-Hung Huang  3   6 , Chia-Yuan Liu  3   7 , Charles Jia-Yin Hou  3   6 , I-Hsien Tsai  8 , Cheng-Huang Su  3   6 , Chung-Lieh Hung  3   6   9 , Ta-Chuan Hung  2   3   6
Affiliations

Visceral Adiposity, Pro-Inflammatory Signaling and Vasculopathy in Metabolically Unhealthy Non-Obesity Phenotype

Meng-Ting Tsou et al. Diagnostics (Basel). .

Abstract

The debate regarding the actual cardiovascular burden in metabolically healthy obese or metabolically unhealthy non-obesity individuals is ongoing. Accumulating data have suggested a unique pathophysiological role of pro-inflammatory cytokines in mediating metabolic and cardiovascular disorders by dysregulated visceral adiposity. To compare the burden of visceral adiposity, the inflammatory marker high-sensitivity C-reactive protein (hs-CRP) and the prevalent atherosclerotic burden in metabolically healthy obese (MHO) or metabolically unhealthy (MU) populations, were compared to those of metabolically healthy non-obesity subjects (MHNO). Coronary artery calcification score (CACS) and visceral fat, including pericardial fat (PCF)/thoracic peri-aortic fat (TAT), were quantified in 2846 asymptomatic subjects using a CT dataset. A cross-sectional analysis comparing CACS, inflammatory marker hs-CRP, and visceral fat burden among four obesity phenotypes (MHNO, metabolically unhealthy non-obesity (MUNO), MHO, and metabolically unhealthy obese (MUO)) was performed. Both MUNO and MUO demonstrated significantly higher hs-CRP and greater CACS than MHNO/MHO (adjusted coefficient: 25.46, 95% confidence interval (CI): 5.29-45.63; 43.55, 95% CI: 23.38-63.73 for MUNO and MUO (MHNO as reference); both p < 0.05). Visceral fat (PCF/TAT) was an independent determinant of MU and was similarly higher in the MUNO/MHO groups than in the MHNO group, with the MUO group having the largest amount. PCF/TAT, obesity, and MU remained significantly associated with higher CACS even after adjustment, with larger PCF/TAT modified effects for MU and diabetes in CACS (both pinteraction < 0.05). MU tightly linked to excessive visceral adiposity was a strong and independent risk factor for coronary atherosclerosis even in lean individuals, which could be partially explained by its coalignment with pathological pro-inflammatory signaling.

Keywords: coronary artery calcification score (CACS); hs-CRP; metabolically unhealthy; obese phenotype; visceral adiposity.

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Conflict of interest statement

The authors have no conflict of interest.

Figures

Figure 1
Figure 1
Multidetector computed tomography (MDCT) demonstrated visceral adiposity measures, including pericardial and thoracic peri-aortic fat tissue, and quantification of CACS. The pericardial fat was defined as the fat between the heart and the pericardium, as shown in axial view (A). (A) Pericardial adipose tissue. (B) Thoracic peri-aortic adipose tissue. (C) Semi-automatic quantification of CACS burden using Agatston scoring. *Orange color regions indicate visceral fat tissue. White arrows indicate coronary calcification lesions.
Figure 2
Figure 2
Prevalence of coronary artery calcification (CACS > 0, red) according to metabolic scoring and metabolic unhealthy (MU) according to the body mass index (BMI) strata (A,B). Associations of atherosclerotic burden (CACS) with per one standardized unit increase of anthropometrics, visceral adiposity, and cardiovascular risk scoring (C). FS: Framingham score, PCF: pericardial fat, TAT: thoracic peri-aortic fat, MS: metabolic score.
Figure 3
Figure 3
Associations of coronary artery calcification scores (CACS) with physical obesity from Table 3.
See this image and copyright information in PMC

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