Quebec Heart and Lung Institute, Laval University, Canada.
Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Churchill Hospital.
Curr Opin Lipidol. 2018 Aug;29(4):285-292. doi: 10.1097/MOL.0000000000000522.
Upper body abdominal and lower body gluteofemoral fat depot masses display opposing associations with plasma lipid and lipoprotein and cardiovascular disease (CVD) risk profiles. We review developments on adipose tissue fatty acid metabolism in the context of body fat distribution and how that might be related to adverse lipid and lipoprotein profiles and CVD risk.
Recent data have confirmed the paradoxical relationship of upper abdominal and lower body gluteofemoral adiposity and CVD risk. Mechanistically, this is likely to reflect the different ways fat depots handle lipid storage and release, which impacts directly and indirectly on lipid and lipoprotein metabolism. The upper body enhances immediate fat storage pathway with rapid uptake of dietary-derived fatty acids, whereas the lower body fat depot has a reduced lipid turnover accommodating a slower fat redistribution. Body fat distribution and the fat depots' ability to undergo appropriate expansion when fat storage is required, rather than overall body fatness, appear as the important determinant of metabolic health.
A focus on fat distribution in overweight people, preferably using precise imaging methods, rather than quantifying total body fatness, is likely to provide the medical community with better tools to stratify and treat patients with obesity-related complications.
上半身腹部和下半身臀股部脂肪组织质量与血浆脂质和脂蛋白以及心血管疾病 (CVD) 风险特征呈相反关系。我们综述了脂肪组织脂肪酸代谢在体脂分布方面的发展，以及这可能与不良脂质和脂蛋白谱以及 CVD 风险相关的情况。
最近的数据证实了上腹部和下半身臀股部肥胖与 CVD 风险的矛盾关系。从机制上讲，这可能反映了脂肪储存库处理脂质储存和释放的不同方式，这直接和间接影响脂质和脂蛋白代谢。上半身通过快速摄取膳食来源的脂肪酸增强了即时脂肪储存途径，而下半身脂肪储存库的脂质周转率降低，以适应较慢的脂肪再分布。体脂分布和脂肪储存库在需要脂肪储存时进行适当扩张的能力，而不是总体体脂含量，似乎是代谢健康的重要决定因素。
关注超重人群的脂肪分布，最好使用精确的成像方法，而不是量化总体体脂含量，这可能为医学界提供更好的工具，以对肥胖相关并发症患者进行分层和治疗。
