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Visceral fat versus obesity: Which is riskier for diabetes?

Kathleen Blanchard's picture
Does obesity alone predict who will get type 2 diabetes?

Obesity is consistently linked to higher risk of type 2 diabetes. But new research suggests the disease is more likely to affect people with excess fat around the stomach organs, or visceral fat. It’s not obesity alone that raises diabetes risk. It seems it’s where fat accumulates in the body that’s more important.

Visceral fat is the kind that lies behind the abdominal cavity and is deeper than subcutaneous fat, or fat just under the skin.

Researchers already know that fat in the abdominal area and around internal organs raises the risk of metabolic syndrome, insulin resistance, which is a precursor to diabetes and heart disease.

Being overweight or obese isn’t a reliable predictor. According to background information from the article, published in the Journal of the American Medical Association (JAMA), higher numbers of overweight and obese people in the past three decades may not be entirely to blame for soaring diabetes rates.

The authors write,” Indeed, many obese persons appear resistant to the development of metabolic disease. Because the metabolic disease risks associated with obesity are heterogeneous [dissimilar], there remains an unmet clinical need for tools that differentiate obese persons who will ultimately develop prediabetes and diabetes from those who will remain metabolically healthy."

For their study, the researchers looked at how body fat is distributed as it relates to higher risk of prediabetes and diabetes.

James A. de Lemos, M.D., of the University of Texas Southwestern Medical Center, Dallas, presented the findings of the study at a JAMA media briefing.

The researchers collected data from 732 participants from the Dallas Heart study between 2000 and 2002. None of the participants had prediabetes or diabetes at the start of the study.

They also underwent lab testing and imaging studies that included body dual energy x-ray absorptiometry to determine amounts and distribution of body fat and MRI.

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Among the 732 participants, 512 were tested for baseline fasting glucose levels.

Over 7 years, 84 participants developed diabetes, all of whom had higher levels of visceral or organ fat in addition to other factors like family history of diabetes and weight gain during the follow-up period.

The end analysis showed no increased diabetes risk for participants with higher total body mass index, abdominal or total body fat. Visceral fat was associated with a significantly higher risk of diabetes.

The authors believe there are subtypes of obesity that put people at higher risk for type 2 diabetes.

"Further research is needed to determine whether assessment of adipose tissue distribution and function using imaging tools, circulating biomarkers, or both can improve clinical risk prediction in obese individuals."

The good news is you can get rid of visceral fat with exercise and diet. If you can’t lose the ‘love handles’, don’t worry, especially if your weight is normal. Even if you have some belly fat, it’s not as big a health risk as having fat around the internal organs.

The finding reinforces the importance of remaining active and eating a healthy balanced diet for disease prevention.

Determining where fat is distributed in the body and measuring for biomarkers of insulin resistance could be useful tools for predicting who is at high risk for prediabetes and diabetes.

The study suggests visceral fat is an important and significant risk for developing type 2 diabetes.

JAMA. 2012;308[11]:1150-1159

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